Cost-Effectiveness

• Comparing cost and benefits of alternatives.

Process

• Approaches to care (e.g., primary care, rehabilitation, prescription drugs) within settings and service types.
• Special care units.
• Identifying best practices and distribution by payment.

Structure

• Staffing issues (e.g., mix,training, communication).
• Ownership (e.g., for-profit/nonprofit, chain/or not, increasing vertical integration).
• Impact of amenities and home environment (on quality of life).

Equity/Access

• Monitoring the distribution of LTC expenditures across payment sources Medicare, Medicaid, private pay).
• Measuring financial burden (e.g., LTC insurance, out-of-pocket costs) relative to income and assets.
• Assessing the impact of growth in assisted living on financial burden source.

Financial and Market Incentives

• Studies of impact of the level and type (prospective vs. retrospective, flat vs. cost-based) of reimbursement on:
  • Patient mix.
  • Quality.
  • Outcomes.
  • Cost.
• Impact of prospective payment on quality and cost.
• Understanding the impact of increasing market competition on health outcomes.
• Understanding barriers to diffusion of new technology.

Consumer Issues

• Improving quality information to consumers (e.g., quality report cards).
• Understanding factors affecting consumers' choice of setting and care.
• Understanding consumers' willingness to pay for higher quality.
• Designing facilities to match housing and LTC needs.

Quality Assurance

• Using outcomes to target facilities.
• Developing ways to monitor quality of life.
• Developing ways to assess the quality of the long-term care system as a whole.

Methodology

Improving Measures

• Characterizing processes of care.
• Characterizing changing facility structures.
• Outcome measurement.
  • Quality of life.
  • Risk adjustment.
  • Matching outcome measures to types of care/setting.
• Measuring patient preferences.
• Measuring private prices and reimbursement.
• Assessing consumer preferences and satisfaction.

Data collection

• Feasibility of linking MDS data to survey data.
• Strategies for screening person at high risk of long-term care use.
• Development of a broad residential care frame.

Forecasting

• Projecting future LTC service needs, demographics, and disabilities.