Download eBook for Free

FormatFile SizeNotes
PDF file 1 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Questions

  1. What questions should the CCBHC demonstration evaluation study address?
  2. What data sources exist to answer the evaluation research questions?
  3. How should comparison groups for the evaluation be selected?
  4. How should the evaluation be designed?

This report provides information and recommendations regarding the evaluation design of the Certified Community Behavioral Health Clinic (CCBHC) demonstration. Mandated by Congress in Section 223 of the Protecting Access to Medicare Act of 2014, the CCBHC is a new model of specialty behavioral health clinic, designed to provide comprehensive and integrated care for adults with mental health or substance-use disorders and children with serious emotional distress. Certification criteria for the CCBHCs have been specified by Substance Abuse and Mental Health Services Administration covering six core areas: staffing; accessibility; care coordination; scope of services; quality and other reporting; and organizational authority, governance, and accreditation. In addition, services provided to Medicaid enrollees in CCBHCs will be reimbursed through one of two alternative prospective payment systems. At present, 24 states have been awarded grants to begin the planning process for implementing CCBHCs. Of these states, eight will be selected to participate in the demonstration project beginning in January 2017. Results from the evaluation will inform mandated reports to Congress over the two-year demonstration period and the three years following the end of the demonstration, providing information to policymakers on the program's impact and value. In addition, the results can inform the direction of future efforts at integration of behavioral health into the health care system at this critical time of transformation.

Key Findings

  • Enormous variability exists across states in the availability of data that could potentially inform the CCBHC evaluation, including variability in Medicaid claims data, other human services utilization data, and health and social functioning outcomes data.
  • The CCBHCs are being implemented at a time when multiple service delivery innovations that target the same or overlapping patient populations are being tested. This context should be taken into account in the design of the evaluation.
  • Implementation questions may be addressed through a combination of existing data sources, including documentation of compliance with certification criteria, required quality measure reporting from the CCBHCs and the states, and cost reports. Supplemental data sources, such as quarterly reports from CCBHCs, surveys of providers, or qualitative studies of selected CCBHCs may also prove valuable.
  • Impact questions can be addressed through data from Medicaid claims or encounters covered by managed care payments. Detailed analytic plans, including selection of comparison groups, will need to be informed by conditions within demonstration states regarding the delivery system and data availability.

Recommendations

  • We recommend that the evaluation of the CCBHC demonstration project have three components. First, the evaluation should compile profiles of the mental health systems in each of the demonstration states. Second, the implementation questions can be addressed through a mix of existing data sources and supplemental data collection efforts. Third, the impact questions can be addressed primarily through analysis of the claims and encounter data, with additional information drawn from cost reports or, potentially, other state specific data sets.
  • The evaluation of the CCBHC demonstration can be efficient by making maximum use of existing data to reduce costs in describing the implementation of the model and its impact on care. The ultimate evaluation design will depend on the data sources available in the eight states selected for the demonstration and the resources available for the evaluation.
  • The evaluation has the potential to impact policies in the behavioral health arena in a fundamental way, providing guidance on the value of strengthening and growing the traditional model of CMHCs through expansion of their scope and reform of their financial structure.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Evaluation Research Questions

  • Chapter Three

    Data Sources

  • Chapter Four

    Comparison Groups

  • Chapter Five

    Design Recommendations

  • Appendix A

    Planning Grant Awardees

  • Appendix B

    Required Quality Measures

  • Appendix C

    Methods for Evaluation Design

  • Appendix D

    Discussion Questions

  • Appendix E

    Example of Data Flow

  • Appendix F

    Estimated Burden of Data Collection

The research described in this report was sponsored by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and conducted by RAND Health.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.