Center on Health Care Effectiveness Related Projects

Overview of Selected Projects

Researchers affiliated with the Center on Health Care Effectiveness work in a wide range of health care policy areas to inform decision makers of the best evidence surrounding challenging health care issues. For short descriptions of related Mathematica projects, please click on the link for any one of the following six priority areas:

Comparative Effectiveness Research Study Designs
Mathematica’s portfolio of projects includes many studies that examine how to best design research for determining the effectiveness of health services and delivery strategies.
Promotion of Comparative Effectiveness Research Use Among Providers
Engaging providers in the use of CER is essential to improving quality of care and is the focus of several projects at Mathematica.
Promotion of Comparative Effectiveness Research Use Among Patients and Consumers
Comparative Effectiveness Research can help patients and consumers make decisions about their health care, and several Mathematica projects target consumer understanding and engagement.
Comparative Effectiveness Research through Retrospective Database Analysis
Existing health care datasets can be used to study the comparative effectiveness of different health services and procedures, as is being done in several Mathematica projects.
Comparative Effectiveness Research through Prospective Evaluation of Health Care Delivery System Innovations
Interventions that improve health care quality through health care delivery system reform are critical to the future of health care, and prospective evaluations that examine the comparative effectiveness of various delivery system approaches are being employed at Mathematica.
Systematic Reviews of Comparative Effectiveness Research Findings
Mathematica conducts systematic reviews of the effectiveness of delivery system interventions.

(Projects are listed alphabetically by client.)

Comparative Effectiveness Research Study Designs

Project Name	Establishing Federal Resources to Support the Patient-Centered Medical Home Concept
Client	Agency for Healthcare Research and Quality (AHRQ)
Description	This project supports the efforts of AHRQ and the federal government to build and reinforce primary care using the patient-centered medical home (PCMH) model. Mathematica is conducting an environmental scan of PCMH demonstration projects, activities, and research; preparing a series of five white papers and accompanying policy briefs; facilitating expert meetings; helping AHRQ with a website on the medical home; and working with AHRQ to convene a federal working group on primary care transformation and to develop strategic plans.

Project Name	Federal Facilitation of the Primary Care Medical Home Model
Client	Agency for Healthcare Research and Quality
Description	This project supports the efforts of AHRQ and the federal government to develop the evidence base on the patient-centered medical home (PCMH) for researchers and policymakers and to convene an expert working group on practice facilitation for primary care transformation. This project continues and expands the work of a project that began in September 2009.

Project Name	Improving the Value of HHS Quality Measurement
Client	Agency for Healthcare Research and Quality
Description	This task order addresses two issues that have limited the value of DHHS quality measurement in the past: (1) difficulty finding appropriate benchmarks for health care quality measures, and (2) difficulty demonstrating improvements in outcomes when improvements in health care processes are made. Mathematica and its subcontractors are developing a conceptual framework illustrating the factors that influence the process-outcome relationship, conducting a literature review on this topic, empirically testing two process-outcome measure pairs to examine the factors that affect their relationship (more of this testing is in the optional task), and creating an online tool to assist providers with quality measures for their organization to find benchmarks based on peers.

Project Name	Develop Strategies for Validation Methodology, Cost Estimates, and Impact on Underserved Areas
Client	Centers for Medicare & Medicaid Services (CMS)
Description	Mathematica assessed the new Physician Voluntary Reporting Program (the pre-cursor to the Physician Quality Reporting System) under which physicians began reporting additional quality-related data drawn from patients' medical records on their claim forms. CMS has been using these data to compute new quality measures for physicians. Mathematica also developed a method for validating the physician-supplied data, estimated the cost to physicians of supplying medical record data through this mechanism, and assessed how the program is likely to affect physicians serving minority populations.

Project Name	Evaluation of the Medicaid Value Program (MVP): Health Supports for Consumers with Chronic Conditions
Client	Center for Health Care Strategies, Inc.
Description	The Medicaid Value Program sought to test interventions seeking to improve care for adult Medicaid beneficiaries with multiple chronic conditions. The program was funded by a grant from Kaiser Permanente, with additional funding from the Robert Wood Johnson Foundation. Ten teams all sought to improve care for Medicaid beneficiaries, but they did so in a variety of ways and focused on different populations. Seven targeted their interventions to patients, all but one of them using a case management and coordination model to improve care. The exception augmented a pre-existing disease management program with in-person patient education. Others targeted providers to improve the quality of patient care. Mathematica’s evaluation identified factors that contributed to successful implementation of grantee interventions and lessons learned that would contribute to replicability and sustainability of their programs.

Project Name	Consult with UnitedHealth Group on the Design of Its Medical Home Demonstrations
Client	UnitedHealth Group
Description	In this project Mathematica helped design an intervention and began work on an evaluation to test the effects of additional payments and practice supports for primary care physicians who become medical homes on quality and cost of care. The pilot serves patients with insurance coverage by United Healthcare's commercial, Medicare Advantage, and Medicaid products.

Promotion of CER Use Among Providers

Project Name	Establishing Federal Resources to Support the Patient-Centered Medical Home Concept
Client	Agency for Healthcare Research and Quality (AHRQ)
Description	This project supports the efforts of AHRQ and the federal government to build and reinforce primary care using the patient-centered medical home (PCMH) model. Mathematica is conducting an environmental scan of PCMH demonstration projects, activities, and research; preparing a series of five white papers and accompanying policy briefs; facilitating expert meetings; helping AHRQ with a website on the medical home; and working with AHRQ to convene a federal working group on primary care transformation and to develop strategic plans.

Project Name	Federal Facilitation of the Primary Care Medical Home Model
Client	Agency for Healthcare Research and Quality
Description	This project supports the efforts of AHRQ and the federal government to develop the evidence base on the patient-centered medical home (PCMH) for researchers and policymakers and to convene an expert working group on practice facilitation for primary care transformation. This project continues and expands the work of a project that began in September 2009.

Project Name	MAX Data Analytical Plan
Client	Agency for Healthcare Research and Quality
Description	Mathematica assisted the Children’s Hospital of Boston in the development of pediatric hospital readmission by analyzing pediatric readmission patterns using Medicaid Analytic eXtract data. Mathematica also provided technical assistance in developing the measures based on our expertise in the development and implementation of hospital readmission measures for the Centers for Medicare & Medicaid Services (CMS).

Project Name	ARRA HITECH Eligible Professional Clinical Quality Measures
Client	Centers for Medicare & Medicaid Services (CMS)
Description	The Health Information Technology for Economic and Clinical Health (HITECH) Act established a timeline for the adoption and meaningful use of electronic health records (EHRs). For this project, Mathematica is assisting with the development, electronic specification, and maintenance of clinical quality measures that may be used by Eligible Professionals using certified EHR systems. For this work, we have conducted an environmental scan and gap analysis to determine a set of suitable measures for respecification and identify gap areas for measure development. Newly developed measures will be submitted to the National Quality Forum for endorsement. Mathematica will also support measure implementation and rule-making activities including contributing to implementation timelines; developing training and educational materials; and providing suggested responses to comments submitted during the rule-making public comment period.

Project Name	Community-Based Care Transitions Program (CCTP) Implementation and Monitoring
Client	Centers for Medicare & Medicaid Services (CMS)
Description	The Community-Based Care Transitions Program, a major component of the Partnership for Patients Pledge created by the Affordable Care Act, will provide $500 million in funding over the next five years to test models for improving care transitions from the hospital to the community for Medicare beneficiaries at high risk of readmission. As the implementation and monitoring contractor, we are (1) developing and implementing an electronic system for collecting, validating, and paying invoices from community-based organizations (CBOs), and (2) monitoring CBOs' progress toward meeting their performance targets, as well as the program's impact on federal expenditures. Specifically, we are using Medicare claims and information collected through a participant experience survey to calculate 30-day hospital readmission rates, primary care provider follow-up visit rates, patient activation scores, and adverse event measures, such as 30-day emergency department visit, observation stay, and mortality rates. CMS will use the results to provide real-time performance feedback to CBOs and their hospital partners and to determine whether CBO contracts will be renewed after an initial two-year performance period.

Project Name	Development and Calculation of the Value-Based Payment Modifier (VBM)/Production of the Quality and Resource Use Reports (QRUR) for Physician Feedback
Client	Centers for Medicare & Medicaid Services
Description	The CMS Physician Value program continues efforts to provide comparative quality and resource use performance information to medical group practices and physicians as part of Medicare’s efforts to improve the quality and efficiency of medical care, and to develop and apply a value-based payment modifier (VBM) as directed under the Affordable Care Act. Mathematica will support CMS’s efforts to enhance the value of health care services provided to beneficiaries, provide technical support to CMS in the development and implementation of a VBM, conduct research analyses on topics such as risk adjustment and the application of attribution and benchmarking rules, and support performance measure development and endorsement activities.

Project Name	Development of Physician Quality and Resource Use Reports Using Medicare Fee-for-Service Beneficiary Data
Client	Centers for Medicare & Medicaid Services
Description	Mathematica supports CMS in understanding analytic and policy issues related to measuring and reporting physician-driven costs of care, in relation to the quality of clinical care received by beneficiaries, and the beneficiary health outcomes that result. Mathematica continues to assist CMS with identifying fair, actionable, and meaningful measures of resource use and quality for individual physicians and physician practices, with the ultimate goal of using composite scores of resource use and quality to implement the value-based payment modifier required by the 2010 Patient Protection and Affordable Care Act. Additionally, Mathematica is producing and disseminating confidential reports to physician practices that compare patterns of resource use and quality to provide feedback and education to encourage more efficient medical practices.

Project Name	Development of Physician Quality Measures
Client	Centers for Medicare & Medicaid Services
Description	These projects assisted CMS in the development of new physician quality measures in support of the Physician Quality Reporting System. Key partners included the American Medical Association and the National Committee for Quality Assurance. Tasks included identifying clinical or other topic areas in which quality measures were needed, identifying and specifying measures in conjunction with expert working groups, and providing the literature and supporting evidence for development of the measures. Formative testing of selected measures with practicing clinicians was also conducted. Read more.

Project Name	Development of Resource Use Reports for Medicare Fee-for-Service Claims
Client	Centers for Medicare & Medicaid Services
Description	Mathematica worked with CMS on developing meaningful, actionable, and fair measures of resource use for individual physicians and physician practices treating Medicare beneficiaries. The ultimate goal is to use the measures in future CMS value-based purchasing initiatives for physicians, as well as to provide confidential feedback reports on their relative performance to assist them with identifying opportunities for improvement to encourage efficiency in physician practices. Read more.

Project Name	Evaluation of the Electronic Health Records Demonstration (EHRD)
Client	Centers for Medicare & Medicaid Services
Description	This study is evaluating the effectiveness of the Electronic Health Records Demonstration, which aims to promote high-quality care through the adoption and use of certified electronic health records by primary care physicians in small-to medium-size practices who serve Medicare beneficiaries with chronic illnesses. Mathematica is examining whether financial incentives influenced the adoption and use of electronic health records, whether the demonstration improved quality of care for fee-for-service Medicare beneficiaries with chronic illnesses, and whether the pay-for-performance model tested should be implemented on a larger scale. Read more.

Project Name	Evaluation of the Medicare Care Management Performance Demonstration
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is evaluating a congressionally mandated demonstration on inducements for small- and medium-size physician practices to adopt health information technology and improve quality of care. The initiative is examining whether use of the technology results in better adherence to care standards, improved patient outcomes, and savings to the Medicare program. The demonstration operated in four states. Read more.

Project Name	Evaluation of the Physician Quality Reporting System and Electronic Prescribing Incentive Program
Client	Centers for Medicare & Medicaid Services
Description	Using a combination of qualitative interviews and quantitative analyses (including secondary analyses of Medicare claims and surveys of providers and beneficiaries), this study provides process and impact evaluations of the Physician Quality Reporting System (PQRS)/Electronic Prescribing (eRx) program using a framework focused on four key areas: (1) quality, (2) coordination, (3) cost, and (4) participation (with a more defined focus on the reasons for participation rather than participation rates). Looking at each of these areas in the context of the PQRS/eRx programs will reveal how these programs are contributing to the larger National Strategy for Quality Improvement in Health Care (National Quality Strategy) and Quality Improvement Organization initiatives to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries.

Project Name	Medicare Quality Measurement Support, Mortality Implementation, and Measures Development and Monitoring
Client	Centers for Medicare & Medicaid Services
Description	Mathematica provided support for the Medicare Quality Measurement Support project, an ongoing effort by CMS to improve the quality of care provided to Medicare beneficiaries. Mathematica worked with the Colorado Foundation for Medical Care, a Medicare Quality Improvement Organization that holds the prime contract to advance quality measure reporting and development, primarily for hospital care.

Project Name	Public Reporting of Provider Quality: Research and Testing
Client	Centers for Medicare & Medicaid Services
Description	In response to a mandate to publicly report health plan- and health provider-specific quality indicators, CMS currently reports comparative information on health plans, nursing homes, home health agencies, renal dialysis facilities, and hospitals through the use of interactive tools on its website. CMS will continue to expand the number and types of measures reported. Mathematica is assisting CMS in incorporating additional quality measures, testing language and data displays with consumer and professional audiences, and improving the organization and navigation of the sites.

Project Name	Transparency in Public Reporting: Consumer Testing and Enhancements to CMS's Compare Tools
Client	Centers for Medicare & Medicaid Services
Description	In response to a growing public mandate and federal legislation to publicly report health plan- and health provider-specific quality indicators, CMS currently reports comparative information on health plans, nursing homes, home health agencies, renal dialysis facilities, and hospitals through the use of interactive tools on its website. CMS will continue to expand the number and types of measures reported. Mathematica is assisting in incorporating additional quality measures, testing language and data displays with consumer and professional audiences, and improving the organization and navigation of the sites.

Project Name	Healthy Indiana Plan Evaluation
Client	Indiana Office of Medicaid Policy and Planning
Description	Mathematica is conducting an evaluation of the State of Indiana's Healthy Indiana Plan (HIP). The evaluation includes three major components: annual reports for CMS, a survey of HIP participants and a technical report based on the survey, and white papers on areas of focus within the evaluation.

Project Name	Expert Panel on Pregnant Women and Infants Enrolled in Medicaid
Client	Medicaid and CHIP Payment and Access Commission (MACPAC)
Description	This project helped the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) better understand and consider the policy implications of adverse birth outcomes that relate to pregnant women and children. Mathematica conducted a review of seminal studies and “grey area” literature that speak to these issues and documented key findings in a structured background paper for panelists. This work reviews what is known about recent trends in maternity care, and current related initiatives aimed at improving maternity care processes and outcomes, with a focus on induction of labor and cesarean delivery. Drawing on previously conducted reviews, we discuss the salient literature in the field and highlights some of the key and emerging issues, themes, and findings.

Project Name	Site Visit Study of Resource Use and Quality Measurements in Private Health Plans
Client	Medicare Payment Advisory Commission (MedPAC)
Description	Mathematica assisted MedPAC with collecting detailed information on how different health plans have implemented resource use and quality measurement and what episode groupers and methodologies were used. In addition, the study looked at how plans linked the results of episode-grouping analysis to physician payment and network development, and how physicians and beneficiaries responded to the introduction of such programs.

Project Name	Study of Informed or Shared Decision Making
Client	Medicare Payment Advisory Commission (MedPAC)
Description	MedPAC sought to learn more about how to convey information on the cost and quality of health care services to consumers in a way that can inform their behavior. Mathematica examined programs of shared decision making and the factors that affect their ability to provide actionable support to patients who must decide among various options, with a particular focus on program implementation. The project included a literature review, interviews with researchers and staff from active shared decision-making programs, and site visits.

Project Name	Study of Public Health Consumer Education Programs
Client	Medicare Payment Advisory Commission (MedPAC)
Description	MedPAC recognizes the importance of engaging consumers in the movement to promote greater quality and efficiency in the health care system. In this project, Mathematica explored what can be learned from public health campaigns in other arenas about strategies for engaging consumers and influencing their behavior. Drawing on a limited review of the literature and key informant interviews, as well as focusing on selected campaigns that have demonstrated an effect on consumer behavior, Mathematica identified strategies associated with success, highlighted challenges common to public health consumer education programs, and explored the implications for programs or campaigns targeting Medicare beneficiaries.

Project Name	Minnesota’s Health Reform Initiative: Provider Peer Grouping
Client	Minnesota Department of Health
Description	This project is producing, testing, and disseminating a system of measures for the relative cost and quality of care provided by each physician group/clinic and hospital in the state of Minnesota. The reports will help providers understand how the quality and efficiency of the care they provide compares to that of their peers. The information will also inform consumers and payers of the differences.

Project Name	Health Care Survey of DoD Beneficiaries: Data Analysis and Presentation Support
Client	Office of TRICARE Management Activity
Description	Mathematica assisted the U.S. Department of Defense (DoD) in sampling, analyzing, and reporting for the annual Health Care Survey of DoD Beneficiaries, a mail survey of adults eligible for military health care. The survey measures beneficiaries’ perceptions of their health status;, use of health services and insurance; access to health care; satisfaction with care; and attitudes toward and enrollment in TRICARE, the military health system. Mathematica assists with ongoing research that makes use of the data sets, including analysis to help with briefings to policymakers and research projects addressing selected topics of interest to military health system leadership and the scholarly community. Mathematica also supplements survey analysis with other data collection and analysis and uses focus groups to follow up on survey findings.

Project Name	Analytic Support for Oregon's Coordinated Care Organization (CCO) Implementation
Client	Robert Wood Johnson Foundation
Description	Oregon enacted legislation creating Coordinated Care Organizations (CCOs) to provide integrated medical, behavioral, and dental benefits for Medicaid and dually eligible (Medicaid and Medicare) enrollees in the Oregon Health Plan, as well as newly eligible enrollees under the Affordable Care Act’s expanded Medicaid eligibility rules. CCOs are community-based organizations governed by a partnership between care providers, community members, and holders of financial risk. Responding to a request from the Office of Oregon Health Policy and Research, Mathematica prepared an issue brief exploring how Oregon might assist organizations that wish to become CCOs by sponsoring reinsurance to help finance high-cost care for Medicaid enrollees.

Project Name	Analysis of the Medicare Advantage Marketplace
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Description	Mathematica supported ASPE on Medicare Advantage (MA) policy options. Specifically, Mathematica tested the underlying assumptions about competition among MA health plans and the ability of consumers to navigate the market by examining the link between enrollment and disenrollment patterns and plan characteristics and explored potential options for enhancing value-driven health incentives in the MA marketplace.

Project Name	Development and Testing of Behavioral Health Quality Measures
Client	U.S. Department of Health and Human Services, Office of the Secretary, Assistant Secretary for Planning and Evaluation (ASPE)
Description	This project develops and tests evidence-based measures that assess the quality of behavioral health care across a broad spectrum of disorders and treatment settings. These measures may include structural assessments of behavioral health providers and systems, measures based on administrative or medical records, and beneficiary or provider self-reported measures. Measures will focus on ambulatory care for adults or children and address care provided through federal and state funded programs. The project involves a review of existing measures, the specification and pilot testing of new measures, and submission of the measures for National Quality Forum endorsement. These measures ultimately will be used to monitor progress toward reaching the goals of the SAMHSA’s National Behavioral Health Quality Framework: better care, healthy people, and affordable care.

Project Name	Assessment of Medicaid Psychotropic Drug Management
Client	U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
Description	Mathematica evaluated the effectiveness of a behavioral pharmacy management system that seeks to reduce Medicaid prescription drug costs by using physician education to encourage more appropriate psychotropic drug prescribing and beneficiary utilization. The project evaluated the impact of the system in one state to help state Medicaid and mental health agencies and other stakeholders determine whether this kind of educational intervention is an effective way of encouraging more appropriate use of psychotropic drugs. Although prescriber education through a series of letters and alerts appeared to have had some positive impacts on prescriber behavior, these impacts were generally small, not statistically significant, and not measurably different from fluctuations in prescriber behavior in periods prior to the intervention.

Promotion of CER Research Use Among Patients and Consumers


Project Name	MAX Data Analytical Plan
Client	Agency for Healthcare Research and Quality
Description	Mathematica assisted the Children’s Hospital of Boston in the development of pediatric hospital readmission by analyzing pediatric readmission patterns using Medicaid Analytic eXtract data. Mathematica also provided technical assistance in developing the measures based on our expertise in the development and implementation of hospital readmission measures for the Centers for Medicare & Medicaid Services (CMS).

Project Name	National Institute for Health Care Reform: Primary Care Practitioner Workforce
Client	Center for Studying Health System Change, Inc.
Description	This analysis identified and evaluated options for a policy response to the forecasted shortage in the supply of primary care services, including options for educating, training and influencing practice location of primary-care practitioners, as well as both individual- and team-based approaches for increasing providers’ productivity and encouraging them to remain in practice. It analyzed the steps taken in the Affordable Care Act to address the shortage and described key decision points in implementing the relevant provisions of the legislation.

Project Name	Development of Physician Quality and Resource Use Reports Using Medicare Fee-for-Service Beneficiary Data
Client	Centers for Medicare & Medicaid Services
Description	Mathematica supports CMS in understanding analytic and policy issues related to measuring and reporting physician-driven costs of care, in relation to the quality of clinical care received by beneficiaries, and the beneficiary health outcomes that result. Mathematica continues to assist CMS with identifying fair, actionable, and meaningful measures of resource use and quality for individual physicians and physician practices, with the ultimate goal of using composite scores of resource use and quality to implement the value-based payment modifier required by the 2010 Patient Protection and Affordable Care Act. Additionally, Mathematica is producing and disseminating confidential reports to physician practices that compare patterns of resource use and quality to provide feedback and education to encourage more efficient medical practices.

Project Name	Development of Physician Quality Measures
Client	Centers for Medicare & Medicaid Services
Description	These projects assisted CMS in the development of new physician quality measures in support of the Physician Quality Reporting System. Key partners included the American Medical Association and the National Committee for Quality Assurance. Tasks included identifying clinical or other topic areas in which quality measures were needed, identifying and specifying measures in conjunction with expert working groups, and providing the literature and supporting evidence for development of the measures. Formative testing of selected measures with practicing clinicians was also conducted. Read more.

Project Name	Development of Resource Use Reports for Medicare Fee-for-Service Claims
Client	Centers for Medicare & Medicaid Services
Description	Mathematica worked with CMS on developing meaningful, actionable, and fair measures of resource use for individual physicians and physician practices treating Medicare beneficiaries. The ultimate goal is to use the measures in future CMS value-based purchasing initiatives for physicians, as well as to provide confidential feedback reports on their relative performance to assist them with identifying opportunities for improvement to encourage efficiency in physician practices. Read more.

Project Name	Evaluation of the Medicare Care Management Performance Demonstration
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is evaluating the Medicare Care Management Performance Demonstration, a congressionally mandated test of pay-for-performance incentives to encourage physicians to improve the quality of care they provide to eligible fee-for-service Medicare beneficiaries and foster the implementation and use of health information technology. The demonstration, which started in July 2007, is aimed at physicians in solo or small- to medium-size practices. Read more.

Project Name	Medicare Quality Measurement Support, Mortality Implementation and Measures Development and Monitoring
Client	Centers for Medicare & Medicaid Services
Description	Mathematica provided support for the Medicare Quality Measurement Support project, an ongoing effort by CMS to improve the quality of care provided to Medicare beneficiaries. Mathematica worked with the Colorado Foundation for Medical Care, a Medicare Quality Improvement Organization that holds the prime contract to advance quality measure reporting and development, primarily for hospital care.

Project Name	Production and Implementation of the CMS Hospital Outcomes and Efficiency Measures II
Client	Centers for Medicare & Medicaid Services
Description	Mathematica supported CMS Medicare hospital quality reporting initiatives by producing and implementing the reporting of risk-adjusted hospital 30-day mortality and readmissions measures for acute myocardial infarction, heart failure, and pneumonia. Mathematica produced the mortality and readmission measures using Medicare claims and enrollment data for all hospitals in the country.

Project Name	Public Reporting of Provider Quality: Research and Testing
Client	Centers for Medicare & Medicaid Services
Description	In response to a mandate to publicly report health plan- and health provider-specific quality indicators, CMS currently reports comparative information on health plans, nursing homes, home health agencies, renal dialysis facilities, and hospitals through the use of interactive tools on its website. CMS will continue to expand the number and types of measures reported. Mathematica is assisting CMS in incorporating additional quality measures, testing language and data displays with consumer and professional audiences, and improving the organization and navigation of the sites.

Project Name	Transparency in Public Reporting: Consumer Testing and Enhancements to CMS's Compare Tools
Client	Centers for Medicare & Medicaid Services
Description	In response to a growing public mandate and federal legislation to publicly report health plan- and health provider-specific quality indicators, CMS currently reports comparative information on health plans, nursing homes, home health agencies, renal dialysis facilities, and hospitals through the use of interactive tools on its website. CMS will continue to expand the number and types of measures reported. Mathematica is assisting in incorporating additional quality measures, testing language and data displays with consumer and professional audiences, and improving the organization and navigation of the sites.

Project Name	Assessing Business Plan Options for Financing Clinical Pharmacy Services in HRSA-Supported Programs
Client	Health Resources and Services Administration, Office of Pharmacy Affairs
Description	Mathematica assisted in responding to a congressional mandate to provide information on how clinical pharmacy services might be extended nationally among health centers and other safety net providers. We developed an internet-based business model tool that health centers can use to plan for adding or expanding services; convened a meeting of national organizations concerned with the safety net and pharmaceuticals; conducted case studies of health centers, safety net hospitals, and HIV/AIDS clinics that have managed to sustain these services to find out how they did it; and prepared a report to Congress.

Project Name	Healthy Indiana Plan Evaluation
Client	Indiana Office of Medicaid Policy and Planning
Description	Mathematica is conducting an evaluation of the State of Indiana's Healthy Indiana Plan (HIP). The evaluation includes three major components: annual reports for CMS, a survey of HIP participants and a technical report based on the survey, and white papers on areas of focus within the evaluation.

Project Name	Site Visit Study of Resource Use and Quality Measurements in Private Health Plans
Client	Medicare Payment Advisory Commission (MedPAC)
Description	Mathematica assisted MedPAC with collecting detailed information on how different health plans have implemented resource use and quality measurement and what episode groupers and methodologies were used. In addition, the study looked at how plans linked the results of episode-grouping analysis to physician payment and network development, and how physicians and beneficiaries responded to the introduction of such programs.

Project Name	Study of Informed or Shared Decision Making
Client	Medicare Payment Advisory Commission (MedPAC)
Description	MedPAC sought to learn more about how to convey information on the cost and quality of health care services to consumers in a way that can inform their behavior. Mathematica examined programs of shared decision making and the factors that affect their ability to provide actionable support to patients who must decide among various options, with a particular focus on program implementation. The project included a literature review, interviews with researchers and staff from active shared decision-making programs, and site visits.

Project Name	Study of Public Health Consumer Education Programs
Client	Medicare Payment Advisory Commission (MedPAC)
Description	MedPAC recognizes the importance of engaging consumers in the movement to promote greater quality and efficiency in the health care system. In this project, Mathematica explored what can be learned from public health campaigns in other arenas about strategies for engaging consumers and influencing their behavior. Drawing on a limited review of the literature and key informant interviews, as well as focusing on selected campaigns that have demonstrated an effect on consumer behavior, Mathematica identified strategies associated with success, highlighted challenges common to public health consumer education programs, and explored the implications for programs or campaigns targeting Medicare beneficiaries.

Project Name	Study of Best Practices for Reaching and Enrolling People Newly Eligible for Medicaid
Client	MHA Center for Education
Description	Mathematica conducted a study of outreach and enrollment best practices for the Missouri Hospital Association Center for Education to help the state prepare for the challenges in implementing the upcoming Medicaid expansion. The study included a literature search and key informant interviews to identify effective outreach strategies to raise awareness of Medicaid and motivate people to apply, as well as effective policies and practices to enroll those who choose to apply.

Project Name	Minnesota’s Health Reform Initiative: Provider Peer Grouping
Client	Minnesota Department of Health
Description	This project is producing, testing, and disseminating a system of measures for the relative cost and quality of care provided by each physician group/clinic and hospital in the state of Minnesota. The reports will help providers understand how the quality and efficiency of the care they provide compares to that of their peers. The information will also inform consumers and payers of the differences.

Project Name	Rehospitalization in New York State and Implications for Avoidable Cost
Client	New York State Health Foundation
Description	To address the knowledge gap related to the frequency and cost of avoidable hospital readmissions in New York, Mathematica estimated the potential savings that might be obtained from targeted interventions to reduce avoidable readmissions. The study identified geographic areas, conditions, and patient cohorts in New York with high rates of readmissions; reviewed current payment reforms and care interventions that showed promise for reducing hospital readmissions; and estimated the potential savings in New York from targeted interventions such as hospital procedures to reduce infection rates and improve discharge protocols.

Project Name	Analysis of the Medicare Advantage (MA) Marketplace
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	Mathematica supported ASPE on Medicare Advantage (MA) policy options. Specifically, Mathematica tested the underlying assumptions about competition among MA health plans and the ability of consumers to navigate the market by examining the link between enrollment and disenrollment patterns and plan characteristics, and explored potential options for enhancing value-driven health incentives in the MA marketplace.

Project Name	Identifying Mental Health Policy Issues in the Context of Health Care Reform
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	This project identified mental health policy issues that relate to current proposals for health care reform and informed policymakers of the relevance of mental health to important areas under consideration. Policy issues were identified based on the findings of commissioned research papers, expert meetings, and synthesis reports. The project focused on two topic areas: (1) identifying mental health-related policy issues in the context of health care reform and (2) identifying promising models of comprehensive community-based crisis systems in the management, care, and diversion of people with mental illnesses. Read more.

Comparative Effectiveness Research Through Retrospective Database Analysis

Project Name	Evaluation of Aetna's Care Coordination Program
Client	Aetna
Description	This was a retrospective study of the effects of Aetna’s Medicare managed care (Medicare Advantage) program on enrollees in the northeastern United States (New York, New Jersey, Pennsylvania, and Maryland). Aetna’s nurses provided a case management intervention to approximately 18 percent of its enrolled population, and other, less intense interventions to additional members. The study compared all plan enrollees to a non-experimentally matched comparison group in fee-for-service Medicare in the same market areas. Outcomes of interest included hospital admissions and days, emergency room admissions, skilled nursing facility admissions and days, and mortality.

Project Name	Improving the AHRQ Quality Indicators
Client	Agency for Healthcare Research and Quality (AHRQ)
Description	The AHRQ Quality Indicators (QIs) are measures of inpatient health care quality calculated using hospital administrative data. Recent critiques in the literature and popular press have posited that the methods used to calculate the QIs lead to quality measurements that are biased against certain hospital types, and therefore, not suitable for comparisons of the efficacy of inpatient hospital care. This project is examining potential bias by hospital characteristics and use of the measures in hospital comparisons. We will be using the results of these analyses to test and recommend improvements to the methods for calculating the QIs, with a particular focus on improving the use of the QIs in hospital comparisons.

Project Name	MAX Data Analytical Plan
Client	Agency for Healthcare Research and Quality
Description	Mathematica assisted the Children’s Hospital of Boston in the development of pediatric hospital readmission by analyzing pediatric readmission patterns using Medicaid Analytic eXtract data. Mathematica also provided technical assistance in developing the measures based on our expertise in the development and implementation of hospital readmission measures for the Centers for Medicare & Medicaid Services (CMS).

Project Name	National Institute for Health Care Reform: Primary Care Practitioner Workforce
Client	Center for Studying Health System Change, Inc.
Description	This analysis identified and evaluated options for a policy response to the forecasted shortage in the supply of primary care services, including options for educating, training and influencing practice location of primary-care practitioners, as well as both individual- and team-based approaches for increasing providers’ productivity and encouraging them to remain in practice. It analyzed the steps taken in the Affordable Care Act to address the shortage and described key decision points in implementing the relevant provisions of the legislation.

Project Name	Medicare Quality Measurement Support, Mortality Implementation, and Measures Development and Monitoring
Client	Centers for Medicare & Medicaid Services
Description	Mathematica provided support for the Medicare Quality Measurement Support project, an ongoing effort by CMS to improve the quality of care provided to Medicare beneficiaries. Mathematica worked with the Colorado Foundation for Medical Care, a Medicare Quality Improvement Organization that holds the prime contract to advance quality measure reporting and development, primarily for hospital care.

Project Name	Production and Implementation of the CMS Hospital Outcomes and Efficiency Measures II
Client	Centers for Medicare & Medicaid Services
Description	Mathematica supported CMS Medicare hospital quality reporting initiatives by producing and implementing the reporting of risk-adjusted hospital 30-day mortality and readmissions measures for acute myocardial infarction, heart failure, and pneumonia. Mathematica produced the mortality and readmission measures using Medicare claims and enrollment data for all hospitals in the country.

Project Name	Variation in Efficiency Medicare Advantage Plans Relative to Medicare Fee For Service
Client	Commonwealth Fund
Description	Mathematica will analyze newly released public data from Medicare Advantage plan bids to expand our understanding of the relationship between relative plan efficiency and benefit package plan. We will analyze data from 2009 to answer two questions: (1) How much variation is there in the efficiency of plans compared to those of the same type and within counties with similar FFS costs? (2) How much variation is there in MA benefits among those same plans, and what relationship (if any) do these differences have to rebates?

Project Name	Comparative Effectiveness of Generic and Branded Antidepressants
Client	Forest Laboratories, Inc.
Description	Mathematica used an observational (cohort) design to determine antidepressant use patterns from a large administrative claims dataset for commercially insured patients who had new episodes of treatment and assessed the costs of care associated with alternative antidepressants and use patterns. Multivariate regression with adjustment for selection bias was used to determine differences between a branded selective serotonin reuptake inhibitor and several generically available antidepressants. This information was supplemented by chart reviews to obtain clinical information regarding the underlying reasons for the use patterns observed in claims data.

Project Name	Rehabilitation Research and Training Centers (RRTCs): Employment Policy and Measurement
Client	National Institute on Disability and Rehabilitation Research
Description	This project includes several research studies to support the University of New Hampshire’s Employment Policy and Measurement RRTC in improving the effectiveness of services authorized under the Rehabilitation Act of 1973 through advanced research, training, technical assistance, and dissemination activities. We are leading seven studies to expand knowledge of the effects of program incentives on employment outcomes of people with disabilities. We are also conducting a comparative assessment of employment measures across surveys and administrative records. A unique feature of the project is that it includes data from several restricted access administrative data sources, including the Social Security Administration, Centers for Medicare & Medicaid Services, and Rehabilitation Services Administration.

Project Name	Rehospitalization in New York State and Implications for Avoidable Cost
Client	New York State Health Foundation
Description	To address the knowledge gap related to the frequency and cost of avoidable hospital readmissions in New York, Mathematica estimated the potential savings that might be obtained from targeted interventions to reduce avoidable readmissions. The study identified geographic areas, conditions, and patient cohorts in New York with high rates of readmissions; reviewed current payment reforms and care interventions that showed promise for reducing hospital readmissions; and estimated the potential savings in New York from targeted interventions such as hospital procedures to reduce infection rates and improve discharge protocols.

Project Name	Evaluation of the County Health Rankings and Roadmaps Program: Planning Phase
Client	Robert Wood Johnson Foundation
Description	This evaluation of the Robert Wood Johnson Foundation County Health Rankings and Roadmaps (CHRR) initiative will determine whether and how the combination of CHRR resources is useful and effective in strengthening communities’ ability to work together to improve the health of their residents. CHRR will provide communities with the following resources: county-level data to help identify problems, education in evidence-informed strategies to help resolve those problems, skills to advocate for policy and systems changes, engagement of partners from a range of sectors, and the dissemination of promising results to encourage new communities to follow the same path. During the planning phase, Mathematica will develop an evaluation plan through creating a logic model for the initiative, identifying evaluation priorities, identifying appropriate outcomes, and determining research methods and data sources to measure those outcomes through a series of meetings and discussions with RWJF, UWPHI, Community Catalyst, and other key stakeholders.

Project Name	Analysis of Overuse of Percutaneous Coronary Interventions
Client	United Health Foundation
Description	Mathematica conducted analyses for the American Medical Association Foundation in support of the development of performance measures to improve care in a clinical area with known high levels of variation in care and cost. The focus was the overuse of percutaneous coronary intervention (PCI) for coronary artery disease. Mathematica analyzed available data on resource use (cost) and utilization of procedures, treatments, and tests related to PCI and identified variation and growth in resource use and utilization by geographical area and patient demographic characteristics.

Project Name	Analysis of Integrated HIV Housing and Care Services
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Description	The implementation of the ACA in 2014 and scheduled reauthorization of the Ryan White Program in 2013 provide an unprecedented opportunity to revisit federal HIV housing assistance programs and policies, and to focus more federal funding on best practices in HIV housing programs. Mathematica is using data from the Department of Housing and Urban Development (HUD), HUD's Housing Opportunities for People With AIDS program, and the Ryan White HIV/AIDS Program administered by the Health Resources and Services Administration to assess the association between current HIV housing programs and improved housing and clinical care outcomes. The project also has a qualitative component—conducting site visits to four HUD Integrated HIV Housing Plan Special Projects of National Significance projects to document best practices in integrating HIV housing and health care services.

Project Name	Analysis of the Medicare Advantage Marketplace
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Description	Mathematica supported ASPE on Medicare Advantage (MA) policy options. Specifically, Mathematica tested the underlying assumptions about competition among MA health plans and the ability of consumers to navigate the market by examining the link between enrollment and disenrollment patterns and plan characteristics and explored potential options for enhancing value-driven health incentives in the MA marketplace.

Project Name	Developing Quality Measures for Schizophrenia in Medicaid
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	This project is developing, field testing, and submitting for endorsement at least three quality measures to assess the quality and appropriateness of outpatient care for Medicaid beneficiaries diagnosed with schizophrenia. Mathematica is conducting a targeted literature review to identify potential measure concepts and topics and present findings from the review to our technical advisory group and project consultants. We are examining the feasibility of draft measure specifications using Medicaid Analytic eXtract (MAX) data and field testing the measure specifications using focus groups with stakeholders. Once input from stakeholders has been incorporated, measure specifications will be pilot tested using the MAX data including an assessment of the measures’ psychometric properties.

Project Name	Evaluation of the Medicare Personal Health Records Choice Pilot
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	Mathematica evaluated the Personal Health Records Choice Pilot, which offered a choice of personal health records to fee-for-service Medicare beneficiaries in Arizona and Utah. Personal health records are designed for health care consumers and are intended to provide an online portal for people to view and manage their health information and transactions electronically. Mathematica analyzed Medicare claims and personal-health-record-use data to report on how pilot participants differed from nonparticipants in key demographic and other characteristics, including health care utilization, costs, and quality of care. The analysis is helping to develop an evidence base for understanding the role of personalized health information technology tools, such as personal health records, in improving the value of services for Medicare beneficiaries. Read more.

Comparative Effectiveness Research Through Prospective Evaluation of Health Care Delivery System Innovations

Project Name	Evaluation of the Medicaid Value Program (MVP): Health Supports for Consumers with Chronic Conditions
Client	Center for Health Care Strategies, Inc.
Description	The Medicaid Value Program sought to test interventions seeking to improve care for adult Medicaid beneficiaries with multiple chronic conditions. The program was funded by a grant from Kaiser Permanente, with additional funding from the Robert Wood Johnson Foundation. Ten teams all sought to improve care for Medicaid beneficiaries, but they did so in a variety of ways and focused on different populations. Seven targeted their interventions to patients, all but one of them using a case management and coordination model to improve care. The exception augmented a pre-existing disease management program with in-person patient education. Others targeted providers to improve the quality of patient care. Mathematica’s evaluation identified factors that contributed to successful implementation of grantee interventions and lessons learned that would contribute to replicability and sustainability of their programs.

Project Name	Evaluation of the Comprehensive Primary Care Initiative
Client	Center for Medicare and Medicaid Innovation
Description	Mathematica is evaluating the Comprehensive Primary Care Initiative (CPC) launched by CMMI in seven markets, each of which has about 75 participating primary care practices. Mathematica is evaluating CPC’s effects on cost, quality, and patient and provider experience and providing ongoing rapid cycle feedback to CMS, providers, purchasers, and other market stakeholders to promote learning and ongoing improvements at both the practice and market levels. The design will employ a mixed-methods approach using data collected through site visits; interviews; surveys of practices, patients, clinicians, and staff; program data; and Medicare and Medicaid claims data.

Project Name	Community-Based Care Transitions Program (CCTP) Implementation and Monitoring
Client	Centers for Medicare & Medicaid Services (CMS)
Description	The Community-Based Care Transitions Program, a major component of the Partnership for Patients Pledge created by the Affordable Care Act, will provide $500 million in funding over the next five years to test models for improving care transitions from the hospital to the community for Medicare beneficiaries at high risk of readmission. As the implementation and monitoring contractor, we are (1) developing and implementing an electronic system for collecting, validating, and paying invoices from community-based organizations (CBOs), and (2) monitoring CBOs' progress toward meeting their performance targets, as well as the program's impact on federal expenditures. Specifically, we are using Medicare claims and information collected through a participant experience survey to calculate 30-day hospital readmission rates, primary care provider follow-up visit rates, patient activation scores, and adverse event measures, such as 30-day emergency department visit, observation stay, and mortality rates. CMS will use the results to provide real-time performance feedback to CBOs and their hospital partners and to determine whether CBO contracts will be renewed after an initial two-year performance period.

Project Name	Demonstration to Maintain Independence and Employment (DMIE) Data Analysis
Client	Centers for Medicare & Medicaid Services
Description	Mathematica conducted a national evaluation of how the DMIE impacted participants' health status, employment outcomes and independence from federal disability programs. The projects were funded to encourage states to design, implement, and evaluate interventions for workers with potentially disabling health conditions. Read more.

Project Name	Evaluation of Disease Management Programs
Client	Centers for Medicare & Medicaid Services
Description	Mandated by the Benefits Improvement & Protection Act (BIPA), this demonstration was designed to improve the health care and outcomes of Medicare beneficiaries with severe congestive heart failure, coronary artery disease, or diabetes. The program was expected to accomplish these goals while reducing total Medicare costs for enrollees by providing coverage for prescription drugs and by using disease management techniques to improve care and adherence to recommended medication, diet, and exercise regimens. Mathematica randomly assigned Medicare beneficiaries who agreed to participate in the 4 demonstration programs to a treatment or control group. The evaluation relied on Medicare claims data and a patient survey. We also conducted a telephone survey of 50 physicians from two of the programs to provide information on physicians’ acceptance of these DM programs and on how the programs have affected the physicians’ practice of medicine for chronically ill patients. The evaluation included an implementation analysis that examined the design and operational experience of programs through site visits, site documents, site data, and patient intake data. It also included case studies of each program, a report to Congress, and a final evaluation report on the LifeMasters disease management program.

Project Name	Evaluation of the Electronic Health Records Demonstration (EHRD)
Client	Centers for Medicare & Medicaid Services
Description	This study is evaluating the effectiveness of the Electronic Health Records Demonstration, which aims to promote high-quality care through the adoption and use of certified electronic health records by primary care physicians in small-to medium-size practices who serve Medicare beneficiaries with chronic illnesses. Mathematica is examining whether financial incentives influenced the adoption and use of electronic health records, whether the demonstration improved quality of care for fee-for-service Medicare beneficiaries with chronic illnesses, and whether the pay-for-performance model tested should be implemented on a larger scale. Read more.

Project Name	Evaluation of the Extended Medicare Coordinated Care Demonstration
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is conducting an ongoing evaluation of the CMS Medicare Coordinated Care Demonstration (MCCD), which was designed to test the use of various disease management interventions to improve care coordination, patient adherence to treatment and self-care regimens, and physician adherence to treatment guidelines for targeted chronically ill fee-for-service Medicare beneficiaries. This evaluation looks at those programs that were extended beyond the initial four-year period of operation.

Project Name	Evaluation of the Independence at Home (IAH) Demonstration
Client	Centers for Medicare & Medicaid Services
Description	Under the Affordable Care Act, Congress mandated that CMS conduct a demonstration designed to test the ability of a home-based primary care delivery model led by physicians, nurse practitioners, and physician assistants to reduce expenditures and improve health outcomes of high-need Medicare beneficiaries. Practices participating in the three-year demonstration, called the Independence at Home program, are expected to design and implement coordinated care plans tailored to individual beneficiaries’ chronic conditions and responsive to their preferences, make in-home visits to these patients, and be available 24 hours per day, 7 days per week to meet their health needs. The primary goals of the evaluation are to understand the changes practices made to provide coordinated and timely delivery of primary care to high-need Medicare beneficiaries in their homes, as well as the resulting impact on health outcomes, utilization of services; Medicare cost; transition to long-term placement in nursing homes and associated Medicaid costs; and patient satisfaction for Medicare beneficiaries enrolled in these practices and their family members and caregivers.

Project Name	Evaluation of the LifeMasters Disease Management Demonstration Program for Dual Eligible Beneficiaries
Client	Centers for Medicare & Medicaid Services
Description	Mathematica conducted an evaluation of the LifeMasters Disease Management Demonstration Program for Dual Eligible Beneficiaries that targeted chronically ill dual eligible beneficiaries. Mathematica randomly assigned beneficiaries eligible for the program into treatment and control groups and reviewed Medicare administrative claims data to determine if the primarily telephonic program could reduce health care costs and improve quality of care.

Project Name	Evaluation of the Medicare Care Management Performance Demonstration
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is evaluating a congressionally mandated demonstration on inducements for small- and medium-size physician practices to adopt health information technology and improve quality of care. The initiative is examining whether use of the technology results in better adherence to care standards, improved patient outcomes, and savings to the Medicare program. The demonstration operated in four states. Read more.

Project Name	Evaluation of Programs of Coordinated Care and Disease Management
Client	Centers for Medicare & Medicaid Services
Description	Mathematica evaluated 16 independent demonstration sites that provide coordinated care interventions to Medicare beneficiaries with chronic illnesses. The demonstration sites offered programs designed to improve both the care that patients received and patients’ knowledge of, and compliance with, recommended self-care and behavior. The study estimated the effects of each site on patients’ well-being and satisfaction, in addition to the site’s effects on the use and cost of Medicare-covered services. Read more.

Project Name	Medicaid Emergency Psychiatric Services Demonstration Evaluation
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is evaluating the impacts of the Medicaid Emergency Psychiatric Services demonstration using a longitudinal database of Medicaid claims, Medicare claims for beneficiaries enrolled in Medicare, and data on Institutions of Mental Disease (IMD) services extracted from state data systems. Any psychiatric hospital that participates in Medicare and has available capacity must accept appropriate transfers of individuals found to have emergency medical conditions (EMCs) that require specialized psychiatric service capabilities. Since the inception of Medicaid, however, IMDs have been excluded from receipt of federal matching funds for inpatient psychiatric care for individuals aged 21 to 64, even for services provided to beneficiaries with EMCs. The IMD exclusion, therefore, puts Medicaid beneficiaries with EMCs at a disadvantage in the competition for scarce inpatient beds. To substantiate results of quantitative analyses and examine alternative explanations for demonstration findings, we are gathering qualitative data from stakeholders through key informant interviews and medical record reviews conducted during two rounds of site visits.

Project Name	Payment Reconciliation, Support of the Bundled Payments for Care Improvement Initiative
Client	Centers for Medicare & Medicaid Services
Description	Bundled Payments for Care Improvement is an initiative under development by CMMI. Four models of care will be tested as alternatives to the current fee-for-service payment system. Each model specifies a set of Medicare-covered services and a period of time following an inpatient admission for which payment will be made as a fixed amount. Mathematica has developed operational specifications for the four payment models and constructed provider-specific payment rates using three years of historical data for each episode type.

Project Name	Research and Evaluation of the Money Follows the Person (MFP) Rebalancing Demonstration Grants
Client	Centers for Medicare & Medicaid Services
Description	The Money Follows the Person (MFP) initiative is based on the premise that many Medicaid beneficiaries residing in institutions want to live in the community and could do so if they had support and at a cost no higher than that of institutional care. CMS awarded MFP grants to 47 states to assist them in developing and implementing strategies to reform their long-term care financing and service design. The grants are intended to assist states in making home and community-based services available in a manner that permits funding to “follow the person” to a preferred long-term care setting and to offer services to support those individuals transitioning to community-based settings. Mathematica is evaluating the MFP demonstration program, collecting data on the number of transitions occurring through the state programs, and assessing whether the states are being effective at meeting their annual transition targets.

Project Name	Evaluation of Project Access: Improving Access to Care for Children and Youth with Epilepsy
Client	Epilepsy Foundation
Description	Mathematica is evaluating Project Access, an initiative sponsored by the Maternal and Child Health Bureau of the Health Resources and Services Administration to develop and enhance coordinated and comprehensive service systems for children and adolescents with epilepsy. This evaluation covers the second phase of the project, in which four grantees oversee the development and implementation of nine state demonstration projects. The primary data collection methods include review of grantee documents and semi-structured interviews with the project director from each grantee, staff, and stakeholders. Read more.

Project Name	Healthy Indiana Plan Evaluation
Client	Indiana Office of Medicaid Policy and Planning
Description	Mathematica is conducting an evaluation of the State of Indiana's Healthy Indiana Plan (HIP). The evaluation includes three major components: annual reports for CMS, a survey of HIP participants and a technical report based on the survey, and white papers on areas of focus within the evaluation.

Project Name	Work on PACE and D-SNPs
Client	Medicaid and CHIP Payment and Access Commission (MACPAC)
Description	This project is researching current Medicare and state Medicaid payment methodologies for two integrated programs for dual Medicare-Medicaid beneficiaries: (1) Program of All-Inclusive Care for the Elderly (PACE) and (2) Dual Special Needs Plans (D-SNPs), a type of Medicare Advantage plan. Mathematica is providing state-specific information on PACE and D-SNP payment methods and rates, based on information provided by state Medicaid agencies to the CMS. Mathematica is also providing an overview of PACE and D-SNP program features, highlighting areas of congruence and divergence between the two programs and across Medicare and Medicaid policies in enrollment and disenrollment processes, eligibility requirements, transition issues in and out of the programs, provider network adequacy, and quality measurement requirements.

Project Name	Evaluation of the Patient Care Management and Rewards Program
Client	Robert Wood Johnson Foundation
Description	This project will study a randomized controlled experiment with uninsured patients with diabetes and heart disease at a primary care clinic in rural Mississippi. Mathematica is using an orthogonal design to test the effect of financial incentives for patients to lose weight, exercise, and take their medications.

Project Name	Evaluation of the Head Start Oral Health Initiative
Client	U.S. Department of Health and Human Services, Administration for Children and Families
Description	Mathematica designed and implemented an evaluation of the Head Start Oral Health Initiative, which was designed to improve oral health services to young children and pregnant women. Mathematica monitored the first two years of implementation, documented grantees’ implementation experiences and challenges, identified promising program models and service delivery strategies, assessed the feasibility of replication or expansion of the models in other programs and communities, and disseminated information about lessons learned to the broader Head Start community. Read more.

Project Name	Center of Excellence in Research on Disability Services and Care Coordination and Integration
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	The American Recovery and Reinvestment Act of 2009 allocated funds to DHHS for the development of comparative effectiveness research for persons with disabilities. To date, this three-year project has conducted a systematic review of the evidence on which care coordination models work best for persons with disabilities and identified criteria for assessing the effectiveness of services and models in this area. Pending approval of the contract modification currently under consideration at ASPE, the remainder of the project will focus on conducting comparative effectiveness research and supporting studies on new initiatives and innovative systems of care designed to improve health outcomes and quality of life for persons with disabilities, as well as disseminating findings to policymakers, consumers, providers, and researchers. Findings from the studies will be presented at a national conference in March 2013.

Project Name	Research Evaluation and Impact Assessment of ARRA Comparative Effectiveness Research Portfolio
Client	U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
Description	This evaluation of our nation's comparative effectiveness research (CER) portfolio, funded under the American Recovery and Reinvestment Act of 2009, is identifying gaps and barriers to achieving long-term CER goals. The study is also developing metrics needed to assess long-term impacts and provide immediate feedback on short-term effects. Our approach incorporates primary and secondary data and multiple data collection methods to evaluate the array of relevant federal programs and community perspectives.

Project Name	Assessment of Medicaid Psychotropic Drug Management
Client	U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
Description	Mathematica evaluated the effectiveness of a behavioral pharmacy management system that seeks to reduce Medicaid prescription drug costs by using physician education to encourage more appropriate psychotropic drug prescribing and beneficiary utilization. The project evaluated the impact of the system in one state to help state Medicaid and mental health agencies and other stakeholders determine whether this kind of educational intervention is an effective way of encouraging more appropriate use of psychotropic drugs. Although prescriber education through a series of letters and alerts appeared to have had some positive impacts on prescriber behavior, these impacts were generally small, not statistically significant, and not measurably different from fluctuations in prescriber behavior in periods prior to the intervention.

Systematic Reviews of Comparative Effectiveness Research Findings

Project Name	Establishing Federal Resources to Support the Patient-Centered Medical Home Concept
Client	Agency for Healthcare Research and Quality (AHRQ)
Description	This project supports the efforts of AHRQ and the federal government to build and reinforce primary care using the patient-centered medical home (PCMH) model. Mathematica is conducting an environmental scan of PCMH demonstration projects, activities, and research; preparing a series of five white papers and accompanying policy briefs; facilitating expert meetings; helping AHRQ with a website on the medical home; and working with AHRQ to convene a federal working group on primary care transformation and to develop strategic plans.

Project Name	Evaluation of the Rethinking Care Program
Client	Center for Health Care Strategies, Inc.
Description	Mathematica evaluated the State of Pennsylvania’s Serious Mental Illness Innovations Project which tested whether integration of physical and behavioral health care services would result in better-coordinated, lower-cost care for Medicaid beneficiaries with co-occurring physical and behavioral health conditions. The evaluation investigated program impacts on emergency department use, hospitalizations, and readmissions on members eligible for the pilot programs compared to a non-experimental comparison group. We also conducted an implementation analysis via qualitative methods, including key informant interviews and focus groups, to produce site-specific case studies and assess implementation strategies and their relative effectiveness across sites.

Project Name	Extended Stay Clinic Demonstration Evaluation Project
Client	Centers for Medicare & Medicaid Services
Description	The Frontier Extended Stay Clinic demonstration tests the feasibility of providing extended stay services under Medicare payment and regulations for rural remote clinics serving seriously or critically ill or injured patients for whom transportation to a full-service acute care hospital is problematic or not necessary. Using quantitative and qualitative analyses, this evaluation will assess the demonstration’s impact on health outcomes and patient experiences; hospitalizations and emergency transport services; and efficiency and cost in the delivery of health care services to elderly residents of remote towns and villages in Alaska and Washington. The evaluation will study difficulties that providers experienced in implementing the demonstration and the strategies they developed to overcome those challenges.

Project Name	Project Evaluation Activity in Support of Partnership for Patients
Client	Centers for Medicare & Medicaid Services
Description	Mathematica is conducting formative and impact evaluations of the CMS-sponsored Partnership for Patients (PfP) initiative. The goal of PfP is to reduce preventable inpatient harm by 40 percent and hospital readmissions by 20 percent by the end of 2013. This initiative includes the following: using 26 Hospital Engagement Network contractors to train and educate hospitals in best practices in patient safety; using a national content developer contractor to develop supporting methods and materials and build a community of practice; and using a patient and family engagement contractor to engage and educate patients and families and encourage hospital inclusion of patients and families in patient safety efforts. The formative evaluation includes assessing and providing feedback to CMS on the progress of all the other contractors and the participating hospitals and on the PfP initiative overall. The impact evaluation will estimate the impacts of the PfP on hospital behavior, rates of inpatient adverse events and hospital readmissions, and health care costs.

Project Name	Expert Panel on Pregnant Women and Infants Enrolled in Medicaid
Client	Medicaid and CHIP Payment and Access Commission (MACPAC)
Description	This project helped the Medicaid and Children’s Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) better understand and consider the policy implications of adverse birth outcomes that relate to pregnant women and children. Mathematica conducted a review of seminal studies and “grey area” literature that speak to these issues and documented key findings in a structured background paper for panelists. This work reviews what is known about recent trends in maternity care, and current related initiatives aimed at improving maternity care processes and outcomes, with a focus on induction of labor and cesarean delivery. Drawing on previously conducted reviews, we discuss the salient literature in the field and highlights some of the key and emerging issues, themes, and findings.

Project Name	Evaluation of the County Health Rankings and Roadmaps Program: Planning Phase
Client	Robert Wood Johnson Foundation
Description	This evaluation of the Robert Wood Johnson Foundation County Health Rankings and Roadmaps (CHRR) initiative will determine whether and how the combination of CHRR resources is useful and effective in strengthening communities’ ability to work together to improve the health of their residents. CHRR will provide communities with the following resources: county-level data to help identify problems, education in evidence-informed strategies to help resolve those problems, skills to advocate for policy and systems changes, engagement of partners from a range of sectors, and the dissemination of promising results to encourage new communities to follow the same path. During the planning phase, Mathematica will develop an evaluation plan through creating a logic model for the initiative, identifying evaluation priorities, identifying appropriate outcomes, and determining research methods and data sources to measure those outcomes through a series of meetings and discussions with RWJF, UWPHI, Community Catalyst, and other key stakeholders.

Project Name	ARRA HITECH EHR Incentive Program for Electronic Clinical Quality Measure Development
Client	U.S. Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (ONC)
Description	Mathematica is assisting Booze Allen Hamilton in the identification and development of clinical quality measures for the Electronic Health Record Incentive Program sponsored by ONC and leading the measurement implementation task. This includes developing a framework for implementing new measures, ensuring the electronic specifications incorporate all changes to the measures from the testing and validation process, developing specifications for end-users, and developing a final report.

Project Name	Health Technology Assessment
Client	WA Health Care Authority
Description	Under this master contract, Mathematica is working with a partner firm to produce health technology assessments for the Washington State Health Care Authority. Analyses undertaken as a part of this work could include cost-effectiveness analyses, analysis of Agency data, meta-analysis of individual studies, or consideration of specific issues related to a unique patient population or social or cultural situation.