What's New with HCFO - October 21, 2005 (Print All Articles)
Medicare Part D: Enrollment and Implementation
On September 23rd, the Centers for Medicare and Medicaid Services (CMS) announced the plan options available to Medicare beneficiaries who choose to enroll in the Medicare prescription drug benefit. The enrollment period for prescription drug coverage begins November 15th and continues through May 15th, after which enrollees will incur a penalty for late enrollment. Ten companies will offer national standalone plans. CMS also approved a number of regional plans ensuring that every beneficiary will have a choice of at least 11 stand alone plans, with many more options available in certain areas.1 The drug plans differ in terms of the range of premiums, deductibles, co-payments, and the medications included in the different formularies. Forty-nine states have options with monthly premiums below $20, the average premium being about $40. Some plans have flat co-payments, while others have tiers. Additional savings could be provided through certain Medicare Advantage plans by potentially eliminating monthly drug coverage premiums or providing some fill-in coverage.2 The wide variety of options increases the likelihood that beneficiaries can find a plan that suits their needs, yet the very number and complexity of choices may be overwhelming for some. A survey conducted in late September by USA Today/CNN/Gallup Poll indicates that 61 percent of seniors say they don’t understand the program even after months of education efforts. As a result, according to the same poll, only 24 percent of seniors plan to join the program, 54 percent do not plan to join, and 22 percent were still unsure.3 The plethora of plans with varying levels of coverage, cost sharing, and premiums are, at best, confusing to beneficiaries and, at worst, a potential barrier to electing coverage. In order for Medicare to meet its coverage goals for beneficiaries, CMS and the drug plans must provide appropriate information for beneficiaries to feel comfortable choosing among and enrolling in plans. It is important to know how seniors use information, what factors affect plan choice, and how health care decisions are made. Several HCFO projects address these issues and could provide valuable insight into factors that will affect Medicare Part D enrollment and implementation. HCFO grantee, Cindy Parks Thomas, Ph.D. at Two other projects sponsored by HCFO are looking at the impact of information on health plan and health care choices. Katherine Harris, Ph.D. of RAND Corporation investigated the impact of health status on consumers’ use of quality information in making health plan choices. Her work found that there is substantial variation in the degree of consumer activism across patient subgroups highlighting the importance of decision support tools.4 While not focusing directly on beneficiary choice of drug plans, Judith Hibbard, Ph.D. of the University of Oregon is examining the factors that influence consumer activism. In particular, she is focusing on consumer activism in CDHPs by comparing patients who choose CDHPs and more traditional PPO participants over time. Hibbard has published preliminary results that show patients become “activated” to participate in health care decisions in four stages, 1) believing the patient role is important; 2) having the confidence and knowledge necessary to take action; 3) actually taking action to maintain and improve one’s health; and 4) staying the course even under stress.5 The many organizations and policymakers involved in implementing the Medicare prescription drug benefit can use information generated from these projects to guide their efforts to effectively communicate to beneficiaries, consider the effects of different plan designs, and motivate seniors to actively participate in their healthcare. HCFO Funded Research: Title: The Role of Benefit Design in Enrollment, Use and Spending in State Prescription Drug Assistance Programs for Seniors – Lessons for Medicare Institution: Time: March 2004 - February 2006 Principal Investigator: Cindy Parks Thomas, Ph.D. How does the design of a prescription drug benefit for seniors – either under Medicare or in individual states – affect drug use and costs? Building on evaluations currently underway for CMS, the researchers are comparing the SeniorCare prescription drug assistance programs in Illinois and Wisconsin to assess the impact of different key features, including enrollment approach and fees, and the use of a PBM or not. The scope of the CMS evaluations of the Medicaid 1115 waivers in each state does not permit direct comparison of the programs to assess the impact of the different design features. The researchers plan to: 1) compare enrollment selection between the two programs; 2) compare utilization and spending patterns for enrollees; 3) assess the impact of Illinois’ ‘soft cap’ and Wisconsin’s deductible on drug use and spending; and 4) compare patterns of use for specific diseases (COPD/asthma, congestive heart failure, diabetes, and arthritis) and drug therapeutic classes in each of the two states. Click here for further information on this grant. Title: State Experience with Pharmaceutical Assistance Programs Institution: Time: January 2004 - September 2005 Principal Investigator: Jack F. Hoadley, Ph.D. What has been the state experience in implementing pharmaceutical assistance programs serving Medicare beneficiaries? Through a series of case studies the researchers will gather information on issues such as communicating with enrollees, administering eligibility and cost sharing, and managing drug costs. The objective of the project is to reveal best practices and lessons learned that are useful to policymakers considering a Medicare prescription drug benefit and those in states implementing or modifying pharmaceutical assistance programs. Publications: Goodell, S., Hoadley, J. et al. “State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Costs?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, October 2005. Also see http://www.hcfo.net/pdf/issue1005.pdf. Williams, C., Hoadley J. et al. “State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, July 2005. Also see http://www.hcfo.net/pdf/brief0705.pdf. Click here for further information on this grant. Title: The Impact of Quality Information on Consumer Plan Choices: Does Health Status Matter? Institution: RAND Corporation Time: July 2001 - June 2002 Principal Investigator: Katherine M. Harris, Ph.D. What is the impact of health status on consumers' use of quality information in making health plan choices? Using an Internet-based survey, researchers at Publications: Harris, K. “How do Patients Choose Physicians? Evidence from a National Survey of Enrollees in Employment-Related Health Plans,” Health Services Research, Vol. 38, Iss. 2, April 2003. Click here for further information on this grant. Title: How Valid Are the Assumptions Underlying Consumer-Driven Health Plans? Institution: Time: May 2004 - April 2007 Principal Investigator: Judith Hibbard, Ph.D. How valid are the assumptions underlying consumer-driven health plans? The researchers propose to use both qualitative and quantitative methods to examine the key assumption underlying consumer driven health plans: if consumers are given financial incentives, choices and information to support these choices, they will take charge of their health and health care and make prudent choices. Working with Definity Health Plan and a large employer that offers their employees a choice of Definity and a PPO option, the researchers are following one cohort of employees who enroll in Definity and another cohort who enroll in a PPO plan. The objective of the study is to compare the knowledge, use of information, satisfaction with care, cost-effective utilization, and cost of care for persons enrolled in Definity and the PPO over time. Publications: Hibbard, J., et al. “Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers,” Health Services Research, Vol. 39, Iss. 4, August 2004. Click here for further information on this grant.
Grantee Spotlight: Jack Hoadley, Ph.D.
John F. Hoadley, Ph.D. serves as a research professor in
Prior to joining
In January 2004, HCFO awarded Hoadley a grant to examine state pharmacy assistance programs and their implications for a Medicare prescription drug benefit. Through a series of case studies, Hoadley and colleagues gathered information on issues such as communicating with enrollees, administering eligibility and cost sharing, and managing drug costs. The objective of the project was to identify best practices and lessons learned that would be of use to those implementing the Medicare prescription drug benefit and those in states implementing or modifying pharmacy assistance programs.
Hoadley and his colleagues found that many state pharmacy assistance programs are reconfiguring their programs in light of the Medicare prescription drug benefit. Several of the smaller state programs will be terminated, but many others will pay at least a portion of their enrollees’ out-of-pocket costs under the Medicare benefit. Some have also considered other options for preserving current benefits at low cost and risk while maintaining administrative simplicity. In terms of cost containment, state pharmacy assistance programs and their enrollees are likely to see major changes as the Medicare prescription drug benefit is implemented. Compared to most state programs, the Medicare benefit is likely to bring tighter formularies, higher cost sharing for those who do not qualify for the low-income subsidy, and more use of techniques such as prior authorization. Although state policymakers are seeking to hold beneficiaries’ out-of-pocket costs constant, the impact of other changes remains unclear.
Publications from HCFO-Sponsored Work:
Goodell, S., Hoadley, J. et al. “State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Costs?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, October 2005. Also see www.hcfo.net/pdf/issue1005.pdf.
Williams, C., Hoadley J. et al. “State Pharmacy Assistance Programs at a Crossroads: How Will They Respond to the Medicare Drug Benefit?” Changes in Health Care Financing and Organization Issue Brief, AcademyHealth, July 2005. Also see www.hcfo.net/pdf/brief0705.pdf.
HCFO Policy Brief--State Pharmacy Assistance Programs vs. Medicare Prescription Drug Plans: How Do They Contain Rising Costs?
This policy brief presents results of a recent study examining the implementation experience of State Pharmacy Assistance Programs (SPAPs) and their initial responses to the new Medicare drug benefit. These results should be of interest to state policymakers examining future options, to federal policymakers implementing and monitoring the new Medicare drug benefit, and to beneficiary groups concerned with consumers’ drug choices and coverage.
Spotlight on Grantee Publication
HCFO grantee, Daniel Polsky, Ph.D. of the
Current HCFO grantee publications and recent grant findings will be regularly featured in the results section of our Web site.
2006 National Center for Health Statistics/AcademyHealth Fellowship Call for Applications
Information: www.academyhealth.org/nchs
Questions: nchs@academyhealth.org
This program brings visiting scholars in health services research-related disciplines to the National Center for Health Statistics (NCHS) to use NCHS data systems and collaborate on studies of interest to policymakers and the health services research community.
Applicants must:
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Demonstrate training or experience in health services research
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Be at any stage in their careers from doctoral students to senior investigators. (Doctoral students must have completed coursework and be at the dissertation phase of their programs.)
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Be
National Health Policy Conference
February 6-7, 2006 - Renaissance
Join AcademyHealth and Health Affairs to hear leading experts from the Administration, academia, Congress, and the health industry share their insights on critical health care issues confronting policymakers. Among the topics to be addressed: reducing disparities in health care, patient safety, improving services for mental health and substance use disorders, public and private sector perspectives on responsibility for America’s health care, preventing and managing chronic conditions in children, pay for performance, and Medicare modernization.
Participants include federal and state policymakers, policy researchers and analysts, health industry executives, clinical decision makers, research funders, and health services researchers.
For more information and to register, visit: www.academyhealth.org/conferences/nhpc.htm
Health in Foreign Policy Forum: Migration and the Global Shortage of Health Care Professionals
February 8, 2006 - Renaissance
The 2006 Forum will focus on an issue that literally crosses borders: health worker migration. The Forum will examine the causes, consequences, and possible domestic and foreign policy responses to the global shortage of nurses and physicians. Panel discussions will focus on the following topics:
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Domestic Staffing Shortages: Role of International Recruitment: A panel of experts, including academics and the CEO of one the largest nurse recruitment firms, will describe the past, present and future directions of this phenomenon as it relates to nurses and physicians.
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Developing Nations: Migration, Retention & Return of Professionals International: Speakers will present data and an analysis of differing interests and viewpoints in developing nations.
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Promising Domestic & Foreign Policy Practices: Speakers will present an overview of both the domestic policy debate regarding strategies to increase self-sufficiency, and a discussion of different foreign aid strategies that seek to build health system capacity in the world’s poorest nations.
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Public & Private Sector Policy Debate: Participants will be asked to react to the policy proposals presented during the day and to offer their own ideas on short and long-term strategies for strengthening health workforce capacity in this country and abroad.
Additional registration is required. For more information, visit: www.academyhealth.org/nhpc/foreignpolicy/
Building Bridges: Making a Difference in Long-Term Care
February 8, 2006, Embassy Suites -
Sponsored by The Commonwealth Fund's Building Bridges: Making a Difference in Long-Term Care initiative, this seminar will address long-term care issues of interest to state and federal policymakers. The seminar will feature highlights from Randall Brown’s background paper on consumer-directed care.
Additional registration is required. For more information, visit: www.academyhealth.org/ltc/2004/index.htm
Public Health Systems Research Audioconference
The recent
"Accreditation of Public Health Agencies: Lessons from Three States"
December 7, 2005, 2:00 p.m. ET
"The Guide to Community Preventive Services: Developing an Evidence Base for Public Health."
January 11, 2006, 2:00 p.m. ET
For more information or to register, please visit: http://www.academyhealth.org/phsr/