Centers for Medicare & Medicaid Services Research Agenda

1. Centers forMedicare & Medicaid ServicesResearch Agenda William Saunders Deputy Director Office of Research, Development, and Information June 27, 2005

2. Today’s Objective • Describe: • Outlook for CMS FY2006 research budget in 2006 • Factors that are driving our research agenda • Research themes and planned projects

3. 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.

4. 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)

5. Examples of Past CMS Research Contributions • Prospective payment systems • Medicaid Home and community-based services programs, State reforms • New Medicare benefits • Managed care systems

6. CMS’s Research BudgetOver Time

7. RD&E, FY03 - FY06 ($ Millions)

8. How Research Agendas are Formulated • Intelligent design • Evolution • Chaos theory

9. 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

10. Major Elements in President’s FY06 CMS Research Budget • Medicare Current Beneficiary Survey • MMA Mandates • New Initiatives

11. CMS’ Research Themes • Monitoring & Evaluating CMS Programs • Strengthening Medicaid, SCHIP & State programs • Beneficiary Choices & Managed Care Options • Developing FFS Payment & Delivery Systems • Improving Outcomes, Quality & Performance • Improving Health of our Beneficiaries • Implementing Medicare prescription drug benefit • Building Research Capacity

12. 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)

13. 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

14. 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

15. 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)

16. 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)

17. 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)

18. Implement the MedicarePrescription Drug Benefit • 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

19. 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

20. New R&D Task Order Contracts • Medicare and Medicaid Research and Demonstrations task order contracts (MRAD) • Small business R&D task order contracts (XRAD)

21. 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

22. Questions? • “If we knew what it was we were doing, it would not be called research, would it?”Albert Einstein