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Quality and Value Topics

• Quality Measurement
• Delivery Systems
• Consumers
• Health Information Technology
• Payment Systems
• Vulnerable Populations
• Selected Publications

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Getting Quality and Value from a High-Functioning Health Care System

Despite remarkable breakthroughs in biomedical research and technology, the U.S. health care system does not consistently deliver safe, effective, and affordable health care. Across the nation, health care spending is twice that of other developed countries, yet key quality and outcomes indicators lag behind international benchmarks. Mathematica researchers are proud to be active participants in the search for higher quality, more affordable health care.

• Quality Measurement: How can the quality and value of health care be measured, monitored, and reported?
• Delivery Systems: How can the delivery of health care be organized and managed more effectively and efficiently?
• Consumers: How can the health care system help patients receive higher quality health care?
• Health IT: How can health information technology improve the quality and value of health care?
• Payment Systems: How can payment systems be restructured to improve efficiency and value?
• Vulnerable Populations: What can be done to improve quality and outcomes for vulnerable populations?

How can the quality and value of health care be measured, monitored, and reported?

Improving health care quality and value requires methods to measure quality and the efficiency of the health care system. Mathematica has been at the forefront of developing, using, and reporting on measurement tools essential to understanding the performance of health care providers and organizations. Our clients include the Centers for Medicare & Medicaid Services (CMS); Agency for Healthcare Research and Quality (AHRQ); California HealthCare Foundation; U.S. Department of Health and Human Services (DHHS), Assistant Secretary for Planning and Evaluation (ASPE); and the states of Maryland and Massachusetts.

Developing Quality and Efficiency Measures

• "Diabetes Prevalence, Outcomes, and Preventive Services Among Maryland Medicare Beneficiaries, 2002" (January 2005)
• Development of Physician Quality Measures for the CMS Physician Quality Reporting Initiative (PQRI): Development and expansion of physician quality measures where existing measures were not applicable or where there were too few measures.
  
• Providing Technical Assistance in Producing the Centers for Medicare & Medicaid Services Medicare Quality Monitoring System (MQMS): Development of a surveillance system to give CMS an early warning about declines in quality.

Implementing Measures and Monitoring Quality

• "Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission." Circulation: Cardiovascular Quality Outcomes (2009) 
  

Reporting on Quality

• "Health Plans' Use of Physician Resource Use and Quality Measures" (October 2007)
  
• "Hospital Response to Public Reporting of Quality Indicators."Health Care Financing Review (Spring 2007)
  
• "Improving Health Care Quality Reporting: Lessons from the California HealthCare Foundation" (January 2007)
  
• "Using Quality Information for Health-Care Decisions and Quality Improvement" (May 2005)
  

How can the delivery of health care be organized and managed more effectively and efficiently?

Models for health care delivery—such as care coordination, disease management, and medical homes—have been used to organize and manage health care more effectively. Mathematica has led a number of evaluations of these models. Our clients include CMS, AHRQ, ASPE, Center for Health Care Strategies (CHCS), and Oregon Health & Science University.

Care Coordination

• "The Promise of Care Coordination: Models that Decrease Hospitalizations and Improve Outcomes for Medicare Beneficiaries with Chronic Illnesses" (March 2009)
  
• "Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries: 15 Randomized Trials.” Journal of the American Medical Association (Winter 2009)
• "15-Site Randomized Trial of Coordinated Care in Medicare Fee-for-Service." Health Care Financing Review (Fall 2008)

Disease Management

• "Report to Congress on the Evaluation of Medicare Disease Management Programs" (February 2008)
  
• "Impacts of a Disease Management Program for Dually Eligible Beneficiaries." Health Care Financing Review (Fall 2008)

Medical Homes

• "Matching Patients to Medical Homes: Ensuring Patient and Physician Choice." Policy Perspective: Insights into Health Policy Issues, No. 1 (December 2008)
  

Other Models of Delivery

• "The Effect of the Program of All-Inclusive Care for the Elderly (PACE) on Quality, Final Report" (February 2008)
  

How can the health care system help consumers receive higher quality health care?

Providing information to support consumer decision making about health, engaging consumers to be active participants in health care decisions, and providing program options that allow consumers to better access services based on their personal needs can help consumers receive higher quality care. Our clients include CMS, AHRQ, and MedPAC.

Providing Quality Information to Inform Consumer Decision Making

• "Using Quality Information for Health-Care Decisions and Quality Improvement" (May 2005)
  
• "Testing Consumers' Comprehension of Quality Measures Using Alternative Reporting Formats" Health Care Financing Review (Spring 2007)
  
• "Estimating the Proportion of Health-Related Websites Disclosing Information that Can Be Used to Assess Their Quality" ( May 2006)

Engaging Consumers

• "Engaging Consumers: What Can Be Learned from Public Health Consumer Education Programs?" (March 2008)
• "Personal Health Records: What Do Underserved Consumers Want?" Trends in Health Informatics, Issue Brief #4 (May 2007)

Providing Program Options that Allow Consumers to Better Access Services Based on Their Personal Needs

• "Cash and Counseling: Improving the Lives of Medicaid Beneficiaries Who Need Personal Care or Home- and Community-Based Services" (August 2007)
• "Lessons from Local Access Initiatives: Contributions and Challenges" (August 2007)
  

How can health information technology improve the quality and value of health care?

Health information technology has the potential to improve the quality, reliability, and safety of health care, but we need a better understanding of how best to achieve these goals on a national scale. Substantial national investment in health information technology through the American Recovery and Reinvestment Act (ARRA) and the HITECH Act, make these questions ever more urgent. Our clients include CMS, AHRQ, Office of the National Coordinator for Health Information Technology (ONC), ASPE, and the Robert Wood Johnson Foundation.

Cross-Cutting Studies

• "New Hospital Information Technology: Is It Helping to Improve Quality?" Trends in Health Care Quality, Issue Brief #3 (May 2006)
  
• "Health Information Exchange: The Role of Safety-Net Providers" Trends in Health Informatics, Issue Brief #5 (June 2009)

Ambulatory Care Electronic Health Records

• "Using Payment Incentives to Improve Care for the Chronically Ill in Medicare: First Year Implementation of the Medicare Care Management Performance Demonstration (MCMP)" (March 2009)

Personal Health Records

• "Personal Health Records: What Do Underserved Consumers Want?" Trends in Health Informatics, Issue Brief #4 (May 2007)

Telemedicine

• "Costs to Medicare of the Informatics for Diabetes Education and Telemedicine (IDEATel) Home Telemedicine Demonstration: Findings from an Independent Evaluation" (July 2009)
• "Implementing Telemedicine Services for Low-Income Seniors: Potential Strategies." Trends in Health Informatics, Issue Brief #2 (September 2005)
  

How can payment systems be restructured to improve efficiency and value?

Health care costs, including costs of Medicare, Medicaid, TRICARE, and the Veterans Administration health system in particular, are rising at unsustainable rates. Innovative ways of organizing health care delivery and structuring payment systems may hold the key to “bending the curve.” Clients include CMS, MedPAC, and the state of Massachusetts.

• "Medicare's Private Plans: A Report Card on Medicare Advantage." Health Affairs, Web Exclusive (November 2008)
  
• "Evaluation of the Local Initiative Rewarding Results Collaborative Demonstrations" (October 2006)
  
• "Using Payment Incentives to Improve Care for the Chronically Ill in Medicare: First Year Implementation of the Medicare Care Management Performance Demonstration (MCMP)" (March 2009)
  
• "Making Pay-for-Performance Work in Medicaid.” Health Affairs, Web Exclusive (June 2007)
• "Using Physician Payment Reform to Enhance Health System Performance" (December 2008)
  
• "Pay for Performance: Are Hospitals Ready and Willing?" (November 2006)
  

What can be done to improve quality and outcomes for vulnerable populations?

The fact that some health care consumers do not have adequate access to insurance, high quality providers, and appropriate medications and treatments has many negative consequences for minority groups and all health care consumers.  Our efforts to measure disparities and identify their causes haves led to innovative approaches to reducing disparities. These approaches include initiatives relevant to public programs, providers, and consumers. Clients include CMS, AHRQ, CHCS, U.S. Department of Defense (DoD), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Mathematica's Center for Studying Disability Policy (CSDP) has also conducted research on the quality and value of care for the disabled, an important population of interest. For more information, visit the CSDP website.

Measuring and Collecting Data to Assess Disparities

• "Availability of Data to Measure Disparities in Leading Health Indicators at the State and Local Levels." Journal of Public Health Management Practice (November 2008)
  
• "Measuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data Collection" (May 2009) 
  
• "Reducing Racial and Ethnic Disparities in Health Care: Partnerships Between Employers and Health Plans" (July 2009) 
  
• "Differences in Hospitalizations for Ambulatory Care Sensitive Conditions Among Maryland Medicare Beneficiaries 2006” (December 2008)
  
• "Racial and Ethnic Health Disparities in TRICARE."Journal of the National Medical Association (July 2009)
• "Practical Lessons for Health Reform from the Military Health System." Trends in Insurance Coverage, Issue Brief #6. (November 2009)

Documenting Disparities in Prescription Drug Use

• "Racial Disparities in Prescription Drug Use Among Dually Eligible Beneficiaries."Health Care Financing Review (Winter 2003-2004)
  
• "Antidepressant Use in Black and White Populations in the United States." Psychiatric Services (October 2008)
• "Antidepressant Use in a Nationally Representative Sample of Community-Dwelling U.S. Latinos With and Without Mental Disorders." Depression and Anxiety (July 2009)
  

How to Reduce Disparities

• "Evidence of Trends, Risk Factors, and Intervention Strategies." A Report from the Healthy Start National Evaluation 2006: Racial and Ethnic Disparities in Infant Mortality (June 2008)
  
• "Receiving Advice About Child Mental Health From a Primary Care Provider: African American and Hispanic Parent Attitudes." Medical Care (November 2007)
  
• More than Ramps: Improving Health Care Quality for People with Disabilities (2006)
  
• "State Efforts to Address the Healthy People 2010 Goal to Eliminate Health Disparities: Two Case Studies" (September 2008)
  
• "Emerging National and State Activities on Language Services in Health Care" (Summer 2009) 
  

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