Health Care Utilization, Quality, and Care Improvement

Using its expertise in the analysis of Medicare administrative data, ARC routinely assists its clients in the review of utilization and cost patterns and the potential and realized impacts of program policy changes, research demonstrations, or other interventions and models. These projects generally aim to improve quality of care, improve patient health, and reduce medical expenditures. Some recent initiatives include:

  • Reducing hospital readmissions for frail elderly patients
  • Improving primary care through care management, utilization of health IT, and stratification of patients based on risk
  • Increasing scores on quality measures prescribed by the National Quality Forum

In such enterprises, ARC assists in defining the population, estimating savings, calculating payments, and identifying quality improvements. As a resultĀ of this work, ARC staff have developed a deep understanding of CMS administrative data sets including Medicare claims data and denominators, the Enrollment Database (EDB), and the Medicaid Statistical Information System (MSIS). These data have been used for a variety of purposes, including developing analytic files to determine the impact of improving health IT systems, evaluating various Health Care Innovation Awards (HCIA) to determine the impact on high cost/high risk beneficiaries, and grouping claims to determine the costs of various health care episodes. We have used these and other data in a variety of environments, including the Chronic Conditions Data Warehouse (CCW) Virtual Research Data Center and the CMS Integrated Data Repository (IDR).