Common use of Evaluation Requirements Clause in Contracts

Evaluation Requirements. The demonstration evaluation will meet the prevailing standards of scientific and academic rigor, as appropriate and feasible for each aspect of the evaluation, including standards for the evaluation design, conduct, and interpretation and reporting of findings. The demonstration evaluation will use the best available data; use controls and adjustments for and reporting of the limitations of data and their effects on results; and discuss the generalizability of results. The State shall acquire an independent entity to conduct the evaluation. The evaluation design shall discuss the State’s process for obtaining an independent entity to conduct the evaluation, including a description of the qualifications the entity must possess, how the State will assure no conflict of interest, and a budget for evaluation activities. Evaluation Design. The Evaluation Design shall include the following core components to be approved by CMS: Research questions and hypotheses: This includes a statement of the specific research questions and testable hypotheses that address the goals of the demonstration. At a minimum, the research questions shall address the goals of improving access, reducing churning, improving quality of care thereby leading to enhanced health outcomes, and lowering costs. The research questions will have appropriate comparison groups and may be studied in a time series. The analyses of these research questions will provide the basis for a robust assessment of cost effectiveness. The following are among the hypotheses to be considered in development of the evaluation design and will be included in the design as appropriate: The formation of new partnerships and collaborations within the delivery system The increased acceptance of TCOC risk-based payments among MassHealth providers Improvements in the member experience of care, particularly through increased member engagement in the primary care setting or closer coordination among providers Reductions in the growth of avoidable inpatient utilization Reductions in the growth of TCOC for MassHealth’s managed care-eligible population More robust EHR and other infrastructure capabilities and interconnectivity among providers Increased coordination across silos of care (e.g., physical health, behavioral health, LTSS, social supports) Maintenance or improvement of clinical quality The enhancement of safety net providers’ capacity to serve Medicaid and uninsured patients in the Commonwealth Increased coverage of out-of-state former xxxxxx care youth and improved health outcomes for this population. The strength of aggregate provider networks in the ACO and MCO programs (excluding Primary Care ACOs) relative to the PCC Plan, in first three years of demonstration, including: Types of providers Breadth of providers Quality of services Outcomes of services These hypotheses should be addressed in the demonstration reporting described in STC 83 with regard to progress towards the expected outcomes. Data: This discussion shall include: A description of the data, including a definition/description of the sources and the baseline values for metrics/measures; Method of data collection Frequency and timing of data collection. The following shall be considered and included as appropriate: Medicaid encounters and claims data, Enrollment data, and Consumer and provider surveys Study Design: The design will include a description of the quantitative and qualitative study design, including a rationale for the methodologies selected. The discussion will include a proposed baseline and approach to comparison; examples to be considered as appropriate include the definition of control and/or comparison groups or within-subjects design, use of propensity score matching and difference in differences design to adjust for differences in comparison populations over time. The former will address how the effects of the demonstration will be isolated from those other changes occurring in the state at the same time through the use of comparison or control groups to identify the impact of significant aspects of the demonstration. The discussion will include approach to benchmarking, and should consider applicability of national and state standards. The application of sensitivity analyses as appropriate shall be considered.

Evaluation Requirements. The demonstration evaluation will meet the prevailing standards of scientific and academic rigor, as appropriate and feasible for each aspect of the evaluation, including standards for the evaluation design, conduct, and interpretation and reporting of findings. The demonstration evaluation will use the best available data; use controls and adjustments for and reporting of the limitations of data and their effects on results; and discuss the generalizability of results. The State shall acquire an independent entity to conduct the evaluation. The evaluation design shall discuss the State’s process for obtaining an independent entity to conduct the evaluation, including a description of the qualifications the entity must possess, how the State will assure no conflict of interest, and a budget for evaluation activities. Evaluation Design. The Evaluation Design shall include the following core components to be approved by CMS: Research questions and hypotheses: This includes a statement of the specific research questions and testable hypotheses that address the goals of the demonstration. At a minimum, the research questions shall address the goals of improving access, reducing churning, improving quality of care thereby leading to enhanced health outcomes, and lowering costs. The research questions will have appropriate comparison groups and may be studied in a time series. The analyses of these research questions will provide the basis for a robust assessment of cost effectiveness. The following are among the hypotheses to be considered in development of the evaluation design and will be included in the design as appropriate: The formation of new partnerships and collaborations within the delivery system The increased acceptance of TCOC risk-based payments among MassHealth providers Improvements in the member experience of care, particularly through increased member engagement in the primary care setting or closer coordination among providers Reductions in the growth of avoidable inpatient utilization Reductions in the growth of TCOC for MassHealth’s managed care-eligible population More robust EHR and other infrastructure capabilities and interconnectivity among providers Increased coordination across silos of care (e.g., physical health, behavioral health, LTSS, social supports) Maintenance or improvement of clinical quality The enhancement of safety net providers’ capacity to serve Medicaid and uninsured patients in the Commonwealth Increased coverage of out-of-state former xxxxxx care youth and improved health outcomes for this population. The strength of aggregate provider networks in the ACO and MCO programs (excluding Primary Care ACOs) relative to the PCC Plan, in first three years of demonstration, including: Types of providers Breadth of providers Quality of services Outcomes of services These hypotheses should be addressed in the demonstration reporting described in STC 83 86 with regard to progress towards the expected outcomes. Data: This discussion shall include: A description of the data, including a definition/description of the sources and the baseline values for metrics/measures; Method of data collection Frequency and timing of data collection. The following shall be considered and included as appropriate: Medicaid encounters and claims data, Enrollment data, and Consumer and provider surveys Study Design: The design will include a description of the quantitative and qualitative study design, including a rationale for the methodologies selected. The discussion will include a proposed baseline and approach to comparison; examples to be considered as appropriate include the definition of control and/or comparison groups or within-subjects design, use of propensity score matching and difference in differences design to adjust for differences in comparison populations over time. The former will address how the effects of the demonstration will be isolated from those other changes occurring in the state at the same time through the use of comparison or control groups to identify the impact of significant aspects of the demonstration. The discussion will include approach to benchmarking, and should consider applicability of national and state standards. The application of sensitivity analyses as appropriate shall be considered.

Evaluation Requirements. The demonstration evaluation will meet the prevailing standards of scientific and academic rigor, as appropriate and feasible for each aspect of the evaluation, including standards for the evaluation design, conduct, and interpretation and reporting of findings. The demonstration evaluation will use the best available data; use controls and adjustments for and reporting of the limitations of data and their effects on results; and discuss the generalizability of results. The State shall acquire an independent entity to conduct the evaluation. The evaluation design shall discuss the State’s process for obtaining an independent entity to conduct the evaluation, including a description of the qualifications the entity must possess, how the State will assure no conflict of interest, and a budget for evaluation activities. Evaluation Design. The Evaluation Design shall include the following core components to be approved by CMS: Research questions and hypotheses: This includes a statement of the specific research questions and testable hypotheses that address the goals of the demonstration. At a minimum, the research questions shall address the goals of improving access, reducing churning, improving quality of care thereby leading to enhanced health outcomes, and lowering costs. The research questions will have appropriate comparison groups and may be studied in a time series. The analyses of these research questions will provide the basis for a robust assessment of cost effectiveness. Additionally, the state should revise their approved Evaluation Design to include specific research questions, hypotheses, and analytical approaches for the SMI amendment as well as to address any changes to the CSP and MSP programs. The following are among the hypotheses to be considered in development of the evaluation design and will be included in the design as appropriate: The formation of new partnerships and collaborations within the delivery system The increased acceptance of TCOC risk-based payments among MassHealth providers Improvements in the member experience of care, particularly through increased member engagement in the primary care setting or closer coordination among providers Reductions in the growth of avoidable inpatient utilization Reductions in the growth of TCOC for MassHealth’s managed care-eligible population More robust EHR and other infrastructure capabilities and interconnectivity among providers Increased coordination across silos of care (e.g., physical health, behavioral health, LTSS, social supports) Maintenance or improvement of clinical quality The enhancement of safety net providers’ capacity to serve Medicaid and uninsured patients in the Commonwealth Increased coverage of out-of-state former xxxxxx care youth and improved health outcomes for this population. The strength of aggregate provider networks in the ACO and MCO programs (excluding Primary Care ACOs) relative to the PCC Plan, in first three years of demonstration, including: Types of providers Breadth of providers Quality of services Outcomes of services These hypotheses should be addressed in the demonstration reporting described in STC 83 93 with regard to progress towards the expected outcomes. Data: This discussion shall include: A description of the data, including a definition/description of the sources and the baseline values for metrics/measures; Method of data collection Frequency and timing of data collection. The following shall be considered and included as appropriate: Medicaid encounters and claims data, Enrollment data, and Consumer and provider surveys Study Design: The design will include a description of the quantitative and qualitative study design, including a rationale for the methodologies selected. The discussion will include a proposed baseline and approach to comparison; examples to be considered as appropriate include the definition of control and/or comparison groups or within-subjects design, use of propensity score matching and difference in differences design to adjust for differences in comparison populations over time. The former will address how the effects of the demonstration will be isolated from those other changes occurring in the state at the same time through the use of comparison or control groups to identify the impact of significant aspects of the demonstration. The discussion will include approach to benchmarking, and should consider applicability of national and state standards. The application of sensitivity analyses as appropriate shall be considered.