CMS Research Update
Thomas W. Reilly, Ph.D.
g Director
Acting
Office of Research, Development, and Information
June 27, 2010
1
Overview of Today’s Session




Introduction on R&D at CMS
The Center for Medicare & Medicaid
Innovation
Special topic: Design Features of
Accountable Care Organizations
N
New:
M di
Medicare
& Medicaid
M di id
Research Review
2
Introduction on R&D at CMS
3
CMS R&D Niche



Conduct research and evaluations of interest
to the Administration and Congress to
develop, assess, and refine Medicare,
Medicaid and CHIP policies
Medicaid,
Develop, implement, and evaluate
demonstrations to test program innovations
Develop data infrastructure to enhance
research capacity
4
Drivers of the CMS R&D
Agenda



Affordable Care Act
of 2010 (ACA)
Other Administration initiatives/priorities
American Recovery and Reinvestment
Act of 2009 (ARRA)
5
Affordable Care Act
• Center for Medicare & Medicaid
Innovation
• Many mandated
d d demonstrations
d
and
d
reports
p
to Congress
g
• New programs requiring design research
(e g accountable care organizations)
(e.g.,
6
Administration initiatives

Examples:


Multi payer Advanced Primary Care Practice
Multi-payer
Demonstration
Federally Qualified Health Center Advanced
Primary Care Practice Demonstration
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American Recovery and
Reinvestment Act

Develop data infrastructure to support
comparative effectiveness research (CER)




Enhance Medicare data for CER
Enhance Medicaid data for CER
I
Increase
th
the accessibility
ibilit off CMS data
d t through
th
h
public use files
Develop a longer-term strategic plan
8
Data Infrastructure:
The CCW


Includes data for Medicare population (45 million
b
beneficiaries)
fi i i )
Content


Enrollment/eligibility data
Claims data




Medicare
M
di
fee-for-service
f f
i institutional
i tit ti
l claims
l i
(inpatient,
(i
ti t
outpatient, skilled nursing facilities, home health, hospice)
Medicare fee-for-service non-institutional claims
( h i i /
(physician/supplier,
li durable
d bl medical
di l equipment)
i
t)
Medicare prescription drug event data for beneficiaries
enrolled in Part D
Medicaid claims for dual eligibles
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Data Infrastructure:
The CCW

Content, continued

Health assessment data




Minimum Data Set (MDS) – nursing homes
Outcome and Assessment Information Set (OASIS)
– home health
Inpatient Rehabilitation Facility Patient Assessment
Instrument (IRF-PAI)
Flags to identify beneficiaries with 21
selected chronic conditions
10
Data Infrastructure:
The CCW

Our intent is that the CCW will provide
an improved infrastructure to support
comparative effectiveness research



Longitudinal analyses
Linkage across the continuum of care
Large enough to support the study of small
populations and relatively rare events
11
F M
For
More IInformation
f
ti

Medicare demonstrations:
h
http://www.cms.hhs.gov/DemoProjectsEvalRpts/CMS
//
hh
/D
P j
E lR /CMS

Research reports and results:
h
http://www.cms.hhs.gov/Reports/Reports/list.asp
//
hh
/R
/R
/li

Medicare and Medicaid statistics:
http://www.cms.hhs.gov/researchers/statsdata.asp

Research Data Assistance Center (ResDAC):
http://www.resdac.umn.edu
E-mail: resdac@umn.edu
12
Questions for the group

We need to explore and test
innovations to help the Medicare and
Medicaid programs adapt


If you were in our shoes, what research
would you focus on going forward?
What data, if available, would help you
contribute to innovation in the Medicare,
Medicare
Medicaid and CHIP programs?
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My contact Information
Thomas W. Reilly, Ph.D.
Phone: 410
410-786-0631
786 0631
E-mail: Thomas.Reilly2@cms.hhs.gov
y
g
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