Healthcare Economics and Finance

Projects

Current Projects

• Better Payment Policies for Quality of Care: Fostering the Business Case for Quality Phase II – Medicaid Demonstrations – During the first phase of this project the selection process for quality enhancing initiatives that are likely to yield financial payoffs to at least one business entity in the financing and delivery system was developed. During this second phase the actual cash flows, which result from Medicaid managed care organizations and Primary Care Case Management Programs investing in and operating selected quality-enhancing initiatives at carefully chosen demonstration sites across the nation, will be quantified. (Supported by a grant to the Department of Health Policy and Administration, School of Public Health.)

  Principal Investigator: Sandra B. Greene, Dr.P.H.

  Funding Source: Commonwealth Fund

  Total Project Period: 05/04 – 09/07 (extended)
  
  

• Identification of Zip Code Areas Eligible for the Health Professional Shortage Area (HPSA) Bonus Designation – The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003) amended the Social Security Act that provides for bonus payments for physician services provided in geographic Health Professional Shortage Areas (HPSAs) and mandated that CMS pay a new physician scarcity bonus. Beginning in 2005, Medicare carriers began to automatically pay the HPSA bonus for services provided in ZIP codes that fully fell within designated HPSA areas. In addition, they will also pay the bonus based on the inclusion of a modifier for services delivered in certain other areas. CMS must also include the lists of ZIP codes eligible for bonus payments on its web site. To facilitate identification of eligible claims, this project is identifying ZIP codes that correspond to areas where physicians qualify for bonus payments. Two types of ZIP code lists are being produced, those that contain ZIP codes for which the bonus payment should be automatic and those that contain ZIP codes for which the physician may be located within the qualifying HPSA, and so payment is not automatic. In addition, under this contract, files of ZIP codes will be developed that identify those eligible for scarcity bonus payments. Finally, lists of the physician scarcity areas that will gain and lose designated status for 2007 based on the new data as well as a list of how many physicians would be impacted by the changes in each of those areas will be provided.

  Principal Investigator: Rebecca T. Slifkin, M.H.A., Ph.D.

  Funding Source: Centers for Medicare and Medicaid Services

  Total Project Period: 04/06 – 03/11
  
  

• Carolina Cost and Quality Initiative (CCQI) – This is a collaborative partnership between UNC’s School of Public Health and the Cecil G. Sheps Center for Health Services Research to build, maintain and oversee the use of data on health care services provided to North Carolina residents, and to promote the use of these data for research. Data from public and private primary payers populate the patient specific database. Periodic updates from the payers keep the research database current and relevant. All patient identifiers will be encrypted by the data owners prior to submission to the CCQI. This allows the researcher to link line items for the same individual, but no individual can be identified. The mission of the CCQI is to promote population-based research on the incidence and prevalence of disease in insured populations, patterns of utilization, treatment and cost of care in North Carolina with an objective to improve the delivery and quality of care to its residents.  Funding from DMA will be used to support several projects using Medicaid data.

  Principal Investigator: Sandra B. Greene, Dr.P.H.

  Type: Research

  Secondary Program Area: Medical Practice and Prevention

  Funding Source #1: Private Bequest
  Total Project Period: 07/05 – 06/09

  Funding Source #2: UNC-CH School of Public Health (SPH) Dean’s Office
  Total Project Period: 07/05 – 06/09

  Funding Source #3: N.C. Department of Health and Human Services, Division of Medical Assistance (DMA)
  Total Project Period: 07/07 – 06/08 (renewable)
  
  

• Trauma Center Brief Alcohol Treatment and Cost Effectiveness – The prevalence of alcohol use disorders among people hospitalized for trauma far exceeds that in the general population, making trauma centers a promising venue for brief interventions to reduce future alcohol-related harm and related costs. Optimal approaches for such intervention are unclear, but two strategies appear promising: motivational interviewing (MI) and brief physician advice. MI is a general health behavior change counseling method, requiring significant time and training to establish proficiency. A simpler option in a hospital setting after acute injury is brief advice from the trauma surgeon treating the injured patient. The proposed study will evaluate these two different strategies (specialist MI counseling and brief physician advice) and compare them with standard care at a Level I trauma Center using a randomized clinical trial with 375 trauma patients. The overall aim of the study is to determine whether these two distinct models can reduce alcohol use and related harm and costs in trauma patients with alcohol disorders.

  Principal Investigator: Sally C. Stearns, PhD

  Funding Source: National Institute on Alcohol Abuse and Alcoholism (NIAAA0, NIH (subcontract with Loyola University of Chicago)

  Total Project Period: 8/21/06 – 07/31//07 (renewable for three more years)
  
  

• Evaluation of the Nurse Practitioner Initiative at AXIS Healthcare – The objective of the Nurse Practitioner Initiative for AXIS Healthcare is to determine if there is a business case to be made for implementing a new model of intense medical care coordination for Medicaid members in Minnesota with multiple sclerosis (MS) and spinal cord injuries (SPI). Sheps Center staff will evaluate claims data and operating expense data for a group of MS and SPI patients who are managed by two nurse practitioners, as well as a similar group who receive episodic care through their usual source of care. Utilization, health care cost and operating cost measures will be evaluated over a three year period, to determine if there is a business case for the new care management program.

  Principal Investigator: Sandra B. Greene, Dr.P.H.

  Funding Source: AXIS Healthcare

  Total Project Period: 09/06 – 02/08
  
  

• Better Payment Policies for Quality of Care: Fostering the Business Case for Quality (BCO) Phase III – Medicaid Managed Care Initiatives – The objective of this project is to determine if quality pays in Medicaid managed care and to identify the financial misalignments that may deter investments in quality. The UNC evaluation team will analyze claims and financial data from five participating Medicaid sites. Using financial models developed by UNC in BCQ-Phase I, it will be determined whether a return on investment from the site’s quality improvements in asthma and congestive heart failure care management initiatives can be measured.

  Principal Investigator: Sandra B. Greene, Dr.P.H.

  Funding Source: Center for Healthcare Strategies

  Total Project Period: 01/08 – 12/11

   

Recently Completed Projects

• North Carolina State Planning Grant Initiative – The objectives of this initiative are three-fold: 1) to evaluate the existing data and enhance the methods for estimating the numbers of uninsured at the county level, 2) to gain greater understanding of the demographic characteristics and the circumstances of the uninsured, and 3) to engage statewide stakeholders in the discussion of policy alternatives to address the issues associated with a lack of insurance. The work is a collaborative effort of four different agencies and organizations: NC Department of Health and Human Services, NC Department of Insurance, the Sheps Center’s Program on Health Care Economics and Finance, and the NC Institute of Medicine. The final product will be a prioritized list of solutions to move the state forward in its goal to provide health care to all of its residents.

  Principal Investigator: Sandra B. Greene, Dr.P.H.

  Funding Source: Health Resources and Services Administration, USDHHS (subcontract with North Carolina Department of Health and Human Services)

  Total Project Period: 11/04 – 08/06 (extended)