The Moran Company has significant experience studying population based health care utilization for Medicare fee for service beneficiaries. Organizations that wish to understand service utilization patterns and costs for segments of a target population often commission a study that will address a range of research questions. Pharmaceutical and device manufacturers have commissioned studies to examine the patterns and costs of care for target populations for their products. Studies often explore unusual ways to segment the target population based on different trajectories of care, demographic characteristics, treatment decisions, geographic region, type of provider initiating care, frequency of contact with different providers and other factors. Studies have been performed looking closely at re-hospitalization and emergency room visit rates, post acute care, need for coordination among physician specialties, adequacy of primary care and severity of illness based on co-morbidities and combinations of services.
Profiling a target population
Many TMC clients are interested in studying a target population across a significant length of time in order to profile the population demographically, look at co-morbid conditions and treatments, track service utilization by type of service and pattern of service and examine the costs of care. TMC analysts have experience performing these types of profiles on a variety of conditions. In order to ensure that the profile is as targeted and accurate as possible, TMC analysts work with our clients to develop the appropriate clinical criteria and services to be targeted. Some profiles have been published in peer-reviewed journals, and clients have used these profiles to develop longer-term care protocols based on the patterns found in the profiles.
Studying the implications for payment system reforms
Having profiled a target population, and costs associated with patterns of care, we can examine the potential to define “episodes of care” to which payment reforms may be applied. We can also look at specific payment reforms in different types of markets and explore how different patient groups and different types of providers may fare under test conditions. For organizations planning future strategies to introduce products to the market, these studies include population based information that is highly detailed and can provide the basis for a wide range of decisions. For provider groups looking at referral practices, and trends in service utilization, these studies offer insight into the patterns of care and gaps in service and continuity that they may need to address in the future.
We do highly specialized surveys that involve complex issues that require difficult data collection from of a targeted group with specialized knowledge. We do not do opinion or other broad based surveys. We typically will be asked to survey a provider group to investigate financial issues relevant to payment system reforms or in response to regulatory policies, where more refined data are needed to make progress in answering questions. We may also be asked to survey clinicians about factors that influence their decisions or to verify suspected changes in patterns of care.
Independence and research process
We will work closely with clients to clarify research questions and to review methodology. We do not, however, agree to research that is expected to produce any particular outcome. We retain the rights to all final decisions on methods and will produce results based on the rigorous application of scientific method and relevant research techniques, whether or not those results are the ones desired by a client. Clients may choose to use our research findings, or not, but often our reports are used with policy audiences, presented at professional meetings, and periodically we are asked to develop a manuscript for publication.
Our methods draw on a broad and interdisciplinary repertoire of approaches, and we use iterative techniques to do research. We do not develop detailed research proposals that we then follow, but rather define the parameters of the research and modify methods as we discover the adequacy of particular methods for answering a research question. Our experience shows that this approach improves our research, allowing us to learn from the data in stages and adapt to produce more interesting and targeted results. We are also able to interact with clients through the research to produce interim results, and include client feedback in the interpretation of findings.