Care Management

Performance Budget Submission for Congressional Justification

Care Management

Long-term Goal: Increase the delivery of evidence-based treatments for acute and chronic conditions, through research and research syntheses; development of tools; identification of effective implementation strategies; and promotion of effective policies.

Data Source: National Health Care Quality Report (NHQR); National Healthcare Disparities Report (NHDR); RFC Healthplan Disparities Collaboratives; Effective Healthcare Program reports.

Data Validation: Measures in the NHQR and NHDR are based on validated surveys conducted by Department of Health & Human Services (HHS) Agencies including the Agency for Healthcare Research and Quality (AHRQ and Centers for Disease Control and Prevention (CDC) and private partners such as the National Committee for Quality Assurance (NCQA).

Cross Reference: SG 1/5; HP2010-3/4/5/12/13/14/16/21/24; 500-Day Plan—Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004.

The long-term goal of the Care Management Portfolio is to improve care and reduce disparities for common chronic conditions such as diabetes, asthma, and heart disease. In 2006, the AHRQ Portfolio Team supported information on effective interventions for practices and health systems to improve care; worked in partnership with health plans and States to improve the care they deliver; and identified changes in the health care system that will make it easier to deliver effective chronic illness care, such as evidence-based decision support, population data management, and support for patient self-management.

In 2006, the NHQR and NHDR reported that care for chronic diseases is improving as some disparities in care are narrowing. At the same time, important gaps in care and disparities in care remain, and some disparities are worsening, especially those affecting for Hispanic patients. Two important AHRQ initiatives continued to mature in 2006. The Health Disparities Collaboratives, involving 9 health plans serving over 73 million members, has developed information on existing disparities within healthplans and has moved plans to developing interventions to address these disparities. An initiative with 6 state Medicaid programs begun in 2005 (with assistance of an additional 2 states as faulty) is adding 6 additional states in 2006 to assist them in their efforts to improve the quality of chronic disease care delivered under primary care case management.

Two new "knowledge translation" initiatives were launched in 2006 to address asthma and diabetes. AHRQ is working with 6 state coalitions to improve asthma care and is working with health systems to improve diabetes care in Latino women. By working with States and plans to develop rigorous evaluations of their efforts, we will help develop new data sources to track improvements in care for diabetes in health plans and public programs. We will release and disseminate two new Best Practices reports on interventions to improve asthma care and interventions to improve care coordination in fall 2006. Under section 1013 of the Medicare Modernization Act, we have released the first three of a series of reports on the comparative effectiveness of different treatments or diagnostic interventions for chronic conditions. Reports on care for depression, diabetes, osteoporosis, and arthritis are scheduled for release by the end of 2006.

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Effectiveness—Data Development

Long-term Goal: Achieve wider access to effective health care services and reduce health care costs.

Data Source: MEPS Web site; HCUP database and Quality Indicators (QI) Project Officers

Data Validation: MEPS Web site; HCUP database and QI Project Officers

Cross Reference: SG-4/5; HP2010-23; 500-Day Plan—Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004
2. New efficiency measure developed FY 2006 for PARTed program

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Effectiveness—Data Development

Long-term Goal: Assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices.

Data Source: HCUP and QI Project Officers; CAHPS®; National CAHPS® Benchmarking Database (NCBD).

Data Validation: Personal communication; Tracking Medicare and Medicaid beneficiaries and NCQA accredited commercial health plan members covered by health plans that use CAHPS®. Prior to placing surveys and related reporting products in the public domain a rigorous development, testing and vetting process with stakeholders is followed. Once, deemed ready, based on scientific evidence and potential user feedback, the tools are released for broad use. Following release of the tools technical assistance is provided to users. The overall process enhances the likely adoption of the tools

Cross Reference: SG-2/3/4/5/6/7/8; HP2010-23; HHS Objectives: Transform the Healthcare System; Advance Medical Research; Emphasize Healthy Living; Prevention of Disease, Illness and Disability.

^*People are in plans that use CAHPS® data.

MEPS—Efficiency

The MEPS is part of AHRQ's Efficiency strategic plan goal area and the Data Development Portfolio. A significant factor that reduces the efficiency of our modern-day health care system is waste caused by systems that do things that don't improve care, processes that could be designed to do things better and systems that fail to do things that would assure more effective treatment. AHRQ's investments include efforts to develop ways to:

1. Measure and report on the efficiency of systems, procedures, and processes.
2. Assess the scope, nature, and impact of waste in health care systems.
3. Design techniques, methods, and technology to improve treatment outcomes and reduce associated costs.

HCUP—Efficiency

The long term goal for efficiency is to achieve wider access to effective health care services and reduce health care costs. HCUP has set a goal that by 2010, at least 5 organizations will use HCUP databases, products or tools to improve health care quality for their constituencies by 5%, as defined by AHRQ Quality Indicators. By increasing the number of organizations using HCUP and the Quality Indicator tools, we support the overall program goal by expanding to add new states that will improve national and regional representation and by expanding the number of Partners that contribute ambulatory surgery and emergency department data. AHRQ added Arkansas to HCUP this year. AHRQ also added two new ambulatory surgery databases (Iowa, Michigan) and two new emergency department databases (Iowa, New Jersey). They were selected based on the diversity—in terms of geographic representation and population ethnicity—they bring to the project, along with data quality performance and their ability to facilitate timely processing of data. Currently, 38 statewide data organizations participate in HCUP.

HCUP—Effectiveness

The long term goal for effectiveness is to assure that providers and consumers/patients use beneficial and timely health care information to make informed decisions/choices. The examples provided below demonstrate the progress made in achieving information dissemination that is being used to implement interventions aimed at making better informed decisions and choices.

2006 Examples of Organizations using HCUP/QIs to assess quality improvement and implement an intervention: 3 new users are the: Employer Health Care Alliance Cooperative of Wisconsin, Florida Agency for Health Care Administration (AHCA); and Massachusetts Department of Health and Human Services.

1. The Employer Health Care Alliance Cooperative of Wisconsin used the AHRQ Quality Indicators to produce a hospital level Quality Report to improve health care quality for its members.
2. The Florida AHCA used the Quality Indicators to produce a publicly reported hospital level Quality Report to improve health care quality.
3. Massachusetts Department of Health and Human Services used the Quality Indicators to produce a publicly reported hospital level Quality Report to improve health care quality.

CAHPS—Effectiveness

The long-term goal is to ensure that providers and consumers/patients use beneficial and timely health care information to make informed choices/decisions. CAHPS® has set a goal of ensuring that patient experience of care data will be more readily available to consumers by 2008 in order to help them make choices among competing providers in the marketplace on the basis of quality. By moving to create surveys for a range of providers beyond the widely used CAHPS® health plan surveys, including hospitals, nursing homes, and dialysis facilities, CAHPS® is rapidly expanding the capacity to collect data that can be utilized to make more informed choices by the purchasers who contract with and the consumers who visit these providers.

The CAHPS® program also directly addresses patient-centeredness, one of the six aims for the health care system espoused by the Institute of Medicine in its 2001 report, Crossing the Quality Chasm. Data generated by the implementation of CAHPS® surveys by the Medicare and Medicaid programs, NCQA accredited commercial health plans, and states populates several of the measures included in the annual National Healthcare Quality and Disparity Reports, mandated by Congress. In addition, Medicare and other CAHPS® sponsors regularly produce public reports of CAHPS® data. AHRQ is working with the Centers for Medicare & Medicaid Services (CMS) in the design of the Web site on which HCAHPS data will be published. It is also working with a number of states to collect HCAHPS data and make it available for a variety of audiences including consumers, hospitals, health plans and employers. AHRQ also continues to work with Medicaid agencies to collect CAHPS® Health Plan data, prepare benchmarks and make the data available to a variety of audiences.

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Cost, Organization, and Socio-Economics

Long-term Goal: By 2010, in at least 5 cases, public or private health care policymakers and decisionmakers will have used AHRQ findings or tools in the area of:

Data Source: Publications, intramural plans for the Center for Financing, Access and Cost Trends (CFACT) and Center for Delivery, Organization, and Markets (CDOM), grants management tracking of funded projects, and tracking of all deliverables by the Integrated Delivery System Research Network (IDSRN) project officer.

Data Validation: The CFACT and CDOM intramural plans are maintained and reviewed by senior staff. Grants are monitored by project staff, and the IDSRN has a senior project officer.

Cross Reference: SG-1/5; HP2010-17; 500-Day Plan–Transform the Healthcare System; Advance Medical Research

1. New measure developed FY 2004

The Cost, Organization and Socio-Economics Portfolio implements particular sections of AHRQ's reauthorizing legislation, most particularly those that relate to:

• Research on health care costs, efficiency, utilization, and access.
• The ways in which health care services are organized, delivered, and financed and the interaction and impact of these factors on the quality of patient care.
• Health care productivity, efficiency, and market forces.
• Analyses of MEPS and HCUP.

The mission of the portfolio is to provide public and private policymakers with the information they need to make improvements in the organization and financing of the U.S. health care system. Research conducted and supported by AHRQ has been used in the development and implementation of numerous public and private initiatives in recent years, including the design and implementation of the State Children's Health Insurance Program (SCHIP) program, estimates of the impact of the Medicare Modernization Act on health care costs, state initiatives to address the problems of the uninsured, and private efforts to incorporate quality measures into payment schemes. AHRQ will continue to develop and disseminate this type of critical information for policymakers in 2007.

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Training

Long-term Goal: By 2010, enhance capacity to conduct and translate HSR by:

Data Source: IMPAC II

Data Validation: AHRQ budget data management system used to keep annual track of spending relative to budget allotment

Cross Reference: SG-1/5; HP2010-23; 500-Day Plan–Advance Medical Research

1. New measure developed FY 2004

The Training Portfolio's mission is to continue to foster the growth, dissemination, and translation of the field and science of Health Services Research to achieve AHRQ's mission and address Departmental priorities geared toward the transformation of health care. Special attention will be paid to:

• Individuals: Foster the growth of the next generation of researchers and knowledgeable users or research.
• Diversity: Foster the institutional and individual diversity in the field of health services research.
• Science: Foster the development of an integrated science of health services research and refine its foundation.

Throughout its research training portfolio, AHRQ seeks to address its three main research goals, focusing on enhancing efficiency, patient quality/safety, and effectiveness, as well as addressing AHRQ's priority populations.

New activities in developing the science of HSR were launched in FY 2005 with the completion of a feasibility study and related conference on the development of core competencies for doctoral training. FY 2006 activities in this area continued to impact this portfolio goal by broadly disseminating findings from the conference, soliciting feedback from key stakeholders and developing a plan to further refine and garner support for adoption of core competencies across training programs that educate and grow the next generation of health services researchers. The core competencies emphasize evolving needs in health service research, in conjunction with traditional emphases placed on interdisciplinary training, and intense exposure to sophisticated research design and analytic method and knowledge of the health care system and health policy. Included among the evolving needs are translating research into practice and policy and the ability to communicate research results to scientists as well as users of research (e.g., policy makers, clinicians, consumers, payors). It is anticipated that these core competencies will then be used by programs as they develop learning objectives and future curricula and by AHRQ as it prepares to design responsive, applied future initiatives in training.

FY 2007 and FY 2008 activities are expected to build on activities begun in FY 2006 to find ways to integrate quality improvement into research training. A series of conversations with training program directors in FY 2006 will lead to concrete next steps to be undertaken, including such projects as: sharing of curricula and resources, development of theoretical and methodological papers to advance the science of quality improvement, and the formation of partnerships between academia and users of research such as Quality Improvement Organizations (QIOs), HCUP partners, and health plans.

Grants awards in FY 2006 that related to the goal of increasing diversity included four new awards to increase the geographic diversity of states conducting health services research and three new awards to institutions serving predominantly minority populations. These grants were awarded to institutions in Arkansas, Georgia, Nebraska, North Dakota, North Carolina, Texas, and West Virginia. In addition, approximately three more new awards may be made in these programs in FY 2006 commensurate with grant budget. Projects supported through the programs address Departmental and Agency priorities including use of hand-held information technologies to support primary care decisionmaking, reductions in health disparities, and pharmaceutical outcomes research. All focus upon priority populations, including rural and frontier health care, disparities, and aging and long-term care. Plans are under development to launch an evaluation of these programs beginning in FY 2007. A revised program announcement is planned for FY 2008.

It is anticipated that in FY 2007 and FY 2008, AHRQ will continue to support new career development and research infrastructure grants to emerging institutions, which will further the mission of AHRQ by focusing on key priorities such as patient safety, health care quality, management of multiple chronic conditions and translating research into policy and practice as well as on new research foci as they emerge. New, highly targeted announcements, specifically tailored to AHRQ's evolving agenda, will be issued in FY 2007, in conjunction with the development of highly targeted dissertation and fellowship announcements.

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