Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs: User's Guide

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Appendix 1. Example Measures for Evaluating the Impact of Medicaid Care Management

This table provides examples of different measures that could be used by States to monitor and evaluate their CM programs. This is not an exhaustive list of measures. We have divided the measures into six types: intervention-process, quality-process, quality-outcome, satisfaction, utilization, and cost.

Appendix Table. Examples of Evaluation Measures

Type	Measure	Description	Data source
Intervention—process	Eligible for CM	Percent of beneficiaries who are eligible for the CM program, among all beneficiaries	Administrative data (and/or health risk appraisals
	Enrolled in CM	Percent of beneficiaries who are enrolled in CM, among all eligible	Administrative data
	Engaged in CM	Percent of beneficiaries who are engaged in the CM program, among all enrolled	Administrative data
Quality—process	Smoking cessation	Percent of enrollees who received advice to quit smoking among all smokers enrolled in CM	Medical record
	Blood pressure	Percent of patients with BP measurement recorded among those enrolled in CM	Medical record
	LDL cholesterol screen	Percent of patients who have documentation in the medical record of cholesterol screening within the last year among those enrolled in CM	Medical record
	Lipid profile	Percent of patients receiving at least one LDL-C screen among those enrolled in CM	Administrative: lab claims
	ACE inhibitor	Percent of patients with CAD who have diabetes and were prescribed ACE inhibitor	Administrative: pharmacy claims
	HbA1c screen	Percent of patients with diabetes receiving HbA1c screen within the past year	Medical record
	Retinal exam	Percent of patients with diabetes who have had a retinal exam in the past year	Administrative: claims
Quality—outcome	Blood pressure management	Percent of patients with most recent BP <140/90 mmHg among those enrolled in CM	Medical record
Quality—outcome	LDL cholesterol control	Percent of patients with diabetes with most recent LDL-C <130 mg/dL	Medical record
Satisfaction	CAHPS™	Patient experience of care	Survey
Utilization	Hospital admissions	Number of hospital admissions in last year among those enrolled in CM	Administrative: claims
	ED use	Number of emergency department visits in last year among those enrolled in CM	Administrative: claims
	Physician visits	Number of physician visits in last year among those enrolled in CM	Administrative: claims
	Pharmacy	Number of 30-day prescriptions filled in last year among those enrolled in CM	Administrative: pharmacy claims
Cost	Hospital claims	Total $ of hospital claims paid	Administrative: hospital claims
	Pharmacy claims	Total $ in pharmacy claims paid	Administrative: pharmacy claims
	Total expenditures	Total $ in claims paid	Administrative: claims

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