Centers for Medicare

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Centers forMedicare Medicaid ServicesResearch
Agenda
William Saunders Deputy Director Office of
Research, Development, and Information June 27,
2005
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Todays Objective

• Describe
• Outlook for CMS FY2006 research budget in 2006
• Factors that are driving our research agenda
• Research themes and planned projects

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Value of Health Services Research

• A microscope and a telescope.
• Looks backward and forward.
• Identifies problems, and develops and tests
  solutions.
• Translates findings into useful information for
  clinical, management and policy decisions.

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Activities Supported by the CMS Research Budget

• Research studies to design, monitor and refine
  programs
• Development, implementation and evaluation of
  demonstrations to test innovations
• Program evaluations of various aspects of current
  CMS programs
• The Medicare Current Beneficiary Survey
• Grant programs to foster capacity-building or
  innovation in State programs.
• Support for external researchers using CMS data
  through the Research Data Assistance Center
  (ResDAC)

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Examples of Past CMS Research Contributions

• Prospective payment systems
• Medicaid Home and community-based services
  programs, State reforms
• New Medicare benefits
• Managed care systems

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CMSs Research BudgetOver Time
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RDE, FY03 - FY06 ( Millions)
  FY 2003 FY 2004 FY 2005 Pres. Budget FY 2006
Total 73.7 77.8 77.5 45.2
. .Earmarks 5.7 11.2 9.8 0.0
. .Real Choice Grants 39.7 39.5 39.7 0.0
. .New Freedom Grants 6.0 5.9 2.9 0.0
. .Basic RDE        
. . . .MCBS 9.3 12.8 12.9 13.6
. . . .Mandates 4.8 4.0 6.7 5.1
. . . .Discretionary 8.2 4.4 5.5 6.8
. . . .MMA       19.7
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How Research Agendas are Formulated

• Intelligent design
• Evolution
• Chaos theory

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Drivers of the CMS RD Agenda

• Laws
• Executive Orders
• Administration and HHS Initiatives
• CMS Administrator priorities
• CMS component ideas or needs for information /
  analyses
• Interests of the broader health research community

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Major Elements in Presidents FY06 CMS Research
Budget

• Medicare Current Beneficiary Survey
• MMA Mandates
• New Initiatives

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CMS Research Themes

1. Monitoring Evaluating CMS Programs
2. Strengthening Medicaid, SCHIP State programs
3. Beneficiary Choices Managed Care Options
4. Developing FFS Payment Delivery Systems
5. Improving Outcomes, Quality Performance
6. Improving Health of our Beneficiaries
7. Implementing Medicare prescription drug benefit
8. Building Research Capacity

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Monitor Evaluate CMS Programs

• Evaluations of the new MA and Part D programs
• Study of specialty hospitals (MMA s. 507)
• Review of physician practice expense geographic
  adjustment data (MMA s. 605)

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Strengthen Medicaid, SCHIP, other State Programs

• Continue demonstrations in Minnesota, Wisconsin,
  and Massachusetts to provide improved
  coordination of Medicare and Medicaid services
  for dual eligible beneficiaries
• Medicaid data
• Impact of Part D on dual eligibles

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Expand Choices andManaged Care Options

• Continue development and refining of risk
  adjustment methodologies, particularly for
  specialty plans.
• Conduct disease management demonstrations testing
  capitated payment for ESRD
• MMA-mandated evaluations of the impacts of the
  new Medicare Advantage program and specialty plans

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Develop FFS Payment and Service Delivery Systems

• Continue to refine PPS for SNF, HHAs, IRFs,
  LTCHs, psych facilities, etc.
• Evaluate the new Medicare competitive acquisition
  system for durable medical equipment (MMA s. 302)
• Implement MMA demos
• bundled case-mix adjusted payment system for ESRD
  services (MMAs. 623e)
• competitive bidding for clinical laboratory
  services (ORDI) (MMA s. 302)
• chiropractic services (651)
• expanded definition of homebound for home health
  services (702)
• provision of adult day care services by HHAs (703)

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Improve Quality Performance

• Conduct pay for performance demonstrations
• Physician Group Practice Demonstration
• Premier hospital demonstration, which will
  provide bonus payments for health care providers
  that achieve specified performance standards
• DOQIT / Care Management Performance Demo (MMA s.
  649)
• Develop test new P4P approaches
• Conduct Health Care Quality Demonstration (MMA s.
  646)

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Improving Health of our Beneficiary Populations

• BIPA Cancer Prevention Treatment Demonstration
• Conduct fee-for-service disease management
  demonstrations for selected populations with
  conditions such as diabetes and congestive heart
  failure
• Evaluate the Chronic Care Improvement program
  (MMA s. 721)

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Implement the MedicarePrescription Drug Benefit

• Analyses Of Medicaid Prescription Drug Programs
  And Data
• Evaluations of Medicare Replacement Drug
  Demonstration
• Research To Help Implement Medicare Part D
• Planning To Evaluate Part D
• Future Research with Medicare Drug Data

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Building ResearchCapacity

• HBCU and Hispanic Grant Programs
• MCBS
• Produce data set(s) to facilitate health research
• chronically ill Medicare beneficiaries (MMA s.
  723)
• Medicaid Analytic eXtract files (MAX)
• Research Data Assistance Center

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New RD Task Order Contracts

• Medicare and Medicaid Research and Demonstrations
  task order contracts (MRAD)
• Small business RD task order contracts (XRAD)

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For More Information

• Medicare Demonstrations
• http//www.cms.hhs.gov/researchers/demos/
• CMS Chart books and Chart Series
• http//www.cms.hhs.gov/charts/default.asp
• Research reports and results
• http//www.cms.hhs.gov/researchers/projects/defau
  lt.asp
• Medicare and Medicaid statistics
• http//www.cms.hhs.gov/researchers/statsdata.asp

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Questions?

• If we knew what it was we were doing, it would
  not be called research, would it? Albert
  Einstein