A public resource designed to bring together high-value datasets, tools, and applications using data about health and health care to support your need for better knowledge and to help you to solve problems. These datasets and tools have been gathered from agencies across the Federal government with the goal of improving health for all Americans.
The CMS Office of Information Products and Data Analytics produces an annual CMS Data Compendium to provide key statistics about CMS programs and national health care expenditures. The CMS Data Compendium contains historic, current, and projected data on Medicare enrollment and Medicaid recipients, expenditures, and utilization. Data pertaining to budget, administrative and operating costs, individual income, financing, and health care providers and suppliers are also included. National health expenditure data not specific to the Medicare or Medicaid programs is also included making the CMS Data Compendium one of the most comprehensive sources of information available on U.S. health care finance. This CMS report is published annually in electronic form and is available for each year from 2002 through present.
Reports from the Centers for Medicare & Medicaid Services sponsored research available on a broad range of health care issues. Recent documents include: 2nd Report to Congress on the Evaluation of Cancer Prevention and Treatment for Ethnic and Racial Minorities; A Comparison of the Explanatory Power of Two Approaches to the Prediction of Post Acute Care Resources Use; A Comparison of the PACE Capitation Rates to Projected Costs in the First Year of Enrollment; A Study of Charge Compression in Calculating DRG Relative Weights.
Section 4108 of the Affordable Care Act mandated the creation of the Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program for States to develop evidence-based prevention programs that provide incentives to Medicaid beneficiaries to participate in and complete the MIPCD program. Ten states were awarded demonstration grants to implement chronic disease prevention approaches for their Medicaid enrollees to test the use of incentives to encourage behavior change. Consistent with the requirements of Section 4108 of the Affordable Care Act, the Centers for Medicare & Medicaid Services (CMS) awarded a contract to RTI International to conduct an independent, national evaluation of the 10 State programs. This report provides an interim evaluation of the effectiveness of the programs based on information provided by the States through their semi-annual reports and contains a recommendation regarding whether funding for expanding or extending the programs should be extended beyond January 1, 2016.
Congress directed the secretary of the Department of Health and Human Services (HHS) to conduct and evaluate a demonstration on the impacts of providing Medicaid reimbursements to private psychiatric institutions (which are referred to in Medicaid as “institutions for mental disease” (IMDs)) that treat beneficiaries ages 21 to 64 with psychiatric emergency medical conditions (EMCs). The demonstration is testing the extent to which reimbursing these hospitals for inpatient services needed to stabilize a psychiatric EMC, which is generally prohibited under Medicaid statute, improves access to and quality of care for beneficiaries and reduces overall Medicaid costs and utilization. This report presents the initial steps taken to implement the demonstration and is based on limited preliminary information provided by participating states and IMDs.
The Affordable Care Act (the Act), passed in March 2010, contains several provisions relating to prevention under Medicare, Medicaid, and private health insurance coverage. In Section 4202, subsection (b), entitled “Evaluation and Plan for Community-based Prevention and Wellness Programs for Medicare Beneficiaries”, Congress directed the Secretary of Health and Human Services to conduct an evaluation of community-based prevention and wellness programs and to develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries. CMS adopted a multi-phase approach to evaluating the impacts of these programs on Medicare beneficiaries. This report presents the results of the first two phases of CMS’s research, describes CMS’s plans for phase 3 of our ongoing evaluation, and briefly discusses ongoing work to promote wellness and prevention among Medicare beneficiaries.
Racial and ethnic disparities in cancer screening and treatment have been well documented. Minority populations are less likely to receive cancer screening tests than Whites and, as a result, are more likely to be diagnosed with late-stage cancer (Agency for Healthcare Research and Quality [AHRQ], 2004; National Institutes of Health/National Cancer Institute [NIH/NCI], 2001. Racial and ethnic minorities with positive test results are more likely to experience delays in receiving the diagnostic tests needed to confirm cancer diagnoses (Battaglia et al., 2007; Reis et al., 2003. Similarly differences in primary cancer treatment and appropriate adjuvant therapy have been shown to exist between White and minority populations (AHRQ, 2004). Although the ability to pay is one of the explanatory factors, similar disparities have been found among Medicare beneficiaries. To address this problem, Congress mandated that the U.S. Department of Health and Human Services conduct demonstrations aimed at reducing disparities in screening, diagnosis, and treatment of cancer among racial and ethnic minority Medicare-insured beneficiaries (Section 122 of the Medicare, Medicaid, and SCHIP [State Children's Health Insurance Program] Benefits Improvement and Protection Act of 2000).
The Affordable Care Act requires that the Secretary of Health and Human Services submit to Congress a report on the Innovation Center’s activities at least once every other year, beginning in 2012. This report covers activities between January 1, 2011 and October 31, 2012. During that time, the Innovation Center announced 14 initiatives under the authority of section 1115A of the Social Security Act (Appendix 1). Interest in these initiatives has been significant and the level of public and provider engagement has been high. Hundreds of ideas for improvement in care delivery and payment have been shared with the Innovation Center through its web site. One initiative – the Health Care Innovation Awards – received almost 3,000 applications.
The report describes the HAC program, summarizes the findings of the study that RTI International conducted under a contract with the Centers for Medicare & Medicaid Services (CMS), and presents the Secretary’s recommendations. These recommendations include development of additional measures of conditions acquired in a variety of health care settings, in alignment with the National Quality Strategy and Inpatient Quality Reporting Program, and exploration of other payment policies that help reduce the occurrence of these conditions.
The Center for Medicare & Medicaid Innovation (CMS Innovation Center) conducts research to better understand the effects of new payment models on beneficiary health, healthcare and costs. Numerous researchers from academia share this interest, and are presently conducting studies or plan to conduct studies to also learn about new payment models. This page outlines criteria that the CMS Innovation Center will use to determine whether or not the CMS Innovation Center will provide letters in support of research activities conducted by academic research groups.
The Medicaid/CHIP Environmental Scanning and Program Characteristics (ESPC) Final Report describes the first ever compendium developed-the ESPC Database, that contains Medicaid and CHIP program characteristics as well as selected environmental factors available through other publicly available databases for the 50 States and District of Columbia from 2005 onward. Data on program characteristics include information on eligibility, waiver programs, managed care, benefits, reimbursement, expenditures, and other policy topics. In addition, the report provides information on 2 research studies conducted using the ESPC database with MAX data. These studies required information on State-level Medicaid and CHIP program characteristics hence demonstrating the utility of the ESPC database. The ESPC database is available on medicaid.gov.
The Nursing Home Value-Based Purchasing (NHVBP) Demonstration is part of the Centers for Medicare & Medicaid Services’ (CMS) initiative to improve the quality of care for Medicare beneficiaries in nursing homes. The three-year demonstration tested the concept of value-based purchasing in nursing home settings in three states – Arizona, New York and Wisconsin. This report explores whether a performance-based reimbursement system focusing on key quality areas may have improved the quality of nursing home care while maintaining budget neutrality, based on the data available to the evaluation team at the time.
This study aimed to identify the impact of 2010 Part D Medication Therapy Management (MTM) programs on Medicare beneficiaries’ adherence, medication use, drug therapies and resource utilization associated with hospital and emergency room (ER) visits, medications, and costs. Although the same Part D MTM programs serve enrollees with a variety of chronic conditions, this study focused on high-cost, high-risk beneficiaries with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes because these individuals stood to benefit significantly from MTM program interventions. Findings indicate that MTM programs substantially improved medication adherence and quality of prescribing for CHF, COPD and diabetes patients enrolled in 2010, particularly when CMRs were administered. There was a larger improvement in adherence to drug therapy for a chronic condition when that condition was targeted by MTM.
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) in medical home evaluations to identify practice-level “conditions” (e.g., specific practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). This guide provides an overview of the QCA approach and key analytic steps.
The Centers for Medicare & Medicaid Services (CMS) contracted with Research Triangle Institute (RTI) to conduct a study of medical homes that have been recognized by the National Committee for Quality Assurance’s Physician Practice Connections®–Patient-Centered Medical Home™ (PPC-PCMH) Recognition Program. The study analyzed the relationship between medical home attributes and patterns of health care quality, utilization, and cost for Medicare fee-for-service (FFS) beneficiaries receiving their health care services from PCMHs, compared with physician practices that were not NCQA-recognized. As an incentive for participation in the study, RTI developed a “Practice Feedback Report” containing practice-level data on patterns of care, health outcomes, and costs of care for their Medicare FFS patients. The feedback reports were given to the 312 practices that agreed to participate in the study.
Because multiple new initiatives involving shared savings may be operating within a State implementing a managed fee-for-service (MFFS) Financial Alignment Demonstration, the Centers for Medicare & Medicaid Services (CMS) is providing this guidance on how beneficiaries will be aligned with different models for purposes of calculating shared savings. In all of these Medicare fee-for-service initiatives, beneficiaries will continue to have the freedom to receive care from any provider of their choosing.
In the year since opening its doors, the Innovation Center’s work is well underway. It has introduced 16 initiatives (see Table at end of report) involving over 50,000 health care providers that will touch the lives of Medicare and Medicaid beneficiaries in all 50 states and will continue to expand its partnerships and reach in the years to come. These initial efforts are focused on improving patient safety, promoting care that is coordinated across health care settings, investing in primary care transformation, creating new bundled payments for care episodes, and meeting the complex needs of those dually eligible for Medicare and Medicaid.
In accordance with the requirements of the Privacy Act of 1974, CMS established a System of Records titled ‘‘Master Demonstration, Evaluation, and Research Studies (DERS) for the Office of Research, Development and Information (ORDI),’’ System No. 09–70–0591, which may serve as the Master system for all demonstrations, evaluation, and research studies administered by the Center for Medicare & Medicaid Innovation.
With a Medicare budget of approximately $460 billion and serving nearly 46 million beneficiaries, the Centers for Medicare & Medicaid Services (CMS) plays a key role in the overall direction of the health care system. CMS has developed the Innovators’ Guide to Navigating Medicare to assist stakeholders in understanding the processes used to determine coverage, coding, and payment for new technologies under the Medicare fee-for-service program. (Note: this document does not address the provision of the Affordable Care Act)