Performance Improvement 2011-2012. Objective: Emphasize primary and preventive care linked with community prevention services

The family planning program, Title X of the Public Health Service Act, serves approximately 5 million individuals each year. The program provides contraceptive, health screening, and sexually transmitted disease prevention and treatment services. To help safety-net providers, including those supported by Title X continue to serve clients, the federal government has implemented some cost-saving mechanisms and programs. One such effort, the 340B Drug Pricing Program, requires that manufacturers provide outpatient drugs at a discounted price to certain federal grantees, including Title X-supported entities. The study researchers sought to better understand Title X providers' experiences using the programs and alternatives available to achieve pharmaceutical discounts. The research included a literature review and in-depth discussions with grantee and delegate agencies around the country currently receiving Title X funds.

Researchers found that a large portion of Title X grantees were enrolled in the 340B Program and about half of the study participants participated in the Prime Vendor program, though this proportion is increasing.

Report Title: Analysis of the Effectiveness of Title X Family Planning Providers' Use of the 340B Drug Pricing Program

http://www.hhs.gov/opa/pdf/304b-analysis-of-effectiveness.pdf
Agency Sponsor: OASH, Office of the Assistant Secretary for Health
Federal Contact: Eugenia Eckard, 240-453-2831
Performer: The Lewin Group
Record ID: 9200 (Report issued October 16, 2009)

Six focus groups were conducted as formative research about food choice attitudes and behaviors among adults with low health literacy. Researchers sought to learn about participants' knowledge, attitudes and behaviors related to their food planning and selection decisions, identify barriers and motivators to healthy eating, examine participants' understanding of food groups and health-related food characteristics, examine reactions to various images that may be used to help identify effective methods to depict food portion sizes, and identify healthy eating goals and messages.

This research informed the communication of the 2010 Dietary Guidelines for Americans. The research yielded the following recommended strategy: To develop a set of materials that provides information about the Dietary Guidelines coupled with images to visualize portion sizes and concrete examples as well as actionable messages that suggest what people can do to meet the guidelines and overcome barriers, and that explain potential benefits from new behaviors. Examples include:  (1) provide information and tools enabling people to make ‘healthy eating' choices in everyday situations; (2) use images or information about the health conditions and risk factors of not eating healthy; (3) refer to the actionable goals most often mentioned by the focus groups such as increasing knowledge of nutritional content, eating smaller portions, eating more fruits and vegetables and less fat; (4) use measuring instruments as tools for visualizing portion size; (5) be careful about using reference objects as a way to determine portion size; (6) include low-cost, easy-to-prepare, healthy eating options so people can more easily adopt the dietary guidelines.

Report Title: 2010 Dietary Guidelines for Americans Consumer Focus Group Testing on Adults with Limited Health Literacy
Agency Sponsor: OASH, Office of the Assistant Secretary for Health
Federal Contact: Rachel Hayes, 240 8252
Performer: American Institutes for Research (AIR)
Record ID: 9205 (Report issued December 31, 2010)

This case study examined how particular health information technology (HIT) tools are being used in nursing homes and home health agencies, and uses qualitative data to identify the costs and benefits associated with their use.

The types of benefits and costs of HIT implementation in nursing homes and home health agencies are generally reported to be the same as those reported in hospitals and physician offices. The scope of these benefits may be greater in long-term care (LTC) because care is provided by interdisciplinary teams of clinicians who are often geographically dispersed. Benefits were reported to outweigh costs.

Report Title: Understanding the Costs and Benefits of Health Information Technology in Nursing Homes and Home Health Agencies: Case Study Findings http://aspe.hhs.gov/daltcp/reports/2009/HITcsf.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Vidhya Alakeson
Performer: University of Colorado
Record ID: 9334 (Report issued October 30, 2009)

This study provides a snapshot of workforce competencies that have been identified for professionals who work in long-term care settings. This is provided through examination of basic roles and responsibilities of professionals and options presently available for specialization, through an analysis of the long-term care workforce literature, and through identification of initiatives launched by professional associations and providers. Additionally, the paper examines whether there might be differences in the competencies required to care for the geriatric population in long-term care settings compared to acute and ambulatory care settings.

Efforts are underway by various stakeholders to identify competencies and necessary skill-sets for professionals who work with older persons in long-term care settings; however more work is needed. Currently, licensure requirements for most health care professionals are variable and therefore do not include mandatory competencies. Professional competencies that pertain to older populations in long-term care settings are difficult to define. The alternatives for additional or supplemental training come in the form of modifying curricula, and/or adding continuing education; both are viable avenues but would require consensus within individual fields to determine the most optimal path.

Report Title: Examining Competencies for the Long-Term Care Workforce: A Status Report and Next Steps http://aspe.hhs.gov/daltcp/reports/2009/examcomp.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Emily Rosenoff, 202-690-6443
Performer: Institute for the Future of Aging Services, HHS Office of the Assistant Secretary for Planning and Evaluation
Record ID: 9338 (Report issued May 21, 2010)

As private equity firms are increasingly buying and investing in nursing home chains, policymakers are concerned with the effect of corporate structure on the quality of care provided. Based on detailed ownership data from the State of Texas, ASPE's study found that the trend in ownership structure of nursing homes is more complex with increasing numbers of layers of organization between the nursing home and the actual individual owners. The quality of care has nevertheless remained the same as before the changes in corporate structure.

Individual nursing homes are increasingly using limited liability structures. A limited liability structure is one in which each owner has limited personal liability for the debts and actions of the company. By contrast, in a sole or general partnership each owner is personally responsible for all risks, liabilities, and debts of a company. Most of the limited liability corporations and partnerships in this study were for-profit facilities. Corporate structures often have multiple layers of limited liability entities between the individual nursing home and the ultimate owners of multiple facilities. The use of management companies to deliver care has increased in the past 10 years. Texas has experienced an increase in separate ownership of operations and ownership of physical property through lease agreements and real estate investment trusts. Quality of care does not appear to change as a result of changes in corporate structure. Nursing homes that were poorer performing facilities when part of a national nursing home chain, remained poorer performing facilities after the change in corporate structure.

Report Title: Nursing Home Ownership Trends and Their Impact on Quality of Care http://aspe.hhs.gov/daltcp/reports/2009/TXNHown.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Susan Polniaszek, 202-690-6443
Performer: Harvard Medical School
Record ID: 9340 (Report issued March 26, 2010)

The first report provides information on the extent and nature of state contracts with Medicare Advantage Special Needs Plans (SNPs). Review of SNP applications revealed the number of states that are already contracting with SNPs but highlighted a number of policy issues related to how states contract with SNPs.

Existing state Medicaid contracts with SNPs raise important definitional questions about the dual SNP contracting mandate established under the Medicare Improvements for Patients and Providers Act of 2008. A dual SNP is often operated as a distinct product within a larger corporate entity. The corporate parent may or may not also operate a Medicaid managed care contract that includes duals. SNP-state contracts take a variety of approaches for providing incentives for coordination of care. Those that include long-term care services in the contract have explicit provisions for managing care as a single benefit. Those in which long-term care is not included contain a range of proposals for encouraging/requiring coordination between Medicare and Medicaid. Benefits included in SNP-state contracts range from a full slate of services (Medicare cost sharing, drugs, primary and acute care, long-term care, and behavioral health) to a minimum of Medicare cost-sharing responsibilities. Some SNP-state contracts explicitly obtain value-added services for beneficiaries.

Report Title: State Purchasing Strategies Drive State Contracts with Medicare Special Needs Plans http://aspe.hhs.gov/daltcp/reports/2009/stpur.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Hunter McKay, 202-690-6443
Performer: Thomson Reuters
Record ID: 9341 (Report issued June 18, 2010)

The second report provides a more in-depth look at five contracts between Medicare Advantage SNPs and state Medicaid programs. The five featured programs were selected as examples of types of contracts currently being used by states and SNPs.

Existing state Medicaid contracts with SNPs raise important definitional questions about the dual SNP contracting mandate established under the Medicare Improvements for Patients and Providers Act of 2008. A dual SNP is often operated as a distinct product within a larger corporate entity. The corporate parent may or may not also operate a Medicaid managed care contract that includes duals. SNP-state contracts take a variety of approaches for providing incentives for coordination of care. Those that include long-term care services in the contract have explicit provisions for managing care as a single benefit. Those in which long-term care is not included contain a range of proposals for encouraging/requiring coordination between Medicare and Medicaid. Benefits included in SNP-state contracts range from a full slate of services (Medicare cost sharing, drugs, primary and acute care, long-term care, and behavioral health) to a minimum of Medicare cost-sharing responsibilities. Some SNP-state contracts explicitly obtain value-added services for beneficiaries.

Report Title: Medicaid Contracts with Medicare Special Needs Plans Reflect Diverse State Approaches to Dually Eligible Beneficiaries http://aspe.hhs.gov/daltcp/reports/2009/SNPdual.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Hunter McKay, 202-690-6443
Performer: Thomson Reuters
Record ID: 9342 (Report issued June 18, 2010)

In the years immediately following the introduction of prospective payment systems (PPS) for skilled nursing facilities (SNFs), large numbers of hospital-based SNFs closed. During the same time period, long-term care hospitals (LTCHs) expanded rapidly, especially in certain areas of the country. Some of the increase in LTCH services was provided to medically complex beneficiaries who previously might have been treated in SNFs. Because LTCH payments are typically much higher than SNF payments, this trend might well represent an increase in Medicare spending with little or no corresponding benefit to patients.

Between 1997 and 2007, both the number of hospital-based SNFs and the number of beds declined by over 50%; the number of LTCHs more than doubled. The supply of LTCH beds increased more rapidly in cities that lost hospital-based SNFs than in cities that did not. The analysis of PAC episodes found sharp declines in medically complex patients admitted to hospital-based SNFs (from 26% in 1997 to 9% in 2006). In communities that experienced a loss of hospital-based SNF, admissions of medically complex patients to LTCH increased in cities that expanded LTCH. In cities without a LTCH, medically complex care shifted to freestanding SNFs.

Report Title: Substitutability Across Institutional Post-Acute Care Settings: 1998-2006 http://aspe.hhs.gov/daltcp/reports/2009/instPAC.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Susan Polniaszek, 202-690-6443
Performer: Mathematica Policy Research
Record ID: 9343 (Report issued June 25, 2010)

Starting in April 2010, ASPE and National Center for Health Statistics began the first nationally representative survey of residential care facilities (including assisted living facilities). A sample frame was created of all of the licensed residential care facilities in the United States. This study chronicled the sample frame development, including preliminary estimates of the size of the residential care industry and the number of beds.

There are approximately 39,000 residential care facilities, which offer a supply of a little over 1 million beds. These numbers indicate that residential care is starting to rival the nursing home industry in size. Approximately 41% of the facilities on the sample frame were affiliated with a chain. Of those that were part of a chain, only 8% were associated with the top forty chains and the rest were associated with regional or smaller chains. Residential care licensure terminology varies widely by state.

Report Title: National Survey of Residential Care Facilities: Sample Frame Construction and Benchmarking Report http://aspe.hhs.gov/daltcp/reports/2010/sfconst.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Emily Rosenoff, 202-690-6443
Performer: RTI International
Record ID: 9345 (Report issued July 16, 2010)

This study was in response to the Health Information Technology for Economic and Clinical Health Act of the American Recovery and Reinvestment Act of 2009 (Pub. L. 1115). The Act directs the HHS Secretary to conduct several studies and produce reports to Congress. including the “Study and Report on Application of EHR (Electronic Health Record) Payment Incentives for Providers Not Receiving Other Incentive Payments.”  This study was conducted to determine the extent to and manner in which payment incentives for implementing and using certified EHR technology should be made available to health care providers who receive minimal or no payment incentives or other funding under HITECH, Medicare, or Medicaid for such purposes.

Report Title: Report to Congress on the Application of EHR Payment Incentives for Providers Not Receiving EHR Incentive Payments http://aspe.hhs.gov/daltcp/reports/2010/EHRcr.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Jennie Harvell, 202-690-6443
Performer: HHS Office of the Assistant Secretary for Planning and Evaluation, Centers for Medicare and Medicaid Services
Record ID: 9346 (Report issued August 13, 2010)

The health information technology (HIT) questions on nursing home (NH) adoption, use, and barriers to adoption or use that were developed under this project were designed to be fielded as a part of the National Nursing Home Survey (NNHS) or a freestanding survey, and to enable comparisons on health information technology (HIT) or electronic health record (EHR) adoption in other provider settings (e.g., the National Home Health and Hospice Survey, the National Ambulatory Care Survey, etc.).

The project developed two sets of survey questions on NH HIT adoption, use, and barriers: The "core" survey questions were designed for possible administration with the NNHS or other surveys. The "expanded" survey questions include the core questions and follow-up questions designed to obtain additional detail on certain electronic functions in use in NHs. The expanded survey may be of use to NH providers seeking a more information regarding HIT use in targeted NH(s) and/or more details on the use of particular HIT functions (e.g., e-prescribing).

Report Title: Survey Questions for EHR Adoption and Use in Nursing Homes: Final Report http://aspe.hhs.gov/daltcp/reports/2010/EHRques.htm
Agency Sponsor: OASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Jennie Harvell, 202-690-6443
Performer: University of Colorado
Record ID: 9347 (Report issued September 3, 2010)