HCIA Evaluations: Behavioral Health/Substance Abuse

Like most parts of the health care system, service systems for people with mental illness and substance abuse are evolving rapidly in response to the need for cost efficiencies, increased use of managed care plans for high-risk populations, and the growing emphasis on quality measurement and public reporting. To help guide this evolution, the Center for Medicare & Medicaid Innovation (CMMI) within the Centers for Medicare & Medicaid Services (CMS) has developed the Health Care Innovation Award (HCIA) initiative to test new models of service delivery and payment that promise to improve health and mental health care, and lower costs for Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) enrollees with mental health and substance abuse issues.

CMS contracted with Mathematica to evaluate the impacts of projects being implemented by the 10 HCIA awardees focused on mental health and substance abuse services. These awardee demonstrations addressed a wide array of interventions and targeted different subgroups within this broad priority population. The three primary goals of the evaluation addressed approximately 100 evaluation questions; told the story of each awardee through narratives describing the projects' logic models, implementation processes, and project outcomes; and derive cross-cutting lessons learned.

The Mathematica project team used a mixed-methods approach to this evaluation. The evaluation used qualitative data from key informant interviews, document reviews, and focus groups; quantitative data obtained from the project administrative files, Medicare and Medicaid claims, and provider records; and data from a workforce survey administered twice during the study period. We analyzed this information to produce a series of quarterly and annual reports for CMMI.