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Office of the Assistant Secretary for Planning and Evaluation |
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Policy Information Center |
MISSION: To promote the timely delivery of appropriate, quality health care to the Nation's aged, disabled, and poor through administration of the Medicare and Medicaid programs.
Evaluation Program
The research arm of the Centers for Medicare and Medicaid Services (CMS), the Office of Strategic Planning (OSP), performs and supports research and evaluations of demonstrations (through intramural studies, contracts and grants) to develop and implement new health care financing policies and to provide information on the impact of CMS' programs. The scope of OSP's activities embraces all areas of health care: costs, access, quality, service delivery models, and financing approaches. OSP's research responsibilities include evaluations of the ongoing Medicare and Medicaid programs and of demonstration projects testing new health care financing and delivery approaches. These projects address the following major themes:
Fiscal Year 2000 Evaluation Reports
This project examined the quality of care in the treatment of asthma in Medicaid children in Alabama and Michigan. It assessed the extent of prescribing problems for pediatric asthma in these Medicaid programs. The study first examined whether asthma medication regimes for children covered by Medicaid were in compliance with the recommendations made by the NIH consensus National Asthma Education Project in 1991. The findings indicate that asthma care provided in urgent-oriented settings is not conducive to on- going, appropriate, prevention-oriented treatment of the condition. Secondly, the study assessed the utility of claims data for measuring the quality of asthma care. Generally, claims accurately represented what occurred during an encounter, but did not accurately identify all of the cases where a diagnosis or procedure occurred. Thus, claims data were a better measure of medication availability than medical records, but the failure to fill a prescription (based on claims data) was not a good indicator of a physician's failure to prescribe a medication. Third, the study used claims data to simulate a letter reminder system that would notify physicians if problems were associated with any of their patient care activities. The assumption is that information from claims data could be used to reach out to families and encourage them to be seen for routine, prevention oriented asthma care.
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Beth Benedict, 410-786-7724
PIC ID: 7192
PERFORMER: University of Alabama, School of Public Health, Birmingham, AL
This project examined a broad range of managed-care decision making strategies, their implications for the development and diffusion of new technologies, and their impact on future health care costs, especially Medicare program costs. Regarding Managed Care Organizations (MCOs), most stress the clinical orientation of their technology assessment process and assert that cost is very rarely an explicit consideration. Price is more often a factor in setting drug formularies and all plans indicated they would not refuse to cover a technology that had been generally accepted as the standard of care, no matter how expensive. The report found no evidence of an important independent effect of Medicare managed care among either MCOs or manufacturers. MCOs generally set uniform coverage policies for their Medicare and commercial products. The conclusions are: while managed care plans do attempt to control use of certain technologies, their ability to do so is restricted. Also, while managed care influences manufacturer R&D investment decisions, it is not clear that it has changed the likelihood that cost-increasing technologies will come to market, nor has it altered the fundamental feedback relationship between insurance, technological innovation, and health care expenditure growth.
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Brigid Goody, 410-786-6640
PIC ID: 7170
PERFORMER: Health Economics Research, Inc., Waltham, MA
The recent structure of the U.S. Renal Data System (USRDS) has been marked by significant changes. In 1999 the USRDS was divided into a Coordinating Center (CC) and four Special Studies Centers (SSCs). In addition, alterations have been made to the focus, format, and appearance of the report. This 2000 ADR presents data on End Stage Renal Disease (ESRD) patients through 1998, the most recent year for which complete data is available. Users of the USRDS website can access PDF files of the printed Annual Data Reports (ADR), Reference Tables, and Researcher's Guide, download aggregate data and USRDS slides for use in their own analyses and presentations, and correspond with USRDS staff. Most of the data sets used by the USRDS are provided by CMS. Data are also obtained from the United Network for Organ Sharing (UNOS) and from the National Surveillance of Dialysis-Associated Diseases in the U.S., compiled by the Centers for Disease Control and Prevention (CDC). The structure of the USRDS database is illustrated in Figure i.w, and detailed descriptions of the database itself and of the methods used to work with and analyze the data are provided in Appendix A.
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Joel Greer, 410-786-6695
PIC ID: 7198.2
PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
The Centers for Medicare and Medicaid Services (CMS) is charged with the effective administration of Medicare benefits to eligible persons with end stage renal disease (ESRD). Integral to the effective management of the ESRD program is the operation of a comprehensive data base covering medical and demographic information for the Medicare ESRD population. This data base, along with other ESRD program-related data, is contained within the ESRD Program Management and Medical Information System (PMMIS). CMS recognizes the need to disseminate the information developed from the ESRD PMMIS data and any resulting analyses of these data. This report presents statistics concerning recent trends in ESRD treatment and detailed discussions of selected health issues involving the ESRD population. Several of the tables in this report emphasize trends and comparisons over time, making this report a standard reference on the Medicare ESRD population and on ESRD treatment patterns. Data released to CMS from other organizations have been included and identified where appropriate.
AGENCY SPONSOR: Centers for Medicare and Medicaid Services
FEDERAL CONTACT: Joel Greer, 410-786-6695
PIC ID: 7182
PERFORMER: The Lewin Group, Fairfax, VA
Under this demonstration, enrollment in the Department of Defense's (DoD's) Senior Prime plan is offered to military retirees over age 65 who live within 40 miles of the primary care facilities of one of the six sites, have recently used military health facility services and are enrolled in Medicare Part B. Medicare makes a capitation payment to the DoD for each enrollee, but the DoD must maintain a level of effort for health care services to all retirees who are also Medicare beneficiaries, whether or not they choose to enroll. The evaluation will examine issues in four basic areas: (1) enrollment demand, (2) enrollee benefits, (3) cost of the program, and (4) impacts on other DoD and Medicare beneficiaries. See PIC ID 7171.1.
EXPECTED DATE OF COMPLETION:03/02/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Victor McVicker, 410-786-6681
PIC ID: 7171
PERFORMER: Rand Corporation, Santa Monica, CA
This interagency agreement (IAA) provided funds to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to cover the costs of having the coordinating center for the U.S. Renal Data System (USRDS) perform economic and cost-effectiveness studies. The NIDDK contracted with the University of Michigan to be the coordinating center for 5 years. The coordinating center conducts cost or cost-effectiveness components for at least four existing data studies and for one special study focused on economic issues.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Joel Greer, 410-786-6695
PIC ID: 7198
PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
The Center for Medicare and Medicaid Services's (CMS's) goal is to move towards a regulatory monitoring system that allows for an appropriate use of indicators to evaluate the quality and appropriateness of care provided to residents, and to determine a facility's compliance with the long-term care requirements. This study will develop and test (with volunteering State survey agencies) various options for using a variety of quality indicators to improve the effectiveness and efficiency of the CMS's facility performance monitoring.
EXPECTED DATE OF COMPLETION:09/29/2003
AGENCY SPONSOR: Office of Clinical Standards & Quality
FEDERAL CONTACT: Sue Nonemaker, 410-786-6825
PIC ID: 7177
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
A consortium of organizations in Kansas and Missouri agreed to participate in an Agency for Healthcare Research and Quality (AHRQ) test of a health plan quality assessment system--the Consumer Assessment of health Plans Study (CAHPS) report. The report is designed to examine consumer quality ratings about local managed care plans' performance. CMS joined AHRQ and the coalition to extend the evaluation from private plan enrollees and Medicaid enrollees to the Medicare population in Kansas City Metropolitan Statistical Area (MSA). The purpose of this study is to learn whether Medicare beneficiaries use comparative quality information to make health plan choices and whether the Medicare information program (print material) is effective.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Sherry Terrell, 410-786-6601
PIC ID: 7168.1
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
This project will test the feasibility and effectiveness of establishing Medicare fees for durable medical equipment (DME) and Prosthetics, Prosthetic devices, Orthotics and supplies (POS) through a competitive bidding process. The evaluation will examine competitive bidding impacts in terms of expenditures, quality, access and product diversity, as well as other impacts of the demonstration.
EXPECTED DATE OF COMPLETION:05/15/2003
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Ann Meadow, 410-786-6602
PIC ID: 7173
PERFORMER: University of Wisconsin, Madison, WI
The goal of the demonstration is to test the feasibility of this partial risk bearing payment arrangement between the Center for Medicare and Medicaid Services and qualifying physician-based organizations in the fee-for-service (FFS) market. FFS rules apply within the context of a performance target, beneficiaries are not enrolled, and physician-sponsored organizations develop structures and processes to manage the services and cost of care received by FFS patients.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Center for Beneficiary Choices
FEDERAL CONTACT: Cynthia K. Mason, 410-786-6680
PIC ID: 7181
PERFORMER: Health Economics Research, Inc., Waltham, MA
As a method of assuring availability of insurance in the individual market, the Health Insurance Portability and Accountability Act (HIPAA) alows the use of an acceptable State alternative mechanism in placeof adopting precise HIPAA provisions. One of these accceptable mechanisms is to use a State's High-Risk Pool for HIPAA eligibles. Since the statutory objective of this acceptable mechanism is to guarantee the availability of insurance to individuals, the goal of this project will be to evaluate the best standards for a High Risk Pool to be sustained and to remain an acceptable alternative mechanism for HIPAA eligibles. This project will summarize and detail the similarities and differences between risk pools in the context of the dynamics in individual insurance law for States which have accepted these risk pools as alternative mechanisms.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Center for Medicaid & State Operations
FEDERAL CONTACT: James Fuller, 410-786-3365
PIC ID: 7422
PERFORMER: Abt Associates Inc., Cambridge, MA
The Oregon Medicaid Reform Demonstration seeks to increase the number of individuals with access to affordable health care services and to contain State and Federal expenditures for health care. Under the demonstration, Medicaid coverage is made available to all State residents with family incomes less than, or equal to, the Federal poverty level (FPL) and who meet an assets test. The objectives of the evaluation are to determine the impact on: (1) access to care, (2) quality of care, (3) enrollee satisfaction, and (4) the cost of care, for both new enrollees and those previously enrolled in Medicaid. To the extent possible, the impact of the prioritized list and the increased use of managed care will be identified separately. Other areas of interest include: (1) the impact of the demonstration on the number of uninsured in the State, (2) provider participation and satisfaction, and (3) the number of private employers who offer health insurance as a fringe benefit.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Paul J. Boben, 410-786-6629
PIC ID: 6166
PERFORMER: Health Economics Research, Inc., Waltham, MA
This demonstration is testing two alternative methods of paying home health agencies (HHA) on a prospective basis for services furnished under the Medicare program: (1) per visit by type of HHA visit discipline (Phase I), and (2) payment per episode of Medicare-covered home health care (Phase II). The evaluation will combine estimates of program impacts on cost, service use, access and quality, with detailed information on how agencies actually change their behavior to produce a full understanding of what would happen if prospective payment replaced the current cost-based reimbursement system nationally.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Ann Meadow, 410-786-6602
PIC ID: 7203
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
This project is designed to evaluate quantitatively and qualitatively the Qualified Medicare Beneficiary (QMB) and the Specified Low-Income Medicare Beneficiary (SLMB) Programs in the following areas: (1) the motivations and perceptions of enrollees and non enrollees, (2) reasons for state variation in enrollment patterns, (3) the impact of enrollment on Medicare and Medicaid costs and service use, and (4) the impact of enrollment on out-of-pocket costs of eligible individuals. Primary data collection activities will include: a survey of a national sample of QMB and SLMB enrollees and of eligible non-enrollees, focus groups of enrollees and non-enrollees, a survey of state agencies, and case study interviews with officials from agencies and advocacy groups. Secondary data sources include: the Medicare Current Beneficiary Survey, the Medicare National Claims History file, the Medicaid Statistical Information System, Third party Buy-In file, and the Medicare Enrollment Database. Descriptive and multivariate analyses will be conducted with the primary and secondary data.
EXPECTED DATE OF COMPLETION:12/14/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Noemi Rudolph, 410-786-6662
PIC ID: 7390
PERFORMER: Health Economics Research, Inc., Waltham, MA
The State Children's Health Insurance Program (SCHIP) established by the Balanced Budget Act (BBA) in 1997 is designed to provide medical coverage for children under age 19 who are not eligible for Medicaid and with family incomes below 200 percent of the Federal poverty level or 50 percentage points above the current State Medicaid limit. States are required to examine and track the impact of SCHIP in reducing the numbers of low-income uninsured children. This project will involve a summary and analysis of the State evaluations and an analysis of external SCHIP-related activities. It will provide an analysis of the effect of SCHIP on enrollment expenditures and use of services in Medicaid and State health programs, and an evaluation of stand-alone and Medicaid expansion programs, including the effectiveness of their outreach activities and the quality of care.
EXPECTED DATE OF COMPLETION:07/13/2004
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Rose Marie Hakim, 410-786-6698
PIC ID: 7380
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
This demonstration tests a capitated, nurse-managed system of care. The two fundamental elements of the CNO are capitated payment and nurse case management. The evaluation tests the feasibility and effect on patient care of this capitated, nurse case-managed service delivery model. Both qualitative and quantitative components are included.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: James Hawthorne, 410-786-6689
PIC ID: 6306.1
PERFORMER: Abt Associates Inc., Cambridge, MA
The original purpose of this project was to evaluate the Delaware Health Care Partnership for Children, specifically the effectiveness of the demonstration in reaching its goal of improving access to, and the quality of, health care services delivered to Medicaid-eligible children in a cost-effective way. In May 1996, the contract was modified to focus more generally on the impacts of the Diamond State Health Plan (DSHP) on children, including children with special health care needs (the original evaluation had been limited to the Nemours Children's Clinics). The goal of the evaluation was broadened to assess whether this section 1115 demonstration's objective of increased access to high-quality, cost-effective care for Medicaid children is being met.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Penny Pine, 410-786-7718
PIC ID: 6288
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
The major goals of the EverCare demonstration are to reduce medical complications and dislocation trauma resulting from hospitalization, and to save the expense of hospital care when patients can be managed safely in nursing homes with expanded services. The EverCare evaluation will combine data from site case studies, a network analysis of nurse practitioners, participant and caregiver surveys and participant utilization data to examine: (1) a comparison of enrollees and non-enrollees; (2) the process of implementation and operation of EverCare changes in the care process, as well as quality of care; (3) effects of the demonstration on enrollees' health and health care utilization; (4) satisfaction of enrollees and their families; and (5) effects of the demonstration on the costs of care, as well as payment sources.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: John Robst, 410-786-1217
PIC ID: 7185
PERFORMER: University of Minnesota, Minneapolis, MN
The Home and Community-Based Services (HCBS) waiver program has been operating since 1981 and has experienced tremendous growth in recent years. The percent of Medicaid long-term care spending devoted to HCBS has increased from 10 percent to 19 percent (between the financial and beneficiary-level impacts of the program) in over a decade. The aim of this task order is to gain a better understanding of the broader HCBS waiver program and determine what programmatic mechanisms have been successful.
EXPECTED DATE OF COMPLETION:03/29/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Susan Radke, 410-786-4450
PIC ID: 7208
PERFORMER: The Lewin Group, Fairfax, VA
This evaluation of the Medical Savings Account (MSA) demonstration will compare the experiences of MSA enrollees with other Medicare beneficiaries. The evaluation will address access to care and determine if MSAs promote an inappropriately low use of services.
EXPECTED DATE OF COMPLETION:09/27/2003
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Renee Mentnech, 410-786-6692
PIC ID: 7172
PERFORMER: Barents Group, KPMG Peat Marwick LLP, Washington, DC
TheMedicare Choice Demonstration tests the feasibility and desirability of new types of managed care plans for Medicare, such as integrated delivery systems and preferred provider organizations. The purpose of this evaluation project is to provide a detailed assessment of the overall demonstration project, which looks specifically at beneficiary experiences in the demonstration, cost and use of services within the demonstration sites and quality of care issues.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Renee Mentnech, 410-786-6692
PIC ID: 6292
PERFORMER: Mathematica Policy Research, Inc., Plainsboro, NJ
Medicare's annual graduate medical education (GME) spending reached $7 billion, of which nearly 20 percent was for New York teaching hospitals. This is a coordinated evaluation of a major demonstration which provided incentives for New York State teaching hospitals to reduce their residencies by 20 to 25 percent over a 5-year period, and several provisions of the Balanced Budget Action of 1997 (BBA) which were also aimed at reducing Medicare GME spending. The evaluation assessed the impacts of residency reduction on access to service delivery as well as the economic and workforce effects. This is a follow-on project to the design effort; thus, the work is being performed in the manner described in the "Design for Evaluation of the New York Medicare GME Demonstration and Related Provisions in P.L. 105-330 (BBA): Recommended Design and Strategy for NY GME Demonstration and National BBA GME Provisions." The project will present a series of reports.
EXPECTED DATE OF COMPLETION:09/29/2004
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: William Buczko, 410-786-6593
PIC ID: 7379
PERFORMER: Health Economics Research, Inc., Waltham, MA
This project will help the CMS determine the impact of specific ancillary services on the Resource Utilization Groups (RUG). It analyzes and potentially refines the extensive care and other categories to determine the impact on the prospective payment system for skilled nursing homes.
EXPECTED DATE OF COMPLETION:09/01/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Edgar Peden, 410-786-6594
PIC ID: 6307
PERFORMER: Abt Associates Inc., Cambridge, MA
This project will address the following two components: (1) a focused evaluation of the behavioral health component of OhioCare, and (2) a case study of the implementation of Ohio's section 1115 State health reform demonstration, OhioCare. The case study will complement the focused evaluation by providing a context for findings and supplementing findings.
EXPECTED DATE OF COMPLETION:09/14/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Penny Pine, 410-786-7718
PIC ID: 7184
PERFORMER: Health Economics Research, Inc., Waltham, MA
This project will evaluate Hawaii, Rhode Island, Tennessee, Oklahoma and Maryland State Health Reform Demonstrations. The evaluator is conducting State-specific and cross-State analyses of demonstration impacts on utilization, insurance coverage, public and private expenditures, quality, access and satisfaction.
EXPECTED DATE OF COMPLETION:09/30/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Penny Pine, 410-786-7718
PIC ID: 6289.1
PERFORMER: Urban Institute, Washington, DC
The purpose of this task order is to design and implement a strategy for tracking and evaluating the performance of managed health care organizations, both nationwide and within specific markets. Dimensions of performance to be tracked include beneficiary access to managed care, as well as the cost and quality of services delivered to beneficiaries by managed care organizations.
EXPECTED DATE OF COMPLETION:09/15/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Brigid Goody, 410-786-6640
PIC ID: 7169
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
This project assesses the use of Medicare covered services among Medicare beneficiaries with ischemic heart disease based on sociodemographic characteristics (e.g., race/ethnicity, sex, age, socioeconomic status). It is one part of a larger CMS and Department of Health and Human Services effort to address health disparities among Medicare beneficiaries. This will be done using a longitudinal database that links Medicare enrollment and claims data with small-area geographic data on income (e.g., U.S. Census data) Due to recent change in the race/ethnic coding in the Medicare enrollment database (EDB), it is not possible to examine health care access, utilization, and outcomes among minority groups.
EXPECTED DATE OF COMPLETION:01/21/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Linda Greenberg, 410-786-0677
PIC ID: 7419
PERFORMER: Health Economics Research, Inc., Waltham, MA
This project will develop data and examine the impact of welfare reform on Medicaid eligibility, utilization and payments for various populations. It will study the effects of the following four changes: (1) de-linking Aid to Families with Dependent Children (AFDC) and Medicaid eligibility, (2) terminating access to Medicaid for some legal immigrants because of lost eligibility for Supplementary Security Income (SSI), (3) barring most future legal immigrants from Medicaid, and (4) narrowing Medicaid eligibility for selected disabled children and disabled alcohol and substance abuse populations.
EXPECTED DATE OF COMPLETION:02/28/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Penny Pine, 410-786-7718
PIC ID: 7183
PERFORMER: Mathematica Policy Research, Inc., Washington, DC
Rapid growth in home health use has occurred despite limited evidence about the necessary volume of HHC needed to achieve optimal patient outcomes, and whether or not it substitutes for more costly institutional care. The central hypotheses of this study are that: (1) volume-outcome relationships are present in HHC for common patient conditions, (2) upper and lower volume thresholds define the range of services most beneficial to patients, and (3) a strengthened physician role and better integration of HHC with other services during an episode of care can optimize patient outcomes while controlling costs.
EXPECTED DATE OF COMPLETION:09/30/2001
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Ann Meadow, 410-786-6602
PIC ID: 7179
PERFORMER: Center for Health Policy Research, Denver, CO
This project is conducting an evaluation of the Centers for Medicare and Medicaid Services's (CMS's) Medicare payment demonstration. The evaluation examines the medical effectiveness, patient and provider acceptance, and costs associated with telemedicine services, as well as their impact on access to care in rural areas.
EXPECTED DATE OF COMPLETION:09/28/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Joel Greer, 410-786-6695
PIC ID: 6303
PERFORMER: Center for Health Policy Research, Denver, CO
This task order will design an evaluation to examine quality of life (QOL) issues for nursing home residents. It will focus on three topics: (1) measuring and developing indicators of QOL, (2) developing quality improvement programs for nursing home QOL, and (3) evaluating environmental design influences on QOL.
EXPECTED DATE OF COMPLETION:05/31/2002
AGENCY SPONSOR: Office of Clinical Standards & Quality
FEDERAL CONTACT: Mary Pratt, 410-786-6867
PIC ID: 7176
PERFORMER: University of Minnesota, Minneapolis, MN
The purpose of this project is to study the impact of the Balanced Budget Act (BBA) and other policy changes on Medicare utilization and delivery patterns of post-acute care. Post-acute care is generally defined to include the Medicare covered services provided by skilled nursing facilitie s(SNFs), home health agencies, rehabilitation hospitals and distinct part units, long term care hospitals, and outpatient rehabilitation providers. Understanding the relationships among post-acute care delivery systems is critical to the development of policies that encourage appropriate and cost-effective use of the entire range of care settings. The results of this work may be useful in refining policies for individual types of post- acute care, as well as in developing a more coordinated approach across all settings.
EXPECTED DATE OF COMPLETION:09/20/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Philip G. Cotterill, 410-786-6598
PIC ID: 7417
PERFORMER: Medstat Group, Washington, DC
This evaluation is designed to assess the impact of dual eligible demonstrations in the States of Minnesota, Colorado, Wisconsin and New York. Analyses will be conducted for each State and across States.
EXPECTED DATE OF COMPLETION:09/29/2005
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Noemi Rudolph, 410-786-6662
PIC ID: 7186
PERFORMER: University of Minnesota, Minneapolis, MN
This is an analysis of the expansion or modification of preventive or other services covered by Medicare. The study includes coverage of: (1) nutrition therapy, including parenteral and enteral nutrition; (2) skin cancer screening; (3) medically necessary dental care; (4) routing patient care costs for beneficiaries enrolled in approved clinical trial programs; and (5) elimination of time limitation for coverage of immunosuppressive drugs for transplant patients. The IOM will consider both short-term and long-term benefits and costs to the Medicare program.
EXPECTED DATE OF COMPLETION:02/28/2002
AGENCY SPONSOR: Office of Clinical Standards & Quality
FEDERAL CONTACT: Kathy Pirotte, 410-786-6774
PIC ID: 7174
PERFORMER: National Academy of Sciences, Washington, DC
This task order develops a model that uses scientifically based, normative standards to determine thresholds for payment authorization within home health service categories, and will test the model to determine the extent of its validity and reliability. The contractor will also recommend an appropriate demonstration design to evaluate the use of the model by fiscal intermediaries prior to full implementation.
EXPECTED DATE OF COMPLETION:09/24/2001
AGENCY SPONSOR: Office of Clinical Standards & Quality
FEDERAL CONTACT: Mary Wheeler, 410-786-6892
PIC ID: 7175
PERFORMER: Center for Health Policy Research, Denver, CO
This task order: (1) evaluates, (2) sets up an ongoing system for feedback from consumers, and (3) makes recommendations for future changes concerning two web sites sponsored by the Department of Health and Human Services. The web sites include www.medicare.gov, which was developed by the Centers for Medicare and Medicaid Services (CMS), and www.healthfinder.gov, which was developed by the Office of Disease Prevention Health Promotion in collaboration with other agencies.
EXPECTED DATE OF COMPLETION:04/30/2002
AGENCY SPONSOR: Center for Beneficiary Choices
FEDERAL CONTACT: Barbara Crawley, 410-786-6590
PIC ID: 7212
PERFORMER: Barents Group, KPMG Peat Marwick LLP, Washington, DC
This task order will develop and validate a comprehensive set of performance measures and indicators of quality for institutional post-acute and long-term care settings. The post-acute settings involved are: SNF short-stay units, inpatient rehabilitation facilities (which include hospital-based rehabilitation units) and long-term care hospitals.
EXPECTED DATE OF COMPLETION:09/29/2002
AGENCY SPONSOR: Center for Medicaid & State Operations
FEDERAL CONTACT: David Greenberg, 410-786-2637
PIC ID: 6310
PERFORMER: Abt Associates Inc., Cambridge, MA
This is a study of associations between pregnancy-related care and outcomes, and the ethnic and racial characteristics of women who had a Medicaid covered delivery during calendar year 1995. This study is expected to identify and explain the patterns of disparities in prenatal and postpartum care and outcomes provided to Medicaid women. The project will evaluate the use of health services from entry into prenatal care through the delivery and into the first three postpartum months. The CMS eligibility and utilization data contain information on racial and ethnic minority groups. These data include diagnoses, procedures, date and type of delivery, reimbursements, demographics, and geographic location. The study will examine the use of and Medicaid expenditures for health services from the initial prenatal care visit through the delivery and into the first three postnatal months. specific prenatal care markers to be considered include delayed prenatal care, no prenatal care, and an insufficient total number of prenatal care visits for a full-term, normal pregnancy.
EXPECTED DATE OF COMPLETION:09/30/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Beth Benedict, 410-786-7724
PIC ID: 7416
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
When HMOs withdraw from the Medicare program or reduce their service areas, thousands of Medicare beneficiaries become disenrolled involuntarily each year. There has, therefore, been concern among policymakers about the impact of the recent HMO withdrawals on the beneficiary population. CMS anticipates that additional withdrawals may occur in 2001 and subsequent years. It is desirable to know the impact on beneficiaries if a significant number of additional withdrawals occurs in 2001. This project will conduct a survey that asks about the experience of beneficiaries whose plans withdraw from Medicare or reduce their service areas in January 2001. the universe from which the survey sample will be drawn is the Medicare population enrolled in managed care plans taht either terminate their risk contracts or reduce their service areas in January 2001. They survey will be conducted by mail with telephone followup, and will consist of 20-30 questions.
EXPECTED DATE OF COMPLETION:02/28/2002
AGENCY SPONSOR: Office of Strategic Planning
FEDERAL CONTACT: Gerald Riley, 410-786-6699
PIC ID: 7421
PERFORMER: University of Wisconsin, Madison, WI