Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Compare the effectiveness of using predictive modeling data vs. traditional care management systems to empower patients that need care after hospital discharge with information.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

SeniorMetrix has a large database of postacute outcomes that identify the cost and clinical results of different patterns of care. This data has helped Medicare Advantage plans reduce their postacute costs to approximately 60% of Medicare FFS costs with the same clinical results. I would like to see the data used by FFS providers to empower individual patients with information that can give them much better insight in regards to decisions to use one particular postacute service versus another.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Medicare eligible individuals that have been hospitalized and need postacute care.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

40% of seniors that are hospitalized will utilize one or more postacute service after discharge. A high percentage of those members would experience the same clinical outcome if their services were provided in a lower level of care.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Patients would have more accurate expectations of their eventual recovery and the best place to go as they recuperate. This results in safer discharge plans and better eventual outcomes.

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cardiovascular disease, including stroke and hypertension
• Dementia, including Alzheimer's disease
• Functional limitations and disability

AHRQ Priority Populations

• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Medicare could save $14B per year in postacute costs by taking advantage of an existing technology that has proven it's effectiveness in care management. Postacute costs continue to rise in real dollars and in the percentage of Medicare costs. The highest users of postacute care are those over 85 which is the fastest growing senior segment. Placing seniors unnecessarily in institutional settings exposes them to infection, injury, theft and elder abuse. If there are technologies that can improve the health care episode after hospitaliztion it will improve both the clinical and economic results.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

We have been working with this technology for over 10 years and have seen dramatic results. As a small firm, we have not had the ability to distribute our technology as widely as possible. Even though we had very positive results in the MHS program with Medicare FFS members, we have had difficulty in expanding to a larger FFS population. Our organization feels that our technology could bring tremendous benefits to Seniors in the U.S.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Our technology introduces uncertainty because we challenge the status quo. As with any disruptive approach, apprehension is usually the first response. However, in a relatively short time, the effectiveness of our approach is embraced and expanded within our client organizations.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Demonstrating the effectiveness of our approach in a new setting will validate the clinical value to a new audience. With the potential for postacute bundling on the horizon, this technology could quickly empower hospitals or physicians with the tool they need to drive better results.

Describe the timeframe in which an answer to your question is needed.

Prior to postacute bundling enactment.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Our technology addresses the issue of unexplained practice variation between regions and between payors. It has to potential to expand the benefits to Medicare FFS beneficiaries that are currently being exposed to unnecessary care and risk.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Demonstrating the effectiveness of our approach in a new setting will validate the clinical value to a new audience. With the potential for postacute bundling on the horizon, this technology could quickly empower hospitals or physicians with the tool they need to drive better results.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program