Assessing the Value of a Medicare Demonstration Program

As required by Congress, the Centers for Medicare and Medicaid Services (CMS) established a three-year demonstration program that paid for in-home administration of intravenous immunoglobulin (IVIG) to CMS beneficiaries with a primary immune deficiency disorder. Congress also required that CMS evaluate the program, including Medicare beneficiaries’ experiences with the program. As a subcontractor to Dobson|Davanzo, ERG conducted a statistical analysis to help CMS understand how the in-home IVIG administration program was affecting beneficiaries.

ERG wrote, designed, and implemented a survey in two parallel forms, one for program participants and the other for non-participants. All of the approximately 1,500 program participants were asked to take the survey. For non-participants, ERG drew a geographically matched random sample from approximately 10,000 Medicare beneficiaries who were eligible for the in-home IVIG program but had not enrolled. Because both survey populations skewed older and were often ill, ERG administered the surveys in three modes: by mail, online, and by telephone. Following the initial survey, Congress extended the three-year program for three more years, and CMS then asked ERG to implement a second cycle of the survey. For the second cycle, ERG excluded beneficiaries who had been eligible for the first cycle to ensure that no one was sampled twice.

In total, ERG administered the survey to 5,840 potential respondents. Through strategic use of mail and telephone reminders during both cycles, ERG was able to achieve unusually high response rates for this type of survey: 55.7 percent for participants and 45.6 percent for non-participants. The response data provided statistical measures of participants’ satisfaction with their IVIG treatments, their relative difficulty obtaining treatment, side effects experienced, reasons for participating or not participating in the in-home IVIG program, reasons for changing immunoglobulin brands, reasons for and frequency of missed treatments, and several other relevant factors. We also operated a survey helpline and compiled hundreds of oral comments that, together with the written comments encouraged by the survey, provided a human context to the statistical survey data.