Changes in Health Care Financing and Organization (HCFO)

1. Changes in Health Care Financing and Organization (HCFO) An Initiative of The Robert Wood Johnson Foundation Program Overview Anne K. Gauthier Bonnie J. Austin Vice President, AcademyHealth HCFO Senior Manager HCFO Program Director June 7, 2004

2. Overview of Presentation • Program Purpose and History • Grantmaking • Convening and Dissemination • HCFO website www.hcfo.net

3. 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.

4. Program History • 15th Year • Reauthorized four times since its inception in 1989 • Last authorized in July 2002 for $15 million over 3 years

5. 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.

6. Active Grant Funding Levels, 2003

7. Portfolio of Active Grants

8. 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

9. Types of Projects Research 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

10. Principle Investigator Disciplines

11. Ongoing Solicitation Call for Proposals 2004 is Active - available on the web • 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

12. 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

13. Larger Grants Timeline Submit Brief Proposal Submit Proposal Award Grant Invite Proposal 3-4 Months 2 Months 2 Months Brief Proposals are accepted at any time.

14. Small Grants Timeline Submit Proposal Award Grant 3-4 Months Small grant proposals are accepted at any time.

15. How to Apply

16. 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.

17. 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

18. Convening • Policy Conferencesfoster 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.

19. Convening • Cyber Seminarsan 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.

20. Convening HCFO 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.

21. Convening Other 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.

22. 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.

23. Web Site: www.hcfo.net

24. 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

25. 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 Web Site: www.hcfo.net

26. National Advisory Committee Robert Reischauer, Ph.D., Chair, The Urban Institute Kathleen Buto, Johnson and Johnson Robert Crane, Kaiser Permanente Jose Escarce, M.D., RAND Marsha Lillie-Blanton, Dr.P.H., Henry J. Kaiser Family Foundation Harold Luft, Ph.D., University of California, San Francisco Kathleen Means, Patton Boggs, LLP Mark Pauly, Ph.D., University of Pennsylvania Mark Peterson, Ph.D., University of California, Los Angeles Louis Rossiter, Ph.D., Chironet, LLC Katherine Swartz, Ph.D., Harvard University Joseph Thompson, M.D., University of Arkansas Alan Weil, J.D., The Urban Institute Designate, Ex Officio, CMS (Stuart Guterman) Designate, Ex Officio, AHRQ (Michael Hagan)

27. HCFO Staff Anne K. Gauthier, Director Deborah L. Rogal, Deputy Director Sharon B. Arnold, Senior Research Manager Bonnie J. Austin, Senior Manager Laura A. McDaniel, Research Assistant Robert E. Kornegay, Research Assistant Sharon D. Ragland, Program Coordinator