Tracking the Impact of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions

Notice of Intent: The Department of Health and Human Service (DHHS), Office of the Secretary (OS), Office of the Assistant Secretary for Planning and Evaluation (ASPE) intends to award a purchase order to develop research that will explore practice patterns of chain versus non-chain providers within the broader profit and non-profit categories and assess whether this approach to ownership analysis is more informative in evaluating key differences across the different types of providers. In accordance with 41 United States Code (U.S.C.) 3304 (a) (1) as set forth in Federal Acquisition Regulation (FAR) 6.302-1 (a) (i) (A). "Vanderbilt University" is the only responsible source because Vanderbilt University has a unique and innovative concept and no other source will satisfy agency requirements, full and open competition need not be provided. Upon conducting extensive market research of literature published by Vanderbilt and other qualified researchers on this topic, Vanderbilt is the only contractor we have identified to have extensive familiarity with the hospice payment system; has methodology to identify changes in ownership status for each year, and the expertise in developing algorithms that effectively identifies chain status of hospice providers. Vanderbilt has developed a unique and detailed methodology that relies primarily on text fields and commonalities in provider names for the initial chain coding, and supplemented with information from other data files (i.e. PECOS), provider websites, and news articles. This methodology uses the name of the parent organization from the previous year to determine changes in ownership status over each year, such as when parent organizations dissolve into one single agency, and when agencies drop out of chains and join or form chains. The methodology is a series of intricate steps that match and verify provider names to determine the correct chain vs. non-chain assignment for each year. Through market research it has been identified that no other source possesses the same capabilities or has developed the same methodologies as Vanderbilt. Project background: Most of the research exploring differences in practice patterns of hospice providers based on ownership type has mainly focused on the for-profit and non-profit dichotomy (Med PAC 2013). More recently, new studies have found substantial differences in the practices within these two broad categories based on chain status that warrant a more in-depth look at the ownership structure beyond that of for-profit and non-profit (Stevenson e al, 2015). This research will explore practice patterns of chain versus non-chain providers within the broader profit and non-profit categories and assess whether this approach to ownership analysis is more informative in evaluating key differences across the different types of providers. This study is intended to update and complement previous research to provide a deeper understanding of the link between providers of different ownership structure and their care practices to better inform policy and reform related to payment, and quality of care and oversight. This research will also explore in more detail the largest hospice agencies that belong to chains where there may be significant differences in care compared to non-chains. Description: Work under this contract requires a contractor to have extensive familiarity with the hospice payment system to determine which data sources ought to be used for each of the analysis described above. In addition, because CMS data do not reliably identify whether hospices belong to a multi-agency chain, the contractor must also have a comprehensive methodology that identifies changes in ownership status for each year, such as when parent organizations dissolve into one single agency, and when agencies drop out of chains and join or form chains. Correctly identifying chain status is challenging and requires a complex and detailed methodology that accurately matches and verifies agencies' chain status for each year. The contractor shall be expected to have unique experience and expertise in developing the appropriate algorithm that effectively identifies chain status of hospice providers. Research Questions: Completion of this research will result in a final report that will address the following research questions: - Using the latest year of data available, what is the overall number of agencies in the market, by ownership type (for-profit chains, for-profit non-chains, not-for-profit chains, not-for profit non-chains)? How does the size of the agencies and number of Medicare enrollees served differ across the different types of agencies? - How has the number and share of population served by the different types of hospice providers (for-profit chains, for-profit non-chains, not-for-profit chains, not-for profit non-chains) changed over time, during the study period? Using the latest year of data available for this study, what are the largest chains servicing Medicare hospice beneficiaries, and how do they differ in terms of beneficiaries served? - How do the different types of providers (for-profit chains, for-profit non-chains, not-for-profit chains, not-for profit non-chains) differ in terms of service use outcome metrics examined in this study (e.g., proportion of non-cancer diagnoses vs. other diagnosis; site of service - lived in nursing homes or assisted living; average LOS; rates of live discharges; percent of decedents who have little or no care in the last 7 days of life; staffing data - if available and attainable)? Using the latest year of data available for this study, how do the largest hospice chains compare to all other providers in terms of service use? - What are other key features of chain agencies that differ from other types of providers? - Exploring chain providers: How has the ownership status of the largest chain providers changed over time? How has key service use metrics of these providers changed over time? To what extent are the hospice chain providers affiliated with other providers (i.e., skilled nursing facilities)? What has been the role of private equity investment in these chain providers over the years? This notice of intent is not a request for competitive proposals. Interested parties may identify their interest and capabilities in response to this synopsis. The determination by the Government not to compete the proposed contract based on responses to this notice is solely within the discretion of the Government. Comments regarding this announcement, referencing synopsis number may be submitted to the Program Support Center, Acquisition Management Services, U.S. Department of Health and Human Services, 12501 Ardennes Ave., Suite 400, Rockville, MD 20852, attention Peter Preston, Contract Specialist (Peter.Preston@psc.hhs.gov). Vendors possessing the capability to conduct the required study are encouraged to respond in writing no later than June 5th, 2015. All responses shall provide at a minimum: 1. Cover Letter/Capability Statement illustrating organizations' technical capabilities, business size, and expertise, as it relates to the requirements presented in this notice. 2. List of at least 3-5 Past Performance references to include: a. Description of previous work efforts b. Contract number c. Point of contact