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Health Care Policy Research
IMPAQ provides health care policy research and evaluation services to its clients. IMPAQ is currently working with several major agencies at the U.S. Department of Health and Human Services, including the Centers for Medicare & Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ), and the National Institutes of Health (NIH). Our work to date has enabled us to develop a depth of expertise in such areas as: quality / performance measures, payment error identification, and long-term care systems.
In response to the ground-breaking reports, “To Err is Human: Building a Safer Health System” (1999) and “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001), the health care community recognized a compelling need to develop quality and performance measures for health care providers. The growing interest in this area over the past decade has led to the government investing in the development of such measures for health care providers offering services under Federally-funded programs.
Over the past several years, IMPAQ has developed significant knowledge and expertise in the design, development, and application of quality and performance measures for health care systems, providers, and programs, with special expertise in developing performance measures for Medicare Part C and Part D plan providers. For example, for CMS, we recently developed a Medicare Part D Report Card for which we developed the business logic and statistical algorithms for evaluating Medicare Part D (Prescription Drug Benefit Plans) plan sponsors. As part of this project, we developed a “star rating” system to statistically rate providers on a set of more than 20 quality, customer service, and cost-related performance measures. These ratings are currently available on CMS’ website for use by Medicare beneficiaries in making their individual choices for Part D providers.
For the Performance Measures project for CMS, we are currently developing performance measures in three areas directly impacting Medicare beneficiaries and their health plan choices: 1) Voluntary Disenrollment (for Medicare Parts C & D), 2) Accessibility to Care (for Medicare Part C), and 3) Complaints Closure (Medicare Parts C & D). Once these measures have been developed and validated through a pilot program, they will then be included in the measurement systems currently available to the American public.
Payment Error Identification and Analysis
In response to the Improper Payments Information Act (IPIA) of 2002 and associated initiatives undertaken by the U.S. Office of Management and Budget (OMB), the Centers for Medicare & Medicaid Services (CMS) has undertaken a series of research studies to develop methodologies for estimating components of payment errors and improper payments in the Medicare Part C, Part D, and Retiree Drug Subsidy (RDS) programs.
For the past several years, IMPAQ has been working with CMS on several of these important payment error identification and analysis projects. Through our experience, we have acquired significant knowledge of Medicare Advantage, as well as payment and enrollment considerations on Medicare Advantage (MA), Medicare Advantage Prescription Drug (MA-PD) Plan and Medical Savings Accounts (MSA). IMPAQ has conducted extensive reviews of various sources to further understand the Medicare system, its data flow, and the associated risks of improper payments.
For example, for CMS, IMPAQ recently completed the Development of Medicare Part C, D, and Retirement Drug Subsidy (RDS) Error Rates project. For this project, IMPAQ developed a Medicare Part C, D and RDS Risk Assessment report which included a payment system overview, a comprehensive identification of all risks, a ranking of all risks identified, and a definition of Part C Payment Errors. In addition, we developed a Measurement Methodology for selected Part C, D and RDS High Risk Areas.
In the Part C and Part D Payment Error Analysis project, we worked with CMS to develop methodologies for estimating components of payment error and improper payments in Medicare Part C, Part D, and the Retiree Drug Subsidy (RDS) programs. Specifically, IMPAQ is supporting this effort through: 1) the development of payment error rates for Medicare Part C and Part D prospective payment systems; 2) the identification of the error rates associated with erroneous external data, such as Low Income Subsidy status; and 3) the development of a composite error rate. We are also supporting CMS in conducting their monthly Beneficiary Payment Validation analyses and preparing the associated reports.
Long-term Care Systems
The IMPAQ team is currently supporting several projects related to the health care system’s new approaches to addressing long-term care in the U.S. Working with our clients and other key stakeholders, we use relevant long-term care data to help analyze a variety of long-term care issues and develop recommendations for policy and program development and/or changes.
We are currently working on several important long-term care systems projects with the Centers for Medicare & Medicaid Services (CMS). In its role as the National Balancing Indicator Contractor, IMPAQ is supporting CMS in developing a set of national indicators to assess States’ efforts to balance their long-term care/support systems between institutional and community-based services, including characteristics correlated with improved quality of life for individuals.
IMPAQ is also leading an evaluation of the Medicaid Program Demonstration Project: Community-Based Alternatives to Psychiatric Residential Treatment Facilities (PRTF) for CMS. This national evaluation is designed to assess whether the provision of home- and community-based alternatives to psychiatric residential treatment for Medicaid child enrollees results in the maintenance or improvement in a child’s functional status, and, on average, costs no more than anticipated aggregate PRTF expenditures in the absence of such a demonstration.
IMPAQ is also supporting a project examining the available services and supports for individuals with Autism Spectrum Disorders (ASDs) and their families. This work is expected to lead to the development of model programs and approaches which can be disseminated to states throughout the U.S.