July 2012

• CMMI Awards Altarum $8.4 Million to Reduce Unnecessary Medical Imaging
• Altarum Awarded Contract to Support MACPAC in Recommending Changes to Medicaid and CHIP
• Altarum Wins Award to Assess YMCA Evaluation Capacity
• Managing Exposure to Potentially Concussive Events for the Defense Centers of Excellence
• Enabling Rapid Launch of NCATS Website and Content Management System
• Developing an Online Resource to Support Nursing Mothers in the Workplace
• Creating the Cosmetic Surgery Estimator for TRICARE Management Activity
• Developing Data Standards for the National Institute of Neurological Disorders and Stroke
• Making It Safe to Grow Old—Altarum’s Center for Elder Care and Advanced Illness

CMMI Awards Altarum $8.4 Million to Reduce Unnecessary Medical Imaging

The Center for Medicare and Medicaid Innovation (CMMI) has awarded Altarum $8.4 million to reduce unnecessary medical imaging in Southeast Michigan. Inappropriate use of imaging studies, such as magnetic resonance imaging tests, can result in avoidable costs and risks to patient care. In this 3-year project, Altarum and its partners United Physicians and the Detroit Medical Center Physician Hospital Organization will work to incorporate clinical guidelines developed by the American College of Radiology into the image ordering process, leverage health information exchange capabilities, and use patient education campaigns to curb the inappropriate use of imaging studies.

For more information about this project, please contact Dan Armijo at dan.armijo@altarum.org

Altarum Awarded Contract to Support MACPAC in Recommending Changes to Medicaid and CHIP

Altarum recently won a contract to support the Medicaid and CHIP Payment and Access Commission (MACPAC), a newly established federal advisory group, in assessing and recommending changes to the state and federal Medicaid and CHIP programs. The Commission makes recommendations to Congress, the Department of Health and Human Services, and states on various issues affecting Medicaid and CHIP populations. These include, for example, eligibility and enrollment, financing, access to and quality of care, and the development of data to support policy analysis and accountability. Altarum will draw from its extensive experience with these health programs, as well as its expertise in policy analysis and program evaluation, to support MACPAC in making relevant and reasonable program refinement recommendations.

For more information about this project, please contact Holly Korda at holly.korda@altarum.org.

Altarum Wins Award to Assess YMCA Evaluation Capacity

Altarum’s Center for Healthy Child and Youth Development recently won an award from YMCA of the USA to assess the evaluation capacity of their organization and local YMCAs. Using a collaborative and systematic process that involves an evaluation capacity survey, virtual focus groups, in-depth interviews, and site visits, the Center will seek to understand the breadth and depth of YMCA’s capacity to evaluate outcomes from their programs and initiatives. The findings from this assessment will be compiled into a final report of results and recommendations, which will be used to formulate a capacity building process to improve organizational evaluation practices at the national and local levels.

For more information about the Center for Healthy Child and Youth Development, please contact Karah Mantinan at karah.mantinan@altarum.org.

Managing Exposure to Potentially Concussive Events for the Defense Centers of Excellence

Service members who suffer from concussions or mild traumatic brain injuries (mTBI) do not always experience clear symptoms and, as a result, may forgo medical treatment. This presents a serious challenge as a missed or delayed diagnosis can jeopardize full recovery. Altarum supports the Defense Centers of Excellence, an agency of the TRICARE Management Activity, in addressing this concern by evaluating and improving policies and practices related to these conditions.

For example, Altarum recently conducted a multidimensional analysis of data from the Blast Exposure and Concussion Incident Report (BECIR), the main platform used to document and track service members exposed to potentially concussive conditions. This involved developing models to determine service members at high risk and using the data to inform training efforts, prevention strategies, and other theater practices. Altarum also linked BECIR data to event-specific data from the Joint Trauma Analysis and Prevention of Injury in Combat and medical record data from Armed Forces Health Surveillance Center. These actions helped to improve data sharing across partners and contributed to creating a simple, comprehensive, sensitive, and timely document and tracking system.

Additionally, Altarum assessed Directive Type Memorandum-mandated practices including screening, medical evaluation, and timely medical attention. This assessment highlighted return-to-duty trends, discovered reporting gaps, and identified practices in need of improvement. Altarum also examined mTBI occurring in the nondeployed setting to support future training and incident reporting practices. Overall, through this work, Altarum is helping to ensure that service members exposed to potentially concussive events are identified, screened, and provided with the appropriate care.

For more information on this project, please contact Yll Agimi at yll.agimi@altarum.org.

Enabling Rapid Launch of NCATS Website and Content Management System

In December 2011, Congress established the National Institutes of Health (NIH) National Center for Advancing Translational Sciences (NCATS). Several existing NIH programs transitioned to form this new Center, which aims to leverage basic research in support of translational science. Palladian Partners, an Altarum subsidiary, led the rapid launch of a new website for NCATS in early 2012.

An integrated team of content strategists, science writers, Web developers, and Web designers worked together in this effort. Palladian’s content strategists, for example, conducted a content audit and created the information architecture for the site. They reviewed more than 1,000 pages from five websites, migrating and archiving content accordingly and identifying new content needed to communicate key NCATS messages. Palladian’s science writers, well versed in the nuances of biomedical research, developed this new content and explained NCATS initiatives in plain language. Palladian's Web designers and developers collaborated on visually compelling pages that reflect the overall NIH brand and design motifs. Additionally, Palladian and its partner, Aquilent, implemented the Percussion content management system to speed future updates and streamline ongoing maintenance.

All of these pieces came together in less than 4 months for the April 2012 launch of an elegant, engaging new website for NIH’s newest Center, located at www.ncats.nih.gov. At that time, the site contained 283 pages, including 32 pages with original content.

For more information about this project or Palladian Partners, please contact Beth Maloney at bmaloney@palladianpartners.com.

Developing an Online Resource to Support Nursing Mothers in the Workplace

Breastfeeding affords a multitude of health benefits to women and children, as well as a return on investment for employers that accommodate nursing mothers. Recognizing this value, the health reform law amended the Fair Labor Standards Act, requiring employers to provide a reasonable break time and a private place for mothers to express breast milk for one year after a child’s birth. These requirements became effective March 23, 2010.

Altarum has partnered with the U.S. Department of Health and Human Services Office on Women’s Health and the nonprofit organization, Every Mother, Inc., in a national initiative to support women who are nursing after they return to work. Specifically, Altarum’s Center for Food Assistance and Nutrition (CFAN) is assisting in the development of an online resource to highlight best practices and creative ways in which employers are complying with the requirements. Altarum is also working with coalitions in five states—California, Colorado, Washington, Kansas and Texas—to identify employers that are willing to share innovative strategies. The searchable resource, which is expected to be available in January 2013, will feature videos of business sites and interviews with employers and employees. A webinar for businesses and state breastfeeding coalitions is also planned in spring 2013.

This project is of special importance to Altarum’s CFAN staff members, who have extensive experience working with Women, Infant, and Children programs. Since “returning to work” is a primary reason why low-income women stop breastfeeding, Altarum is helping to address this challenge by scaling up successful efforts nationwide to support nursing mothers in the workplace. This work also supports the 2012 theme for National Breastfeeding Month (August): “Everyone Can Help Make Breastfeeding Easier.”

For more information about this project, please contact Linnea Sallack at linnea.sallack@altarum.org.

Creating the Cosmetic Surgery Estimator for TRICARE Management Activity

In 2005, the Department of Defense Office of Health Affairs released a policy allowing a limited number of elective cosmetic surgery cases in Military Treatment Facilities (MTFs). The surgeries are permitted to support military graduate medical education training, as well as skill maintenance, certification, and recertification for qualified specialists.

Elective cosmetic surgery is not a TRICARE covered benefit. All patients, including active duty personnel, must pay, in full, for all elective cosmetic procedures before surgery is scheduled. Pre-payment is based on estimated charges for: surgical professional services, facility resources, anesthesia, cosmetic pharmaceuticals, and implants. Depending on the procedure(s) selected, discounts may apply for: combining an elective cosmetic procedure with a medically necessary procedure, multiple elective cosmetic procedures performed during the same surgical encounter, and procedures performed by a resident physician.

To simplify the payment process and assist MTF staff in creating accurate price estimates for elective cosmetic procedures, Altarum created the Cosmetic Surgery Estimator (CSE). The CSE is a Microsoft Access-based application that allows MTF staff to generate itemized invoices for payment. Information from the patient’s physician is entered into the application and an estimate for each cost component is automatically calculated. Applicable discounts are also automatically applied based on the information supplied. Each year, the CSE is updated to reflect changes in procedure rates as well as the business rules developed to govern billing elective cosmetic procedures. The latest version, CSE v8.0, was deployed throughout the Military Health System on July 1, 2012.

For more information about this project, please contact Charisse Gates at charisse.gates@altarum.org.

Developing Data Standards for the National Institute of Neurological Disorders and Stroke

In clinical research, the collection and management of data is often a challenge. Collection forms and tools can be complex, containing inadequate data descriptions and definitions. Once collected, data are stored in various formats that do not enable sharing and aggregation across studies. In order to address these issues and accelerate clinical research in neuroscience, KAI Research, Inc., a wholly owned subsidiary of Altarum, was contracted by the National Institute of Neurological Disorders and Stroke (NINDS) to implement the Common Data Element (CDE) Project.

KAI staff members worked closely with NINDS program directors and over 600 members of the research community to develop data elements, structures, and forms related to neurological clinical research. This involved, for example, reviewing case report forms used in neurological studies, conducting literature reviews, and evaluating policies related to clinical research. They also developed a process to vet the recommended CDEs via public review by various stakeholders and make improvements as needed. Through this iterative process, the KAI and NINDS team established disease-specific CDEs for 12 neurological diseases and disorders to date (e.g., epilepsy, stroke, traumatic brain injury) and plan to develop several more disease-specific CDEs through the fall of 2012. They continue to track and evaluate use of the CDEs, which are included on the NINDS CDE website, and offer related training materials for investigators.

As a result of the CDE Project, KAI has helped to simplify and harmonize data collection in neuroscience clinical research studies. These efforts should reduce study start-up time and facilitate data sharing, and may also lead to cost savings for researchers. More details about the project have been published in an article in Clinical Trials.

For more information on this work or KAI, please contact Patti Shugarts at pshugarts@kai-research.com.

Making It Safe to Grow Old—Altarum’s Center for Elder Care and Advanced Illness

In the past few months, Altarum’s Center for Elder Care and Advanced Illness sponsored two roundtable discussions showcasing prominent women authors who have written about aging, caregiving, and the end of life. The first session met in Washington, D.C., on April 13, and featured Pulitzer-Prize winning journalist Ellen Goodman as moderator. Panelists included geriatricians Cheryl Woodson, Muriel Gillick, and Center Director, Joanne Lynn, along with authors Susan Jacoby and Francine Russo. Some 80 individuals attended in person, and nearly 100 joined via webcast. An encore program met in Detroit on June 5 for a session filmed by Detroit Public Television (DPTV). Moderated by political commentator Eleanor Clift, the discussion featured Cheryl Woodson, Muriel Gillick, Joanne Lynn, and Lynn Alexander. Approximately 150 audience members filled the DPTV studio for a live streaming broadcast, which is currently being developed into a public television program for wide-ranging audiences.

The Center continues to pursue its aim to “make it safe to grow old,” bringing together stakeholders who share a common vision for improving care for frail elders. For example, in May, Keri Thomas, who leads the Gold Standards Framework (GSF) project in Great Britain, visited Altarum and presented on GSF’s efforts to enable a gold standard of care for people nearing the end of life. In June, writer Janice Lynch Schuster participated in a plenary session at the annual conference of the National Organization for Women, which is beginning to focus on issues older women face.

To keep up with the Center for Elder Care and Advanced Illness, be sure to like Medicaring on Facebook, follow us on Twitter @medicaring, and read our blog at www.medicaring.org. For more information, please contact Joanne Lynn at joanne.lynn@altarum.org.