Centers for
Medicare & Medicaid Services
Research Agenda
William Saunders
Deputy Director
Office of Research, Development, and Information
June 27, 2005
1
Today’s Objective

Describe:
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Outlook for CMS FY2006 research budget
in 2006
Factors that are driving our research
agenda
Research themes and planned projects
2
Value of Health Services
Research


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
A microscope and a telescope.
Looks backward and forward.
Identifies problems, and develops and tests solutions.
Translates findings into useful information for clinical,
management and policy decisions.
3
Activities Supported by the
CMS Research Budget
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Research studies to design, monitor and refine programs
Development, implementation and evaluation of
demonstrations to test innovations
Program evaluations of various aspects of current CMS
programs
The Medicare Current Beneficiary Survey
Grant programs to foster capacity-building or innovation in
State programs.
Support for external researchers using CMS data through
the Research Data Assistance Center (ResDAC)
4
Examples of Past CMS
Research Contributions
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Prospective payment systems
Medicaid Home and community-based
services programs, State reforms
New Medicare benefits
Managed care systems
5
CMS’s Research Budget
Over Time
$160
$140
$120
$100
$80
$60
$40
$20
$0
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
*
Appropriation (millions)
CMS's RD&E Budget
Total
Basic RD&E
MMA
Fiscal year
6
RD&E, FY03 - FY06
FY 2003
Total
FY 2004
FY 2005
($ Millions)
Pres. Budget
FY 2006
$73.7
$77.8
$77.5
$45.2
5.7
11.2
9.8
0.0
39.7
39.5
39.7
0.0
6.0
5.9
2.9
0.0
. . . .MCBS
9.3
12.8
12.9
13.6
. . . .Mandates
4.8
4.0
6.7
5.1
. . . .Discretionary
8.2
4.4
5.5
6.8
**
**
19.7
. .Earmarks
. .Real Choice Grants
. .New Freedom Grants
. .Basic RD&E
. . . .MMA
7
How Research Agendas are
Formulated
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Intelligent design
Evolution
Chaos theory
8
Drivers of the CMS’ R&D
Agenda
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Laws
Executive Orders
Administration and HHS Initiatives
CMS Administrator priorities
CMS component ideas or needs for
information / analyses
Interests of the broader health research
community
9
Major Elements in President’s
FY06 CMS Research Budget

Medicare Current
Beneficiary Survey

MMA Mandates

New Initiatives
10
CMS’ Research Themes
1)
2)
3)
4)
5)
6)
7)
8)
Monitoring & Evaluating CMS Programs
Strengthening Medicaid, SCHIP & State programs
Beneficiary Choices & Managed Care Options
Developing FFS Payment & Delivery Systems
Improving Outcomes, Quality & Performance
Improving Health of our Beneficiaries
Implementing Medicare prescription drug benefit
Building Research Capacity
11
Monitor & Evaluate CMS
Programs
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Evaluations of the new MA and Part D
programs
Study of specialty hospitals (MMA s.
507)
Review of physician practice expense
geographic adjustment data (MMA s.
605)
12
Strengthen Medicaid, SCHIP,
& other State Programs
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Continue demonstrations in Minnesota,
Wisconsin, and Massachusetts to provide
improved coordination of Medicare and Medicaid
services for dual eligible beneficiaries
Medicaid data
Impact of Part D on dual eligibles
13
Expand Choices and
Managed Care Options
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Continue development and refining of risk
adjustment methodologies, particularly for
specialty plans.
Conduct disease management
demonstrations testing capitated payment for
ESRD
MMA-mandated evaluations of the impacts of
the new Medicare Advantage program and
specialty plans
14
Develop FFS Payment and
Service Delivery Systems
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Continue to refine PPS for SNF, HHAs, IRFs, LTCHs, psych
facilities, etc.
Evaluate the new Medicare competitive acquisition system for
durable medical equipment (MMA s. 302)
Implement MMA demos:
 bundled case-mix adjusted payment system for ESRD
services (MMAs. 623e)
 competitive bidding for clinical laboratory services (ORDI)
(MMA s. 302)
 chiropractic services (651)
 expanded definition of homebound for home health
services (702)
 provision of adult day care services by HHAs (703)
15
Improve Quality &
Performance
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Conduct pay for performance demonstrations
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Physician Group Practice Demonstration
Premier hospital demonstration, which will provide
bonus payments for health care providers that
achieve specified performance standards
DOQIT / Care Management Performance Demo
(MMA s. 649)
Develop & test new P4P approaches
Conduct Health Care Quality Demonstration
(MMA s. 646)
16
Improving Health of our
Beneficiary Populations
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BIPA Cancer Prevention & Treatment
Demonstration
Conduct fee-for-service disease management
demonstrations for selected populations with
conditions such as diabetes and congestive
heart failure
Evaluate the Chronic Care Improvement
program (MMA s. 721)
17
Implement the Medicare
Prescription Drug Benefit

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Analyses Of Medicaid Prescription Drug
Programs And Data
Evaluations of Medicare Replacement Drug
Demonstration
Research To Help Implement Medicare Part D
Planning To Evaluate Part D
Future Research with Medicare Drug Data
18
Building Research
Capacity
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HBCU and Hispanic Grant Programs
MCBS
Produce data set(s) to facilitate health
research

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chronically ill Medicare beneficiaries (MMA
s. 723)
Medicaid Analytic eXtract files (MAX)
Research Data Assistance Center
19
New R&D Task Order Contracts
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
Medicare and
Medicaid Research
and Demonstrations
task order contracts
(MRAD)
Small business R&D
task order contracts
(XRAD)
20
For More Information
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Medicare Demonstrations:
http://www.cms.hhs.gov/researchers/demos/
CMS Chart books and Chart Series:
http://www.cms.hhs.gov/charts/default.asp
Research reports and results:
http://www.cms.hhs.gov/researchers/projects/default.asp
Medicare and Medicaid statistics:
http://www.cms.hhs.gov/researchers/statsdata.asp
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Questions?

“If we knew what it was we were doing,
it would not be called research, would
it?” Albert Einstein
22