Developing Managed Care Programs for Seniors
Many states are determined to design and develop programs to provide seniors with better access to key services, reduce or defer long-term nursing home admissions and control the growth of state and federal expenditures. In collaboration with professional staff from both the state Medicaid programs and the Centers for Medicare and Medicaid Services (CMS), JAI has helped a number of states design, develop and evaluate their managed care programs for seniors.

An Integrated Database & Related Analytics for Program Design
JAI has developed a state-of-the-art information source that is used by Medicaid and Medicare health care policy makers to design new senior managed care programs. JAI’s fully-integrated Medicare-Medicaid database contains information across several critical dimensions, including: demographics, financing, patterns of disease and disability, quality of care, health care use and health data outcomes. The database is a research-grade, person-level longitudinal database (and related descriptive data book) that describes basic population dynamics and utilization trends in the state population.

Using the database, JAI has developed a series of customized analyses to assist clients in: (1) designing program features (such as determining population risk categories), (2) conducting waiver analyses related to budget neutrality; (3) setting rates for the contractor’s portion of the Medicaid program; and (4) providing baselines for the surveillance and evaluation of the program.

Evaluating Managed Care Programs for Seniors
JAI has developed an analytical approach to evaluating new senior care managed care programs. The approach focuses on the effectiveness of the new program against agreed-upon goals and outcomes, such as: (1) increasing access to key services; (2) reducing or deferring long-term nursing home entries; (3) reducing preventable hospitalizations; (4) increasing the probability of nursing home discharge to community care; and (5) controlling the growth of state and federal expenditures. The program evaluation involves using multivariate econometric modeling for payment and utilization, logistical regression to analyze access to care, and an analysis of relative risks of nursing home entry and lengths of stay.

Quality and Access Database for Program Evaluation
In collaboration with its clients, JAI identifies and establishes performance measures for any newly established or existing senior managed care program. This approach includes the development of a performance monitoring database that incorporates quality and access measures in order to monitor the performance of the new program against agreed-upon benchmarks. This database can include performance measures for both the target population and a comparison non-enrollee population (based on a number of relevant factors relevant, including age, gender, race, program administrative status, county of residence, long-term care status, acute-care status, and chronic disease and frailty-related diagnoses, etc.).

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