Research Priorities at CMS

Just as CMS programs span a wide range of American health care, our research needs cover a broad spectrum of topics, methods, and interests. The current research priorities at CMS fall into eight themes, which shed light on the greatest interests for the Agency as well as the emerging research needs of CMS programs and the American health care system.

Funding for research activities is limited in this era of federal budgetary restraint, particularly for grants or contracts to outside research groups. Those interested in more information about funding opportunities should follow this link.

Find out more about CMS research priorities by scrolling down or by selecting one of the following links.

Theme 1: Monitoring and Evaluating CMS Programs

As the United States health care system continues to change, there is an ongoing need to monitor and evaluate the performance of the programs CMS administers. Beyond traditional measures of performance, like cost containment, quality, health outcomes, and access to care, we attempt to measure various beneficiary-focused attributes, such as knowledge of health behaviors. In our monitoring, we track how well Medicare, Medicaid, and the State Children's Health Insurance Program (SCHIP) meet the needs of specific groups of beneficiaries, including vulnerable populations. Our research also examines more specific policy issues. For example, as Medicare and Medicaid continue to pursue managed care options, we examine the cost-effectiveness and quality of managed care, as well as beneficiary satisfaction. CMS continuously monitors and evaluates the impact of Medicaid, Welfare Reform, SCHIP, and our Beneficiary Information program on beneficiaries. We continue to be custodians of the Nation's public health -- studying regional, geographical and cultural differences in health care, improving monitoring systems for prospective payment systems, developing more detailed information on how many people and what services are covered by Medicaid or SCHIP, and analyzing variations in expenditures across different types of patients and across settings.

Theme 2: Improving Managed Care Payment and Delivery

The Balanced Budget Act of 1997 created the Medicare+Choice (M+C) program, coordinated care plans such as health maintenance organizations (HMOs), preferred provider organizations, and provider-sponsored organizations. Since 1997, CMS has been working continuously to ensure that there is a wide range of high-quality health care options available to Medicare beneficiaries. As part of this effort, we continue to devote significant time and effort to better understanding the M+C program's successes and shortcomings. For example, we are researching favorable selection in enrollment, developing systems for measuring beneficiary risk to refine capitated payments, and conducting demonstrations that test and evaluate the effectiveness of a wide range of capitated health plan arrangements. CMS research and demonstration projects include Medicare capitation demonstrations, Medicare capitation models that integrate acute and long-term care services, refinement and/or development of risk adjustment methodologies, an examination of trends in HMO enrollment, a look at managed care outcomes for selected population, and other aspects of M+C plans.

Theme 3: Improving Fee-For-Service Payment and Delivery

CMS is working to ensure a wide range of high-quality health care options for Medicare beneficiaries. Improving fee-for-service payment and delivery involve activities that support efforts to modernize the program, and exploring how Medicare can adopt successful innovations of private purchasers. We test approaches that provide opportunities and appropriate incentives for coordination of complex care and that reward cost-effective decisions on the part of beneficiaries and providers. CMS projects include: coordinated care models, prospective payment for post-acute care services, payment systems focused on vulnerable populations, implementing and evaluating the durable medical equipment consumer direct purchasing demonstration, aligning hospital and physician incentives by using an all inclusive payment for hospital and physician services, competition-based payment models, bonus payments for health care groups, preferred provider arrangements, evaluating the graduate medical education payment alternative demonstration, assessing the impact of private contracting on beneficiaries and providers, evaluating work and practice expense of physicians, and evaluating rural telemedicine projects.

Theme 4: Future Trends Influencing Our Programs

CMS performs environmental scanning, identifying, evaluating, and reporting emerging trends in health care delivery and financing, and their interactions with Agency programs. Our research and evaluation projects study the effect on beneficiaries, providers, plans, States and other partners and customers. Projects are designed to assess potential improvements, and develop new measurement tools. For example, we identify trends in health care delivery and assess the impact of long-term structural reforms necessary to address major demographic changes in the beneficiary population. Specific projects in this area include examining the demographics of future Medicare beneficiaries and considering the effect of "healthy aging," assessing the effect on quality of life, health and services as beneficiaries move into "deinstitutionalized" settings, assessing long term growth assumptions for health expenditures, identifying the possible impacts of possible eligibility changes and of potential changes in health status, technology, and the marketplace, looking at potential changes in the benefit package (including a prescription drug benefit), and examining how our payment systems affect adoption of new technology.

Theme 5: Strengthening Medicaid, State Children's Health Insurance Program (SCHIP), and State Programs

This effort includes research on ways to improve access to and delivery of health care to the persons served by the Medicaid and State Children's Health Insurance programs and to the uninsured. An important set of projects is the Demonstration to Maintain Independence and Employment, mandated by the Ticket to Work and Work Incentives Improvement Act of 1999. We also continue the Nursing Home Transition Grant program. Other projects in this area include the Medicaid Oral Health Demonstration and the Children's Hospice Care Demonstration, research to identify model approaches, evaluating the effects of the Medicaid coverage expansions for children, the outcome and expenditure effects of preventive services for children, the effects of early intervention for Medicaid children with asthma, Medicaid managed care demonstrations and evaluations, attendant care and personal assistance services, assessing the cost and benefits to the uninsured of Health Insurance Portability and Accountability Act provisions, the costs and benefits to enrollees and taxpayers associated with high-risk pools, examining how associations are treated in the various State insurance reform laws, and the effect that States' laws governing associations have on the more general insurance reform law.

Theme 6: Meeting the Needs of Vulnerable Populations

A special focus of this research area is the demonstration of coordinated care models that integrate the range of services available to persons who are dually eligible for Medicare and Medicaid. Development of a risk adjustment system to support capitated payment for dual eligibles is a key element of this activity. We are implementing and evaluating demonstrations for the dually eligible population, and exploring ways to improve coordination between the Medicare and Medicaid programs.

Theme 7: Outcomes, Quality and Performance

The CMS research, demonstration and evaluation agenda involves the development and testing of improved information resources to enable consumers to choose among health plans and providers based on their relative value and quality. One part of this agenda seeks to better understand how choices are made. The aim is to develop better tools for measuring health care outcomes and quality, as well as the performance of health plans and providers. Projects in this area include; development and assessment of performance measures, developing and testing approaches for selective contracting with providers (institutions and Medicare contracting health plans) based on quality, implementing and evaluating the Medicare lifestyle modification program demonstration, and developing new quality measures, especially for rehabilitation hospitals.

Theme 8: Building Research Capacity

CMS's research budget supports a variety of activities to increase the efficiency of our research and demonstration program and to meet the crosscutting research needs of the wider health research community. These activities include assisting the infrastructure of health services research and providing tools to support CMS's research program. One example is the Medicare Current Beneficiary Survey (MCBS) -- the only comprehensive source of information on the health status, health care use and expenditures, health insurance coverage, and socioeconomic and demographic characteristics of the entire spectrum of Medicare beneficiaries.

Report on Active Research Projects

Researchers Home Page

on the CMS website offers additional information on research-related activities at the Agency, and important links to new developments.