Post on 09-Feb-2016
description
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Centers forMedicare & Medicaid
ServicesResearch Agenda
William SaundersDeputy Director
Office of Research, Development, and Information
June 27, 2005
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Today’s 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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CMS’s Research BudgetOver Time
CMS's RD&E Budget
$0$20$40$60$80
$100$120$140$160
Fiscal year
App
ropr
iatio
n (
mill
ions
)
Total Basic RD&E MMA
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RD&E, FY03 - FY06 ($ Millions)
FY 2003 FY 2004 FY 2005Pres. 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 RD&E
. . . .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’ R&D 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 President’s FY06 CMS Research Budget
Medicare Current Beneficiary Survey
MMA Mandates New Initiatives
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CMS’ Research Themes
1) Monitoring & Evaluating CMS Programs2) Strengthening Medicaid, SCHIP & State
programs3) Beneficiary Choices & Managed Care Options4) Developing FFS Payment & Delivery Systems5) Improving Outcomes, Quality &
Performance6) Improving Health of our Beneficiaries7) Implementing Medicare prescription drug benefit8) 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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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
Implement the MedicarePrescription Drug Benefit
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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 R&D Task Order Contracts Medicare and
Medicaid Research and Demonstrations task order contracts (MRAD)
Small business R&D 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/default.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