Health Care Delivery: Medicare and Medicaid, Access to Care, Rural Health, and HIV/AIDS

Assessing Access to Specialty Healthcare: El Dorado County Specialty Care Needs Assessment

For the El Dorado County Public Health Department, Mission Analytics conducted a specialty care needs assessment for the to assess resident demands for specialty care, in El Dorado County, in addition to providers’ capacity to meet these needs.  The team developed a data collection tool and provided technical assistance to referral specialists within El Dorado County primary care clinics.  Primary metrics in the analysis included distance traveled to the appointment and wait-time between the appointment request and actual appointment date, by specialty and health insurance type.

Development of Medicare Advantage and Prescription Drug Plan Monitoring Methods

Under subcontract to IMPAQ International for the Centers for Medicare & Medicaid Services (CMS), as part of ongoing work to measure compliance in Medicare Part C and D, Mission Analytics is evaluating access in preferred pharmacy networks within Part D plans. Using geographic analysis software, Mission Analytics will measure and compare geographic access to preferred networks and assess whether access for certain groups is disproportionately limited. In particular, we will examine whether beneficiaries in rural areas and inner city areas have more limited access to preferred pharmacies.

Evaluation Methods of Part C Funds

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics, as a subcontractor to Walter R. McDonald & Associates, Inc., addresses the lack of historical variation in Objective Review Committee (ORC) scores and subsequent allocations while incorporating a model that addresses the methodological and policy issues. The Division of Community HIV/AIDS Programs (DCHAP) has also outlined specific goals to be addressed in an allocation model. These goals fall into five key areas: (1) linking funding to current indicators of need, (2) ensuring funding addresses legislative priorities, (3) aligning costs per patient based on geographic and health care financing considerations, (4) promoting programmatic results along the HIV Care Continuum, and (5) addressing individual grant actions.

Evaluation of the Health Care Innovation Awards Round 2

Under subcontract to Mathematica Policy Research, inc. for the Centers for Medicare & Medicaid Services (CMS), the purpose of this project is to conduct an evaluation of the 39 awardees in the Health Care Innovation Awards (HCIA), Round 2, which is being conducted by the Center for Medicare and Medicaid Innovation (CMMI, “The Innovation Center”), within CMS. The evaluation includes a range of models proposed and implemented by CMS awardees to achieve better care for the individual, better health for populations, and lower costs through improvement of the care delivery processes and payment model designs for Medicare, Medicaid, and CHIP beneficiaries.

Evaluation of Rural Community Hospital Demonstration

Mission Analytics, in partnership with prime contractor IMPAQ International, is conducting the Evaluation of the Rural Community Hospital Demonstration (RCHD) for the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The demonstration offers participating rural hospitals an alternative payment mechanism based on costs for Medicare inpatient services.  The purpose of the evaluation is to assess whether this alternative payment mechanism has enabled hospitals to meet their strategic goals, improve services for their communities, and achieve financial stability. The evaluation will assess the financial impact of the demonstration, conduct market analyses based on publicly available data, and gather information about hospital operations from qualitative interviews and document review. Following the completion of this evaluation, finding will be reported to Congress.

Electronic Data Collection, Storage and Retrieval: National Training and Technical Assistance Cooperative Agreement (HIV/AIDS)

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics, as a subgrantee to Cicatelli & Associates, provides technical assistance to Ryan White grantees to improve the collection, retrieval, and submission of client-level data for program reporting, evaluation, and quality improvement purposes. Project activities include designing and hosting a webcast series on data issues; analyzing and providing feedback on data quality; identifying solutions for grantees experiencing data collection and submission challenges; and developing tools to facilitate high quality data submission across grantees and providers.  Many of our TA products are featured on the Ryan White Services Report page of the TARGET Center website for the Ryan White community, including the X-ERT tool (Xml Extraction and Reporting Tool) and the RSR Training Video Series. http://www.careacttarget.org/category/topics/ryan-white-services-report-rsr

Factors that Impact AIDS Drug Assistance Program (ADAP) Enrollment Management in the Face of ADAP Waiting Lists

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics, as a subcontractor to Walter R. McDonald & Associates, Inc., studied states’ use of waiting lists and other cost-containment strategies to manage their AIDS Drug Assistance Programs (ADAPs).  This mixed-methods project examined the use of waiting lists and other cost-containment strategies and potential opportunities for ADAPs to more effectively serve clients and avoid reliance on such options.  The quantitative analysis assembled data on ADAP expenditures, demographics, epidemiology, health insurance and economic conditions to determine the factors that drive demand for ADAP and how these differ between states with waitlists and states without waitlists. The qualitative component included site visits with eight states to examine ADAP management practices, budget forecasting, and the use of waitlists and other cost containment practices, to identify best practices and potential strategies to improve efficiency in states turning to waitlists. 

National Training and Technical Assistance

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics, as a subcontractor to Abt Associates Inc., provides training, technical assistance, and facilitative support to Ryan White HIV/AIDS Program Part A jurisdictions throughout the United States to improve health outcomes of individuals living with HIV and ultimately reduce new HIV infections. Mission assists Abt in the implementation collaborative learning efforts among Part A grantees. 

Network Adequacy Assessments and Reporting Implementation

Mission Analytics supports the California Department of Managed Health Care (DMHC) in its work monitoring Medicaid managed care plans that operate under the state's 1115 demonstration waiver, which requires the automatic enrollment of seniors and persons with disabilities (SPDs) into managed care plans in 16 counties, Mission Analytics provides DMCH with quarterly assessments of access to providers of services to SPD in 37 separate networks across the participating counties. Mission Analytics processes provider lists submitted by the networks, and advises DMHC in the development of a standardized reporting template for provider networks. Currently Mission Analytics is developing an analytic template using Quest Analytics, a software suite that geocodes beneficiary and provider locations to calculate measures of geographic access.

Provider Network Statistical Analysis

Mission Analytics supports the California Department of Managed Health Care (DMHC) in providing analysis related to DMHC's licensing of health care service plans to operate in the state of California, pursuant to the Knox-Keene Act (KKA) Health and Safety Code section 1340, et seq. Mission Analytics is developing a statistical model based on provider network data, the DMHC’s analysis resulting from the use of geographic mapping software, and other resources identifying overall patterns of practice which will assist the DMHC in determining network compliance.  Mission Analytics identifies statistically significant variations between individual health plan networks and the industry overall in order to determine what constitutes “reasonable” access for where a clear network standard is not established.

Providing Primary Care and Preventative Medical Services in Ryan White-Funded Medical Care Setting

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics has partnered with Walter R. McDonald & Associates, Inc. (WRMA) to identify the types of primary and preventative care services provided by Ryan White clinics, models of service provision, gaps in care, and strategies for filling those gaps. The treatment advances in HIV/AIDS care are allowing people living with HIV/AIDS to live longer, fuller lives. As the impact of HIV/AIDS disease is changing, so are the health care needs of PLWHA. HIV/AIDS care needs to improve overall well-being by including strategies to prevent disease, promote healthy lifestyles, and manage other chronic conditions. This shift requires more integration of HIV/AIDS disease management and primary care.  

Ryan White HIV/AIDS Programs Part A Supplemental Funding- Feasibility Study of Proposed Allocation of Funds Responsive to Need

For HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics has partnered with Walter R. McDonald & Associates, Inc. (WRMA) to serve as the contractor. Part A of the Ryan White HIV/AIDS Treatment Extension Act of 2009 provides assistance to EMAs and Transitional Grant Areas (TGAs)—locales that are most severely affected by the HIV/AIDS epidemic. In addition to formula funds, HAB funds grantees with Part A supplemental awards on an annual basis. The current method for evaluating need for this supplemental funding involves reviewing and scoring applications submitted by grantees demonstrating the need for additional funding. Historical data related to this process shows that Part A grantees, all of which are established and longstanding recipients of Part A funds, uniformly score within a very limited point range, resulting in proportional funding with little differentiation in regard to absolute need. This project identifies for a HRSA/CDC workgroup an empirical, quantifiable framework or formula for awarding supplemental funding to Part A grantees.

To achieve the goals of the project, the Mission Analytics team is developing an electronic database that will include historical funding patterns, alternative measures of unmet need, data quality measures, performance measures, and cost measures. In addition to implementing it as a statistical model, Mission Analytics is building an excel tool to allow HRSA/HAB to experiment with alternative strategies.  

State Innovation Models Round 2

For the Centers for Medicare & Medicaid Services (CMS), Mission Analytics, as a subcontractor to RTI International, is designing and carrying out an independent evaluation of Round 2 of the State Innovation Models (SIM) Initiative, which is being conducted by the Center for Medicare and Medicaid Innovation (CMMI, “The Innovation Center”), within CMS. Like Round 1 of SIM, Round 2 is based on the premise that state innovation with broad stakeholder input and engagement, including multi-payer models, will accelerate delivery system transformation to provide better care to their population at lower costs. 

Supporting Youth Living with AIDS

For HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics serves as a subcontractor to DSFederal, Inc. to assess the current state of HIV infected youth aged 13-24 receiving Ryan White HIV/AIDS Program (RWHAP) funded care and treatment, their unique barriers to care, and RWHAP providers' capacity to engage and retain them in care with optimal health outcomes.

Technical Assistance for HRSA Data Warehouse (HDW) Insure Kids Now (IKN) Project

To improve Medicaid and CHIP beneficiaries’ access to dental providers, the Secretary of Health and Human Services developed a Dental Provider Locator tool on the pre‐existing Insure Kids Now (IKN) website. Data on dental providers are submitted by states and/or their dental care organizations on a quarterly basis. Mission Analytics has been contracted by the Centers for Medicare & Medicaid Services (CMS) in partnership with the Health Resources and Services Administration (HRSA) to improve the usability of the IKN Dental Locator. The project entails conducting webinars with states and developing issue briefs, outlining strategies to improve the accuracy and completeness of the data submitted. In addition, we have conducted user testing of the Dental Locator to identify features to improve its user-friendliness. Finally, we provide one-on-one technical assistance to states, responding to ad hoc requests for support and following up with struggling states to trouble shoot and resolve issues.

Understanding and Monitoring the Interrelationships between Funding Stream in Ryan White-Funded Clinical Settings

For the HIV/AIDS Bureau, Health Resources and Services Administration (HRSA/HAB), Mission Analytics has partnered with Walter R. McDonald & Associates, Inc. (WRMA) to study how Ryan White HIV/AIDS Program-funded Part C and Part D grantees use multiple funding sources to provide comprehensive HIV/AIDS care.  The project includes a survey of Part C and D grantees on Ryan White services provided to uninsured and underinsured clients, the dynamics of health care coverage, and the interactions among Medicaid, Medicare, private insurance, and HRSA Ryan White funding. The team will also develop a prototype tracking tool to assist grantees in monitoring and assessing changes in funding streams by service category.  The goal of this tool is to help grantees better plan for shifts in coverage, especially now that the Affordable Care Act has extended coverage to more individuals, especially under Medicaid.

Waiver Modernization Manager for the Colorado Department of Health Care Policy and Financing

Mission Analytics worked with the Colorado Department of Health Care Policy and Financing (HCPF) to simplify the state’s Medicaid funded system of community-based long-term services and supports while improving access and controlling costs. For this project, Mission Analytics reviewed research on other states’ efforts to consolidate waivers. Using input from wide array of stakeholders, Mission Analytics drafted a "concept paper" for the Centers for Medicare and Medicaid Services (CMS) that proposes specific changes to the state’s waiver system. Mission Analytics also led a feasibility analysis for implementing the Community First Choice (CFC) State Plan Option as a means to expand access to consumer-directed personal assistance services for Medicaid consumers who meet institutional level of care. As part of this work, Mission Analytics  constructed a cost model that allows the state to specify which services will be included in the CFC program and how expensive those services are likely to be (based on uptake and level of need). Completion of all deliverables relied heavily on a close working relationship with existing state committees, DHCPF staff, and various other stakeholder groups.