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 |
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 |
Return to Contents
Proceed to Next Section