Centers for Medicare and Medicaid Services
Mission
We assure health security for beneficiaries.
Evaluation Program
The research arm of the Centers for Medicare and Medicaid Services (CMS), the Office of Research, Development and Information (ORDI), 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 ORDIs activities embraces all areas of health care: costs, access, quality, service delivery models, and financing approaches. ORDIs research responsibilities include evaluations of the ongoing Medicare and Medicaid programs and of demonstration projects testing new health care financing and delivery approaches.
Examples of research themes include state program flexibility, the future of Medicare, provider payment and delivery, and vulnerable populations and dual eligibles.
Completed Evaluations
The Impact of Home Health Prospective Payment on Medicare Service Use and Reimbursement
As part of its ongoing effort to study methods of providing
more cost-effective care, the Centers for Medicare and Medicaid Services (CMS)
implemented the Per-Episode Home Health Prospective Payment Demonstration. Ninety-one agencies in five states entered
the three-year demonstration at the start of their 1996 fiscal years. Before the start of the demonstration, the
participating agencies were randomly assigned to either the treatment or the
control group. Agencies assigned to the
treatment group were reimbursed under the demonstrations prospective payment
method, while those assigned to the control group continued to be reimbursed
under cost-based reimbursement (the payment method Medicare used for all home
health agencies when the demonstration began).
This report examines data from the first two years of the demonstration
to test hypotheses about the possible effects of prospective payment on the use
of Medicare-covered services by agency patients and on reimbursement for those
services. It was found that the
prospective payment led to a 25 percent reduction in home health visits and
episode length over the year following admission to a demonstration home health
agency. However, these reductions did
not appear to lead to an overall increase in the use of other Medicare services
during that year. Other findings
were: Emergency room use appeared to
decline slightly; Use of skilled nursing facility and hospice services was not
affected; Use of nondemonstration home health services increased somewhat but
did not reflect adverse patient outcomes; and, Use of Part B services and
overall reimbursement were not affected.
Total Medicare spending for treatment agency patients was somewhat lower
than spending for control agency patients.
PIC ID: 7738.2; CONTACT: Ann Meadow, 410-786-6602; PERFORMER:
Mathematica Policy Research, Inc., Plainsboro, NJ
Economic and Cost-Effectiveness Studies from the U.S. Renal Disease Data
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. Each
year 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. This study produced
economic chapters in the USRDS Annual Data Report and the economic components
of a number of scientific publications in medical journals. The raw results are included in the many
tables available at the USRDS web site:
http://www.usrds.org/. Among the tables presented are: the incidence/prevalence of End-Stage Renal
Disease (ESRD), patient characteristics at the start of ESRD, transplantation,
preventive healthcare measures, provider characteristics, economic costs of
ESRD, and international comparisons.
PIC ID: 7198; CONTACT: Joel Greer, 410-786-6695; PERFORMER:
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
Educating New Members of Medicare+Choice Plans About Their Health Insurance Options: Does the National Medicare Education Program Make a Difference?
The National Medicare Education Program (NMEP) addresses one
of the biggest challenges facing Medicare--educating beneficiaries about their
insurance options. Data from a national
survey of Medicare HMO enrollees and fee-for-service beneficiaries age 65 and
over indicate that most of these beneficiaries are aware of at least one NMEP information
source, such as the Medicare &You handbook.
Recent Medicare HMO enrollees are more likely than
fee-for-service beneficiaries to have searched for information about
Medicare. About 44 percent of recent
Medicare HMO enrollees recall using a NMEP source.
Most beneficiaries who use NMEP sources find them helpful. About 40 percent of recent Medicare HMO
enrollees and 67 percent of fee-for-service beneficiaries still do not
understand key aspects of Medicare.
PIC ID: 7168.2; CONTACT: Peri Iz, 410-786-6589; PERFORMER:
Mathematica Policy Research, Inc., Plainsboro, NJ
Evaluation of Oregon Medicaid Reform Demonstration
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. This report
presents selected analyses conducted as part of a CMS-funded evaluation of the
Oregon Health Plan (OHP). While the
report focuses largely on OHP's Phase 1 population (traditional Aid to
Dependent Children (ADC) expansion eligibles), future reports also will examine
the Phase 2 population: SSI disabled
and dual Medicare eligibles. Higher
than expected costs have meant that OHP has had to seek new ways to finance
care. OHP garnered national attention
for its use of a prioritized list of health care services to define the
program's benefit package. However, the
priority list has not served well as a tool for budgetary control. Restricting the list has been cumbersome
because of approval requirements at the State and Federal levels. Like some other states, Oregon has turned to
tobacco tax revenues to support its expanded Medicaid program. This will allow for the expansion of the program to cover pregnant women up to
170 percent of FPL; re-extend coverage to uninsured Pell Grant college students
who had lost coverage as the result of an early OHP budget shortfall and create
the Family Health Insurance Assistance Program (FHIAP) to subsidize private
insurance premiums for low-income adults and children. The newest source of revenue for OHP will
come from the State Children's Insurance Program (SCHIP).
PIC ID: 7705.1; CONTACT: Paul J. Boben, 410-786-6629;
PERFORMER: Health Economics Research, Inc., Waltham, MA
Focus Group Results from the National Evaluation of Medicare & You 2000 Handbook: Non-Beneficiary Decision Helpers
In focus groups with friends and family members who help
Medicare beneficiaries with their coverage decisions, this study found that the
friends and family members who assist Medicare beneficiaries with their
coverage decisions have some informational needs that overlap with
beneficiaries, while others are unique to their status. They understood the intent of the Handbook,
and found it useful as a reference tool and as a learning resource. Helpers expressed more confusion and
frustration than did beneficiaries in similar focus groups, particularly in
attempting to collect consistent information dealing with what Medicare covers
and to what extent. This disparity may
be because they are less familiar with the complex Medicare system. The report suggests CMS should give consideration
to whether the National Medical Education Program (NMEP) is intended to apply
to non-beneficiaries who aid in decision-making as well as to
beneficiaries. Informational material
and the methods by which that material is disseminated may require some
tailoring to the special needs of decision helpers who are not themselves
beneficiaries.
PIC ID: 7363.2; CONTACT: Sherry Terrell, 410-786-6601;
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
Focus Group Results from the National Evaluation of Medicare & You 2000: Beneficiaries
This report summarizes the findings from three focus groups
with Medicare beneficiaries. The
overall aim of this work was to contribute to efforts to evaluate the National
Medicare Education Program (NMEP) by augmenting information collected in the
national Medicare and You evaluation survey that RTI conducted between July
1999 and February 2000. Beneficiaries
generally perceived that the purpose of the handbook was to provide general
knowledge and information about the Medicare program.
The handbook also increased participants awareness of
CMS-sponsored information sources, although many were reluctant to use the
Internet. Gains in participants
understanding appeared to be associated with the perceived relevance of the
issues addressed. These findings
suggest that it will be challenging to develop effective methods to assess the
impact of the NMEP on beneficiary knowledge, as interest is an important
intervening variable between exposure and gains in knowledge. Most participants saw the handbook as a
reference guide.
PIC ID: 7363.1; CONTACT: Sherry A. Terrell, 410-786-6601;
PERFORMER: Research Triangle Institute, Research Triangle Park, NC
In-Progress Evaluations
Evaluation of Group-Specific Volume Performance Standards Demonstration
The Physician Group Practice (PGP) demonstration tests a
hybrid payment methodology that combines Medicare-fee-for-service payments with
a bonus pool derived from savings achieved through improvements in practice
efficiency and patient processes and outcomes by physician groups and
affiliated organizations. The goals of
the demonstration are to: (1) encourage
coordination of Part A and Part B services, (2) promote efficiency via
investment in administrative structure and care processes, and (3) reward
physicians for improving health outcomes.
The Benefits Improvement and Protection Act of 2000 mandated the PGP
demonstration.
PIC ID: 7181; EXPECTED COMPLETION: FY 2002; CONTACT: John
Pilotte, 410-786-6558; PERFORMER: Health Economics Research, Inc., Waltham, MA
Performance Assessment of Web Sites
This task order evaluates, sets up an ongoing system for
feedback from consumers, and makes recommendations for future changes
concerning two web sites sponsored by the Department of Health and Human
Services. The project covers web sites:
http://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. Each focuses on different aspects of patient
information rather than seeking to provide organizational information about the
Department.
PIC ID: 7212; EXPECTED COMPLETION: FY 2002; CONTACT: Barbara
Crawley, 410-786-6590; PERFORMER: Barents Group, KPMG Peat Marwick LLP,
Washington, DC
Evaluating Alternative Methods to Assure and Enhance the Quality of Long-Term Care Services for Persons with Developmental Disabilities
This task order develops and validates 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.
PIC ID: 6310; EXPECTED COMPLETION: FY 2002; CONTACT: David
Greenberg, 410-786-2637; PERFORMER: Abt Associates Inc., Cambridge, MA
Evaluation of High Risk Pools
As a method of assuring availability of insurance in the
individual market, the Health Insurance Portability and Accountability Act
(HIPAA) allows the use of an acceptable state alternative mechanism in place of
adopting precise HIPAA provisions. One
of these acceptable mechanisms is to use a states High-Risk Pool for HIPAA
eligibles. Since the statutory
objective of this acceptable mechanism is to guarantee the availability of
insurance to individuals, this project evaluates the best standards for a High
Risk Pool, standards which allow it to be sustained and to remain an acceptable
alternative mechanism for HIPAA eligibles.
It summarizes and details the similarities and differences between risk
pools in the context of the dynamics in individual insurance law for states
which have accepted risk pools as alternative mechanisms.
PIC ID: 7422; EXPECTED COMPLETION: FY 2002; CONTACT: James
Fuller, 410-786-3365; PERFORMER: Abt Associates Inc., Cambridge, MA
Assessment of Medicare & You Education Program
As part of the National Medicare Education Program, CMS must provide
information to beneficiaries about the Medicare program and their
Medicare+Choice (M+C) options.
Performance assessment plays a critical part in CMSs efforts to provide
this information. This project provides
assistance to CMS in assessing how well CMS is communicating with Medicare
beneficiaries, caregivers and partners.
The specific activities include: toll-free telephone services, including
Mystery Shopping Monitoring and Assessment Activities; State Health Insurance
Assistance Programs (SHIPs); Regional Education about Choices in Health
(REACH), including National Training and Support for Information Givers, and
Partnering Assessment; Print Materials including The Medicare & You
Handbook.
PIC ID: 7666; EXPECTED COMPLETION: FY 2003; CONTACT: Lori
Teichman, 410-786-6684; PERFORMER: Barents Group, KPMG Peat Marwick LLP,
Washington, DC
Cost-Benefit of HIPPA
This is a multi-phase study that focuses on groups that have
been in the forefront of interacting with the population affected by the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) and three HIPAA
related provisions: MHPA (Mental Health
Parity Act of 1996), NMPHA (Newborns and Mothers Health Protection Act of
1996) and WHCRA (Womens Health and Cancer Rights Act of 1998). The groups, i.e., state agencies, consumer
advocacy groups or individual researchers, are being contacted, and benefits,
in terms of assisting individuals in obtaining coverage as guaranteed under
HIPAA and related provisions, identified.
Since strategy for implementation of HIPAA is technically based on state
insurance regulatory models, the project will delineate and describe similar
and/or differing effects as this model is applied at the federal level. Evaluation results to assist CMS in the
planning of any future endeavors in private health insurance regulation.
PIC ID: 7420; EXPECTED COMPLETION: FY 2002; CONTACT: James
Fuller, 410-786-3365; PERFORMER: Arthur Andersen and Company, Washington, DC
Evaluation of BBA Impacts on Medicare Delivery and Utilization of Inpatient and Outpatient Rehabilitation Therapy Services
This project studies the impact of the Balanced Budget Act of
1997 (BBA) on the delivery and utilization of inpatient and outpatient
rehabilitation therapy services to Medicare beneficiaries. It is a continuation and extension of
previous work under Medicare Post-Acute Care: Evaluation of BBA Payment
Policies and Related Changes which covered the period 1996-1999. This project studies the period 2000-2003
and also tracks and analyzes (1) Medicare beneficiaries utilization patterns
of rehabilitation therapies and other post-acute care from 2001-2003 and (2)
the allocation of resources among post-acute care providers over the same
period. These analyses will provide a
general framework for understanding shifts in access and utilization of care
among post-acute care settings. It will
also explore in detail the changes specific to rehabilitation therapy services.
PIC ID: 7668; EXPECTED COMPLETION: FY 2005; CONTACT: Philip
G. Cotterill, 410-786-6598; PERFORMER: Health Economics Research, Inc.,
Waltham, MA
Evaluation of Private Fee-for-Service Plans in the Medicare+Choice Program
The purpose of this project is to evaluate the new private
fee-for-service (PFFS) option available under the Medicare+Choice (M+C)
program. The evaluation uses a
combination of primary and secondary data sources to evaluate the effects of
the option on beneficiaries and program costs.
The private fee-for-service plan option is one of the new types of
organizations provided for under the M+C provisions. Primary data will be
collected through site visits to participating plans and beneficiary surveys.
The Sterling Plan is the first insurer approved to offer this option--it has
been available to beneficiaries since July 2000 and by the end of January 2001,
there were 10,098 beneficiaries enrolled.
Analytic issues to be addressed in the evaluation can be grouped into
three broad categories: impacts on
beneficiaries, impacts on Medicare program expenditures, and impacts on
participating plans and providers. The
evaluation will report on the views of the Sterling Plan regarding issues of
marketing and administering the PFFS policies, the reasons for the
participation in the M+C program, how markets were selected to enter, and other
pertinent issues relating to their participation in the M+C program. The evaluation will also report on provider
impacts.
PIC ID: 7664; EXPECTED COMPLETION: FY 2004; CONTACT: Nancy
Zhang, 410-786-9362; PERFORMER: Abt Associates Inc., Cambridge, MA
Evaluation of Programs of Coordinated Care and Disease Management
This project is an the evaluation of a group of
Congressionally mandated demonstration programs and two CMS-initiated
demonstration programs which test various methods of managing care in the
fee-for-service Medicare environment.
The demonstration programs to be studied as part of this evaluation will
vary widely with respect to the demographics, medical and social situations of
the target population, intensity of services offered, interventions under
study, type(s) of health care professionals delivering the interventions, and
other factors. Sites may be added to
the demonstration as it progresses.
PIC ID: 7669; EXPECTED COMPLETION: FY 2005; CONTACT: Barbara
Silverman, 410-786-8263; PERFORMER: Mathematica Policy Research, Inc.,
Plainsboro, NJ
Evaluation of the Impact on Beneficiaries of the Medicare+Choice Lock-in Provision
This project explores the impact on Medicare beneficiaries of
the lock-in provision of the Balanced Budget Act of 1997 (BBA). Lock-in places limits on the frequency,
timing and circumstances under which Medicare+Choice (M+C) enrollment elections
can be made. These changes are being
phased in over a two year period beginning January 1, 2002. The purpose of this project is to: Examine
the pre-lock-in patterns of enrollment and disenrollment in M+C using existing
CMS administrative data. Particular
emphasis shall be on the types of actions (i.e. beneficiary enrollment choices)
that will be impacted by the lock-in provision.
This analysis will use existing administrative systems and data
to provide the beneficiaries likely to be affected and characterize the
resulting impact to beneficiaries.
PIC ID: 7665; EXPECTED COMPLETION: FY 2004; CONTACT: Mary
Kapp, 410-786-0360; PERFORMER: Barents Group, KPMG Peat Marwick LLP,
Washington, DC
Evaluation of the Program of All-Inclusive Care for the Elderly (PACE) as a Permanent Program and of a For-Profit Demonstration
PACE is an innovative model that seeks positive outcomes and
cost savings by providing a range of integrated preventative, acute care, and
long-term care services to manage the often complex medical, functional, and
social needs of the frail elderly. The
Balanced Budget Act (BBA) states this current study must cover the quality and
cost of providing PACE program services under Medicare and Medicaid when it is
operated as a permanent program. It
also must compare the cost, quality, and access to services [provided] by
entities that are private, for-profit entities operating under demonstration
project waivers...with the costs, quality, and access to services of other PACE
providers. This project is to expand on
the foundations laid in the previous evaluations of PACE by predicting costs
beyond the first year of enrollment, assessing the impact of higher end of life
costs and long term nursing home care, and assessing the impact of local
treatment practices.
PIC ID: 7667; EXPECTED COMPLETION: FY 2002; CONTACT: Fred
Thomas, 410-786-6675; PERFORMER: Mathematica Policy Research, Inc., Plainsboro,
NJ
Study of Pharmaceutical Benefit Management
This project is an extension of an earlier CMS ORDI research,
completed in 1996. This earlier study
remains valuable for its description of the industry functions and the
origins. However, most information is
no longer current as this industry has undergone major stages of evolution
during the past five years. While the
industry has grown impressively in size, there has been an increasing concentration
in market power. The pharmacy benefit
management (PBM) industry is becoming a dominant player in the administration
of pharmaceutical benefits. It seems
certain that the PBM sector will play a significant role in administering the
Medicare program in case a drug benefit is added to Medicare. This study systematically examines the
growing PBM industry.
PIC ID: 7591.2; EXPECTED COMPLETION: FY 2002; CONTACT: Peri
Iz, 410-786-6589; PERFORMER: Price Waterhouse, Washington, DC
Evaluating the Use of Quality Indicators in the Long Term Care Survey Process
CMSs 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 facilitys
compliance with the long-term care requirements. This study develops and tests
(with volunteering state survey agencies) various options for using a variety
of quality indicators to improve the effectiveness and efficiency of the CMSs
facility performance monitoring.
PIC ID: 7177; EXPECTED COMPLETION: FY 2003; CONTACT: Sue
Nonemaker, 410-786-6825; PERFORMER: Research Triangle Institute, Research
Triangle Park, NC
Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes
This task order examines 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.
PIC ID: 7176; EXPECTED COMPLETION: FY 2002; CONTACT: Mary
Pratt, 410-786-6867; PERFORMER: University of Minnesota, Minneapolis, MN
Normative Standards for Medicare Home Health Utilization
This task order develops a model that uses scientifically
based, normative standards to determine thresholds for payment authorization
within home health service categories.
It will test the model to determine the extent of its validity and
reliability. The project will also recommend an appropriate demonstration
design to evaluate the use of the model by fiscal intermediaries prior to full
implementation.
PIC ID: 7175; EXPECTED COMPLETION: FY 2002; CONTACT: Mary
Wheeler, 410-786-6892; PERFORMER: Center for Health Policy Research, Denver, CO
Department of Defense Subvention Demonstration Evaluation
Under this demonstration, enrollment in the Department of
Defenses (DoDs) 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 examines 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.
PIC ID: 7171; EXPECTED COMPLETION: FY 2002; CONTACT: Victor
McVicker, 410-786-6681; PERFORMER: Rand Corporation, Santa Monica, CA
Evaluation System for Medicare+Choice
This task order designs and implements a strategy for
tracking and evaluating the performance of managed health care organizations,
both nationwide and within specific markets. Dimensions of performance being
tracked include beneficiary access to managed care, and the cost and quality of
services delivered to beneficiaries by managed care organizations.
PIC ID: 7169; EXPECTED COMPLETION: FY 2002; CONTACT: Brigid
Goody, 410-786-6640; PERFORMER: Mathematica Policy Research, Inc., Washington,
DC
Evaluation of CAHPS/Bulletin/Medicare and You in Kansas City MSA
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
examined 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). This study will look at
whether Medicare beneficiaries use comparative quality information to make
health plan choices and whether the Medicare information program (print
material) is effective.
PIC ID: 7168.1; EXPECTED COMPLETION: FY 2002; CONTACT: Sherry
Terrell, 410-786-6601; PERFORMER: Research Triangle Institute, Research
Triangle Park, NC
Evaluation of Competitive Bidding Demonstration for DME and POS
This project tests 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 examines competitive bidding impacts in terms of
expenditures, quality, access and product diversity, as well as other impacts
of the demonstration.
PIC ID: 7173; EXPECTED COMPLETION: FY 2003; CONTACT: Ann
Meadow, 410-786-6602; PERFORMER: University of Wisconsin, Madison, WI
Evaluation of Phase II of the Home Health Agency Prospective Payment Demonstration
This demonstration tested 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) per episode of Medicare-covered
home health care (Phase II). The evaluation combined 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.
PIC ID: 7203; EXPECTED COMPLETION: FY 2002; CONTACT: Ann
Meadow, 410-786-6602; PERFORMER: Mathematica Policy Research, Inc., Washington,
DC
Evaluation of QMB and SLMB Programs
This project is designed to quantitatively and qualitatively
evaluate 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 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.
PIC ID: 7390; EXPECTED COMPLETION: FY 2003; CONTACT: Noemi
Rudolph, 410-786-6662; PERFORMER: Health Economics Research, Inc., Waltham, MA
Evaluation of the Child Health Insurance Program
The State Childrens Health Insurance Program (SCHIP),
established 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 involves a summary and analysis of the state evaluations and an
analysis of external SCHIP-related activities.
It provides 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.
PIC ID: 7380; EXPECTED COMPLETION: FY 2004; CONTACT: Rose
Marie Hakim, 410-786-6698; PERFORMER: Mathematica Policy Research, Inc.,
Washington, DC
Evaluation of the Community Nursing Organization Demonstration
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.
PIC ID: 6306.1; EXPECTED COMPLETION: FY 2002; CONTACT: James
Hawthorne, 410-786-6689; PERFORMER: Abt Associates Inc., Cambridge, MA
Evaluation of the Diamond State Health Plan
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 project 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 Childrens Clinics). The goal of the evaluation was
broadened to assess whether this section 1115 demonstrations objective of
increased access to high-quality, cost-effective care for Medicaid children is
being met.
PIC ID: 6288; EXPECTED COMPLETION: FY 2002; CONTACT: Penny
Pine, 410-786-7718; PERFORMER: Research Triangle Institute, Research Triangle
Park, NC
Evaluation of the EverCare Demonstration Program
The EverCare demonstration attempts 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 combines 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.
PIC ID: 7185; EXPECTED COMPLETION: FY 2002; CONTACT: John
Robst, 410-786-1217; PERFORMER: University of Minnesota, Minneapolis, MN
Evaluation of the Home & Community-Based Services Waiver Program
The Home and Community-Based Services (HCBS) waiver program
has been operating since 1981 and has experienced strong 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.
PIC ID: 7208; EXPECTED COMPLETION: FY 2002; CONTACT: Susan
Radke, 410-786-4450; PERFORMER: The Lewin Group, Fairfax, VA
Evaluation of the Medical Savings Account Demonstration
This evaluation of the Medical Savings Account (MSA)
demonstration compares 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.
PIC ID: 7172; EXPECTED COMPLETION: FY 2003; CONTACT: Renee
Mentnech, 410-786-6692; PERFORMER: Barents Group, KPMG Peat Marwick LLP,
Washington, DC
Evaluation of the New York Medicare Graduate Medical Education Payment Demonstration and Related Provisions
Medicares 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 Act 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. 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 presents a
series of reports.
PIC ID: 7379; EXPECTED COMPLETION: FY 2004; CONTACT: William
Buczko, 410-786-6593; PERFORMER: Health Economics Research, Inc., Waltham, MA
Evaluation of the Ohio Behavioral Health Program
This project addresses:
(1) a focused evaluation of the behavioral health component of OhioCare,
and (2) a case study of the implementation of Ohios section 1115 State health
reform demonstration, OhioCare. The case study will complement the focused
evaluation by providing a context for findings and supplemental findings.
PIC ID: 7184; EXPECTED COMPLETION: FY 2002; CONTACT: Penny
Pine, 410-786-7718; PERFORMER: Health Economics Research, Inc., Waltham, MA
Health Disparities: Longitudinal Study of Ischemic Heart Disease Among Aged Medicare Beneficiaries
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 is 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.
PIC ID: 7419; EXPECTED COMPLETION: FY 2002; CONTACT: Linda
Greenberg, 410-786-0677; PERFORMER: Health Economics Research, Inc., Waltham,
MA
Impact of Welfare Reform on Medicaid Populations
This project develops data and examines the impact of welfare
reform on Medicaid eligibility, utilization and payments for various
populations. It studies 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.
PIC ID: 7183; EXPECTED COMPLETION: FY 2002; CONTACT: Penny
Pine, 410-786-7718; PERFORMER: Mathematica Policy Research, Inc., Washington, DC
Maximizing the Cost Effectiveness of Home Health Care (HHC)
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.
PIC ID: 7179; EXPECTED COMPLETION: FY 2002; CONTACT: Ann
Meadow, 410-786-6602; PERFORMER: Center for Health Policy Research, Denver, CO
Maximizing the Effective Use of Telemedicine: A Study of the Effects, Cost Effectiveness, and Utilization Patterns of Consultation via Telemedicine
This project is conducting an evaluation of the CMSs
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.
PIC ID: 6303; EXPECTED COMPLETION: FY 2002; CONTACT: Joel
Greer, 410-786-6695; PERFORMER: Center for Health Policy Research, Denver, CO
Medicare Post-Acute Care: Evaluation of BBA Payment Policies and Related Changes
This project studies the impact of the Balanced Budget Act
(BBA) and other policy changes on Medicare utilization and delivery patterns in
post-acute care. Post-acute care is
generally defined to include the Medicare covered services provided by skilled
nursing facilities (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.
PIC ID: 7417; EXPECTED COMPLETION: FY 2002; CONTACT: Philip
G. Cotterill, 410-786-6598; PERFORMER: Medstat Group, Washington, DC
Multi-State Evaluation of Dual Eligible Demonstrations
This evaluation is designed to assess the impact of dual
eligible demonstrations in the states of Minnesota, Colorado, Wisconsin and New
York. Analyses are being conducted for each state and across states.
PIC ID: 7186; EXPECTED COMPLETION: FY 2005; CONTACT: Noemi
Rudolph, 410-786-6662; PERFORMER: University of Minnesota, Minneapolis, MN
Racial Disparities in Health Services Among Medicaid Pregnant Women (Multi-State) Analysis
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 evaluates 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. It examines
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 markets
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. For each of the health care
utilization analysis, expenditures will also be analyzed.
PIC ID: 7416; EXPECTED COMPLETION: FY 2002; CONTACT: Beth
Benedict, 410-786-7724; PERFORMER: Research Triangle Institute, Research
Triangle Park, NC
Survey of Medicare Beneficiaries Who Were Involuntarily Disenrolled from HMOs that Withdrew from Medicare
When HMOs withdraw from the Medicare program or reduce their
service areas, thousands of Medicare beneficiaries become disenrolled
involuntarily. There has been concern
among policymakers about the impact of the recent HMO withdrawals on the
beneficiary population. Additional
withdrawals occurred in 2001 and may also occur in subsequent years. This project conducts 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 that either terminated their risk
contracts or reduced their service areas in January 2001. The survey is conducted by mail with
telephone followup.
PIC ID: 7421; EXPECTED COMPLETION: FY 2002; CONTACT: Gerald
Riley, 410-786-6699; PERFORMER: University of Wisconsin, Madison, WI
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