Long-Term Care Survey: Process, Operational Support, and Analysis

Long-Term Care Survey: Process, Operational Support, and Analysis

Project Overview The Centers for Medicare & Medicaid Services (CMS) developed and tested a new long-term care survey process for nationwide use that will replace the Quality Indicator Survey (QIS), previously used by 27 states and the District of Columbia for nursing home inspections. This project provides support to CMS in the implementation of the[...]

Read More

CMS End-Stage Renal Disease Services Monitoring and Evaluation

Project Overview The Centers for Medicare & Medicaid Services (CMS) implemented the End-State Renal Disease (ESRD) Services Prospective Payment System (PPS) in 2011 and the ESRD Quality Incentive Program (QIP) in 2012 to improve the quality and efficiency of treatment for ESRD, a condition of permanent kidney failure. The most common treatment for ESRD is dialysis. In January[...]

Read More

Evaluation of the Diffusion and Impact of the Chronic Care Management (CCM) Fees

Project Overview In 2015, the Centers for Medicare & Medicaid Services (CMS) issued a new billing code to allow eligible professionals to be reimbursed for chronic care management (CCM) activities. The fee is designed to support primary care through financial investment in care management services. Under the program, eligible professionals can bill CMS and participating[...]

Read More

Evaluation of the Accountable Care Organization (ACO) Investment Model (AIM)

Project Overview This project focuses on evaluating the Accountable Care Organization (ACO) Investment Model (AIM) to assess whether infrastructure funding provided to AIM ACOs results in increased ACO participation in the Medicare Shared Savings Program (MSSP), sustained ACO participation in those programs that were previously MSSPs, and increased willingness by ACOs to accept greater financial[...]

Read More

Evaluation of the Coverage to Care (C2C) Initiative

Project Overview The Centers for Medicare & Medicaid Services launched its From Coverage to Care Initiative (C2C) in 2014 to help the newly insured understand what it means to have health insurance, how to find a provider, and when and where to seek health services. The initiative also aims to educate consumers about the importance[...]

Read More

Consumer Research on Personal Responsibility and Its Relationship to Choice of Coverage and Willingness to Navigate the Health Care System

Project Overview Insight assisted Rolling Thunder Research to conduct this study to explore the relationship between personal responsibility and beneficiary willingness to navigate the health care system. Of interest were 2 research questions: 1) Who do beneficiaries believe is responsible for the outcome of coverage and payment decisions: themselves, the government, or health plans/third-party payors?[...]

Read More

Evaluating a Pilot Mobile Health Program

Project Overview The Centers for Medicare and Medicaid Services (CMS) is supporting a pilot of the mobile health program Text4baby. This pilot aims to assess the effect of Text4baby on enrollment in Medicaid and the Children’s Health Insurance Program (CHIP), as well as on health knowledge, health behaviors, and health care engagement among those who[...]

Read More

Evaluation of the Impact of CMS’s Recovery Audit Contract Initiative on the Medicare Provider Community

Project Overview This 3-year demonstration assessed the effectiveness of using Recovery Audit Contractors (RACs) to identify and recover over- and underpayments made to Medicare providers while also incurring minimal burden on the provider community (e.g., physicians, providers, and suppliers who provide services paid under Medicare). The States of California, New York, and Florida were selected[...]

Read More

Medicare Advantage Risk Adjustment Data Validation / Calculation of Medicare C Composite Payment Error

Project Overview Insight provides statistical support for the Medicare Advantage Risk Adjustment Data Validation (RADV) contract for Medicare Advantage Plans. This involves a wide range of tasks including the development of a sample design and analysis plan and implementation of 3 samples (national, targeted, and random) of continuously enrolled Medicare Advantage enrollees for whom the[...]

Read More