PERFORMANCE IMPROVEMENT 2000

Chapter III

Compendium of HHS Agency FY 1999

Evaluations Completed and In Progress

HEALTH CARE FINANCING ADMINISTRATION

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.

The research arm of the Health Care Financing Administration (HCFA), 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 HCFA's 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:

· Medicare Health Plans: Enrollment, Delivery, and Payment--Highlights of these research, demonstration and evaluation (RD&E) efforts include research demonstrating favorable selection in enrollment, the development of systems for measuring beneficiary risk that can be used for refining capitated payments, and demonstrations that have tested and evaluated the effectiveness of a wide range of capitated health plan arrangements.

Provider Payment and Delivery Innovations in Traditional Fee-for-Service Medicare--Current RD&E projects include attempts to better align providers' incentives to deliver cost-effective care, either through payment innovations such as bundled payment models or prospective payment systems for post-acute care. Other initiatives include competitive bidding and experiments to foster coordinated care.

Research on the Future of Medicare--HCFA requires more information in order to assess the impact of longer term structural reforms of the Medicare program necessary to deal with the dramatic increase in the number of beneficiaries. Analyses to support the development of proposals for Medicare reform for congressional consideration will be required. In addition, it is anticipated that there will be a need for demonstration and evaluation activities related to future of Medicare reform.

Outcomes, Quality and Performance--HCFA's RD&E agenda involves the development and testing of improved information resources that will enable consumers to choose among health plans and providers based on their relative value and quality. One part seeks to better understand how choices are made so that beneficiaries can use information most effectively. The complementary part of the agenda aims to develop better tools for measuring health care outcomes and quality, as well as the performance of heOutcomes, Quality and Perfo

Vulnerable Populations and Dual Eligibles--A special focus of projects in this area is the demonstration of coordinated care models that integrate the range of services available to persons dually eligible for Medicare and Medicaid. Development of a risk adjustment system that would support capitated payment for dual eligibles is a key element related to this activity.

State Programs--This demonstration authority is used to provide expanded eligibility or additional services to individuals. In return for greater flexibility, States commit to a policy experiment that can be evaluated.

Research & Development Support Services--HCFA's research budget supports a variety of activities to increase the efficiency of our research and demonstration program and meet the crosscutting research needs of HCFA and the wider health research community.

Cross-Cutting

Implementing State Health Care Reform: What Have We Learned From the First Year? The First Annual Report of the Evaluation of Health Reform in Five States

This project provided initial State-specific and cross-State analyses of demonstration impacts on utilization, insurance coverage, public and private expenditures, quality, access and satisfaction. Analyses of all groups is, where possible, stratified by age, income, geographic location, and other relevant demographic variables. Data come from site visit interviews with providers, advocacy groups, and State officials, participant surveys, hospital discharge data, and secondary data sources such as the area resource file and current population survey. During 1996, two important design and funding additions were made to the project: (1) examination of the impacts on the disabled; and (2) assessment of the impacts on mental health and substance abuse service users.

Managed Care

HCFA On-Line: Market Research for Providers--Final Focus Group Report on the Managed Care Module

This report describes findings from focus group meetings with Health Maintenance Organizations (HMOs) held to help inform HCFA about: (1) what information managed care plans and providers need and want, and (2) how such information can most effectively be provided. This report summarizes common issues/themes which emerged and provides insight about the following key questions: (1) How do HMO communications with HCFA compare to and contrast with their communications with the plan's largest group purchaser (or other group with which the HMO regularly communicates)?; (2) What new information would HMOs like to receive from HCFA; (3) What sources do HMOs rely on to get information about Medicare?; (4) How would HMOs like to receive information from HCFA?; (5) What are HMOs' general experiences in communication with HCFA representatives? and (6) What one recommendation to HCFA would HMOs make to improve HCFA's communications? In general, HMOs indicated a desire to work more collaboratively with HCFA and to increase opportunities for HMOs to communicate with HCFA. According to focus group participants, improvements in communications are needed to clarify HCFA's message and to ensure the consistency and timeliness of communications. (See PIC ID 6921)

Medicare

1999 Annual Data Report (ADR) of the USRDS

This 1999 Annual Data Report US Renal Data System (USRDS) updates last year's analysis of 1) the economic cost of End- Stage Renal Disease (ESRD), 2) Medicare spending for different treatment modalities, and 3) Medicare spending by physician speciality and supplier type (e.g., medical supply company, ambulance, laboratory). Data are reported through the end of 1997. In addition to updating previously reported information, data on the interstate variation of Medicare spending are reported for the first time. The results are reported in four sections of Chapter X, entitled, "The Economic Cost of ESRD and Medicare Spending for Alternative Modalities of Treatment." Previous annual data reports were issued from 1994-1998 and can be downloaded from the USRDS web site: http://www.usrds.org.

PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

Evaluation Plan for the Medicare-DoD Subvention Demonstration

This evaluation plan describes the Medicare-DoD Subvention demonstration mandated by Section 4015 of the Balanced Budget Act of 1997. It examines issues involved in implementing the programs encompassed and presents RAND's planned approach to perform the evaluation. The plan describes how HCFA will assess the impact of the demonstration on government costs and effects on enrollees, other Medicare or DoD beneficiaries, military treatment facilities, TRICARE Lead Agents and contractors, and other stakeholders. The planned evaluation will generate operational information and "lessons learned" from sites' implementation experiences. It will conduct site visits, focus groups and interviews, analyze eligible population and enrollment data, review payment and cost data and results of several DoD Surveys of retirees and of military treatment facility patients.

Interim Report: Evaluation of the Medicare-DoD Subvention Demonstration

This report presents early results from RAND's evaluation of the Medicare-DoD subvention demonstration, established by the Balanced Budget Act of 1997 to implement cost-effective alternatives for care for those eligible for both Medicare and military retiree health benefits while ensuring that total federal costs for either the Health Care Financing Administration (HCFA) or the Department of Defense (DoD) are not increased. This phase of the demonstration began to examine implications for establishing Senior Prime as a permanent part of the TRICARE program. (See also PIC ID numbers 7171 and 7171.1) TRICARE Senior Prime established Medicare+Choice health plans operated by DoD, under contract with HCFA in six demonstration sites. Senior Prime enrollees chose a military primary care manager at a participating military treatment facility (MTF) to receive their primary care and other services there. For any services not provided by the MTF, enrollees were referred to other MTFs or to civilian providers under contract to the Senior Prime network, depending on facility proximity and enrollee choice. Because this demonstration had only been underway for 6 to 10 months, depending on the site, it was too early to assess the effects of Senior Prime on dual-eligible beneficiaries or on government costs. This study includes preliminary assessments of the following activities involved in the initial phase of Senior Prime implementation: obtaining Medicare certification for the plans, marketing and enrolling beneficiaries, enrollee intake and initial service delivery, and managing and monitoring plan performance.

Minimal-Burden Risk Adjusters for the Medicare Risk Program

Studies have shown that payments to risk plans under the Medicare program exceed the cost that HCFA would have incurred under traditional fee-for-service (FFS) Medicare. The overpayment occurs because the mechanism for setting the capitation rates that risk plans are paid for providing coverage of Medicare services fails to reflect health status adequately. HCFA funded this study, among others, to develop more effective risk adjusters for the general Medicare population. This project developed a risk adjuster that is based on 1) a history of serious disease (including cancer, heart disease or stroke) and severity of illness; 2) the length of time since the last hospital stay; and (3) comorbidities. The predictive power from using history of serious illness was compared to the predictive power of two existing risk adjusters--the diagnostic-cost group and ambulatory-care group models. Both predictive accuracy and operational features were compared.

The Kansas City Evaluation of "Medicare and You (1999)" and "Medicare CAHPS": Results from Focus Groups with Aged, Disabled, and Dual Eligible Beneficiaries

The purpose of this study is to evaluate new Medicare consumer information materials, i.e., the "Medicare and You" handbook (1999) and the "Medicare CAHPS" report. This describes the main findings from seven focus groups conducted with aged, disabled, and beneficiaries dually eligible for Medicare and Medicaid (56 participants) in Kansas City, Kansas and in Missouri. The goal of the focus groups was to learn what Medicare beneficiaries though about the handbook (1999) and the report, and whether the information helped them to decide about a health plan. Beneficiaries generally believe that the handbook is: (1) comprehensive and understandable, (2) more useful as a reference tool than as a decision tool, and (3) more trustworthy than information from managed care plans. Beneficiaries also responded favorably to the CAHPS report. They believed that the CAHPS report is relevant primarily for people considering membership in an HMO. The level of trust in the report was mixed, e.g., some believed the report was intended to encourage people to join an HMO or that it was marketing material from a particular HMO. In summary, the focus group findings reflect well on both the "Medicare and You" handbook and the "Medicare CAHPS" report. Most beneficiaries understood the main messages of each booklet.

Quality of Care

The Case Identification Challenge in Measuring Performance in Breast Cancer Care

It may not be difficult to realize the importance of valid measures of the performance of medical providers, groups, and plans, however, the challenges of valid performance measurement are not as easily understood. The purpose of this paper is to inform and assist cancer care providers' responses to these challenges by clarifying the issues critical to one area of performance measurement, case identification, and recommending possible strategies for handling these issues. Case identification is an important and complex undertaking. Registry rapid case ascertainment has considerable potential for accurately producing the information needed. Performance measurement researchers would be well-advised to work closely with cancer registry officials to realize this potential. Improving the understanding of critical steps in case identification across health services research, clinical settings, pathology laboratories, registries, and hospital management is likely to generate more valid data at lower costs, data which can be used with confidence to assess and improve care delivered to patients with breast cancer.

In-Progress Evaluations

Child Health Insurance

Evaluation of the Child Health Insurance Program

Cross-Cutting

Economic and Cost-Effectiveness Studies from the U.S. Renal Disease Data System
Maximizing the Effective Use of Telemedicine: A Study of the Effects, Cost Effectiveness, and Utilization Patterns of Consultation via Telemedicine
Multi-State Evaluation of Dual Eligibles Demonstrations
Performance Assessment of Web Sites

Home Health Care

Evaluation of Phase II of the Home Health Agency Prospective Payment Demonstration
Maximizing the Cost Effectiveness of Home Health Care

Managed Care

Decision Making in Managed Care Organizations
Evaluation of Group-Specific Volume Performance Standards Demonstration

Medicaid

Evaluation of Oregon Medicaid Reform Demonstration
Evaluation of the Diamond State Health Plan
Evaluation of the Home & Community-Based Services Waiver Program
Evaluation of the Ohio Behavioral Health Program
Evaluation of the State Health Reform Demonstrations (OH, MN)
Impact of Welfare Reform on Medicaid Populations
Project Demonstrating and Evaluating Alternative Methods to Assure and Enhance the Quality of Long- Term Care Services for Persons with Developmental...

Medicare

Department of Defense Subvention Demonstration Evaluation
Evaluation of CAHPS/Bulletin/Medicare and You in Kansas City MSA
Evaluation of Competitive Bidding Demonstration for DME and POS
Evaluation of QMB and SLMB Programs
Evaluation of the Community Nursing Organization Demonstration
Evaluation of the Evercare Demonstration Program
Evaluation of the Medical Savings Account Demonstration
Evaluation of the Medicare Choice Demonstration
Evaluation of the New York Medicare Graduate Medical Education Payment Demonstration and Related Provisions
Evaluation System for Medicare + Choice
Expanded Evaluation of Medicare and You Handbook: 2000
NAS/Institute of Medicine Study on Preventive Services
Normative Standards for Medicare Home Health Utilization
Survey and Evaluation of New Medicare Members of Medicare+Choice Plans

Quality of Care

Comparison of Pharmaceutical Quality of Care for Pediatric Asthma
Evaluating the Use of Quality Indicators in the Long Term Care Survey Process
Evaluation of the Nursing Home Case-Mix and Quality Demonstration
Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes

Child Health Insurance

Evaluation of the Child Health Insurance Program

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.

Cross-Cutting

Economic and Cost-Effectiveness Studies from the U.S. Renal Disease Data System

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.

PERFORMER: National Institute of Diabetes and Digestive and Kidney Diseases
Bethesda, MD

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 Health Care Financing Administration's (HCFA'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.

Multi-State Evaluation of Dual Eligibles Demonstrations

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.

Performance Assessment of Web Sites

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 Health Care Financing Administration (HCFA), and www.healthfinder.gov, which was developed by the Office of Disease Prevention Health Promotion in collaboration with other agencies.

Home Health Care

Evaluation of Phase II of the Home Health Agency Prospective Payment Demonstration

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.

Maximizing the Cost Effectiveness of Home Health Care

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.

Managed Care

Decision Making in Managed Care Organizations

This project examines 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.

Evaluation of Group-Specific Volume Performance Standards Demonstration

The goal of the demonstration is to test the feasibility of this partial risk bearing payment arrangement between the Health Care Financing Administration 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.

Medicaid

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. 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.

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 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.

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 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.

Evaluation of the Ohio Behavioral Health Program

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.

Evaluation of the State Health Reform Demonstrations (OH, MN)

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.

Impact of Welfare Reform on Medicaid Populations

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.

Project Demonstrating and Evaluating Alternative Methods to Assure and Enhance the Quality of Long-Term Care Services for Persons with Developmental...

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.

Medicare

Department of Defense Subvention Demonstration Evaluation

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.

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 is designed to examine consumer quality ratings about local managed care plans' performance. HCFA 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.

PERFORMER: Research Triangle Institute
Box 12194, Research Triangle Park, NC 27707-2194

Evaluation of Competitive Bidding Demonstration for DME and POS

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.

Evaluation of QMB and SLMB Programs

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.

Evaluation of the Community Nursing Organization (CNO) 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.

Evaluation of the Evercare Demonstration Program

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.

Evaluation of the Medical Savings Account Demonstration

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.

Evaluation of the Medicare Choice Demonstration

The HCFA is in the process of implementing the Medicare Choice Demonstration to test 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.

Evaluation of the New York Medicare Graduate Medical Education Payment Demonstration and Related Provisions

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.

Evaluation System for Medicare + Choice

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.

Expanded Evaluation of Medicare and You Handbook: 2000

The purpose of this project is to establish national measures of Medicare beneficiaries' knowledge of the basic Medicare program and their understanding of new Medicare+Choices available under the Balanced Budget Act of 1997. The program objective is to evaluate National Medicare Education Program (NMEP) print material (Handbook 2000) and selected information distribution channels (i.e., print, Internet, 1-800-MEDICARE) using the knowledge index. The policy objectives of this project are to support HCFA strategic plan initiatives, contribute to Government Performance and Results Act program performance reporting, and provide feedback for monitoring and continuous quality improvement of NMEP informational materials directed to the Medicare population over time.

AGENCY SPONSOR: Health Care Financing Administration
FEDERAL CONTACT: Terrell, Sherry
410-786-6601

NAS/Institute of Medicine Study on Preventive Services

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.

Normative Standards for Medicare Home Health Utilization

This task order will develop 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.

Survey and Evaluation of New Medicare Members of Medicare+Choice Plans

The purpose of this project is to design a survey for and collect data from Medicare beneficiaries who are new members of Medicare+Choice (M+C) plans and to evaluate the effectiveness of the National Medicare Education Program (NMEP) for these beneficiaries. The objective is to understand the special information needs of new Medicare members, their sources of information (who/where), their preferred distribution channels (how), their understanding of the basic (standard) Medicare program, their understanding of their particular M+C plan, and the impact NMEP activities may have on new members' decision to choose an M+C plan or change their plan. This project does not include the disenrollee population. The project will support HCFA strategic plan initiatives, contribute to Government Performance and Results Act program performance reporting, and provide feedback for monitoring and quality improvement to NMEP informational materials directed to the M+C population over time.

Quality of Care

Comparison of Pharmaceutical Quality of Care for Pediatric Asthma

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.

Evaluating the Use of Quality Indicators in the Long Term Care Survey Process

The Health Care Financing Administration's (HCFA'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 HCFA's facility performance monitoring.

Evaluation of the Nursing Home Case-Mix and Quality Demonstration

This project will help the HCFA 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.

Measurement, Indicators, and Improvement of the Quality of Life in Nursing Homes

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.

	Office of the Assistant Secretary for Planning and Evaluation

	Policy Information Center

Office of the Assistant Secretary for Planning and Evaluation

Policy Information Center

Chapter III

Compendium of HHS Agency FY 1999

Evaluations Completed and In Progress

HEALTH CARE FINANCING ADMINISTRATION

Fiscal Year 1999 Evaluation Reports

In-Progress Evaluations