Reports

This report is the third in a series of reports commissioned by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) from the RAND Corporation addressing state all payer claims databases (APCDs). APCDs include medical, pharmacy, and dental claims, as well as enrollment and provider files collected from private and public payers by states, usually as part of a State mandate.

The number of older adults at risk of and currently experiencing homelessness has increased rapidly in recent years, a trend that is projected to continue and further accelerate. Older adults at risk of or experiencing homelessness have unique needs compared to other populations experiencing homelessness.

Team-based behavioral health care can effectively address clinical needs and mitigate behavioral health workforce shortages. Despite the demonstrated benefits of team-based care models, experts in the fields of behavioral health workforce and network adequacy have noted that existing reimbursement models do not adequately support team-based care.

This brief describes a joint project of the ASPE and the Office of Refugee Resettlement in the Administration for Children and Families to enhance the data infrastructure of agencies managing refugees and Medicaid services. This project is funded by the Patient-Centered Outcomes Research Trust Fund.

This report presents the set of guiding principles for linking state Medicaid data with birth certificates that was developed by state and national experts and leaders. These guiding principles can be implemented to create a multistate linked database that researchers would be able to access and use for research on maternal health, including patient-centered outcomes research (PCOR).

Home and community-based services (HCBS) are a range of medical and non-medical services provided in the home and community that support individuals with functional limitations, enabling them to reside in the community rather than in institutional settings.

This report describes validation of claims-based frailty algorithms for potential use in Medicare claims. Related Products:

RAND identified use cases on identifying frailty using electronic health record (EHR) data in health systems in the US and examples from other countries, which demonstrate applications in both primary and specialist care. The final EHR implementation guide summarizes the learnings from participants in the EHR Learning Network and the identified use cases.

Drug manufacturers may change the list prices of their drugs at any time after launch. Over the period from January 2022 to January 2023, more than 4,200 drug products had price increases, of which 46 percent were larger than the rate of inflation. The average drug price increase over the course of the period was 15.2 percent, which translates to $590 per drug product.

The Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report summarizing lessons learned from surging the governmental public health workforce at state, tribal, local, and territorial (STLT) public health agencies during the COVID-19 pandemic.

The rise of artificial intelligence (AI) in health care and health care research has stimulated discussion on the application of trustworthy principles for AI. This report summarizes 15 considerations and 14 opportunities for the implementation of HHS’s trustworthy AI principles in patient-centered outcomes research projects that incorporate AI technology.

The Inflation Reduction Act (IRA) is helping people with Medicare afford their medications, including the 2.1 million Asian, 5.8 million Black, and 5.3 million Latino Part D enrollees. These fact sheets review existing research to present the projected impacts of key IRA Medicare drug-related provisions for these populations.

This report presents findings from an interim qualitative assessment that examined the ways in which OS-PCORTF projects collectively advanced the ability of researchers to conduct patient-centered outcomes research (PCOR) by (1) improving the quality of data; (2) providing more relevant, comprehensive data; (3) enhancing analytical resources; and (4) reducing barriers to data access and use.

During the COVID-19 public health emergency, states used Appendix K, a standalone appendix available during emergency situations, to modify their existing Medicaid HCBS 1915(c) waiver programs. Using Appendix K, states can make to make temporary changes to access and eligibility, payment, services, and other aspects of their waiver programs.

The Foundations for Evidenced-Based Policymaking Act of 2018 (Evidence Act) provided an important opportunity to Federal Agencies to assess and improve, where needed, their evaluation and other evidence building activities.

Despite the increasing evidence of high suicide rates and associated risk factors for older adults in the United States, the number of programs addressing these risk factors remains limited.

Development of novel antimicrobials has slowed, and the preclinical and clinical pipeline is likely to be insufficient to support current and future patient needs.

Emergency departments (EDs) are key partners in filling the gap between people who need opioid use disorder (OUD) treatment and people who ultimately receive it.

The Inflation Reduction Act (IRA) authorizes the Secretary of the Department of Health and Human Services (HHS) to negotiate prices directly with participating manufacturers for selected drugs that are high expenditure, single source drugs without generic or biosimilar competition.

The market for antimicrobial (AM) drugs is unique in that it is associated with a positive externality (public health) as well as a negative externality (antimicrobial resistance, or AMR) (Mossialos, et al., 2010). AMR occurs when microbes change over time and no longer respond to available medicine.

It is well known that antimicrobial resistance (AMR) creates a substantial and ongoing public health and economic burden and understanding the size and nature of this burden is important for the ability to respond to the threat of AMR. However, estimating or projecting that burden within the U.S.

In 2017, at least 2.8 million people in the U.S. acquired serious infections with bacteria that are resistant to one or more antimicrobial drugs and 35,000 have died as a result. Resistance to antimicrobials is viewed as a global threat with antimicrobial drug use in human and animal health driving resistance.

Introduction

As the United States population ages, a larger proportion of individuals will likely need and use long-term services and supports (LTSS). Much of this support is provided by informal (i.e., unpaid) caregivers. For those that need paid LTSS, most Americans pay out-of-pocket. Some may do so until their personal resources are exhausted, and then rely on the Medicaid safety net.

This report and dataset inventory identifies individual-level measures for conducting patient-centered outcomes research (PCOR) relevant to adults with disabilities, aged 18–64 years.

This project developed a calculator to help people anticipate how a change in earnings from employment would affect their net income, and in so doing, provide public benefit recipients with their estimated effective marginal tax rate on new earnings. Key Points:

To enhance transparency in health care markets, in December 2022, the Centers for Medicare & Medicaid Services (CMS) publicly released comprehensive data on the ownership of all U.S. hospitals that are enrolled in Medicare. This report provides an overview of the available data, a methodology for assigning hospitals to chains, and several preliminary analyses to showcase the data.

This Data Point examines new National Health Interview Survey (NHIS) data to assess recent changes in health coverage for the population. The most recent data finds that the national uninsured rate for all ages declined 1.9% from 2019 to 2022, with early 2023 data showing even greater decreases reaching an all-time low national uninsured rate of 7.7%.

Pathogens that have evolved to be resistant to the drugs currently used to treat infections are an ongoing threat to public health, animal health, food production, and national security. Globally, a recent analysis estimated that 1.2 million deaths were caused by antibiotic-resistant (AR) bacteria in 2019, making this threat a leading cause of death for people of all ages worldwide.

Expanding access to high-quality, affordable health care has been a priority of the Biden-Harris Administration.

This research report updates prior reports on Medicare FFS telehealth trends during the COVID-19 public health emergency with data through end of 2021, by beneficiary characteristics, visit specialty and geography including by state. Medicare telehealth flexibilities during the COVID-19 pandemic continued to encourage use of telehealth among Medicare beneficiaries in 2021.

ASPE contracted with RAND Health Care to catalogue and assess state changes to Medicaid telehealth policies during the COVID-19 PHE through May 2022 and identify the driving circumstances, motivations, and evidence supporting telehealth policy decisions during the COVID-19 Public Health Emergency (PHE).

This first report focuses largely on establishing a baseline and a framework for further evaluation.

The Inflation Reduction Act (IRA) will make key changes to improve drug affordability for people who have Medicare.

Researchers from ASPE, NORC, Washington University in St. Louis, Catholic Physicians’ Guild of San Antonio, and the U.S.

The U.S. Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE) released new research on spending and utilization trends of Medicare Part B drugs, drugs administered in physicians' office or hospital outpatient departments rather than being purchased at the pharmacy counter or by mail order.

Below is a summary of the problems addressed, the solution, and the accomplishments and products. Problems Addressed: Researchers and public health officials frequently rely on the cause of death information made available from the coding and processing of death certificate data for critical programmatic, policy, and research needs.

This report summarizes the results of the evaluation conducted on different PPRL packages to identify the best fit for CODI. Included in the evaluation are the open source anonlink and the R PPRL package, as well as a commercial product called CURL (Colorado University Record Linkage), developed by the University of Colorado.

The product summaries include findings from three gaps analyses: CODI data needs, CODI query architecture, and differences between the VDW and CDM models. Recommendations are also provided on how to address the identified gaps.

This brief presents considerations for program administrators and other practitioners around increasing the use of primary prevention in human services systems to shift from responding to families after they are in crisis to preventing the crisis before it occurs.

This brief provides key considerations for policy designers and funding partners—such as federal staff, technical experts, and philanthropic partners—on incorporating primary prevention into human services delivery.

This brief highlights a new way of delivering primary prevention services that promotes equity by relying on the guidance and leadership of people with lived experience. The policy designers and service providers behind prevention services should have lived experience and/or co-create these services with people who do.

The goal of this project was to strengthen the coordinated registry network as a real-world data source for high quality, relevant, reliable, timely and actionable evidence to improve patient outcomes of medical devices, specifically for technologies affecting women’s health.

Enrollment in Medicare Advantage plans has increased rapidly in recent years. The share of eligible Medicare beneficiaries enrolled in MA rose from 25% in 2010 to 47% in 2021 (27.6 million enrollees). Payments to MA plans more than doubled between 2015 and 2021 (from $175 to $361 billion), taking the share of total Medicare Parts A & B spending on MA from 38% to 54%.

Prescription drug shortages are an ongoing concern in the United States (U.S.). While prior analyses explore the frequency of drug shortages in the U.S., little is known about the extent to which U.S. shortages impact consumer costs and healthcare systems. Drug shortages impact consumer costs in various ways.

The 2022 Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS PCORTF) Annual Report and infographic highlights the accomplishments of 32 multi-agency projects that supports the four goals of the new strategic plan: 

The purpose of this project was to develop and test a suite of electronic Care Plan (eCP) tools for adults with multiple chronic conditions (MCC), including an eCP implementation guide specifying data standards and value sets for key use case conditions and two open-source eCP apps (one for patients and one for clinicians).

Understanding Coverage Considerations for COVID-19 Vaccines and Treatments (Updated May 2023)

Executive Summary Introduction and Background The Training Data for Machine Learning to Enhance PCOR Data Infrastructure project (hereafter termed the Project) led by the Office of the National Coordinator for Health Information Technology (ONC) conducted foundational work to support future applications of artificial intelligence (AI), specifically focused on machine learnin

Executive summary This report describes the research plan and results of a PCOR project that followed a statement of work defined in an intra-agency agreement (IAA) between the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the National Library of Medicine (NLM). ASPE coordinates efforts to build data capacity for patient-centered outcomes research (PCOR).