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FY 2003 Outcome Measures for Measuring Health Care Cost, Use, and Access
Key Outcomes—Cost, Use, and Access, FY '03
- Increase the number partners contributing data to the HCUP databases by 5% above FY 2000 baseline.
Program Outputs Needed to Achieve Expected Results
At the budget level proposed in the President's Budget, AHRQ will maintain funding for Translating Research into Practice grants, HCUP grants and contracts, patient safety and MEPS. At this level, expiring grants are not continued and the dollar amount reduction will be spread across non-patients safety and training grants. At this level AHRQ will:
- Maintain funding for grant and contract commitments supporting the Healthcare Cost and Utilization Project
Indicators AHRQ will use to measure success in this area
- The number of IDSRN finding used by health plans and others
- The number of HCUP journal articles or policy tools which use HCUP data
- The number of HIV research network findings being used by Network providers to improve the delivery of care
2.1.4 Performance Goal: Improving the Quality of Health Care Delivery through Research and Training
Program Description and Context: Research and Training
Today's health environment continues to change rapidly. Consolidation of health plans, movement of patients and providers into managed care settings, efforts to contain rising health care costs, fears that cost containment measures will lower the quality of care, and persistent problems in access to care and health insurance coverage for many Americans are issues of great concern.
Public and private purchasers are experimenting with new, untested financing strategies, organizational arrangements, and delivery approaches. Health plans and providers are seeking to measure and improve the effectiveness and cost-effectiveness of the care they purchase or provide.
Decisionmakers at all levels in the health care system rely on this critical knowledge to inform effective choices. For example:
- Purchasers are looking for value, for high-quality care at a reasonable cost
- Patients and caregivers want to make informed decisions about preventive and other primary care services, treatments, providers, and health care plans.
- Clinicians need information to make the best possible decisions for and with their patients.
- Health plans need information to determine which services to cover.
- Institutional providers (hospitals, groups, and systems of care) need information to make decisions.
- Policymakers need to understand the ramifications of available policy options.
Health services research addresses these issues to provide information to help people make decisions at the clinical, system and policy levels. To ensure there are adequate numbers of highly qualified scholars to address emerging needs in delivery of high-quality health care, AHRQ continues its commitment to support the research education of future leaders in the field through research and institutional training programs. In order to achieve this goal, concerted attention is placed on nurturing the development of a strong, visible, and integrated cadre of health services researchers. Emphasis is given to supporting the education and career development of new investigators through a variety of individual and institutional grant programs. Combining didactic training with experiential research opportunities, these initiatives produce both a cadre of researchers and a body of research that address issues related to the cost and financing of health care, access to health care, quality and outcomes of health care, and the translation of clinical research into health care policy and practice geared toward the provision of effective, safe health care.
Strategies to Improve the Quality of Health Care Delivery through Research and Training
National Research Service Awards (NRSAs)
AHRQ supports 24 U.S. academic institutions that offer advanced training to people with a strong interest in health services research who want to prepare for careers in the organization, provision and financing of health care services. These programs provide tuition support and stipends to highly qualified predoctoral and postdoctoral candidates. The goals of the research education programs are to help ensure that there will be enough well-trained health service researchers to improve quality, assure value for health dollars, and enhance access to services and to equip scholars with the necessary knowledge, skills and experience to conduct research that will meet the evolving needs of patients, providers, health care plans, purchasers, and/or policy-makers.
Dissertation Research Grants
Dissertation research funding is available for students conducting doctoral-level research on some aspect of the health care system. These grant awards are often the first step toward establishing a career in health services research.
Career Development Awards
AHRQ began to support career development activities in FY 2000. These awards, provided to individuals embarking on a research career, allow individuals time and resources to gain experience in carrying out actual research. The intent is to provide transitional support for newly trained investigators in order to launch them on research careers. This program will nurture the next generation of health services researchers. AHRQ supports two career development programs:
Minority Research Infrastructure Support Program (M-RISP)
The Agency is committed to the Department's Initiative to Eliminate Racial and Ethnic Disparities in Health and the complementary Healthy People 2010 Goal to eliminate disparities in health. A critical component in achieving these goals is to expand the nation's health workforce to be more diverse and representative of the racial and ethnic populations in America. This includes bringing needed diversity to the health services research workforce.
In FY 2001, AHRQ launched the Minority Research Infrastructure Support Program (M-RISP). The goals of the M-RISP program are to increase the number of minority health services researchers, and to build capacity for institutions to conduct health services research intended to improve health for racial and ethnic minorities.
Building Research Infrastructure & Capacity Program (BRIC)
In order to build research capacity in States that have not traditionally been involved in health service research, the Building Research Infrastructure & Capacity Program (BRIC), AHRQ has funded four two-year planning grants to pilot test the feasibility of developing a new program to broaden the geographic distribution of AHRQ funding and enhance the competitiveness for research funding of institutions located in States that have a low success rate for grant applications from AHRQ. These grants will stimulate sustainable improvements in capacity and/or multi-disciplinary centers supporting investigators and multiple research projects with a thematic focus.
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FY 2003 Outcome Measures for Measuring Health Care Research and Training
Key Outcomes—Research and Training, FY '03
- Increase the number of minority researchers trained as health services researchers.
- Build research capacity in states that have not traditionally been involved in health services research, by supporting the development of the needed infrastructure;
- Support training programs for junior-level researchers and mid-career scientists to emerging and innovative research methods—Establish Baseline number of programs
- Support training programs that build curricula and foster innovative training approaches.
Program Outputs Needed to Achieve Expected Results
At the budget level requested in the FY 2003 Presidents Budget, AHRQ will be able to maintain only those grant and contract commitments which address translating research into practice, MEPS, HCUP, CAHPS and patient safety. Reductions will be made to ongoing grant and contract commitments in the research and training portfolio, however at the requested budget level AHRQ will:
- Maintain NRSA grants at the level of the NIH set-aside
- Reduce funding to current training programs. The exact amount and form the reductions take will be determined in FY 2002 and final outputs will be conveyed in the Agency's '03 Final Performance Plan.
2.2 Budget Line (2)—Medical Expenditure Panel Surveys (MEPS)
FY 2001: $40,850,000 (Actual - Current Law)
FY 2001: $40,850,000 (Actual - Proposed Law)
FY 2002: $48,500,000 (Appropriation)
FY 2002: $48,500,000 (Current Estimate)
FY 2003: $53,300,000 (Request - Current Law)
FY 2003: $53,300,000 (Request - Proposed Law)
2.2.1: Performance Goal: To provide comprehensive, relevant and timely data on health care use and expenditures for use by public and private sector decision makers and researchers.
22.214.171.124: Strengthen Core MEPS Activities
The Medical Expenditure Panel Survey (MEPS) is designed to continually provide policymakers, health care administrators, businesses, and others with timely, comprehensive information about health care use and costs in the United States, and to improve the accuracy of their economic projections.
MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services and how they are paid for, as well as data on the cost, scope, and breadth of private health insurance held by and available to the U.S. population.
MEPS is unparalleled for the degree of detail in its data, as well as its ability to link data on health services spending and health insurance to the demographic, employment, economic, health status, and other characteristics of survey respondents. Moreover, MEPS is the only national survey that provides a foundation for estimating the impact of changes in sources of payment and insurance coverage on different economic groups or special populations of interest, such as the poor, elderly, families, veterans, the uninsured, and racial and ethnic minorities.
MEPS is designed to help understand how the dramatic growth of managed care, changes in private health insurance, and other dynamics of today's market-driven health care delivery system have affected, and are likely to affect, the kinds, amounts, and costs of health care that Americans use. MEPS also is necessary for projecting who benefits from, and who bears the cost of, changes to existing health policy and the creation of new policies.
AHRQ medical expenditure survey data have been used by:
- The Health Care Financing Administration and other components of the Department of Health and Human Services, the Congressional Budget Office, Office of Management and Budget, Department of the Treasury, Physician Payment Review Commission, Prospective Payment Assessment Commission, and other Federal Government agencies.
- The Heritage Foundation, Lewin-VHI, Urban Institute, RAND Corporation, Project Hope, and other foundations and "think-tanks."
- Health insurance companies, pharmaceutical firms, health care consultants, and other health-related businesses.
- Academic institutions and individual researchers.
MEPS provides answers to hundreds of questions, including:
- How health care use and spending vary among different sectors of the population, such as the elderly, veterans, children, disabled persons, minorities, the poor, and the uninsured.
- How the health insurance of households varies by demographics, employment status and characteristics, geographic locale, and other factors.
MEPS also answers key questions about private health insurance costs and coverage, such as how employers' costs vary by region. The answers to these and other MEPS questions enable Congress, the Federal Government's executive branch, and other public- and private-sector policymakers to:
- Make timely national estimates of individual and family health care use and spending, private and public health insurance coverage, and the availability, costs, and scope of private health insurance among Americans.
- Evaluate the growing impact of managed care and of enrollment in different types of managed care plans.
- Examine the effects of changes in how chronic care and disability are managed and financed.
- Assess the impact of changes in employer-supported health insurance.
- Evaluate the impact of changes in Federal and State health care policies.
- Examine access to and the costs of health care for common diseases and conditions, prescription drug use, and other health care issues.
Strategies to Improve Information Available to Decisionmakers
Household Component (HC)
The HC collects data on approximately 10,000 families and 24,000 individuals across the Nation, drawn from a nationally representative subsample of households that participated in the prior year's NCHS National Health Interview Survey.
The objective is to produce annual estimates for a variety of measures of health status, health insurance coverage, health care use and expenditures, and sources of payment for health services. These data are particularly important because statisticians and researchers use them to generalize to people in the civilian noninstitutionalized population of the United States, as well as to conduct research in which the family is the unit of analysis.
The panel design of the survey, which features several rounds of interviewing covering 2 full calendar years, makes it possible to determine how changes in respondents' health status, income, employment, eligibility for public and private insurance coverage, use of services, and payment for care are related.
Because the data are comparable to those from earlier medical expenditure surveys, it is possible to analyze long-term trends. The information from the Household Component also permits analysts and policymakers to address the health care policy issues facing the Nation in the 21st century.
Medical Provider Component (MPC)
The MPC covers approximately 3,000 hospitals, nearly 17,000 physicians, and 500 home health care providers. Its purpose is to supplement information received from respondents to the MEPS HC. The MPC also collects additional information that can be used to estimate the expenses of people enrolled in health maintenance organizations and other types of managed care plans.
Insurance Component (IC)
The IC consists of two subcomponents, the household sample and the list sample. The household sample collects detailed information on the health insurance held by and offered to respondents to the MEPS HC. The number of employers and union officials interviewed varies from year to year, as the number of respondents in the previous year's HC varies. These data, when linked back to the original household respondent, allow for the analysis of individual behavior and choices made with respect to health care use and spending.
The list sample consists of a sample of approximately 40,000 business establishments and governments throughout the United States. From this survey, national, regional, and State-level estimates (for approximately 40 States each year) can be made of the amount, types, and costs of health insurance available to Americans through their workplace.
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FY 2003 Outcome Measures for Medical Expenditure Panel Survey
Key Outcomes—Medical Expenditure Panel Survey, FY '03
- Provide timely national estimates of health care use and expenditures, private and public health insurance coverage, and the availability, costs and scope of private health insurance benefits among the U.S. population.
- Analyze changes in behavior as a result of market forces or policy changes (and the interaction of both) on health care use, expenditures, and insurance coverage.
- Provide information on access to medical care, quality and satisfaction for the US population and for those with specific conditions, and for important subpopulations.
- Develop cost and savings estimates of proposed changes in policy.
- Identify the impact of changes in policy for key subgroups of the population (i.e., who benefits and who pays more).
Program Outputs Needed to Achieve Expected Results
At the budget level requested in the FY 2003 Presidents Budget, AHRQ will:
- Develop and maintain MEPS-NET
- Conduct 8 MEPS user workshops.
- Expand MEPS list-server participation by 20%.
- Produce 8 Descriptive Data Products (i.e. findings, chartbooks, highlights, or table compendia).
- Update frequently asked question section of MEPS Web site.
- In concert with ULP, develop an IC module for a workshop to promote the use of MEPS-IC data to state policymakers.
- Increase by 15% the number of MEPS-based articles published in peer reviewed journals relative to baseline year (FY 02).
- Determine the feasibility of existing mechanisms to provide off-site access to confidential MEPS data by conducting a review of arrangements other statistical agencies have implemented.
- Expand data center capacity by 10% over FY 02 level.
- Modify MEPS to support annual reporting on quality, health care disparities, and research on long-term care in adults and children with special needs.
Indicators AHRQ Will Use to Measure Success in this Area
- The number of attendees at MEPS user workshops
- The number of policy makers who use MEPS analysis in policy decisions
- Satisfaction ratings of participants in MEPS workshops
- Data Center usage
2.3 Budget line 3—Program Support
FY 2001: $2,500,000 (Actual - Current Law)
FY 2001: $2,587,000 (Actual - Proposed Law)
FY 2002: $2,600,000 (Appropriation)
FY 2002: $2,688,000 (Current Estimate)
FY 2003: $2,700,000 (Request - Current Law)
FY 2003: $2,789,000 (Request - Proposed)
2.3.1: Performance Goal: Maximize the value of AHRQ by developing efficient and responsive business processes, strategic management of human capital by aligning human capital policies and practices with AHRQ's mission, building an integrated and reliable information technology infrastructure
126.96.36.199: Enhance Efforts on Health Outcomes, Quality, Cost, Use and Access
In FY 2000, AHRQ conducted an Agency-wide workforce and workload analysis that identified major Agency work processes and functions, captured data on the competencies of the current workforce and estimated levels of future workforce capacities. In FY 2001, the Agency began following up on the 2000 Study in four areas: 1) a refinement and expansion of Agency work functions and activities that captures more detailed administrative and operational processes; 2) refinement of the staff competencies needed to perform the work of the Agency; 3) review of the Agency's recruitment and selection activities and processes in order to make recommendations for improvement; 4) the development of a multi-year strategy to systematically address the Agency's structure, technology and workforce related issues.
Strategies to Maximize the Value of AHRQ
Developing efficient and responsive business processes
The Agency's five-year workforce restructuring plan, as approved by the Office of the Secretary, focuses on periodic analysis of the manner in which the Agency conducts its work and how well the existing structures, technology, and systems support this work.
- Develop and implement a plan for identifying, obtaining, storing and using programmatic and operations management and performance data to help inform resource allocation decisions.
- Prioritize established work processes and develop a plan to conduct business process reviews. These reviews will be designed to ensure that the following issues are addressed: Are there unnecessary managerial and organizational levels?; Is decision making authority appropriately delegated?; and Do managers have sufficient authority to carry out their responsibilities and manage their programs.
- Initiate a business process review of the AHRQ grants process from conception of a grant announcement to tracking of publications coming from completed grants with the goal being to make this process more effective and efficient.
Strategic Management of Human Capital
In FY 2000, AHRQ conducted an Agency-wide workforce analysis that identified major Agency work processes and functions, captured data on the competencies of the current workforce, and estimated future workforce requirements based on projected workload, retirement, and attrition trends. In FY 2001, the Agency is building on the outcomes of the 2000 Study by continuing to refine their workforce planning tools and conduct additional organizational assessments through four initiatives: 1) development of a more detailed model of the Agency's work that captures the administrative, operational, and programmatic functions and activities; 2) refinement of the core, technical, and leadership competencies needed to perform functions and activities outlined in the model of the Agency's work; 3) review of the Agency's recruitment and selection processes to include recommendations for improvements and; 4) development of a multi-year strategy designed to identify resources, tools, and information needed to meet the changing demands of their work, as well as streamline costs.
The first initiative in FY 2001 involved the development of a detailed model of AHRQ's functions and activities to outline AHRQ's current work. The agency will use this model as an assessment tool for such things as future workload analyses and assessment of gaps in work activities.
In the second initiative, the competencies identified in the Spring 2000 effort are currently being refined and validated to create competency models based on the more detailed functions and activities model. These models will assist the agency in recruiting, selection, training, development, and performance assessment activities.
The third initiative, the recruiting and selection process assessment, benchmarking, and recommendations task, resulted in four primary recommendations for improving AHRQ's processes for recruiting and selecting new employees. These recommendations are currently being evaluated for implementation.
Building an integrated and reliable information technology infrastructure
AHRQ is undertaking a comprehensive review of our business processes and products. This will undoubtedly result in changes in not only how we do our daily work, but also how information flows within the organization. Therefore, we must also redefine our information technology architecture so that not only do we meet requirements multiple statutory requirements, such as GISRA, Clinger-Cohen, but also to ensure that it meets the management and organizational needs of the agency. Evolving technologies, such as Web-based applications, provide opportunities for us to accomplish our work in new, more efficient and timely ways. The IT infrastructure we develop must be adaptable to meet new requirements and while maintaining information security and critical infrastructure protections.
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FY 2003 Outcome Measures for Research Management
Key Outcomes—Research Management
- BPR of grants process, complete with recommendations, will be complete by end of FY 2003
- Succession plans for key Agency leadership roles will be in place by beginning of FY 2004
- AHRQ recruitment and retention plan will be designed to fill gaps identified in the assessment of current Agency workforce competencies
- Conduct a review of AHRQ's FAIR Act Inventory
- Identify and evaluate existing and new technologies to support AHRQ's revised business processes.
Program Outputs to Meet Required Goals
- Establish profile specific competency requirements for each of the agency's key leadership positions
- Define diversity goals and identify sources to target recruiting efforts
- Develop communication strategies for PSC HR and hiring managers that facilitates ongoing identification of staffing needs; consideration of training existing staff or hiring new staff to meet needs; identifying the most effective resources for recruiting the new hires and the timeframes required for obtaining new hires
- Establish criteria to assess success of recruiting and selection efforts
- Complete Business Process Review of AHRQ's grants process and design implementation plan for recommendations
- Identify IT mission critical systems and services, measure current performance and establish systems to monitor ongoing system integrity
Proceed to Appendix 1
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