Community HealthChoices: Independent Evaluation Howard B Community HealthChoices: Independent Evaluation Howard B. Degenholtz, Ph.D. Lead Evaluator Medicaid Research Center University of Pittsburgh SWPPA 11-29-2017

Overview of Evaluation Plan Seven (7) year evaluation of the implementation, process and outcomes of CHC Provide independent, scientifically rigorous evidence of program impact with respect to: Opportunities for community-based living Service coordination Quality and accountability Program innovation Efficiency and effectiveness Multiple Data Sources and Methods Key Informant Interviews Focus Groups Participant Interviews Caregiver Interviews Administrative Data Provider survey Role of Department of Human Services Collaborated on design Provides funding and oversight through Evaluation Work Group Role of MLTSS Sub-MAAC We will provide regular updates to Sub- MAAC Provide feedback & suggest course changes Sub-MAAC representation on Work Group (Oversight) Public Comment Period Evaluation plan was published Over 200 comments received Revised plan re-published

Major Sources of Information Focus Groups with Participants Participant and Caregiver Interviews Key Informant Interviews with Stakeholders LTSS Provider Survey Analysis of Administrative Data

Participant and Caregiver Experience Interviews Goal Measure quality of life and satisfaction Methods Structured, closed and open-ended interviews Prior to enrollment, 1st and 2nd year of enrollment In-person with participant, phone with proxy and caregivers Sample Age 21-59 HCBS users Age 60+ HCBS users Age 60+ non-HCBS users (duals) Caregivers for each subgroup Unpaid relative and non-relatives, co-resident or not Co-resident paid relatives (paid non-co-resident relatives are excluded) Nursing Home Residents Purposive sample of facilities Interviews conducted in Winter starting 2018

Key Informant Interviews (KII) Goal Monitor implementation from multiple perspectives Provide early, independent, ongoing insight Methods Semi-structured, open-ended interviews Qualitative analysis Conducted on a rolling basis before, during and after implementation in each region Informants: Advocacy groups Participants Age 21-59 HCBS User Age 60 + HCBS User Dual Eligible, no-HCBS Caregivers Age 21-59 HCBS and Facility Age 60+ HCBS and Facility Providers: Personal Care Homes, AL, nursing home Centers for Independent Living Home health Personal assistance Adult daily living Hospice Meals Transportation Home modification Habilitation Respite Service coordinator Primary care physician Hospital LIFE Government State officials County officials Area Agency on Aging Ombudsperson

Administrative Data Analysis Goal Effect of CHC on use of HCBS, institutionalization, acute care, and cost Methods Medicaid & Medicare Claims Nursing Home Minimum Data Set (MDS) 3.0 Level of Care Determination & HCBS Service Plan Managed Care Organization Performance Metrics Analysis Difference-in-difference models compare trend in Phase I to trend in Phase II and Phase III groups Propensity score models adjust for unobserved differences between participants in each region Data lag by 6-8 months E.g., data for Year 1, Phase I, will be available in late 2018 Analysis of two year’s of data for all 3 phases in 2022 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Phase I Phase II Phase III |------------------Pre-CHC Baseline------------------/ /----------/------------/----Program Period-----------

Participant and Caregiver Focus Groups Goal Gather early impressions and feedback from participants and caregivers during rollout (in each phase) Group settings elicit different responses than individual interviews Methods Professional focus group moderator will lead structured conversation Thematic analysis Conducted early in the implementation year in each phase Sample Represent major categories: Urban Rural/Adjacent Participants Caregivers

Nursing Home Resident Interviews Importance of resident voice to complement MDS data Purposive sample of nursing facilities Urban/rural For-profit/non-profit Matched comparison group Size Baseline quality measures Sample of residents Stratified 21-59/60+ Launch in 2018

Provider Survey Annual online survey Experience dealing with MCOs HCBS in progress NH pending Experience dealing with MCOs Contracting Billing Credentialing Impact Closure, merger, acquisition Change in staffing Change in clients served Voluntary Confidential Provider perspective is crucial Current Status: 1,003 HCBS Providers 300 responses Reminder calls: 275 out of 700

Study Team Department of Health Policy and Management Howard B. Degenholtz, PhD, Evaluation Lead Keri Kastner Damian DaCosta Lexi Drozd Ray VanCleve Meredith Hughes Terry Ding Joo Yeon Kim, MS Jie Li, PhD Health Policy Institute - Medicaid Research Center Evan Cole, PhD Aiju Men, MS Cassie Leighton, MPH Office of Health Survey Research Todd Bear, PhD Evaluation Institute for Public Health Mary Hawk PhD Health Services Research Data Center Jeremy Kahn, MD Dan Ricketts Consultants Richard Morycz, MD (Abuse and Safety Concerns) Julie Donohue, PhD (Pharmacy and Mental Health) Walid Gellad, MD (Pharmacy) Richard Schulz, PhD (Caregiving) Amy Houtrow, MD (Physical Medicine & Rehab)

Contact Information Howard B. Degenholtz, PhD, Principal Investigator Department of Health Policy and Management Graduate School of Public Health Center for Bioethics and Health Law Health Policy Institute Medicaid Research Center University of Pittsburgh 130 DeSoto St., A748 Pittsburgh, PA 15261 (412) 624-6870 degen@pitt.edu