Areas of Expertise

Our staff have significant experience and excel in the below areas.

 

Public and Private Insurance Programs

Medicare Policy

Providing high-quality analytic research in support of the Medicare program is a major pillar of Acumen’s work. Drawing upon our robust data holdings, clinical and technical expertise, and unparalleled institutional knowledge developed over decades of industry experience, Acumen works on projects at the cutting edge of health care policy development and implementation.

Examples of Our Work

Prominent examples of our work with the Centers for Medicare & Medicaid Services (CMS) include:

Transparency for Health Care Consumers: Acumen manages and processes the universe of Medicare clinicians’ quality measurement and demographic data to power the Physician Compare website, mandated by the Patient Protection and Affordable Care Act (ACA) to inform clinician choice for Medicare beneficiaries.

Pay for Performance: Under the authority of the Medicare Access and CHIP Reauthorization Act (MACRA), Acumen supports the development of episode-based resource use measures for use in the Merit-Based Incentive Payment System (MIPS), which seeks to incentivize cost-efficient, high quality care.

Impact to All Parts of the Medicare Program

The scope of this work affects each Part of Medicare (Parts A, B, C, and D) and has an immense impact on beneficiaries, providers, and the overall system. Some present and past examples of these projects include:

Hospital Insurance (Part A):

  • Support CMS in establishing a comprehensive approach to skilled nursing home facility (SNF) payment reform by evaluating and developing alternative reimbursement models
  • Acumen calculated and developed episode-based cost measures to evaluate hospitals' efficiency in the hospital VBP and Hospital Inpatient Quality Reporting (IQR) programs

Medical Insurance (Part B):

  • Calculate payment rates and analyze policy changes for outpatient procedures by supporting CMS in the implementation of the Outpatient Prospective Payment System (OPPS)
  • Monitor the impact Medicare’s Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program on a variety of health indicators to ensure the program is meeting its goals of reducing Medicare expenditures and beneficiary out-of-pocket expenses while ensuring access to quality items and services

Medicare Advantage (Part C):

  • Monitor the accuracy and availability of Part C plan benefits and services to ensure that Medicare-approved private health insurance plans are compliant with regulations and sufficiently cover their enrollees
  • Provide technical implementation support to CMS’s Medicare Advantage Value-Based Insurance Program, which offers Medicare Advantage plans with supplemental benefits or reduced cost sharing to enrollees with certain clinical conditions

Outpatient Prescription Drug Insurance (Part D):

  • Develop a monitoring system to identify potential cases of opioid abuse and providers who may be responsible for overutilization
  • Design and implement a broad array of patient safety measures to inform Part D plans of inappropriate or concerning drug utilization patterns among beneficiaries
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Medicaid Policy

Our expert teams - comprised of economists, statistical programmers, clinicians, and public health specialists - offer data driven answers to complex policy questions related to the Medicaid program, with a special focus on enrollees dually eligible for Medicare and Medicaid, who account for a disproportionate share of spending under both programs.

Who We Support

  • Centers for Medicare & Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO)
  • Washington State Office of the Insurance Commissioner (OIC)
  • Acumen currently seeks and anticipates additional work with other state insurance offices to support their management of private insurance markets

Examples of Past and Ongoing Work

To support CCIIO, our group developed and maintains a microsimulation model that projects market enrollment and plan premiums, incorporates the effects of state and federal policy choices, and accounts for individual and employer behavioral effects. The model output helps CCIIO set appropriate user fee payment rates and reinsurance parameters, with the aim of improving financial stability in the health insurance exchanges.

Acumen also produces and maintains the Actuarial Value Calculator (AVC) for CCIIO. The AVC is a publically-available tool that insurers may use to cerifty the metal-tier describing a plan's level of coverage. Given a specific benefit design, the tool uses a cost-sharing algorithm and spending information to produce an actuarial value that can be used to certify a plan within a certain metal tier.

Our team also works with the Washington State OIC to investigate the prevalence of discriminatory formulary benefit designs in the Washington State individual and small group markets. Acumen analyzes the formulary structures of hundreds of plans for evidence that issuers may be using prescription drug benefits to dissuade individuals with certain conditions from enrolling.


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Private Insurance Markets

Through our work with federal and state governments, Acumen has gained expertise in modeling and analyzing policies impacting both individual and small group insurance markets, including policies related to the Patient Protection and Affordable Care Act’s (ACA). Acumen’s work focuses on producing analyses to provide actuarial value calculations, identify discriminatory benefit designs, and support federal government rule making for the ACA health exchanges.

Acumen acquires, processes, and securely stores regular updates of Medicaid enrollment and claims data, and has developed reliable strategies for aggregating and analyzing Medicaid data and combining it with Medicare data and other sources to generate sophisticated analyses for policy-makers.

Who We Support

  • Medicaid and CHIP Payment and Access Commission (MACPAC)
  • Medicare-Medicaid Coordination Office (MMCO)
  • Assistant Secretary for Planning and Evaluation (ASPE)
  • Department of Justice (DOJ)
  • Food and Drug Administration (FDA)
  • California Department of Health Care Services (DHCS)
  • Medicare Payment Advisory Commission (MedPAC)

Examples of Past and Ongoing Work

In ongoing work with MedPAC and MACPAC, Acumen analyzes the demographic characteristics, expenditures, and service utilization rates of dually eligible beneficiaries, which form the basis of an annual data book published by those two agencies. Acumen also collaborates with MACPAC to produce data and analysis on a wide range of Medicaid issues, such as physician participation in Medicaid, state differences in coverage of populations and services, and quality and completeness of Medicaid data.

For MMCO, Acumen has investigated enrollment decisions made by beneficiaries participating in Medicare-Medicaid Plans (MMPs), and the number and types of individuals who may be eligible for the Qualified Medicare Beneficiary (QMB) program.

Finally, Acumen also provides data and analytic support related to Medicaid and dually eligible populations at the state level, including to the California DHCS.

Selected Publications

Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid: Medicare Payment Advisory Commission (MedPAC) & Medicaid and CHIP Payment and Access Commission (MACPAC). January 2018.

MACStats: Medicaid and CHIP Data Book: Medicaid and CHIP Payment and Access Commission (MACPAC). December 2017.


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Provider Payment Policy

Value Based Purchasing

Acumen’s teams of analysts, statisticians, and clinicians support the Centers for Medicare & Medicaid Services (CMS) and other clients in the development of metrics for quality reporting and value-based purchasing (VBP) programs. These programs incentivize cost-effective care in hospital, clinician, and post-acute care settings by measuring provider performance.

By measuring the cost of care through resource use metrics and integrating those metrics in quality reporting and VBP programs, Acumen supports CMS’ efforts to reward value and care coordination – rather than volume and care duplication – while improving the way providers are paid.

Who We Support

  • CMS Center for Clinical Standards and Quality (CCSQ)
  • CMS Center for Medicare and Medicaid Innovation (CMMI)
  • CMS Center for Medicare, Performance-Based Payment Policy Group (P3)
  • Other CMS Contractors

Examples of Past and Ongoing Work

Acumen has a long history of involvement in value-based purchasing programs, and previous measures developed by our group are currently used or will be used in the Hospital VBP Program, Hospital Inpatient Quality Reporting Program, and the four post-acute care quality reporting programs. Our group has also drawn on its experience in performance measurement to evaluate, adapt, and newly develop episode grouping algorithms for use in Medicare.

Notably, Acumen is currently developing episode-based cost measures as mandated by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. To develop measures that meet MACRA’s legislative goals and are both clinically and fiscally relevant, Acumen reviews existing measures and research, performs analyses of Medicare claims, solicits clinical input from specially recruited Technical Expert Panels and Clinical Subcommittees with representation from specialty societies, and conducts field testing of developed measures.

Across its VBP projects, Acumen supplements its analytical and clinical work with outreach to a wide range of stakeholders and production and dissemination of documentation.


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Medicare Payment Systems

Acumen’s researchers have sustained a long and distinguished series of projects to support the development, implementation, and maintenance of the Centers for Medicare and Medicaid Services’ (CMS) payment systems in virtually all settings of care.

Who We Support

Acumen serves as a primary Center for Medicare (CM) contractor for the Medicare Part A, B, and D programs, covering the full spectrum of healthcare providers and services, including hospitals, clinicians, post-acute care providers, prescription drugs, and medical devices and equipment.

Examples of Past and Ongoing Work

  • Outpatient Services (OPPS): Since 2010, our group has worked to set OPPS payment rates for outpatient services. Acumen also performs data analyses on impacts of policy updates, informing proposed changes to the OPPS payment methodology and accurately implementing these changes in the rate-setting model.
  • Physician (PFS) and Hospital (IPPS) Payments: Acumen has calculated and implemented the Geographic Practice Cost Indexes (GPCIs) and IPPS wage indexes, which determine how payments to providers vary by geographic location.
  • End Stage Renal Disease Prospective Payment System (ESRD PPS): Acumen provides support in analyzing and implementing changes to the ESRD PPS and the acute kidney injury (AKI) payment system (PS) and monitors the impact of recent and upcoming payment policy changes.
  • Skilled Nursing Facilities (SNF): Acumen has worked with CM to develop a comprehensive proposal for a re-designed SNF PPS that reduces incentives for therapy over-utilization inherent to the current SNF PPS.
  • Durable Medical Equipment (DME): Acumen monitors the impact of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program on a variety of health and care access indicators.
  • Prescription Drug Benefit (Part D): Acumen works with plan sponsors to edit their submissions of Prescription Drug Event data and works with CM on reconciliation efforts, which include the validation of data on plan rebates.

Selected Publications

Report on the CY 2017 Update of the Geographic Practice Cost Index for the Medicare Phyisican Fee Schedule. Acumen, LLC. Prepared for the Centers for Medicare & Medicaid Services. 2016.

Report on the Malpractice Relative Value Units for the CY 2018 Medicare Physician Fee Schedule. Acumen, LLC. Prepared for the Centers for Medicare & Medicaid Services. 2017.

Skilled Nursing Facilities Payment Models Research Technical Report. Acumen, LLC. Prepared for the Centers for Medicare & Medicaid Services. 2017.


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CARE DELIVERY MODELS

Acumen is an industry leader in policy related to care delivery models and supports CMS in all aspects of their reform, including their development, implementation, monitoring, auditing, and evaluation. As part of recent national initiatives to shift to care delivery that incentivizes quality and efficiency over quantity and complexity of services provided, our clients are testing a variety of incentive-based models that hold providers financially accountable for the quality and cost outcomes of their patients.

Who We Support

Established under the Affordable Care Act (ACA) for the purpose of testing innovative payment and service delivery models, Congress created the CMS Center for Medicare and Medicaid Innovation (CMMI) to evaluate models designed to reduce costs, improve care, and support patient-centered practices. Acumen supports several of the payment and service delivery models being tested by CMMI, including a Quality Payment Program Advanced Alternative Payment Model.

Examples of Past and Ongoing Work

Acumen provides the complete spectrum of services to support the life cycle of the Care Delivery Models CMMI is testing. Some examples include:

  • Design and Implementation: Acumen plays an integral role in the ongoing development of the Bundled Payments for Care Improvement (BPCI) Advanced model, which is designed to incentivize efficient resource use by setting a target price for a set of services or episode of care rather than paying separately for individual services included in the bundle.
  • Monitoring: For the ESRD Comprehensive Care Model, Acumen provided CMMI with real-time monitoring of program participants, with indicators related to anemia management, dialysis adequacy, morbidity and mortality, among others.
  • Auditing: Acumen performs auditing/ validation services for care delivery models, including the entire Quality Payment Program (QPP), to ensure that program calculations that affect provider payments are correctly implemented.
  • Evaluation: Acumen has conducted and continues to conduct several rapid-cycle evaluations to assess the impact of a broad array of innovative service delivery models, including the Enhanced Medication Therapy Management Model, the Beneficiary Engagement and Incentive Models, and the Health Care Innovation Awards, among others.

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Program Integrity, Safety, and Emergency Response

Medical Product Safety

Acumen works with federal agencies to monitor the safety and effectiveness of prescription drugs, medical procedures, vaccines, and other biological products. Leveraging our access to numerous national healthcare databases and statistical and epidemiological expertise, Acumen‘s research harnesses the rich information available in claims and administrative data to evaluate the impact of these products on the health and safety of Medicare and Medicaid beneficiaries.

Who We Support

  • Centers for Medicare & Medicaid Services (CMS)
  • Food and Drug Administration (FDA)
  • Centers for Disease Control and Prevention (CDC)
  • Office of the Assistant Secretary of Health (OASH)

Examples of Past and Ongoing Work

For years, Acumen has spearheaded efforts to identify emerging health care trends, analyze rare adverse events, and evaluate risk factors for health outcomes associated with certain medical projects. Some of Acumen’s work includes:

  • Supporting of the FDA’s influenza vaccine surveillance efforts by providing real-time monitoring of Guillain-Barré Syndrome (GBS) rates following vaccination.
  • Designing and implementing case-control analyses to measure the effectiveness of different pneumococcal vaccine formulations.
  • Examining the risk of rare adverse outcomes, e.g., transfusion-related acute lung injury among patients who receive blood transfusions of blood products.
  • Studying the safety and efficacy of a range of vaccines in preventing influenza, pneumonia, herpes zoster, and pertussis.
  • Investigating the comparative risk of anaphylaxis among patients administered different intravenous iron products.
  • Assessing cardiovascular and bleeding risks among patients taking various oral anticoagulants.
  • Evaluating the effectiveness of policies aimed at reducing excess antipsychotic medication use among young children.
  • Measuring the risk of short-term mortality following mechanical v. bioprosthetic aoritc heart valve replacement surgeries.

Selected Publications

"Chart-Confirmed Guillain-Barré Syndrome After 2009 H1N1 Influenza Vaccination Among the Medicare Population, 2009-2010,," (with Laura L. Polakowski, Sukminder K. Sandu, David B. Martin, Robert Ball, Thomas E. MaCurdy, Riley L. Franks, Jonathan M. Gibbs, Garner F. Kropp, Armen Avagyan, Jeffrey A. Kelman, Christopher M. Worrall, Guying Sun, Rebecca E. Kilman, Dale R. Burwen), American Journal of Epidemiology, 2013 (178): 962-973.

"Comparative Risk of Anaphylactic Reactions Associated with Intravenous Iron Products," (with Cunlin Wang, David J. Graham, Robert C. Kane, Diqiong Xie, Michael Wernecke, Mark Levenson, Thomas E. MaCurdy, Monica Houstoun, Qin Ryan, Sarah Wong, Katrina Mott, Ting-Chang Sheu, Susan Limb, Chris Worrall, Jeffrey A. Kelman, and Marsha E Reichman.), Journal of the American Medical Association, 2015 (19): 2062-68.

"Stroke, bleeding, and mortality risks in older patients treated with dabigatran or rivaroxaban for nonvalvular atrial fibrillation (AF)," (with David J. Graham, Marsha Reichman, Michael Wernecke, Yahui Hsueh, Rima Izem, Mary Ross Southworth, Yuqin Wei, Jiemin Liao, Margie Goulding, Katrina Mott, Yoganand Chillarige, Thomas MaCurdy, Chris Worrall, Jeffrey A. Kelman), Journal of the American Medical Association, 2016 (11): 1662-71.

"Pediatric Use of Antipsychotic Medications Before and After Medicaid Peer Review Implementation," (with Julie M. Zito, Mehmet Burcu, Stephen McKean, Rob Warnock, and Jeffrey A Kelman); JAMA Psychiatry. 2018; 75(1):100–103.


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Emergency Preparedness and Response

Acumen has cultivated significant expertise in supporting emergency preparedness and response efforts by public health authorities (PHAs) and investigating the effects of emergency situations on vulnerable populations. In our ongoing work with the Assistant Secretary for Preparedness and Response (ASPR), Acumen supports PHAs with targeted efforts when preparing for and responding to emergency situations, including rapid dissemination of customized datasets to identify at-risk individuals and populations. Our group also works to enhance ASPR’s understanding of the needs and circumstances of vulnerable populations who are at risk during emergency situations.

Who We Support

In the wake of Hurricane Katrina, ASPR was created under the Pandemic and All Hazards Preparedness Act to lead the Department of Health and Human Services’ efforts to prevent, prepare for, and respond to the adverse health effects of public health emergencies and disasters. Leveraging our expertise in working with Medicare data, Acumen supports ASPR in these efforts through claims-based analyses to provide insights into how we can build more resilient communities.

Examples of Past and Ongoing Work

As part of our work with ASPR, Acumen conducts both prospective and retrospective investigations to both plan for and respond to natural disasters and emergencies:

  • Prospective Planning: Acumen develops, implements, and maintains several algorithms that identify various at-risk populations who are vulnerable during emergency situations and create customized datasets containing crucial information on those populations. For instance, to prepare for a flood, a PHA may request data to identify all patients using oxygen tanks in a specific region. Acumen has disseminated individual-level data to over 53 regions including entire states and major metropolitan areas to help them prepare for such emergencies.
  • Retrospective Response: Acumen conducts retrospective investigations to assess the effects of natural disasters on service utilization and health outcomes. Acumen develops monitoring analysis frameworks to assess the impact of and recovery from different natural disasters. For example, Acumen conducted analyses to determine the effect of Hurricane Sandy on levels of care as well as monitor adverse outcomes for Medicare dialysis beneficiaries before, during, and after the hurricane.

Selected Publications

"Early Dialysis and Adverse Outcomes After Hurricane Sandy," (with Nicole Lurie, Kristen Finne, Chris Worrall, Maria Jauregui, Tanayott Thaweethai, Gregg Margolis, and Jeffrey Kelman.), American Journal of Kidney Diseases, 2015 (3): 507-12.

"Dialysis Care and Death Following Hurricane Sandy," (with Jeffrey Kelman, Kristen Finne, Alina Bogdanov, Chris Worrall, Gregg Margolis, Kristin Rising, Thomas E. MaCurdy, and Nicole Lurie), American Journal of Kidney Diseases, 2015 (1): 109-15.


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Program Integrity and Fraud

Acumen advises federal entities in safeguarding healthcare programs from fraud, waste, and abuse. We apply our deep knowledge in federal health care policy and data to uncover fraudulent behavior in Medicare and Medicaid. By using statistical approaches to reveal abnormal scenarios in live claims and provider enrollment data, we give stakeholders the evidence needed to develop policies that protect beneficiaries from unscrupulous practices.

Who We Support

  • CMS Center for Program Integrity (CPI): CPI was established in 2010 to combat and prevent fraud, waste, and abuse in Medicare and Medicaid.
  • Department of Justice (DOJ) Civil Division – Frauds Section: The Frauds section litigates cases involving financial fraud against the government.
  • DOJ Offices of the U.S. Attorneys: The Offices of the U.S. Attorneys are the nation’s principal litigators under the direction of an Attorney General.

Examples of Past and Ongoing Work

  • Analytic Support: Acumen analyzes Medicare claims data to verify alleged fraud schemes discovered by CPI and DOJ stakeholders. Specifically, Acumen is responsible for translating the scheme into Medicare policy and data, and investigating various dimensions, so stakeholders can make an informed decision about whether the scheme is worth pursuing.
  • Policy Design: Acumen derives insights from claims and provider-related data to help CPI develop, enhance, and implement Medicare enrollment and payment policy. Through this work, CPI is able to prevent risky providers from entering Medicare and Medicaid and deter existing providers from committing fraudulent behavior.
  • Data Visualization: Acumen creates interactive databases to inform clients regarding Medicare and Medicaid data analyses through clear and accessible data visualizations, which draw upon large multi-year Medicare data sets. Through this work, we empower DOJ by giving them the ability to target providers who may be receiving improper payments from the Medicare program.
  • Policy Monitoring: Acumen quantifies the impact of CPI’s initiatives and programs by calculating the savings attributable to these actions. Through this work, Acumen’s findings were instrumental for multiple Reports to Congress, which gives CPI the leverage to extend its capacities and activities.

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