AcademyHealth
$419,316
Medicare's Future: Program Direction Grant
Medicare is poised to implement its first-ever outpatient prescription drug benefit along with a major restructuring of the role played by private health plans. These changes raise numerous concerns about their impact on beneficiaries, particularly the most vulnerable-the frail, the sick, and the poor. Medicare officials, moreover, are considering ways to encourage quality improvement, increase provider efficiency, and improve care coordination. The Fund's Program on Medicare's Future provides independent analysis of these and other changes, identifies issues and directions that should be considered, and develops policy options for improving access to care. This grant will provide strategic direction for the program, develop new projects, coordinate ongoing work, and direct efforts to disseminate findings of work it supports to policymakers and the public. The program director also will participate in the critical review of Medicare-related reports submitted for Fund publication, prepare issue briefs and other materials, represent the Fund in public forums, and contribute to the activities of the new Commission on a High Performance Health System.
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Stuart Guterman
Senior Program Director
1801 K Street, Suite 701-L
Washington, DC 20006
(202) 292-6735
sxg@cmwf.org
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National Opinion Research Center
$215,623
Assessing Trends in Retiree Health Benefits and the Impact of Medicare Part D
The Medicare prescription drug benefit (Part D) to be implemented in January 2006 may significantly affect employers' choices regarding the drug coverage they will offer to their retirees. To counteract the potential incentive for employers to drop retiree drug benefits altogether, the Medicare Modernization Act provides for a tax-free payment to employers or unions that provide retirees with a qualified drug coverage plan. Building on their previous experience in surveying employers about health insurance decisions and benefit offerings, the investigators will survey mid-size employers about their retiree health benefits in fall 2005, prior to implementation of Part D, and then re-survey employers in fall 2006, following implementation. The information collected in these surveys will provide policymakers with direct evidence of the effect of the Medicare drug benefit on employers' retiree coverage.
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Jon R. Gabel
Senior Fellow
1350 Connecticut Avenue, NW, Suite 500
Washington, DC, 20036
(202) 223-7205
gabel-jon@norc.org
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George Washington University
$250,510
Expanding Medicare Plans: Issues for Beneficiaries
Through the Medicare Modernization Act of 2003, Congress has authorized major changes to the Medicare program, many of which take effect in 2006. It has expanded the role of private Medicare Advantage (MA) plans and increased plan payments; created a new prescription drug benefit available only though private plans; and introduced new types of plans. This project will examine these changes, particularly with regard to their impact on the benefits available to Medicare beneficiaries. One set of analyses will examine geographic variation in MA benefit packages, how benefits relate to traditional Medicare, and how they correspond to plan payment rates. A second set of analyses focusing on the new prescription drug plans, regional preferred provider organizations, special needs plans, and private fee-for-service plans will determine where these plans are operating, what they have to offer beneficiaries, and what their impact might be. Findings will inform policymakers about the effects of these changes so they can develop refinements as needed.
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Brian Biles, M.D.
Professor and Chair, Department of Health Services Management and Policy
Center for Health Services Research & Policy
2021 K Street, N.W., Suite 800
Washington, DC 20006
(202) 530-2364
bbiles@gwu.edu
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The President and Directors of Georgetown College
$222,626
Improving the Medicare Part D Benefit for the Most Vulnerable Beneficiaries
This project will identify difficulties that Medicare beneficiaries are encountering with the new Part D prescription drug benefit and the accompanying low-income subsidy. The investigators will identify the Part D issues that most affect vulnerable beneficiaries-including those with low incomes or multiple chronic conditions-as well as possible structural and operational improvements for policymakers to consider. They also will survey and interview members of legal services and consumer organizations that work with Medicare beneficiaries, summarizing their findings and policy recommendations in a report for policymakers.
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Laura Summer
Research Instructor
Box 571444
3300 Whitehaven Street, NW
Washington, DC 20057
(202) 687-3595
lls6@georgetown.edu
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University of Maryland, Baltimore
$269,694
Benchmarking the Quality of Medication Use by Medicare Beneficiaries
As the January 2006 start date for Medicare outpatient drug coverage approaches, there is particular concern about how beneficiaries' access to the medications they currently use and need can be ensured under the complex Part D benefit structure. This concern stems in part from the lack of recognized benchmarks against which to evaluate patterns of drug utilization. For this project, the investigators will study the pharmacotherapeutic profiles of Medicare beneficiaries who have any of 10 priority health conditions singled out by federal officials for special attention. Data drawn from the Medicare Current Beneficiary Survey, including special Institutional Drug Administration files, will be used to examine drug utilization patterns of Medicare beneficiaries with the 10 priority conditions and assess the appropriateness of those patterns of use. The project will include a special focus on minority beneficiaries and beneficiaries in long-term care facilities, two groups that may be particularly vulnerable to the new changes.
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Bruce Stuart, Ph.D.
Professor and Director
The Peter Lamy Center on Drug Therapy and Aging
University of Maryland School of Pharmacy
515 W. Lombard St. Room 157
Baltimore, MD 21201
(410) 706-5389
bstuart@rx.umaryland.edu
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Massachusetts General Hospital
$169,879
Improving Medicare Hospital Performance Measures and Payment Methods
There is considerable interest in using quality indicators to assess the performance of hospitals and develop pay-for-performance initiatives. So far, however, hospital quality indicators are based solely on aggregate hospital-level data. This project will depict the quality of acute care hospitals using newly available patient-level data collected through the Hospital Quality Alliance. With these data, the investigators will not only learn what proportion of patients receives recommended care, they will also be able to create new measures of patient care and simulate the impact of different pay-for-performance scoring methods on hospital rankings-information that will be useful to the Centers for Medicare and Medicaid Services. In addition, project staff will examine the extent to which care varies by race, ethnicity, or insurance status within and across hospitals.
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Joel S. Weissman, Ph.D.
Associate Professor
Institute for Health Policy
50 Staniford Street, 9th Floor
Boston, MA 02114-2696
(617) 724-4731
jweissman@partners.org
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Small Grants—Medicare's Future
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American Health Quality Foundation
$26,000
Improving Quality of Care in the New Medicare Drug Benefit
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Lisa M. Croce
Director of Government Affairs
1155 21st Street NW, Suite 502
Washington, DC 20036
(202) 261-7577
lcroce@ahqa.org
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Avalere Health LLC
$49,850
Defining and Measuring Performance of Medicare Prescription Drug Plans' Formularies
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Tanisha Carino, Ph.D.
Manager, Medicare Practice
1350 Connecticut Avenue, NW, Suite 900
Washington, DC 20036
(202) 207-3677
tcarino@avalerehealth.net
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George Washington University
$24,993
The Role of Palliative Care in Paying for Performance
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Sara Rosenbaum, J.D.
Chair, Department of Health Policy
2021 K Street, N.W., Suite 800
Washington, DC 20006
(202) 530-2343
sarar@gwu.edu
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Research Foundation of the State University of New York
$49,275
A Comparative Approach to Examine the Association Between Cost and Quality of Coronary Revascularization Procedures: The Use of Administrative Versus Clinical Data
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Shadi Saleh
Assistant Professor
School of Public Health
1 University Place
Rensselaer, NY 12144
(518) 402-0299
ssaleh@albany.edu
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Research Triangle Institute
$49,921
Physician Group Practice Demonstration Site Roundtable
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Michael Trisolini, Ph.D.
Senior Health Services Researcher
411 Waverly Oaks Road, Suite 330
Waltham, MA 02452-8414
(781) 434-1752
mtrisolini@rti.org
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University of Maryland, Baltimore
$47,141
Chartbook on Medication use by Aged and Disabled Medicare Beneficiaries Across the Spectrum of Morbidity
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Bruce Stuart, Ph.D.
Professor and Director
The Peter Lamy Center on Drug Therapy and Aging
University of Maryland School of Pharmacy
515 W. Lombard St. Room 157
Baltimore, MD 21201
(410) 706-5389
bstuart@rx.umaryland.edu
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