Changes in Health Care Financing and
Organization (HCFO)
An Initiative of The Robert Wood Johnson
Foundation
Program Overview
Anne K. Gauthier
Vice President, AcademyHealth
HCFO Program Director
Bonnie J. Austin
HCFO Senior Manager
June 7, 2004
Title here
Overview of Presentation
• Program Purpose and History
• Grantmaking
• Convening and Dissemination
• HCFO website www.hcfo.net
Program Purpose
• Provide public and private decisionmakers with usable and
timely information on health care policy, financing, and
market developments.
• Bring together the policy and research communities through
significant convening, issues identification, research
translation, and communication activities.
• Translate research findings into implications for policy design
and program implementation.
• Listen to decision leaders in order to influence researchers’
questions so their answers may be of greater value.
Program History
•15th Year
•Reauthorized four times since its inception
in 1989
•Last authorized in July 2002 for $15 million
over 3 years
Grantmaking
• As of June 2004, the program has awarded
approximately 220 grants. About 70 are active.
• Approximately 35% of letters of intent are invited to
submit full proposals.
• Approximately 38% of proposals become grants.
• All funded projects place an emphasis on how
current public and private mechanisms for financing
health care, or proposed major changes in those
mechanisms, will affect health care costs, access,
or quality.
Active Grant Funding Levels, 2003
500K+
16%
< 100K
31%
300K-500K
19%
100K - 300K
34%
Portfolio of Active Grants
Technology
3%
Risk and Risk Adjust ment
Access t o Care
Consumer Behavior
4%
6%
7%
Cost s and Cost Cont ainment
Regulat ion
3%
3%
Qualit y of Care
End-of -Lif e Care
7%
3%
Provider Payment and Behavior
3%
Healt h Care Market s
Prescript ion Drugs
7%
3%
Ment al Healt h
Healt h Care Purchasing
4%
3%
Medicare
Healt h Insurance Coverage
10%
12%
Home- and Communit y-Based Care
Medicaid
9%
1%
Managed Care
Long-Term Care
6%
4%
Potential Research Issues in
2004 Call for Proposals
• Evaluations of changes in premium cost-sharing or of
inpatient and outpatient coinsurance and deductibles
• Analyses of the impact of changes in premiums on
employer offerings and consumer choice
• Evaluations of changes in state and private coverage
programs
• Examinations of the impact of cost- or quality-based
payments to providers
Types of Projects
Research and Policy Analysis
- Design and analyze major health care financing strategies and issues
- Examine the effects of financing and organization strategies on costs,
access, quality, and the market
Evaluation and Demonstration
- Assess major strategies and policies already in place
- Test new strategies with the potential to improve access to more affordable
health care
Quantitative
- includes analysis of primary and secondary data sets
Qualitative
- includes case studies, focus groups, and synthetic analyses
Principle Investigator
Disciplines
Public Policy
3%
Public Health
3%
Sociology
6%
Statistics
1%
Urban Planning
1%
Business Administration
1%
Decision Sciences
1%
Political Science
1%
Public Administration
1%
Economics
35%
Medicine
7%
Law
6%
Health Care Financing and
Organization
1%
Health Services Research
9%
Health Services
Administration
4%
Health Policy
16%
Ongoing Solicitation
Call for Proposals 2004 is Active - available on the web
• Larger grants
– projects over $100,000 and/or
– projects longer than 12 months in duration
• Small grants
– projects $100,000 or less and
– projects 12 months or less in duration
Selection Criteria
• Policy Significance of the health care financing mechanism
being evaluated or tested
• Timeliness of the project for informing policy or practice
• Quality and availability of the data to be used and the
strength of the proposed methodology
• Uniqueness of the project
• Applicant’s experiences and qualifications for conducting
the proposed project
Larger Grants Timeline
Submit Brief
Proposal
Invite
Proposal
2 Months
Submit
Proposal
2 Months
Award
Grant
3-4 Months
Brief Proposals are accepted at any time.
Small Grants Timeline
Submit
Proposal
Award
Grant
3-4 Months
Small grant proposals are accepted at
any time.
How to Apply
Technical Assistance
• Provided to Applicants
– Program Office staff are available to respond to telephone, email
and face-to-face inquiries regarding the requirements for
application and the nature of topics that might be considered within
HCFO’s scope.
– Staff frequently advise on scope of project and approach to
research prior to BP submission.
– For invited BPs, critical questions are asked and sources of data
and additional expertise are suggested.
– At the proposal stage, there is a critical methodological review. In
select cases, there is an opportunity for applicants to respond to
reviewers’ questions. In rare cases, applicants are offered the help
of a consultant.
Technical Assistance
• Provided to Grantees
– Monitor progress over the course of the grant, including site visits
– Conduct grantee briefings
– Work with grantees to overcome obstacles (i.e. data collection and
analysis)
– Review papers
– Disseminate findings to policy audiences
Convening
•Policy Conferences foster debate and discussion on policy
relevant topics among key leaders in health policy and
the health care market.
•Mid-Size Dissemination Meetings bring together grantees
with findings on a similar topic and provide them with a
forum to present their findings and receive feedback.
•Small Meetings permit a small number of HCFO grantees
and other experts working on similar topic areas or similar
types of research to advance the field through a facilitateddiscussion format.
Convening
•Cyber Seminars an interactive meeting format in which
participants can listen to HCFO grantee presentations by
phone and watch slides on their computers. The
technology also allows participants to pose questions by
phone or through a computer.
•Grantee Briefings are small, off the record briefings we
hold at our office. Grantees have an opportunity to present
their findings to a group of experts and policy makers in
their topic area, who give candid feedback to the grantees
while they are completing their project.
Convening
HCFO conducts a variety of meetings varying in size and topic. For
example, during the past year we convened:
•Health-Based Risk Adjustment: Payment and Other Innovative
Uses, a working meeting looking at uses of risk assessment tools,
in collaboration with the Kaiser Permanente Institute for Health
Policy.
•Non-Visit-Based Communication: Finding the Appropriate Role and
Payment Tools, a working meeting looking at the practical
application and payment issues surrounding phone and ecommunication.
•Pregnant and Poor: Did Medicaid and Welfare Policy Changes
Improve Care for These Women as Intended?, a cyber seminar
during which two HCFO grantees presented study findings.
Convening
Other meetings we have conducted include:
•Consumer-Driven Health Care: Evidence From the Field, a large
meeting examining current research evaluating the effects of
consumer-driven health care, in collaboration with the
Commonwealth Fund.
•Determinants of Premiums in the Individual Market, a working
meeting looking at how premium prices in the individual insurance
market are set and the factors that influence pricing.
•AHRQ/HCFO Research Synthesis Conference, a small meeting to
develop and refine a methodology for synthesizing policy-relevant
health services research findings, with a focus on Medicare.
Dissemination
• HCFO News and Progress
– Newsletter published twice a year
– Reports on newly funded grants, HCFO meetings, and policy-relevant
topics
• Findings Briefs/Issue Briefs
– Monthly publication (hard copy or web)
– Highlights findings or summarizes key issues raised by HCFO
grantees; targeted to policymakers
• Non-Technical Reports
– On topics such as financing end-of-life care, models of defined
contribution, and the challenges of managed care regulation
• Journals
– HCFO staff periodically publish articles and editorials in peer reviewed
journals, often highlighting the work of grantees and papers presented
at HCFO convening activities.
Web Site: www.hcfo.net
Web Site: www.hcfo.net
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The HCFO program has moved toward more online interaction with our
stakeholders. We have developed strategies to make the web site a userfriendly information clearinghouse and electronic community for
information exchange among HCFO’s core audience of researchers and
policymakers. New features include:
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Hot Topics – a feature linking policy relevant topics to HCFO grantee results,
convening activities, and publications
Searchable Results – including grant findings by topic area, grantee
publications and HCFO publications
Grantee Spotlight – features information about one HCFO grantee and his or
her work
Web Site: www.hcfo.net
Inside HCFO: numbers you always wondered about
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www.hcfo.net/statistics
Program Statistics
Grants by Type of Project
Grants by Topic
Grants by Discipline of the PI
Grants by Post-Degree Experience of the PI
BPs and Small Grants by New/Previous
Applicant/Institution
Grants by Funding Levels
National Advisory Committee
Robert Reischauer, Ph.D., Chair, The Urban Institute
Kathleen Buto, Johnson and Johnson
Robert Crane, Kaiser Permanente
Jose Escarce, M.D., RAND
Marsha Lillie-Blanton, Dr.P.H., Henry J. Kaiser Family Foundation
Harold Luft, Ph.D., University of California, San Francisco
Kathleen Means, Patton Boggs, LLP
Mark Pauly, Ph.D., University of Pennsylvania
Mark Peterson, Ph.D., University of California, Los Angeles
Louis Rossiter, Ph.D., Chironet, LLC
Katherine Swartz, Ph.D., Harvard University
Joseph Thompson, M.D., University of Arkansas
Alan Weil, J.D., The Urban Institute
Designate, Ex Officio, CMS (Stuart Guterman)
Designate, Ex Officio, AHRQ (Michael Hagan)
HCFO Staff
Anne K. Gauthier, Director
Deborah L. Rogal, Deputy Director
Sharon B. Arnold, Senior Research Manager
Bonnie J. Austin, Senior Manager
Laura A. McDaniel, Research Assistant
Robert E. Kornegay, Research Assistant
Sharon D. Ragland, Program Coordinator