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Clinical Practice Team Adds to Econometrica’s Capabilities

Clinical Practice Team Adds to Econometrica’s Capabilities

BETHESDA, MD – Econometrica has formed a dedicated Clinical Practice Team consisting of healthcare professionals from a variety of healthcare disciplines. The addition of this team augments the technical capabilities of Econometrica’s Health Group to provide expertise in training, information diffusion, health research, quality measure development, monitoring, evaluation, technical assistance, and data analytics.

The team will be led by Dr. Kristie McNealy and includes a geriatric nurse practitioner and two registered nurses with clinical experience spanning primary care, acute care, hospice, home health, and rehabilitation settings.

The Clinical Practice Team provides clinical and health operations insights to a range of Econometrica’s projects, including supporting the Centers for Medicare & Medicaid Services (CMS) in selecting clinically relevant quality measures for the Bundled Payments for Care Improvement Advanced model and developing training content around patient assessment and coding for nurses and quality staff working in post-acute care settings. Team members also provide valuable perspective on the challenges providers face in delivering and coordinating care in different settings and the barriers beneficiaries experience attempting to access the care they need.

“The Clinical Practice Team will continue to support our various healthcare projects as well as allow Econometrica to support new projects in the areas of medical records abstraction, electronic health records, and clinical consultation,” President/CEO Cyrus Baghelai said. “We look forward to offering our clients and partners these expanded services.”

With healthcare and related industry trends constantly evolving, Econometrica’s experts use a variety of research and evaluation methods to provide innovative approaches for each client. In recent years, our Health Group, has developed tailored technical assistance plans for CMS, including working with States in accessing and using CMS data sources under the State Data Resource Center contract; has had more than 250,000 provider impacts based on trainings focused on understanding and complying with the IMPACT Act on the Post-Acute Care Training contracts; and has had 3 quality measures endorsed by the National Quality Forum under our Programs of All-Inclusive Care for the Elderly contract.

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.

With healthcare and related industry trends constantly evolving, Econometrica’s experts use a variety of research and evaluation methods to provide innovative approaches for each client.

Press Contact

Jonathan Fusfield

Opioid Use Disorder and the Medicare/Medicaid Population

Opioid Use Disorder and the Medicare/Medicaid Population

BETHESDA, MD – The United States has long been engulfed in an opioid epidemic that stemmed from increased prescribing of opioids in the 1990s and is characterized today by use of synthetic opioids, like fentanyl, as well as illicit opioids such as heroin.[1] By 2017, there were 58 opioid prescriptions written for every 100 Americans.[2] This rise in opioid use has led to an increased prevalence of Opioid Use Disorder (OUD) in a variety of populations.

OUD—which may involve the misuse of prescribed opioid medications, diverted opioid medications, or illicitly obtained heroin—is typically a chronic, relapsing illness associated with significant rates of morbidity and mortality.[3] The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, describes OUD as a “pattern of opioid use leading to problems or distress,” with at least two of the following occurring within a 12-month period:[4]

  1. Taking larger amounts or taking drugs over a longer period than intended.
  2. Persistent desire or unsuccessful effort to cut down or control opioid use.
  3. Spending a great deal of time obtaining or using the opioid or recovering from its effects.
  4. Craving, or a strong desire or urge to use opioids.
  5. Problems fulfilling obligations at work, school, or home.
  6. Continued opioid use despite having recurring social or interpersonal problems.
  7. Giving up or reducing activities because of opioid use.
  8. Using opioids in physically hazardous situations.
  9. Continued opioid use despite ongoing physical or psychological problems likely to have been caused or worsened by opioids.
  10. Increased tolerance (i.e., need for increased amounts, or diminished effect with continued use of the same amount).
  11. Experiencing withdrawal (opioid withdrawal syndrome) or taking opioids (or a closely related substance) to relieve or avoid withdrawal symptoms.

Although OUD is similar to other substance use disorders, there are many unique features, including risk of physical dependence in as little as 4 to 8 weeks and severe symptoms such as chills, cramps, vomiting, and insomnia during withdrawal.[3] Despite its unique features, the factors contributing to OUD are very general and can include ease of access, environmental and genetic factors, social support system, addictivity of the drug, and early use.

Looking at the rate of opioid prescribing among Medicare and Medicaid beneficiaries can help us gain an understanding of the development of OUD in America. In 2018, the Centers for Medicare & Medicaid Services (CMS) analyzed the prevalence of OUD among beneficiaries and reported that 6 out of every 1,000 Medicare beneficiaries and 8.7 of every 1,000 Medicaid beneficiaries suffer from OUD.[5] Using data from 2006 to 2015, another CMS study found that 23.5 percent of dual-eligible beneficiaries in 2015 had a substance use disorder.[6] For the Medicaid-only population, there were 31 million opioid claims in 2017, and opioid prescriptions represented 4.57 percent of all Medicaid prescription claims.[7] One year earlier, in 2016, 14.4 million of the 43.6 million Medicare-only beneficiaries enrolled in Part D received opioids.[8]

The national data for OUD and opioid prescriptions is presented here to provide the foundation for a larger discussion around OUD in the United States. Over the course of this series of newsletters, we will dive into topics such as OUD treatment options, how COVID-19 is impacting treatment centers across the country, and much more. To read more of our OUD coverage, please click here. 

[1] Centers for Disease Control and Prevention (CDC). (2020). Opioid overdose: Understanding the epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html.

[2] CDC. (2020). Opioid overdose: Prescribing practices. Retrieved from https://www.cdc.gov/drugoverdose/data/prescribing/ prescribing-practices.html.

[3] Strain, E. (2020). Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. UpToDate. Retrieved from https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis.

[4] American Psychiatric Association. (2018). Opioid use disorder. Retrieved from https://www.psychiatry.org/patients-families/addiction/opioid-use-disorder/opioid-use-disorder.

[5] CMS. (2018, June 11). CMS opioids roadmap. CMS.gov Blog. Retrieved from https://www.cms.gov/blog/cms-opioids-roadmap.

[6] Anderson, K. K., Hendrick, F., & McClair, V. (2018, October). Data analysis brief: National trends in high-dose chronic opioid utilization among dually eligible and Medicare-only beneficiaries (2006-2015). Retrieved from https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/ Medicare-Medicaid-Coordination-Office/DataStatisticalResources/Downloads/OpioidsDataBrief_2006-2015_10242018.pdf.

[7] CMS. (2019). Medicaid State Opioid Prescribing Mapping Tool. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/OpioidMap_Medicaid_State.

[8] Office of Inspector General. (2017, July). Opioids in Medicare Part D: Concerns about extreme use and questionable prescribing [OEI-02-17-00250]. U.S. Department of Health & Human Services. Retrieved from https://oig.hhs.gov/oei/reports/oei-02-17-00250.pdf.

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.

Opioid Use Disorder (OUD)—which may involve the misuse of prescribed opioid medications, diverted opioid medications, or illicitly obtained heroin—is typically a chronic, relapsing illness associated with significant rates of morbidity and mortality.

Press Contact

Jonathan Fusfield

Looking Ahead in Quality Improvement

Looking Ahead in Quality Improvement

BETHESDA, MD – In February, the Centers for Medicare & Medicaid Services (CMS) sponsored the CMS Quality Conference, an annual meeting of leaders and stakeholders dedicated to improving the quality, safety, and value of modern healthcare. Econometrica employees participated in this 3-day conference, which gathers the brightest in the field (including Government employees, providers, researchers, policymakers, professional society members, and others) to discuss several existing and future quality improvement initiatives. As the Affordable Care Act, the legislation that created many of these quality programs, celebrated its 10-year anniversary this March, the conference emphasized current and upcoming quality improvement programs. Econometrica has engaged with many of these models in the past; in this article, we highlight and look ahead to several key innovations discussed at the conference.

The Quality Payment Program (QPP) was the focus of many conference sessions. Created under the Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015, the QPP aims to improve care and reduce costs while also easing provider burden. Clinicians may choose to participate via two tracks: the Merit-Based Incentive Payment System (MIPS), or Advanced Alternative Payment Models (APM). Through MIPS, clinicians are reimbursed based on quality of care as measured by performance in four domains: quality, cost, improvement activities, and promoting interoperability. Scores on measures in these domains are aggregated into a final score that determines a payment adjustment. Clinicians may also receive incentive payments for participating in an Advanced APM. APMs are payment frameworks that offer incentive payments for the provision of high-quality, cost-efficient care. Under the QPP’s Advanced APM option, a 5-percent incentive is available for clinicians who meet threshold levels of payments or patients through an Advanced APM.
Conference sessions highlighted CMS’ plans for implementation of the new MIPS Value Pathways (MVP) framework for participation in QPP beginning in the 2021 performance period. The goal of MVPs is to simplify and lower reporting burden. MVPs allow clinicians to report on measures and activities that are specialty- or practice-specific with a base of interoperability measures and population health measures derived from administrative claims data.

Other innovative models highlighted at the conference include the Integrated Care for Kids model and the Maternal Opioid Misuse model. The Integrated Care for Kids model aims to address challenges in children’s health through early identification and treatment of health issues and improved quality of care for children. It promotes care coordination across providers and creates State-specific APMs to enhance payment for quality of care and outcomes. Model participants include Lead Organizations, which are made up of community partners; State Medicaid Agencies; and Partnership Councils. The Maternal Opioid Misuse model is one of CMS’ models designed to respond to the opioid crisis by targeting the lack of coordination of care for pregnant and postpartum patients with Opioid Use Disorder. It further looks to increase access to necessary services and the availability of care providers for pregnant and postpartum women with Opioid Use Disorder.

Econometrica is excited to be part of such a vibrant conversation about the future of quality improvement! We look forward to continuing to work with CMS and other leaders in the field to drive healthcare innovations that promote the provision of high-quality care at efficient cost.

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.

Econometrica is excited to be part of such a vibrant conversation about the future of quality improvement! We look forward to continuing to work with CMS and other leaders in the field to drive healthcare innovations that promote the provision of high-quality care at efficient cost.

Press Contact

Jonathan Fusfield

Kidney Health Executive Order Policy Review

Kidney Health Executive Order Policy Review

BETHESDA, MD – The Health Group of Econometrica conducted a review of the Kidney Health Executive Order passed by President Trump on July 10, 2019 . This essential decision impacts programs operated by the Centers for Medicare & Medicaid Services (CMS), health providers, kidney patients, and the availability of resources dedicated to treatment . Econometrica is committed to staying informed of decisions like these to better serve the interests of our clients .

In addition to the report, Econometrica also created downloadable Kidney Health White Paper

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 most common risk factors of CKD are diabetes, which causes kidney damage due to excess sugar, and high blood pressure, which can cause damage to the blood vessels in the kidneys over time.

Press Contact

Jonathan Fusfield

Check out our report and downloadable infographics.

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