Researchers could recommend two alternative strategies to respond to this cluster care evaluation.
Cluster care is an important innovation in relaxing Medicaid Long-Term Care regulations, and it has the potential, if implemented carefully, to both improve care and contain costs.
The cluster care evaluation employed a matched-control pretest/posttest design rather than a randomized-controlled experimental design.
Such a model is not constructed by merely assembling the claims advanced by cluster care supporters and criticisms leveled by opponents, nor is it derived by clever manipulation of a set of conveniently available and intuitively plausible control variables.
Since intervention sites were more expensive at baseline, costs are relatively easier to reduce, and the observed savings from cluster care may, in part, be attributable to regression to the mean if the baseline cost differences were temporal blips rather than long-term patterns.