Randall Brown, Ph.D. and Deborah Peikes, Ph.D.

Randall Brown is a vice president at Mathematica Policy Research, and serves as the director of health services research in their New Jersey offices. Over the course of his tenure with Mathematica, Dr. Brown has worked on numerous research projects with the Centers for Medicare & Medicaid Services, as well as projects funded by the Robert Wood Johnson Foundation and the Kaiser Family Foundation. His research interests include Medicare and Medicaid populations, care coordination and disease management programs, and issues related to the chronically ill and those receiving long-term care. His work has been widely published in peer reviewed journals including Journal of the American Medical Association, Health Affairs, Health Services Research, and Medical Care. Dr. Brown received a Ph.D. in economics from the University of Wisconsin.

Deborah N. Peikes is a senior fellow at Mathematica Policy Research. While with Mathematica, Dr. Peikes has worked on projects for the Agency for Healthcare Research and Quality, Centers for Medicare and Medicaid Services, UnitedHealth, Aetna, and the Robert Wood Johnson Foundation. Her research interests include care coordination and disease management for the chronically ill, delivery of primary care through patient-centered medical homes, and issues for people with severe disabilities. Her work has been published in numerous journals including Health Affairs, Journal of the American Medical Association, Annals of Family Medicine, and The American Journal of Managed Care. Dr. Peikes received an M.P.A. in economic policy and a Ph.D. in public policy from Princeton University, and has regularly taught a class there on program evaluation. 

From 2008 to 2010, Dr. Brown and Dr. Peikes served as co-principal investigators on an HCFO-funded study that tested the ability of disease management and care coordination programs to control health care costs. The study was a follow-up to an evaluation of CMS’s Medicare Coordinated Care Demonstration that had been published in the Journal of the American Medical Association, and was selected as the paper of the year by both AcademyHealth and the National Institute for Health Care Management. Their HCFO work extended the evaluation by identifying target populations for which the programs were most effective, and program features that distinguished effective from ineffective programs. Findings from their study were published in two papers in Health Affairs.  Whereas the earlier results had shown only one or two programs reduced hospitalizations, the HCFO study showed that four programs significantly reduced hospitalizations, but only among a high-risk subgroup of patients. The critical program features that these four successful programs exhibited, but few unsuccessful programs shared, included care coordinators’: supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; using motivational interviewing techniques to deliver evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations. The researchers concluded that while incorporating care coordination approaches into new delivery models (e.g. medical homes and ACOs) could reduce hospitalizations and improve patients’ lives, there are challenges to realizing cost savings. 

In a second Health Affairs paper from their study, the researchers described the experience of the Washington University School of Medicine in St. Louis program, one of the initial participants in the Medicare Coordinated Care Demonstration. After failing to demonstrate any reduction in Medicare beneficiaries’ hospitalizations, the program redesigned its care management practices. By employing more in-person contacts and focusing on the highest risk patients, the program realized a reduction in hospitalizations and Medicare spending. 

Together, these findings underscore the need to deliver the right program to the right people, and at the same time find ways to reduce the costs of delivering the programs. More information on their work can be found on the HCFO website.