Performance Improvement 2002. Centers for Medicare and Medicaid Services

01/01/2002

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 ORDI’s activities embraces all areas of health care: costs, access, quality, service delivery models, and financing approaches. ORDI’s 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 demonstration’s 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 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, 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 CMS’s 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 (Women’s 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

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 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 CMS’s 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 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 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 Children’s 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 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.
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

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 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 Ohio’s 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 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.
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