Health Care Delivery: Medicare and Medicaid, Access to Care, and Rural Health

Current Projects

Impact of the Medicaid HCV Cure Affinity Group on Access to HCV Treatment and Cure

Mission Analytics is working with the Program Support Center to monitor and evaluate the function and outcomes of the planned Medicaid HCV Affinity Group.The project describes the formation and management of the Affinity Group, the status of participating states Medicaid hepatitis C treatment policies, changes that states proposed and implemented, the effects of these changes on access, prescription of curative direct acting agents, data on number and percentage of patients cured, costs, and cost effectiveness/cost savings experienced by these programs.

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.

Timely Access Analysis

Mission Analytics supports the California Department of Managed Health Care (DMHC) in developing a statistical model based on timely access compliance data submitted to the DMHC by health care service plans. The statistical model will assist the DMHC in analyzing and evaluating plan-reported timely access data, in order to identify patterns and trends and to assist the DMHC in making its final findings and recommendations for changes that better protect consumers. Mission Analytics will identify statistically significant variations between individual health care service plans and the industry overall in order to assist the DMHC in meeting its timely access-related statutory obligations under Senate Bill 964. Mission Analytics will also identify other data resources that may be useful in the development of the statistical model.

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 assesse whether access for certain groups is disproportionately limited. In particular, Mission Analytics will examine whether beneficiaries in rural areas and inner city areas have more limited access to preferred pharmacies.

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.

Completed Projects

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.

Evaluation of Rural Community Hospital Demonstration

Mission Analytics, in partnership with prime contractor IMPAQ International, conducted the Evaluation of the Rural Community Hospital Demonstration (RCHD) for the Centers for Medicare & Medicaid Services, Department of Health and Human Services. The demonstration offered participating rural hospitals an alternative payment mechanism based on costs for Medicare inpatient services.  The purpose of the evaluation was 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 assessed the financial impact of the demonstration, conducted market analyses based on publicly available data, and gathered information about hospital operations from qualitative interviews and document review. Following the completion of this evaluation, the findings were reported to Congress.

Network Adequacy Assessments and Reporting Implementation

Mission Analytics supported 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 provided DMHC with quarterly assessments of access to providers of services to SPD in 37 separate networks across the participating counties. Mission Analytics processed provider lists submitted by the networks, and advised DMHC in the development of a standardized reporting template for provider networks. Mission Analytics developed an analytic template using Quest Analytics, a software suite that geocodes beneficiary and provider locations to calculate measures of geographic access.

State Innovation Models Round 2

For the Centers for Medicare & Medicaid Services (CMS), Mission Analytics, as a subcontractor to RTI International, designed and carried out an independent evaluation of Round 2 of the State Innovation Models (SIM) Initiative, which was being conducted by the Center for Medicare and Medicaid Innovation (CMMI, “The Innovation Center”), within CMS. Like Round 1 of SIM, Round 2 was 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. 

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 was 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 entailed conducting webinars with states and developing issue briefs, outlining strategies to improve the accuracy and completeness of the data submitted. In addition, Mission Analytics conducted user testing of the Dental Locator to identify features to improve its user-friendliness. Finally, we provided 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.