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

Current Projects

Evaluation of the Rural Maternity and Obstetrics Management Strategies (RMOMS)

Mission Analytics Group is working with the Health Resources and Services Administration’s (HRSA) Office of Rural Health Policy to evaluate the Rural Maternity and Obstetrics Management Strategies (RMOMS) Program. Our team began our evaluation of the first cohort of awardees starting in 2019 and our work was extended to a second cohort of awardees starting in 2021. This multi-year project will:

  1. Document the implementation of the RMOMS program and the alignment with the programs goals, identify best practices and innovations among awardees, and examine factors that help explain effective implementation of the program;

  2. Assess how many women and infants were served by the RMOMS program, examine to what extent services were delivered, and examine factors that help explain the volume and types of services used

  3. Assess the RMOMS program’s impact on the program goals and objectives over time and examine factors associated with improved various patient outcomes; and

  4. Collect and analyze primary and secondary data, provide training and assistance to the awardees on data collection and reporting, and present findings in annual reports.

Provider Network Statistical Analysis & Timely Access Analysis

Mission 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 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 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.

Mission also supports 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 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 will also identify other data resources that may be useful in the development of the statistical model.

Accelerating Cancer Screening (AxCS) Evaluation

Mission is working with HRSA’s Bureau of Primary Health Care (BPHC) to evaluate the Accelerating Cancer Screening (AxCS) grant program. Mission is working with the 11 2022 grantees, which are health centers across the United States. Working alongside a pool of cancer expert consultants, the Mission team will conduct key informant interviews, focus groups, and data analysis to understand the effectiveness of the AxCS grant and identify best practices. Finally, Mission will disseminate our findings through a presentation and publication.

Health center consolidated research and evaluation studies

As a subcontractor to Mathematica, Inc., Mission is working with HRSA BPHC to design and conduct research studies to demonstrate the value, capacity, and impact of the Health Center Program in relation to its core pillars. Mission will collaborate with Mathematica and their team across several research tasks, including multiple short-term analyses and Adjusted Quartile Ranking (AQR) calculations. Mission will also provide expertise on health services research.

Understanding the Causes and Reducing the Curve of PrematuritY

Mission is working with the Office on Women’s Health (OWH) to explore the causes of prematurity, create new efforts to prevent prematurity, and create new streams of data to inform these efforts. Mission will focus on states with the highest and lowest rates of prematurity to determine underlying maternal factors that impact prematurity. Our team will conduct a literature scan, provide a work plan for how to collect and analyze quantitative data, analyze other data, and report and disseminate our findings.

Evaluation of the Primary Care First Model

Under subcontract to Mathematica Policy Research, Inc., this evaluation assesses the effects of Primary Care First (PCF), an advanced primary care model that seeks to reduce Medicare spending and improve quality of care by preventing avoidable inpatient hospital admissions and over-utilization of higher-cost settings through delivery of advanced primary care. The goal of the evaluation is to determine whether PCF has been successful with respect to improving care and lowering costs of Medicare and Medicaid FFS beneficiaries. Mission will review the implementation design, including proposed content on interview protocols and the proposed analysis approach.

Completed Projects

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

For the El Dorado County Public Health Department, Mission 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.

CIHS EVALUATION DESIGN

Mission worked with the Colorado Department of Health Care Policy and Financing (HCPF) to review past evaluations of Colorado’s Complementary and Integrative Health Services (CIHS) by the National Research Center, Inc. from 2012 to 2019 and to prepare and present to HCPF a study design to meet the department’s evaluation goals.

Data Support and Publication Production for Health Equity Report on American Indians and Alaska Natives 2020-2021

HRSA’s Office of Health Equity (OHE) previously developed the Health Equity Report 2017 (released in March 2018) and recently released the 2019-2020 Health Equity Report to address HRSA’s Strategic Plan goals of improving access to quality health care and services, strengthening the health workforce, building healthy communities, and improving population health and reducing health disparities. Mission worked with HRSA OHE to develop and design the Health Equity Report on American Indians and Alaska Natives (AI/AN) for 2020-2021, which includes maps, graphics, tables, and text. Mission acquired, extracted, prepared, and analyzed various data, and then used Geographic Information System (GIS) mapping to present the data for the report.

Development of Medicare Advantage and Prescription Drug Plan Monitoring Methods

Under subcontract to IMPAQ International for CMS, as part of ongoing work to measure compliance in Medicare Part C and D, Mission evaluated access in preferred pharmacy networks within Part D plans. Using geographic analysis software, Mission measured and compared geographic access to preferred networks and assess whether access for certain groups is disproportionately limited. In particular, Mission examined 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 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, in partnership with prime contractor IMPAQ International, conducted the Evaluation of the Rural Community Hospital Demonstration (RCHD) for the Centers for Medicare & Medicaid Services (CMS), 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 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 an earlier evaluation, the findings were reported to Congress.

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

Mission 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.

Network Adequacy Assessments and Reporting Implementation

Mission supported California 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 provided DMHC with quarterly assessments of access to providers of services to SPD in 37 separate networks across the participating counties. Mission processed provider lists submitted by the networks, and advised DMHC in the development of a standardized reporting template for provider networks. Mission 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 CMS, Mission, 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 was contracted by 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 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.