HCFO Announces Cost Solicitation Grants!

Title: Can Disease Management Control Costs?
Institution: Mathematica Policy Research, Inc.
Principal Investigator: Deborah Peikes, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will test the ability of disease management (DM) and care coordination (CC) programs to control health care costs, examine which features make certain programs effective, for which target populations, and how they can be replicated. They will build on prior work for CMS' Medicare Coordinated Care Demonstration that estimated program impacts over the first four years of program operations, described the basic features of the 15 programs’ interventions, and linked program features to overall program effectiveness. Five interrelated studies would determine: 1) the effects of DM/CC on costs over a longer follow-up period and the types of beneficiaries for whom DM/CC is most effective; 2) the operational features of DM/CC programs that were able to reduce costs and how they can be replicated; 3) what features of the DM/CC programs did not work and why; 4) whether intensifying contacts at the time of hospital discharge contributes to reducing costs; and 5) whether DM/CC interventions are more effective at reducing costs if the doctor has a greater number of patients receiving the intervention. The objective of this study is to help decision makers determine whether to offer disease management and care coordination to Medicare beneficiaries, as well as chronically ill patients with commercial insurance and Medicaid, and will provide information about how best to implement this intervention.

Title: Cost and Efficiency in Treating High-Cost Medicare Beneficiaries: The Role of Physician Practice and Health System Factors
Institution: Center for Studying Health System Change
Principal Investigator: James D. Reschovsky, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will examine key physician practice and market characteristics that may contribute to high costs and inefficient care in the Medicare program. The study is composed of three phases. In phase one, they will analyze the treatment of high-cost Medicare beneficiaries in order to identify key physician, practice, and market characteristics associated with differences between actual and predicted Medicare payments and medical care use. In phase two, they will examine whether the factors associated with greater than predicted resource use affect high-cost beneficiaries’ health outcomes. Finally, the researchers will examine possible sources of geographic cost variations for high-cost beneficiaries and the extent to which these variations reflect differences in patient characteristics or supply-related factors and practice patterns of providers in a particular region. The objective of this project is to identify potential policy levers that can influence cost effectiveness in the delivery of medical care to high-cost Medicare patients.

Title: Variation in Health Care Cost Growth
Institution: Harvard Medical School
Principal Investigator: Michael Chernew, Ph.D.
Grant Duration: March 2008 – February 2009
Paragraph Summary: The researchers will investigate the factors related to variation in cost growth in the Medicare and commercial sectors. Specifically, the researchers will determine: (1) whether the factors related to the rate of growth in the Medicare program are the same factors that are related to level of cost; (2) whether the factors associated with cost growth in commercial markets are the same as those related to Medicare cost growth; and (3) the extent to which cost growth varies between employers and health plans and what factors are related to that variation in cost growth. While most research and policy initiatives are aimed at managing the level of costs as opposed to cost growth, the researchers suggest that additional attention must be devoted to understanding and developing initiatives relating to the trajectory of cost growth, since the factors related to high levels of costs may not be the same as factors related to cost growth. The objective of this study is to provide knowledge that will support development of cost containment approaches that address cost growth. 

Title: Defining Affordability for the Uninsured and People with Chronic Conditions
Institution: The Urban Institute
Principal Investigator: Lisa H. Clemans-Cope, Ph.D./Cynthia D. Perry, Ph.D.
Grant Duration: March 2008 – February 2009
Paragraph Summary: The researchers will examine affordability of health insurance. In particular, they will study how different measures of affordability affect access to health insurance for: 1) those that are currently uninsured; and 2) those that have chronic health conditions requiring persistently high health care expenditures. The researchers will use alternative measures of affordability (health care spending falling below a given standard of spending as a percent of family income) to: 1) describe the availability of affordable health insurance among the currently insured and uninsured populations; and 2) explain why take-up of health insurance varies, given affordability. The objective of this project is to provide empirical evidence of various measures of affordability to inform policy choices for increasing coverage and ensuring equitable financial burdens for those who acquire coverage.

Title: How Does Fragmentation of Care Contribute to the Costs of Care?
Institution: Harvard University School of Public Health
Principal Investigator: Eric C. Schneider, M.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will develop new measures of care fragmentation that can be used to assess fragmentation within episodes of care and evaluate the relationship between care fragmentation and the costs of care for Medicare beneficiaries. They hypothesize that a higher degree of fragmentation of care will be associated with higher episode-specific costs of care after controlling for type of clinical episode, severity of clinical episode, clinical comorbidities, and the sociodemographic characteristics of patients. To test this hypothesis, the researchers will modify existing measures of fragmentation and develop new measures based on their relevance for episodes of care, select an approach to measuring costs, and select the clinical episodes for which they will test for the association between fragmentation and costs. The objective of this study is to improve quality and reduce the growth of health care costs in the U.S. by assisting the Medicare program and other insurers to measure and monitor fragmentation and target improvements to episodes with higher fragmentation.

Title: Medicare Spending, Disparities, and Returns to Healthy Behaviors
Institution: University of Maryland, Baltimore
Principal Investigator: Bruce Stuart, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will examine persistently low cost Medicare beneficiaries and determine the extent to which health behavior, preventive services, race and socioeconomic status (SES) appear to be related to low spending. Specifically, the researchers will (1) estimate cost savings in traditional Medicare spending associated with persistently good health behavior and preventive measures; (2) identify population characteristics that can be used to optimally target preventive interventions; and (3) develop simulation models to show how selectively reducing beneficiary cost sharing for primary and secondary preventive measures can achieve significant costs offsets in reduced spending on traditional Medicare services – this mechanism is referred to as “value-based insurance design.” The objective of the proposed project is to identify which disease states and beneficiary segments show the greatest promise for improved compliance and persistency in use of preventive therapies.

Title: Small Area Variation in Medicaid Utilization and Expenditures: Implications for Cost Containment and Quality of Care
Institution: University of California, San Diego
Principal Investigator: Richard Kronick, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will investigate the variation in Medicaid services and payments and explore the implications of these variations for cost containment options. They will compare the services received and cost of care for Medicaid beneficiaries across state Medicaid programs and across hospital referral regions (HRRs) within states. Specifically, the researchers will determine: (1) how much variation there is across states, across HRRs within states, and in Medicaid expenditures per beneficiary; (2) the extent to which variation in expenditures per beneficiary is due to variation in the rate of use of services, and the extent to which it is a result of variation in the rate of payment per unit of service; and (3) whether variation in the use of services and in expenditures per beneficiary is related to variations in the quality of care or the outcomes of care for Medicaid beneficiaries. The objective of this study is to provide policymakers with an understanding of the impact of policy choices regarding benefit limits and payment rates on costs and utilization, and their implication for quality of care.      

Title: Sources of Health Care Cost Growth
Institution: Stanford University
Principal Investigator: M. Kate Bundorf, Ph.D./Anne B. Royalty, Ph.D.
Grant Duration: March 2008 – August 2009
Paragraph Summary: The researchers will study the sources of cost growth among the privately insured by analyzing the contributions to higher spending of changes in prices and changes in the number and types of services performed. They will also examine how changes in prices and changes in the number and types of services have differentially affected different categories of spending and different demographic groups. These findings for the privately insured will also be compared to trends in cost growth in public programs. The researchers will explore which policies or benefit designs will be more effective in reducing spending, as well as whether costs are driven more by increased utilization of certain types of services or by increases in the prices of particular services. In addition, the researchers suggest that the findings will be useful in developing policies to expand coverage by identifying the sources of cost increases that may affect coverage rates. The objective of this study is to provide information for policymakers to design interventions to reduce health spending in ways that benefit consumers. 

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