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Changes in Health Care Financing and Organization (HCFO)

An Initiative of The Robert Wood Johnson Foundation

Program Overview

Anne K. Gauthier Bonnie J. AustinVice President, AcademyHealth HCFO Senior Manager HCFO Program Director

June 7, 2004

Overview of Presentation

• Program Purpose and History

• Grantmaking

• Convening and Dissemination

• HCFO website www.hcfo.net

Program Purpose• Provide public and private decisionmakers with usable and

timely information on health care policy, financing, and market developments.

• Bring together the policy and research communities through significant convening, issues identification, research translation, and communication activities.

• Translate research findings into implications for policy design and program implementation.

• Listen to decision leaders in order to influence researchers’ questions so their answers may be of greater value.

Program History� 15th Year

� Reauthorized four times since its inception in 1989

� Last authorized in July 2002 for $15 million over 3 years

Grantmaking� As of June 2004, the program has awarded

approximately 220 grants. About 70 are active.

� Approximately 35% of letters of intent are invited to submit full proposals.

� Approximately 38% of proposals become grants.

� All funded projects place an emphasis on how current public and private mechanisms for financing health care, or proposed major changes in those mechanisms, will affect health care costs, access, or quality.

Active Grant Funding Levels, 2003

100K - 300K34%

500K+16%

300K-500K19%

< 100K31%

Portfolio of Active Grants

Technology

3%Risk and Risk Adjustment

4%Costs and Cost Containment

3%Regulation

3%

Access to Care

6%

Health Insurance Coverage

12%Home- and Community-Based Care

1%Long-Term Care

4%

Medicare

10%

Mental Health

3%

Prescription Drugs

3%

Quality of Care

7%Provider Payment and Behavior

3%

Consumer Behavior

7%

End-of-Life Care

3%

Medicaid

9%

Managed Care

6%

Health Care Purchasing

4%

Health Care Markets

7%

Potential Research Issues in 2004 Call for Proposals

� Evaluations of changes in premium cost-sharing or of inpatient and outpatient coinsurance and deductibles

� Analyses of the impact of changes in premiums on employer offerings and consumer choice

� Evaluations of changes in state and private coverage programs

� Examinations of the impact of cost- or quality-based payments to providers

Types of ProjectsResearch and Policy Analysis

- Design and analyze major health care financing strategies and issues

- Examine the effects of financing and organization strategies on costs, access, quality, and the market

Evaluation and Demonstration

- Assess major strategies and policies already in place

- Test new strategies with the potential to improve access to more affordable health care

Quantitative - includes analysis of primary and secondary data sets

Qualitative - includes case studies, focus groups, and synthetic analyses

Principle Investigator Disciplines

Public Administration

1%

Political Science

1%

Decision Sciences

1%

Urban Planning

1%

Statistics

1%Business Administration

1%Public Health

3%

Public Policy

3%Sociology

6%

Medicine

7%Law

6%

Economics

35%

Health Care Financing and

Organization1%

Health Policy

16%

Health Services

Administration4%

Health Services Research

9%

Ongoing Solicitation

� Larger grants

– projects over $100,000 and/or– projects longer than 12 months in duration

� Small grants

– projects $100,000 or less and– projects 12 months or less in duration

Call for Proposals 2004 is Active - available on the web

Selection Criteria� Policy Significance of the health care financing mechanism being

evaluated or tested

� Timeliness of the project for informing policy or practice

� Quality and availability of the data to be used and the strength of the proposed methodology

� Uniqueness of the project

� Applicant’s experiences and qualifications for conducting the proposed project

3-4 Months

Larger Grants Timeline

Submit Brief Proposal

Invite Proposal

Submit Proposal

Award Grant

2 Months 2 Months

Brief Proposals are accepted at any time.

Small Grants Timeline

Small grant proposals are accepted at any time.

3-4 Months

Submit Proposal

Award Grant

How to Apply

Technical Assistance� Provided to Applicants

– Program Office staff are available to respond to telephone, email and face-to-face inquiries regarding the requirements for application and the nature of topics that might be considered within HCFO’s scope.

– Staff frequently advise on scope of project and approach to research prior to BP submission.

– For invited BPs, critical questions are asked and sources of data and additional expertise are suggested.

– At the proposal stage, there is a critical methodological review. In select cases, there is an opportunity for applicants to respond to reviewers’ questions. In rare cases, applicants are offered the help of a consultant.

Technical Assistance

� Provided to Grantees– Monitor progress over the course of the grant, including site visits

– Conduct grantee briefings

– Work with grantees to overcome obstacles (i.e. data collection and analysis)

– Review papers

– Disseminate findings to policy audiences

Convening� Policy Conferences foster debate and discussion on policy

relevant topics among key leaders in health policy and the health care market.

� Mid-Size Dissemination Meetings bring together grantees with findings on a similar topic and provide them with a forum to present their findings and receive feedback.

� Small Meetings permit a small number of HCFO grantees and other experts working on similar topic areas or similar types of research to advance the field through a facilitated-discussion format.

Convening

� Cyber Seminars an interactive meeting format in which participants can listen to HCFO grantee presentations by phone and watch slides on their computers. The technology also allows participants to pose questions by phone or through a computer.

� Grantee Briefings are small, off the record briefings we hold at our office. Grantees have an opportunity to present their findings to a group of experts and policy makers in their topic area, who give candid feedback to the grantees while they are completing their project.

ConveningHCFO conducts a variety of meetings varying in size and topic. For example, during the past year we convened:

� Health-Based Risk Adjustment: Payment and Other Innovative Uses, a working meeting looking at uses of risk assessment tools, in collaboration with the Kaiser Permanente Institute for Health Policy.

� Non-Visit-Based Communication: Finding the Appropriate Role and Payment Tools, a working meeting looking at the practical application and payment issues surrounding phone and e-communication.

� Pregnant and Poor: Did Medicaid and Welfare Policy Changes Improve Care for These Women as Intended?, a cyber seminar during which two HCFO grantees presented study findings.

ConveningOther meetings we have conducted include:

� Consumer-Driven Health Care: Evidence From the Field, a large meeting examining current research evaluating the effects of consumer-driven health care, in collaboration with the Commonwealth Fund.

� Determinants of Premiums in the Individual Market, a working meeting looking at how premium prices in the individual insurance market are set and the factors that influence pricing.

� AHRQ/HCFO Research Synthesis Conference, a small meeting to develop and refine a methodology for synthesizing policy-relevant health services research findings, with a focus on Medicare.

Dissemination� HCFO News and Progress

– Newsletter published twice a year– Reports on newly funded grants, HCFO meetings, and policy-relevant

topics

� Findings Briefs/Issue Briefs– Monthly publication (hard copy or web)– Highlights findings or summarizes key issues raised by HCFO

grantees; targeted to policymakers

� Non-Technical Reports– On topics such as financing end-of-life care, models of defined

contribution, and the challenges of managed care regulation

� Journals– HCFO staff periodically publish articles and editorials in peer reviewed

journals, often highlighting the work of grantees and papers presented at HCFO convening activities.

Web Site: www.hcfo.net

Web Site: www.hcfo.net

The HCFO program has moved toward more online interaction with our stakeholders. We have developed strategies to make the web site a user-friendly information clearinghouse and electronic community for information exchange among HCFO’s core audience of researchers and policymakers. New features include:

Hot Topics – a feature linking policy relevant topics to HCFO grantee results, convening activities, and publications

Searchable Results – including grant findings by topic area, grantee publications and HCFO publications

Grantee Spotlight – features information about one HCFO grantee and his or her work

Web Site: www.hcfo.net

Inside HCFO: numbers you always wondered about www.hcfo.net/statistics

Program Statistics Grants by Type of Project Grants by Topic Grants by Discipline of the PI Grants by Post-Degree Experience of the PI BPs and Small Grants by New/Previous

Applicant/Institution Grants by Funding Levels

National Advisory CommitteeRobert Reischauer, Ph.D., Chair, The Urban InstituteKathleen Buto, Johnson and JohnsonRobert Crane, Kaiser PermanenteJose Escarce, M.D., RANDMarsha Lillie-Blanton, Dr.P.H., Henry J. Kaiser Family FoundationHarold Luft, Ph.D., University of California, San FranciscoKathleen Means, Patton Boggs, LLPMark Pauly, Ph.D., University of PennsylvaniaMark Peterson, Ph.D., University of California, Los AngelesLouis Rossiter, Ph.D., Chironet, LLCKatherine Swartz, Ph.D., Harvard UniversityJoseph Thompson, M.D., University of ArkansasAlan Weil, J.D., The Urban InstituteDesignate, Ex Officio, CMS (Stuart Guterman)Designate, Ex Officio, AHRQ (Michael Hagan)

HCFO Staff

Anne K. Gauthier, DirectorDeborah L. Rogal, Deputy DirectorSharon B. Arnold, Senior Research ManagerBonnie J. Austin, Senior ManagerLaura A. McDaniel, Research AssistantRobert E. Kornegay, Research AssistantSharon D. Ragland, Program Coordinator