Exploring the Feasibility of a Navajo Nation Medicaid Agency

Exploring the Feasibility of a Navajo Nation Medicaid Agency

by | Last updated Sep 27, 2018 | Published on Sep 13, 2018 | 2018, Econometrica Remembers Pivotal Projects

Econometrica relied on secondary data and site visits to examine several issues.

State Medicaid administration has additional complexity when Tribal lands cross State lines. The Navajo Nation extends across three States, creating challenges for Medicaid beneficiaries and healthcare providers on Navajo lands.

The Navajo Nation advocated for the creation of a Navajo Nation Medicaid agency to reduce this complexity. The Navajo Nation’s boundaries extend across Arizona, New Mexico, and Utah, meaning residents of Navajo lands may be eligible for Medicaid programs in those States, depending on where they live. The Indian Health Care Improvement Act mandated the Secretary of the U.S. Department of Health & Human Services to study the financial and operational implications of the creation of a Medicaid agency for the Navajo Nation, affected States, and the Federal Government.

On the Navajo Nation Feasibility Study, awarded to Econometrica under the Small Business Research and Demonstration (SBRAD) indefinite delivery, indefinite quantity (IDIQ) contract, we assessed the feasibility of establishing a Navajo Nation Medicaid agency.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents. The study also addressed potential models that could serve as a basis for a plan to design, implement, and operate a Navajo Nation Medicaid agency.

A new agency would provide consistent eligibility rules and benefit packages, provider participation and requirements standards, and claims submission processes for all residents of the Navajo Nation. In addition, a Navajo Nation Medicaid agency would be able to tailor Medicaid to increase cultural appropriateness and responsiveness to Navajo traditions, which, in turn, could improve healthcare use, preventive behaviors, and positive health outcomes.

The methodology for the study included analysis of secondary data and site visits. We used data from a variety of sources, including:

  • 2010 Census data.
  • Data from the States of Arizona, New Mexico, and Utah.
  • 2010 Federal Medical Assistance Percentage rates for each State.
  • A Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary report on 2010 spending.
  • Medicaid budgets and program spending for several small population States and U.S. territories.

We also conducted site visits and discussions with Navajo Nation leadership and the state Medicaid agencies of New Mexico, Arizona, and Utah. Through these discussions, we gathered information to structure the cost estimates, develop the assumptions used to produce the estimates, and understand the impact a Navajo Nation Medicaid agency would have on the affected states’ Medicaid systems. CMS used our Final Report on these topics to develop the Report to Congress on the potential costs and implications of a Navajo Nation Medicaid agency.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

The study addressed several issues related to the feasibility of a Navajo Nation Medicaid agency. These included startup requirements and costs, requirements and costs of ongoing operations, cost implications for the Navajo Nation and the Federal Government, legal and regulatory issues, and the impacts on the three States currently serving Navajo Nation residents.

See our report here

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Econometrica Celebrates Its 20th Anniversary With an Auction Benefitting Friendship Place

Econometrica Celebrates Its 20th Anniversary With an Auction Benefitting Friendship Place

by | Last updated Aug 27, 2018 | Published on Jul 17, 2018 | 2018, Social Impact

Our employees marked the joyous occasion by donating to and participating in a silent auction

On June 29, 2018, Econometrica officially turned 20 years old! To celebrate this milestone, we hosted a silent auction. More than 58 Econometrica employees participated in the auction by donating services and goods or bidding on them. Some of the auction services our generous employees donated included Mandarin lessons, personalized Muay Thai boxing lessons, and a friendly statistics tutorial! The auction proved a great way to learn about the hidden talents of our employees. After some high-stakes bidding, we raised $1,396 in less than 1 hour!

All proceeds from the auction went to Friendship Place—a nonprofit dedicated to finding solutions to homelessness in the Washington, DC, metro area. Friendship Place’s mission of helping people find housing and supporting veterans aligns with Econometrica’s own mission and values. Over the past two decades, Econometrica’s Housing and Community Development Group has supported the U.S. Department of Housing and Urban Development by helping public housing authorities fulfill their mission of providing affordable housing to households in need.

This year, Econometrica is marking its 20-year anniversary with monthly celebrations, which have included donating a tree, creating a memory book, and curating a time capsule. Throughout our history, we have been dedicated to helping our community and the wellbeing of citizens whether it is through our health, housing, and transportation projects or by doing community service. We look forward to our future and will continue to work hard to ensure we have happy employees and happy customers!

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

After some high-stakes bidding, we raised $1,396 in less than 1 hour!

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Econometrica Remembers Its Largest Health Evaluation Project

Econometrica Remembers Its Largest Health Evaluation Project

by | Last updated Jul 19, 2018 | Published on Jul 16, 2018 | 2018, Econometrica Remembers Pivotal Projects

Econometrica performed an evaluation on CMS’ BPCI Initiative to redesign incentives for improving acute care

The Evaluation and Monitoring of the Bundled Payments for Care Improvement (BPCI) Model 1 Initiative examined the BPCI model of alternative payment and service delivery in healthcare. This pivotal project was a major multimillion-dollar evaluation effort for Econometrica and is an ongoing example of our corporate capabilities in evaluation.

The Center for Medicare & Medicaid Innovation, under the Centers for Medicare & Medicaid Services, tests different payment and delivery models that may reduce healthcare expenses while preserving or enhancing quality of care. The BPCI 1 Model Initiative provided financial incentives for redesigns to acute care inpatient hospitals that would support the cost and quality goals.

Incentives include discounting payments hospitals receive for care provided to beneficiaries during an inpatient stay and permitting sharing among hospitals of savings incurred with physicians enrolled in the model (i.e., gainsharing). BPCI Model 1 focuses on the acute care inpatient setting, but participating hospitals are at financial risk for increases in both aggregate Medicare Part A and Part B expenditures 30 days after discharge.

Specific goals of the BPCI Model 1 are reducing provider cost-of-care delivery, maintaining or improving quality of care, and decreasing Medicare payments. The Econometrica Team assessed and oversaw the initiative’s impact, cumulating in a series of annual reports, program monitoring and rapid-cycle quarterly reports, and a final project report with a comprehensive evaluation.

Our team combined qualitative, econometric, and statistical methodologies to examine changes in service utilization patterns, patient case mix, incidence of harm, quality of care, key health outcomes of patients, and Medicare expenditures. Specific analytic tasks were selection of comparison hospitals (nonparticipating hospitals with characteristics statistically similar to participating hospitals), grouping hospitals by similar intervention characteristics, and implementing various quasi-experimental analyses.

We contextualized findings with primary data collected from interviews and focus groups of model participants, focusing on participant activities under BPCI Model 1. Based on the data collected, we produced reports to inform CMS that may affect future models and encourage greater success in care redesign. Our work produced a ready-to-use B-CARE tool that incorporates not only the assessment forms, but also the training and support required for projects to be successful. If implemented, the resulting data would support bundled payments for Medicare, producing better and more affordable healthcare.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers, and business development.

Our team combined qualitative, econometric, and statistical methodologies to examine changes in service utilization patterns, patient case mix, incidence of harm, quality of care, key health outcomes of patients, and Medicare expenditures.

Read more about the BPCI Model 1 here.

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Econometrica Made First Foray Into State Exchanges and Modeled Post-Reform State Marketplace Market Dynamics

Econometrica Made First Foray Into State Exchanges and Modeled Post-Reform State Marketplace Market Dynamics

by | Published on Jun 28, 2018 | 2018, Econometrica Remembers Pivotal Projects

Econometrica produced a literature review and diagnosed key challenges in each State to help CMS better serve its customers in State Insurance Marketplaces

What are State Exchanges and why are they important?

In order to increase affordability of health insurance options for individuals and small businesses, the Affordable Care Act made private health insurance available through new competitive private markets (Marketplaces or Exchanges) on January 1, 2014. Marketplaces provide qualified small businesses and individuals with a diverse selection of private plans, and include pertinent information for consumer comparison of plan options. The Exchanges allow individuals, families, and small businesses to shop for health insurance in these Marketplaces. They are available in every State through websites, call centers, and in-person sessions. The Exchanges are essential in helping people find and enroll in affordable health insurance plans with quality medical coverage.

What was the purpose of Econometrica’s Post-Reform State Marketplace Market Dynamics project?

The Centers for Medicare & Medicaid Services (CMS) and the Center for Consumer Information and Insurance Oversight (CCIIO) needed to understand the landscape of the new Marketplaces to better serve the people using them to find coverage. The Econometrica Team was awarded the contract Post-Reform Consumer Landscape Market Analytics and Implementation to analyze market dynamics, which would help accomplish this goal as well as highlight key challenges in each State.

What did we do on the project?

Specifically, we executed projections of the supply, demand, and pricing of health insurance from 2014 to 2016. We also monitored and reported on individual premium rate changes in the State-based Marketplaces from 2013 to 2014. For each challenge we identified, we also evaluated possible solutions and reviewed them with the States.

Our technical work consisted of a literature review, which had several goals:

  • Identify existing models of insurance market assessment.
  • Recognize gaps in the modeling.
  • Fill in those gaps with additional modeling.
  • Integrate existing models with the additional models.
  • Identify and quantify the impact of the challenges to the Marketplace operations.
  • Develop strategies to address the challenges.
  • Lead working groups with the State Marketplaces to discuss challenges and resolutions.
  • Support the Exchange State teams.
  • Update and expand upon analyses of possible solutions to challenges.

The States involved in the working groups included Illinois, Delaware, West Virginia, Arkansas, Minnesota, California, Colorado, New Hampshire, District of Columbia, Oregon, Washington, Idaho, Nevada, and New York. We also led interviews of key stakeholders in State-based Marketplaces and State Partnership Marketplace to better understand their experiences. These results were presented through Microsoft PowerPoint.

What did we gain from the project?

Ultimately, this work allowed CCIIO to manage enrollment and premium expectations for States receiving grant funding. Its impact also provided State Marketplaces with a clearer picture of the sociodemographic composition of their enrollees and identified the enrollees that could be most effectively targeted for outreach. The Econometrica Team produced high-quality products to inform CCIIO and the States, allowing them to better serve their consumers. This was our first foray into the State Exchanges and laid the groundwork for many future projects on them.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers and business development.

The Econometrica Team was awarded the contract Post-Reform Consumer Landscape Market Analytics and Implementation to analyze market dynamics, which would help accomplish this goal as well as highlight key challenges in each State.

Read GAO’s study about CMS’ efforts to establish federally facilitated health insurance exchanges.

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Econometrica’s First Injury Prevention Project Supporting the IHS

Econometrica’s First Injury Prevention Project Supporting the IHS

by | Last updated Jun 14, 2018 | Published on Jun 14, 2018 | 2018, Econometrica Remembers Pivotal Projects

Econometrica created trainings and skill-building activities for injury prevention in American Indian and Alaska Native Tribal groups

Today’s pivotal project focuses on Econometrica’s work with Indian Health Service (IHS). Econometrica strongly supports promoting health equity and was proud to work on the Tribal Injury Prevention Cooperative Agreement Program (TIPCAP).

From 2011 to 2015, IHS awarded a contract to the Econometrica Team for monitoring services for TIPCAP, which grants funds for infrastructure development targeting health disparities in preventing injuries to American Indian and Alaska Native Tribal groups. The team was responsible for overseeing the 33 TIPCAP recipients in several areas of program management across 9 IHS areas.

The Econometrica Team’s role on the project was to supervise program implementation for the 33 grantees and contribute technical work in a culturally effective manner, including tasks such as program planning, development, implementation, and evaluation and reporting. Our team also created trainings and skill-building activities to enhance knowledge sharing capabilities and ensure the longevity of the injury prevention programs.

The team’s other specific responsibilities under this grant included creating and electronically distributing a quarterly TIPCAP newsletter, hosting semiannual conference calls with each TIPCAP grantee, and producing culturally suitable training tools and resources. We also planned and executed several 2-day training workshops, provided continuous training and technical support, and visited with each of the 33 TIPCAP grantees once per year during the contract term.

We gained many technical skills working on this project, including developing TIPCAP Data Online, an online cloud-based system using Epi InfoTM. TIPCAP Data Online is a program evaluation tool used to collect data on seatbelt use and child care seat use. Many grantees are still using products we developed collaboratively even though the contract ended in 2015. Econometrica was honored to work closely with IHS and the TIPCAP grantees to promote injury prevention practices.

About Econometrica:
Founded in 1998, Econometrica is a research and management organization in Bethesda, MD, established to provide public- and private-sector clients with customized program support services. Econometrica works with multiple agencies to provide high-quality, cost-effective analyses, modeling, and economic evaluations. The company consistently receives exceptional scores from its clients and believes in three principles: technical capabilities, happy customers and business development.

From 2011 to 2015, IHS awarded a contract to the Econometrica Team for monitoring services for TIPCAP, which grants funds for infrastructure development targeting health disparities in preventing injuries to American Indian and Alaska Native Tribal groups.

See a sample of a newsletter we helped create!

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