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Centers forMedicare & Medicaid

ServicesResearch Agenda

William SaundersDeputy Director

Office of Research, Development, and Information

June 27, 2005

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Today’s Objective Describe:

Outlook for CMS FY2006 research budget in 2006

Factors that are driving our research agenda

Research themes and planned projects

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Value of Health Services Research

A microscope and a telescope. Looks backward and forward. Identifies problems, and develops and tests

solutions. Translates findings into useful information for

clinical, management and policy decisions.

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Activities Supported by the CMS Research

Budget Research studies to design, monitor and refine

programs Development, implementation and evaluation of

demonstrations to test innovations Program evaluations of various aspects of current CMS

programs The Medicare Current Beneficiary Survey Grant programs to foster capacity-building or

innovation in State programs. Support for external researchers using CMS data

through the Research Data Assistance Center (ResDAC)

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Examples of Past CMS Research Contributions

Prospective payment systems Medicaid Home and community-based

services programs, State reforms New Medicare benefits Managed care systems

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CMS’s Research BudgetOver Time

CMS's RD&E Budget

$0$20$40$60$80

$100$120$140$160

Fiscal year

App

ropr

iatio

n (

mill

ions

)

Total Basic RD&E MMA

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RD&E, FY03 - FY06 ($ Millions)

  FY 2003 FY 2004 FY 2005Pres. Budget

FY 2006

Total $73.7 $77.8 $77.5 $45.2

. .Earmarks 5.7 11.2 9.8 0.0

. .Real Choice Grants 39.7 39.5 39.7 0.0

. .New Freedom Grants 6.0 5.9 2.9 0.0

. .Basic RD&E        

. . . .MCBS 9.3 12.8 12.9 13.6

. . . .Mandates 4.8 4.0 6.7 5.1

. . . .Discretionary 8.2 4.4 5.5 6.8

. . . .MMA    **  ** 19.7

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How Research Agendas are Formulated

Intelligent design Evolution Chaos theory

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Drivers of the CMS’ R&D Agenda

Laws Executive Orders Administration and HHS Initiatives CMS Administrator priorities CMS component ideas or needs for

information / analyses Interests of the broader health research

community

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Major Elements in President’s FY06 CMS Research Budget

Medicare Current Beneficiary Survey

MMA Mandates New Initiatives

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CMS’ Research Themes

1) Monitoring & Evaluating CMS Programs2) Strengthening Medicaid, SCHIP & State

programs3) Beneficiary Choices & Managed Care Options4) Developing FFS Payment & Delivery Systems5) Improving Outcomes, Quality &

Performance6) Improving Health of our Beneficiaries7) Implementing Medicare prescription drug benefit8) Building Research Capacity

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Monitor & Evaluate CMS Programs

Evaluations of the new MA and Part D programs

Study of specialty hospitals (MMA s. 507)

Review of physician practice expense geographic adjustment data (MMA s. 605)

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Strengthen Medicaid, SCHIP,& other State Programs Continue demonstrations in Minnesota,

Wisconsin, and Massachusetts to provide improved coordination of Medicare and Medicaid services for dual eligible beneficiaries

Medicaid data Impact of Part D on dual eligibles

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Expand Choices andManaged Care Options

Continue development and refining of risk adjustment methodologies, particularly for specialty plans.

Conduct disease management demonstrations testing capitated payment for ESRD

MMA-mandated evaluations of the impacts of the new Medicare Advantage program and specialty plans

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Develop FFS Payment and Service Delivery Systems

Continue to refine PPS for SNF, HHAs, IRFs, LTCHs, psych facilities, etc.

Evaluate the new Medicare competitive acquisition system for durable medical equipment (MMA s. 302)

Implement MMA demos: bundled case-mix adjusted payment system for

ESRD services (MMAs. 623e) competitive bidding for clinical laboratory services

(ORDI) (MMA s. 302) chiropractic services (651) expanded definition of homebound for home health

services (702) provision of adult day care services by HHAs (703)

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Improve Quality &Performance Conduct pay for performance

demonstrations Physician Group Practice Demonstration Premier hospital demonstration, which will

provide bonus payments for health care providers that achieve specified performance standards

DOQIT / Care Management Performance Demo (MMA s. 649)

Develop & test new P4P approaches Conduct Health Care Quality Demonstration

(MMA s. 646)

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Improving Health of our Beneficiary Populations

BIPA Cancer Prevention & Treatment Demonstration

Conduct fee-for-service disease management demonstrations for selected populations with conditions such as diabetes and congestive heart failure

Evaluate the Chronic Care Improvement program (MMA s. 721)

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Analyses Of Medicaid Prescription Drug Programs And Data

Evaluations of Medicare Replacement Drug Demonstration

Research To Help Implement Medicare Part D

Planning To Evaluate Part D Future Research with Medicare Drug

Data

Implement the MedicarePrescription Drug Benefit

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Building ResearchCapacity

HBCU and Hispanic Grant Programs MCBS Produce data set(s) to facilitate

health research chronically ill Medicare beneficiaries

(MMA s. 723) Medicaid Analytic eXtract files (MAX)

Research Data Assistance Center

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New R&D Task Order Contracts Medicare and

Medicaid Research and Demonstrations task order contracts (MRAD)

Small business R&D task order contracts (XRAD)

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For More Information Medicare Demonstrations: http://www.cms.hhs.gov/researchers/demos/ CMS Chart books and Chart Series: http://www.cms.hhs.gov/charts/default.asp Research reports and results:

http://www.cms.hhs.gov/researchers/projects/default.asp Medicare and Medicaid statistics: http://www.cms.hhs.gov/researchers/statsdata.asp

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Questions? “If we knew what it was we were

doing, it would not be called research, would it?” Albert Einstein