Core B will centrally unify primary data collection activities of the renewal P01 and serve all three proposed research projects. This will be done by developing and implementing a series of case studies that will collect data utilized by all of the projects. In addition. Core B will lead efforts to gather and update other relevant federal and state policy data related to health care reform, such as collecting lists of CMS acknowledged Accountable Care Organizations (ACO) and lists of bundled payment demonstration projects participating providers and lists of hospitals fined under CMS's re-hospitalization penalty system. These data will then be transferred to Core C for integration into the overall program project hierarchical data base. The primary purpose of Core B is to qualitatively explore how multiple players in a market affect the choice, use and outcomes of post-acute care (PAC). A total of 8 case studies will be conducted with markets selected based upon Medicare Managed Care penetration (Project #3). In each site two hospitals will be selected based upon their re-hospitalization rate (Project #2) and for every hospital we'll select two skilled nursing facilities based upon whether they appear to be the hospital's preferred referral source or not (Project #1). In order to meet the needs of the three proposed projects, several key informants will be interviewed at each organization selected for each of the case study sites. We will interview approximately 26 individuals at each case study site (6 by telephone and 20 in-person), including five individuals at each of the two hospitals selected at each site, three individuals at each of the four SNFs selected at each site, and one case manager and one medical director from each of the top two MCOs in the market (based on market share). This will result in more than 200 interviews, with each site analyzed as a separate case study. However, consistency will be sought across sites by organization and respondent type and organizations differing in important ways (e.g. 30-day re-hospitalizations rates) will be compared and contrasted.
Core B will serve the three interrelated renewal P01 projects. These projects build upon the same conceptual framework for understanding how policies and market forces affect provider behavior and strategies and ultimately the outcomes experienced by patients. The work of Core B will allow the 3 projects to answer key policy questions about how to best structure incentives and regulations to insure that frail older hospitalized patients receive cost effective and coordinated care
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