Health Policy

Acumen, LLC conducts research and provides technical assistance on a variety of health policy issues, including health insurance coverage for indigent populations, the provision and financing of health care services, the role of safety net providers in delivering care, and ways to assess and improve the quality of care.  Our health policy research encompasses a wide range of analytical and evaluative approaches, from the examination of large claims data for government health insurance programs to the collection of information through employee surveys on preferences for employer-provided health care benefits.

Acumen, LLC also provides an array of pharmaceutical program research and forecasting services to clients.

For details, please see the Health Policy - Pharmaceuticals section.

Current and Recent Projects

Monitoring Drug Safety

Acumen is developing new methods to assess safety of drugs that have passed clinical trials and are currently in use in patient populations. Since the actual administration of prescription drugs commonly differs from the ideal settings and populations used in clinical trials, we are applying non-experimental modeling methods to identify whether adverse events result as a consequence of prescription drug use. These non-experimental methods are widely used in economics and are effective in controlling for patient characteristics and health history to evaluate treatment impacts in the absence of random assignments. We are pioneering the use of these methods in drug safety applications. Because it tracks the real effects of prescription drug utilization in health care provision, this approach has a number of advantages that complement traditional clinical trials, including

Identifying Risk Factors for People with Developmental Disabilities

Acumen provides risk assessment and mitigation services to the Department of Developmental Services as part of its Home and Community-Based Services (HCBS) waiver from CMS. In particular, we assist the department in identifying characteristics associated with and trends in the occurrence of adverse events, including mortality, abuse, neglect, injury, unplanned hospitalization and episodes where clients become missing persons or victims of crime. Acumen works directly with DDS and with 21 regional centers responsible for coordinating services for clients. Our work in this project has provided a set of evidence-based data tools to guide regional centers’ work in mitigating risks for their clients. Key ongoing activities include: using prescription drug claims to identify potentially harmful drug interactions; evaluating the effectiveness of special projects to reduce involuntary psychiatric admissions; assessing mortality rates relative to other populations and investigating cases with unexpectedly high mortality rates; and tracking unexpected jumps in adverse events and assisting regional centers in addressing problems. In addition to data analysis, we run the DDSSafety.net website, publish a quarterly newsletter to educate clients and care providers about various health and safety topics, and provide training and technical assistance.

• Project Name: Risk Assessment and Mitigation, California Department of Developmental Services
• Client: California Department of Development Services

Adjusting Medicare Physician Payments to Account for Geographic Differences

Acumen is currently working to provide the mandated three year update of the Medicare Physician Fee Schedule Geographic Practice Expense Index (GPCI) for FY 2008. The GPCIs measure area resource cost differences in physician work, practice expenses (employee wages, rents, equipment, supplies, etc) and malpractice insurance. Updating the 2008 GPCIs will involve collecting and evaluating the most recent malpractice premium data and the most recent HUD Fair Market Rent data.

• Project Name: Update of the Medicare Physician Fee Schedule Geographic Practice Expense Index
• Client: Centers for Medicare and Medicaid Services

Ensuring Quality of Data on Prescription Drug Prices for Medicare Recipients Selecting Drug Plans

Acumen is providing quality assurance services to the Centers for Medicare and Medicaid Services (CMS) on the four data files that underlie the Plan Finder tool for Medicare Part D – the Beneficiary Cost File, the Formulary File, the Pharmacy Cost File and the Pricing File. Acumen is also working with CMS to document how negotiated drug prices facing Part D beneficiaries compare to retail (cash and third party), average wholesale price, and mail order prices.

• Project Name: CMS Plan Finder Quality Assurance and Analysis Support
• Client: Centers for Medicare and Medicaid Services

Investigating Geographic Variation in Drug Utilization and Prices

Acumen will be one of the first organizations with access to drug utilization and price data from Medicare prescription drug claims, as the contractor selected to draft a report to Congress mandated under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). We will use the Part D claims data to develop indices of drug price and utilization to assess the extent of regional variation, both the overall differences and trends in prices and utilization. We will also create baskets of drugs that are representative of those taken by beneficiaries with certain health profiles of particular interest to policy makers. This will allow us to develop a detailed picture of the sources of variation in price and utilization. This analysis will allow CMS to determine what changes, if any, need to be made to the current risk adjustment model to better predict the true cost of providing drug benefits to beneficiaries. It will also provide a means for determining the effectiveness of the Part D program at managing drug costs, one of the primary goals of the program.

• Project Name: Geographic Variation in RX Drug Spending
• Client: Centers for Medicare and Medicaid Services

Forecasting Federal Pharmaceutical Expenditures for HIV

Appropriations for the Ryan White Care Act (RWCA) have increased steadily from approximately $200 million in 1991 to almost $2 billion in 2002. This increase stems from a number of factors, including increased client enrollment, the increased number and price of approved antiretroviral agents (ARVs), and the prolonged survival of RWCA clients through more successful management of HIV/AIDS. In this project, Acumen, LLC is assisting the Health Resources and Services Administration (HRSA) in developing models to estimate national resource needs for HIV/AIDS pharmaceuticals provided by ADAPs. Our research plan also involves (1) assessing the usefulness of potential data sources for forecasting HIV/AIDS expenditures, (2) testing and validating our forecasting model, (3) developing a computer software interface, (4) making our model accessible to non-technical users and easily modifiable, and (5) creating training materials and curriculum. The results of this project will assist HRSA in its discussion with the federal agencies (e.g., Office of Management and Budget) concerning level of future funding of ADAPs.

• Client: U.S. Department of Health and Human Services, Health Resources and Services Administration

Evaluating Episode Grouper Software for Pay for Performance

CMS is seeking improved strategies to encourage cost effective health care delivery in Medicare through “pay for performance” approaches. Acumen has been selected to provide analytical support to identify tools to use Medicare claims to compare the efficiency of different providers. Our initial work has involved evaluating software that groups claims into episodes of care as a measure of care provision. Such “episode grouper” software is used to rank physicians who provide care for similar types of health events (stroke, diabetes, hip fracture, etc.) We are now assessing the risk adjustments used in these software packages to account for differences in patient mix and the stability of provider rankings. We are currently negotiating with CMS on an expanded scope for this project, since the Secretary of Health and Human Services would like to incorporate episode groupers or other pay for performance measures into Medicare as early as 2008.

• Client: Centers for Medicare and Medicaid Services