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

2. 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

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

4. 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 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

5. 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 HCBS User
Age 60 + HCBS User
Dual Eligible, no-HCBS
Caregivers
Age 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

6. 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 

7. 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

8. 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

9. 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

10. 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)

11. 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)