Content by Keyword: Medicare

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Proposed Uses and Current Applications of

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Proposed Uses and Current Applications of Episodes of Care

We reviewed the empirical literature and held discussions with a small number of experts to identify what types of episodes of care or other groupings of related services have been used, tested, or proposed as a basis for performance measurement and accountability and/or payment.  This review was used to inform our consideration and discussion of
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Medicare Measurement Efforts do not Address the

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Medicare Measurement Efforts do not Address the Continuum of Care Delivered across an Entire Episode

Current health care quality measurement efforts focus on assessing care for individual indicators of performance for a patient with a specific clinical condition or set of risk factors at discrete points in time (e.g., percentage of patients with diabetes who received an HbA1c screening test or the percentage of women between the ages of 40-69 who
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Medicare Collects Quality Performance Data across

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Medicare Collects Quality Performance Data across Many Settings and Conditions

For the FFS program, Medicare currently collects data on quality measures for six different health care settings:
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Performance Measures Currently Reported to

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Performance Measures Currently Reported to Medicare

We catalogued performance measures that are being reported to Medicare as of 2008, finding that Medicare is collecting a significant number of performance measures; however these efforts currently are single setting and provider focused and they emphasizes assessment of the provision of discrete services rather than the full spectrum of services w
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Where Differential Payment Policies Exist, the

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Where Differential Payment Policies Exist, the Focus is on Reporting of Performance

Differential payments to providers currently reflect additional payments for reporting rather than actual performance.  As of July 2008, Medicare had pay-for-reporting programs in place for the hospital inpatient, hospital outpatient, and home health settings; these programs require providers to voluntarily report on a defined set of performance
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Separate Payment Mechanisms Do not Foster

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Separate Payment Mechanisms Do not Foster Coordination and Shared Accountabilities

Medicare uses separate payment mechanisms for each of its FFS provider settings and Medicare Advantage plans, and these payments are currently not aligned in ways that foster coordination, shared accountabilities, and delivery of high quality care.
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Existing Medicare Provider Payment Approaches

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Existing Medicare Provider Payment Approaches

We catalogued the provider payment approaches used by Medicare as of 2008, which revealed two important issues of relevance to this project.
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Executive Summary

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Executive Summary

Substantial deficits in the quality of health care and persistent and unsustainable growth in health care spending have led to calls for reform of the Medicare system, including such
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Exploring Episode-Based Approaches for Medicare

Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report

Cheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra WR-633-ASPE February 2009 Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services The report was prepared by the contractor (RAND). The findings and conclusions are those of the authors and do not n
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Footnotes

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Footnotes

1 2006 Blue Book, United States Department of the Treasury, February, 2006. 2 HDHP stands for High Deductible Health Plan.  This plan design generally has a substantial deductible and/or coinsurance requirement that must be met before catastrophic health insurance is activated for medical care reimbursement.
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Appendix A8 – Low Option PPO Health Care

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A8 – Low Option PPO Health Care Expenditure Model (SAS Output)

Source DF Sum of Squares Mean Square F Value Pr > F The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A7 – Medium Option PPO Health Care

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A7 – Medium Option PPO Health Care Expenditure Model (SAS Output)

Source DF Sum of Squares Mean Square F Value Pr > F The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A6 – High Option PPO Health Care

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A6 – High Option PPO Health Care Expenditure Model (SAS Output)

Source DF Sum of Squares Mean Square F Value Pr > F The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A5 – High Option HRA Health Care

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A5 – High Option HRA Health Care Expenditure Model (SAS Output)

Source DF Sum of Squares Mean Square F Value Pr > F The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A4 – Low Option HRA Health Care

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A4 – Low Option HRA Health Care Expenditure Model (SAS Output)

Source DF Sum of Squares Mean Square F Value Pr > F The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A3 – HMO Health Care Expenditure Model (

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A3 – HMO Health Care Expenditure Model (SAS Output)

The REG Procedure Model: MODEL1 Dependent Variable: Total_Allowed_Amount Weight: Plan_Distribution_Weight Analysis of Variance
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Appendix A2: Plan Choice Regression Results

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A2: Plan Choice Regression Results

Variable Definition from SAS program in Appendix A1
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Appendix A1: Plan Choice Regression Model (SAS

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . Appendix A1: Plan Choice Regression Model (SAS Program Code)

LINR_PRED= 
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D. Health Care Expenditures Model

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . D. Health Care Expenditures Model

Multivariate linear regression models were used to predict health plan expenditures by plan type. The regression results to predict expenditures are presented in Tables A3 to A8.
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C. Plan Choice Model

Continuation of Research on Consumer Directed Health Plans: HSA Simulation Model Refinement . C. Plan Choice Model

A multi-nominal logistic regression was used to create the plan choice estimates.  These were all new estimates that included claims based measures of chronic illness.  The plan choice equation applied to MEPS, along with the intercept terms for the turned down population and the uninsured, is presented in Table A1.  The regression coefficients

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