Performance Improvement 1999. Health Care Financing Administration


Evaluation Program
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, we anticipate 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 health plans and providers.
  • Vulnerable Populations and Dual Eligibles--A special focus of RD&E 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.
  • 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.