On November 29 and 30, 2012, CNA honored National Military Family Appreciation Month by holding a conference in Washington, D.C. titled “Promoting the Resilience of Military Children through Effective Programs.” The conference provided a two-day forum for leaders from the scientific and service communities to advance the goal of helping military children and their families cope with the psychological effects of deployment.
During FY2012, the U.S. Navy's Bureau of Medicine and Surgery (BUMED) asked CNA to conduct an evaluation of its patient-centered medical home model - Medical Home Port. Prior CNA evaluations of BUMED's first medical home in the internal medicine clinic at the Walter Reed National Military Medical Center showed that its medical home was improving access, quality, and cost with greater impacts among patients with chronic conditions. The FY2012 study evaluated medical homes in family practice and pediatrics at two Navy hospitals and two Navy clinics, which have substantially younger and healthier enrollee populations than the Walter Reed medical home.
Prepared by CNA in support of the National Center for Foreign Animal and Zoonotic Disease Defense.
BUMED Future Plans and Strategy Office (M5) asked CNA to investigate how to best incorporate NGOs into health-related HCA (HRHCA) missions. In this study, we assessed previous sea-based HRHCA missions from 2005-2007, identified NGO resources that Navy could leverage for future HRHCA missions, explored differences between NGOs, and identified strategic, operational, and tactical barriers to Navy-NGO coordination. Finally, we recommend a planning framework for Navy to incorporate NGOs in sea-based HRHCA missions.
The Veterans’ Disability Benefits Commission (the Commission) has asked The CNA Corporation (CNAC) to provide a study of the issues involved in offering a one time lump sum payment instead of the current lifetime monthly compensation payments to selected disabled veterans. This topic is of great interest because of the potential benefits both to veterans and to the Department of Veterans Affairs (VA).
The TRICARE Management Activity (TMA) asked CNA to evaluate the joint DoD/VA pilot study for mailed refill services. The pilot program addressed the ability of Military Treatment Facilities (MTFs) to interface with the VA’s automated Consolidated Mail Outpatient Pharmacy (CMOP) system to process refills.
The Deputy Chief BUMED, Resource Management/Comptroller, asked CNA to examine the delivery of primary care to beneficiaries at a selected set of Navy clinics. We examined six primary care clinics and two family practice clinics within naval hospitals engaged in the graduate medical education of interns and residents. We explored several issues, including understanding clinic management practices, developing measures of productivity and costs associated with clinic visits, and the implications of other influences, such as the incentives on managing demand associated with the managed care support contracts.
Health care personnel are expensive to educate and train. Retaining them is critical for any health care system. This study considers the impact of special pays and bonuses in helping recruit and retain qualified doctors, dentists, and other health care providers.
On June 7 and 8, 2012, CNA hosted top military and civilian healthcare executives in the Navy to chart the course of the future of military healthcare for the U.S. Navy, Marine Corps and their families in a two-day workshop led by Navy Surgeon General Vice Adm. Matthew L. Nathan. The following study was prepated by CNA analyst, Dr. Eric Christensen, for presentation at this workshop.
AcademyHealth’s Annual Research Meeting serves as forum for health services researchers, providers, decision makers, clinicians, graduate students, and research analysts to discuss health-policy implications and research methods and to: examine emerging research issues critical to the organization, financing, and management of health services; get updates on the latest research studies and current health policy issues; hear the research funding priorities of foundations and federal agencies; and explore the impact of health services research on improving access and quality of care. At the 2011 meeting, held June 12-14 in Seattle, WA, CNA research analysts made the following presentations.
Colorectal cancer (CRC) is the second leading cancer killer in the U.S. among cancers affecting both men and women. However, screening for CRC is sub-optimal even though evidence-based principles for successful screening programs exist. To address these gaps, the Centers for Disease Control and Prevention (CDC) and the Agency for Healthcare Research and Quality (AHRQ) asked us to conduct a study to determine whether an evidence-based, system-level intervention to improve CRC screening and follow-up among primary care patients could be successfully implemented in a range of primary care practices and be effective.
The System Approach to Tracking and Increasing Screening for Public Health Improvement of Colorectal Cancer (SATIS-PHI/CRC) is a six-step intervention conducted by a centralized organization on behalf of primary care practices. It is intended to assist these practices with providing guideline-based preven¬tive health care to patients who are at average risk for CRC and not up to date in their screen¬ing. It also helps educate both clinicians and patients about CRC screening.
We implemented SATIS-PHI/CRC in primary care practices affiliated with the Lehigh Valley Physician-Hospital Organization (LVPHO) and the Eastern Pennsylvania Inquiry Collaborative Network (EPICNet). Despite experiencing some hurdles, we successfully implemented SATIS-PHI/CRC and identified a set of lessons learned to inform future implementation. We also found that patients of primary care practices participating in SATIS-PHI/CRC had significantly greater odds of screening than patients of a group of comparison practices not participating in the intervention. Our experience with SATIS-PHI/CRC demonstrates that it can be implemented successfully with a wide range of primary care practices and increase guideline-recom¬mended CRC screening.
• For more information about the research study, its methodology, and its findings, see "Health Care Systems for Tracking Colorectal Cancer Screening Tests Final Report" (http://www.ahrq.gov/research/crcscreeningrpt/)
• For more information about how to implement the SATIS-PHI/CRC intervention in future settings, including the intervention materials, see the Toolkit "Tracking and Improving Screening for Colorectal Cancer Intervention A Systems Approach" (http://www.ahrq.gov/research/crctoolkit/)
In this study for the Centers for Medicare and Medicaid Services, a division of the U.S. Department of Health and Human Services, researchers from CNA and the University of Minnesota sought to answer two fundamental questions about the cost and prevalence of annuities in allowing individuals to qualify for Medicaid payments for nursing home care:
The study, which was subsequently published in the March/April 2006 issue of Health Affairs, found that in 2004, annuities cost Medicaid $197 million.Full Document
The Medical Surge Capacity and Capability (MSCC) Handbook was developed for the Office of the Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services. The handbook describes a methodology for managing health and medical response to events resulting in large numbers of patients (surge capacity) and/or victims with unusual or highly specialized medical needs (surge capability). It also spotlights the role of management systems in developing and maintaining preparedness programs. Forming the basis of the MSCC Handbook are valid principles of emergency management and the Incident Command System (ICS). Medical and health systems may apply these principles to coordinate effectively with one another, and to integrate with response organizations that have established ICS and emergency management systems (fire service, law enforcement, etc.). The handbook promotes a common management system for all response organizations public and private that may be involved in major emergencies. In so doing, it helps guide the development of a health and medical response that is consistent with the new National Incident Management System (NIMS). CNA analysts Eric Trabert and Shayne Brannman collaborated with RADM Ann Knebel of HHS and Drs. Joseph Barbera and Anthony Macintyre of George Washington University to develop the handbook.
CNA recently conducted a study to evaluate a selection of existing syndromic surveillance systems. The purpose of these systems is to identify health conditions that precede diagnosis and signal an increased probability of disease outbreak either due to a chemical or biological attack or to a naturally occurring outbreak of disease. Quickly detecting the outbreak via a computer-based surveillance system could help the public health and military health communities implement a timely response and save lives.
Training medical specialists is very expensive. As a result the TRICARE Management Activity/Health Affairs asked CNA to help evaluate the feasibility of increasing the active duty obligation for graduate medical education to lower costs and improve its return on investment.
The Department of Veterans Affairs asked CNA to conduct an economic assessment of the ability of the VA's Consolidated Mail Outpatient Pharmacy Program to meet current and expected future demand. As part of our analysis we reviewed and validated demand projections for the program, determined capacity and estimated when demand will exceed it, and determined a cost-effective investment plan for future expansion.
CNA developed a model that helps medical planners develop first-order estimates of the effects of different intervention strategies in the event of a biological attack. In the event of such an attack the public health community needs to be able to quickly detect, confirm, and treat an exposed population. CNA helped develop the model and metrics to achieve this goal.