title: Testing the Replicability of a Successful Care Management Program: Results from a Randomized Trial and Likely Explanations for Why Impacts Did Not Replicate.
abstract: OBJECTIVE
  To test whether a care management program could replicate its success in an earlier trial and determine likely explanations for why it did not.
  
  
  METHODS
  Medicare claims and nurse contact data for Medicare fee-for-service beneficiaries with chronic illnesses enrolled in the trial in eastern Pennsylvania (N = 483).
  
  
  METHODS
  A randomized trial with half of enrollees receiving intensive care management services and half receiving usual care. We developed and tested hypotheses for why impacts declined.
  
  
  METHODS
  All outcomes and covariates were derived from claims and the nurse contact data.
  
  
  RESULTS
  From 2010 to 2014, the program did not reduce hospitalizations or generate Medicare savings to offset program fees that averaged $260 per beneficiary per month. These estimates are statistically different (p < .05) from the large reductions in hospitalizations and spending in the first trial (2002-2010). The treatment-control differences in the second trial disappeared because the control group's risk-adjusted hospitalization rate improved, not because the treatment group's outcomes worsened.
  
  
  CONCLUSIONS
  Even if demonstrated in a randomized trial, successful results from one test may not replicate in other settings or time periods. Assessing whether gaps in care that the original program filled exist in other settings can help identify where earlier success is likely to replicate.
authors: Mathematica Policy Research, Washington, DC.
authors: G Greg
authors: GG
authors: Peterson
authors: Mathematica Policy Research, Washington, DC.
authors: Jelena
authors: J
authors: Zurovac
authors: Mathematica Policy Research, Princeton, NJ.
authors: Randall S
authors: RS
authors: Brown
authors: Health Quality Partners, Doylestown, PA.
authors: Kenneth D
authors: KD
authors: Coburn
authors: Research and Rapid Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD.
authors: Patricia A
authors: PA
authors: Markovich
authors: Health Quality Partners, Doylestown, PA.
authors: Sherry A
authors: SA
authors: Marcantonio
authors: Research and Rapid Cycle Evaluation Group, Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD.
authors: William D
authors: WD
authors: Clark
authors: Mathematica Policy Research, Washington, DC.
authors: Anne
authors: A
authors: Mutti
authors: Mathematica Policy Research, Princeton, NJ.
authors: Cara
authors: C
authors: Stepanczuk
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D019468:Disease Management; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000191:economics; D010346:Patient Care Management / Q000191:economics* / Q000458:organization & administration; D010414:Pennsylvania; D013997:Time Factors; D014481:United States
keywords: Care management; Medicare Coordinated Care Demonstration; care coordination; chronic disease; cost savings