Pharmaceutical Outcomes and Policy Research

The growing use of pharmaceuticals to control many illnesses has prompted increased interest in managing the costs and monitoring the effectiveness of these drugs. Based in our health research division, Mathematica's pharmaceutical research includes studies of prescription drug policy at the state and national level, as well as research that focuses on the outcomes of medication treatment at the individual level. We also study the effects of pharmaceutical policy and treatment within the broader context of health care and other human services.

Prescription Drug Policy

In 2003, Congress passed the Medicare Modernization Act, authorizing the Centers for Medicare & Medicaid Services (CMS) to incorporate a prescription drug benefit into the Medicare program. To understand the potential consequences of the new benefit, we have analyzed access to prescription drugs and spending on them by those who are dually eligible for both Medicare and Medicaid. We have studied the market areas for plans providing Medicare Part D benefits, and we helped to evaluate a demonstration that provided coverage to certain beneficiaries for outpatient drugs and biologicals before creation of Part D. We have helped CMS identify best practices in helping low-income beneficiaries enroll in the Part D program. Mathematica is working with CMS and the Substance Abuse and Mental Health Services Administration (SAMHSA) on several projects looking at prescription drug use in those dually eligible for Medicare and Medicaid with a variety of medical conditions, such as congestive heart failure and mental illness, as well as in various treatment settings, such as community settings and nursing homes. For example, we are conducting a state-to-state comparison of the Minimum Data Set and Medicaid Analytic Extract data to analyze the rates and patterns of inappropriate use of antipsychotic medicines by people in nursing facilities.

Pharmaceutical Outcomes and Comparative Effectiveness Research

Determining whether drug treatments are being administered effectively and efficiently is an important aspect of care. We are working with the Forest Research Institute to analyze medical and pharmacy insurance claims to assess the costs and quality of care for antidepressant treatment. Additionally, in conjunction with Novo Nordisk's National Changing Diabetes Program, we compiled a summary of expenditures on diabetes-related spending, finding that total spending for treatment of diabetes alone represented three percent of the total federal budget in fiscal year 2005. For CMS, we have examined the outcomes of disease management programs and pharmaceutical treatment. We are working with CMS on the Medicare Health Support project, a disease management demonstration that includes more than 200,000 Medicare beneficiaries with diabetes or congestive health failure. For SAMHSA, we are assessing outcomes associated with the Medicaid Psychotropic Drug Management program, a drug utilization program created by Comprehensive Neurosciences, Inc., with funding from several pharmaceutical companies. This program seeks to improve outcomes and reduce costs associated with antipsychotic medications.

Health Care Quality and Quality Measures

Sound quality measurement is the foundation of quality improvement and better outcomes. Mathematica has developed quality measures, designed programs to report quality measures to the public and to providers, evaluated quality measurement programs, and designed and evaluated pay-for-performance (P4P) programs. Highlights of our experience include teaming with the American Medical Association and the National Committee for Quality Assurance to develop and test the quality measures CMS uses in its Physician Quality Reporting Initiative program for ambulatory providers. Many of these measures involve the appropriate administration of medications. We are working with CMS to design a potential P4P payment formula, including methods for validating provider-supplied data, estimating the cost to providers of participating in the program, and accounting for providers who serve disadvantaged populations. We completed an evaluation of the Rewarding Results P4P program and evaluated the Hospital Quality Alliance program to measure and publish hospital process quality measures now appearing on CMS's Hospital Compare website. We teamed with Yale and Harvard Universities and the Colorado Quality Improvement Organization to produce risk-adjusted hospital mortality rates that CMS intends to add to Hospital Compare. These will be the first outcomes quality measures published by the Medicare program in over 15 years.

Understanding the Broader Effects of Health Care

Health care is not delivered in a vacuum; rather, it is just one element in the foundation of our contemporary society. Together with our human services colleagues, staff in Mathematica's health research division understand the linkages between these elements and actively investigate the intersection between them. Our public health research includes studies of the effects of maternal mental health on child abuse and childhood obesity. For the U.S. Department of Education, we have evaluated the effectiveness of Head Start on developmental, educational, employment, and nutrition outcomes. For Novo Nordisk, we have assessed the intersection of nutrition programs and diabetes. We also recognize the importance of publicly supported health services as part of the safety net for those who are most vulnerable. We have conducted a number of large demonstrations for the Social Security Administration (SSA) that seek to improve health services and vocational rehabilitation for those enrolled in SSA's disability programs. In addition, we have assessed the effects of health and mental health on participation in Temporary Assistance for Needy Families and the effectiveness of welfare-to-work initiatives at the federal, state, and local level.

Using Data, Sound Methods, and Innovative Technologies

Building on our extensive policy expertise, we provide high-quality analysis using state-of-the-art statistical and econometric methods appropriate to a broad spectrum of experimental and nonexperimental study designs. Our services range from providing technical assistance to organizations needing immediate help with pressing issues, to estimating long-term impacts of new programs and policies on the people they are intended to serve. In addition to considerable experience with the analysis of large administrative data sets, we are leaders in all aspects of primary data collection and data management. We have a full staff of sampling statisticians, and our survey researchers have designed, piloted, and fielded major surveys such as the National Beneficiary Survey. We maintain a large, fully integrated data collection center with computer-assisted telephone interviewing and expertise for locating hard-to-find respondents. For studies conducted in person, we draw on our network of interviewers nationwide. All of our studies are staffed with the appropriate expertise and experience to interview physicians and people with disabilities and to conduct interviews in a wide range of languages. Our expertise includes all survey modes including mail, email, computer-assisted in-person interviews, audio computer-assisted self-interviewing (ACASI), and telephone ACASI. We are also skilled in conducting case studies, site visits, and focus groups. We develop surveillance and reporting systems for tracking health indicators and providing formative feedback and performance monitoring.

Our experience includes analysis of large-scale insurance databases for Medicaid, the State Children's Health Insurance Program, and Medicare, and we have designed systems so these data can be used easily for research. To examine the needs of dual eligibles, we linked Medicare and Medicaid data on enrollees in 12 states and constructed a linked claims and eligibility database. We also designed a nationwide database of linked Medicaid and Vital Statistics data for the National Center for Health Statistics.

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