Health Policy

Acumen’s work gives policymakers current, accurate information to ensure publicly funded programs provide health care as efficiently as possible. To achieve this goal, Acumen applies the latest quantitative methods to a variety of datasets, such as detailed Medicare claims data or survey responses. Acumen, LLC conducts research and provides technical assistance on a variety of health policy issues, including:

Health insurance coverage of indigent populations
Provision and financing of health care services
Role of safety net providers in delivering care
Metrics development to assess and improve health care quality
Drug Safety

Current and Recent Projects

Project List
  1. Monitoring Drug Safety
  2. Identifying Risk Factors for People with Developmental Disabilities
  3. Adjusting Medicare Physician Payments to Account for Geographic Differences
  4. Ensuring Data Quality on Prescription Drug Prices for Medicare Recipients
  5. Investigating Geographic Variation in Drug Utilization and Prices
  6. Investigating Various Part D Performance Measures
  7. Forecasting Federal Pharmaceutical Expenditures for HIV
  8. Episode Grouper Software for Pay for Performance
  9. Validating Part C and Part D Payment
  10. Antiretroviral Utilization and Clinical Outcomes among US Veterans Infected with HIV-1
  11. HRSA AIDS Drug Assistance Program Forecasting

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Monitoring Drug Safety

Acumen is developing new methods to assess safety of drugs that have passed clinical trials and drugs that 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, Acumen applies 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. Acumen is pioneering the use of these methods in drug safety applications. Because our non-experimental method 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: access to very large sample sizes (such as all Medicare patients), the ability to estimate differential effects among patients with different characteristics, and the ability to estimate effects in less controlled environments.

  • Project Name: Development for Patient Safety: Pilot Studies Using Medicare Part B Drug Data (AHRQ DEcIDE Center)
  • Client: Agency for Healthcare Research and Quality

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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 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

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Adjusting Medicare Physician Payments to Account for Geographic Differences

Acumen is currently in the process of updating the resource-based Malpractice Relative Value Units (MP RVUs), through a process involving data collection, entry and programming. In a similar process, Acumen will also complete the Sixth Update of the Geographic Practice Cost Indices (GPCIs). Both the MP RVU and GPCI are determinants of the fees paid to health care providers who treat patients insured under Medicare. Specifically, MP RVUs measure differences in insurance-related expenses, and the GPCIs measure area resource cost differences in physician work, practice expenses (employee wages, rents, equipment, supplies, etc.), and malpractice insurance for different regions throughout the country. To update the MP RVUs, Acumen conducted a thorough search for medical malpractice liability insurance rates for physician specialties at the state level, and has coded this underlying data into CPT (procedure) level risk factors and RVUs. For the GPCI update, Acumen will use data from the Census, HUD, malpractice insurance premiums and other sources to recalculate the Practice Expense, Physician Work and Malpractice GPCIs.

Acumen has also examined alternative methods for aggregating county-level Geographic Practice Expense Index (GPCIs) into a regional or “locality” level measure, calculating locality GPCIs by combining the GPCIs of all counties in each locality. Beginning with a multitude of alternative methods for determining locality configurations, Acumen vetted the scenarios down to four. Acumen then analyzed and compared the impacts of these choice alternatives in a report for CMS titled Review of Alternative GPCI Payment Locality Structures. This analysis included detailed and visually appealing impact maps that compare each alternative against the current “baseline” scenario and a comparison of the four scenarios based both on conceptual differences and the magnitude and distribution of their impacts.

  • Project Name: Medicare Physician Fee Schedule-
    1) Geographic Practice Cost Indices
    2) Review of Payment Localities Geographic Practice Cost Indices
    3) Malpractice Relative Value Units and Geographic Practice Cost Indices
  • Client: Centers for Medicare & Medicaid Services

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Ensuring Data Quality on Prescription Drug Prices for Medicare Recipients

Acumen is providing quality assurance services to the Centers for Medicare & 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. The main tasks involved in this project include the quality assurance of submitted plan data files (ensuring that the data meets submission requirements, is consistent with reasonable expectations, and does not deviate drastically from historical patterns) and web-extraction of drug basket and other price data for analysis of the drug basket prices and the prescription drug market. Additionally, Acumen has created a website that enables CMS and Part D contracts to communicate securely to resolve issues regarding drug benefits, pricing, and exceptions.

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

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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 and 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 & Medicaid Services

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Investigating Various Part D Performance Measures

Acumen is one of the few organizations with existing access to and experience working with 100% of the Prescription Drug Event (PDE) data in combination with other Part D data sources such as contract/plan bid data, benefit schedules and formulary information, enrollment data, Medication Therapy Management (MTM) program data, and plan performance data. Moreover, Acumen has developed a database infrastructure for expedited access, validation and update of these data through the monthly PDE files for planned or ad-hoc reporting. Acumen performs a broad set of fast turnaround planned and on-call investigations of various Part D performance measures including: patient safety, patterns in drug utilization, drug pricing and drug tier assignment, administration of Part D benefit program, and health outcomes. For instance, in support of the 2008 Medicare Prescription Drug Benefit Symposium, Acumen produced Part D program statistics on benefit design, enrollment patterns, and the relationship of these characteristics with Part D utilization and costs. In another analysis, Acumen assisted CMS in its deliberation on the public release of PDE claims data, specifically around the issue of protecting the identity of health insurance plans.

  • Project Name: Medicare Part D Claims Analysis
  • Client: Centers for Medicare & Medicaid Services

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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

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Episode Grouper Software for Pay for Performance

Acumen is working to support CMS’s value-based purchasing initiatives in a series of contracts by exploring approaches to evaluating Medicare providers’ cost efficiency based on claims data grouped into episodes of care. Our initial work involved evaluating the functionality of such “episode grouper” software as a measure of care provision. The episode grouper software is used to rank physicians who provide care for similar types of health events (stroke, diabetes, hip fracture, etc.) In a follow-up contract, Acumen created resource efficiency reports for providers with the output from the grouper software evaluation and assessed the usefulness and sensitivity of the reports in rating provider performance. In the current contract, Acumen continues to evaluate the use of episode grouper output for developing measures of physician cost-efficiency by evaluating different methods for risk-adjusting episode costs.

  • Project Name:
    1) Episode Grouper Software Evaluation
    2) Application of Episode Groupers to Medicare
    3) Medicare Grouper Evaluation & Physician Profiling Issues
  • Client: Centers for Medicare & Medicaid Services

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Validating Part C and Part D Payment

Acumen is estimating the level of payment error in both the Part C and Part D Medicare programs. Part C pays for medical and surgical care, and Part D pays for outpatient prescription drug coverage. The Part C payment error analysis focuses on estimating error due to the misreporting of beneficiary diagnoses for risk adjustment calculations. The Part D estimation includes all forms of payment error, including incorrect data used to estimate cost sharing amounts and error within claims processing. Our approach for detecting the presence and the significance of the different types of payment errors from “external data” relies on calculating discrepancies in final Part D payments using original and validated external data, and developing a statistical method for extrapolating findings from the audit process to all Prescription Drug Event (PDE) and direct and indirect remuneration (DIR) data.

Acumen was recently awarded a logical follow-on contract with CMS to continue our work estimating payment error rates for Part C and Part D. It also includes a new task to develop a composite error rate for Part C and Part D payments.

  • Project Name: Part C and Part D Payment Error Analysis
  • Client: Centers for Medicare & Medicaid Services

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Antiretroviral Utilization and Clinical Outcomes among US Veterans Infected with HIV-1

The primary objective of this project is to describe the utilization patterns and outcomes associated with antiretroviral (ARV) therapy among US Veterans infected with HIV-1 during the last 10 years. We also intend to develop data collection and analytic processes that facilitate ongoing monitoring of patterns of care and outcomes. The project relies on the Immunology Case Registry (ICR), an administrative database containing information on the medical experiences of all HIV-infected individuals using services of the Veterans Health Administration (VHA), the largest provider of HIV care in the United States. The database was established in 1992 and contains information on more than 50,000 Veterans. To date, we have completed a comprehensive descriptive analysis of the utilization of ARV therapy by HIV-infected veterans between 1992 and 2003. Currently, we are examining how these treatment patterns are related to clinical outcomes.

  • Funded by: Department of Veterans Affairs

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HRSA AIDS Drug Assistance Program Forecasting

The AIDS Drug Assistance Program (ADAP) is a Federal program funded under the Ryan White Care Act (RWCA) to provide life-saving drugs to low-income AIDS patients. Managed by the Health Resources and Services Administration (HRSA), total appropriations for the program have increased steadily from approximately $200 million in 1991 to almost $2 billion in 2002. Due to the explosive growth in expenditures, HRSA needed guidance developing expenditure forecasts and acquiring in-house forecasting capacity.

Acumen staff designed, estimated, and implemented a framework that models monthly expenditure flows based on HRSA’s administrative data. Using time-series techniques, this model served as the basis for a two-year forecast of annual ADAP expenditures. These results helped shape HRSA's discussion with other federal agencies, including the Office of Management and Budget, concerning future funding levels of ADAPs. The framework was ultimately incorporated into software that enables HRSA staff to easily update the forecast as new data becomes available.

  • Funded by: HRSA HIV/AIDS Bureau