Health

Optimal’s Health Policy Research Center (HPRC) provides rigorous, objective research and evaluation on salient health issues. The HPRC staff includes statisticians, clinicians, and researchers with expertise and experience in conducting large research studies and focused evaluations of programs and initiatives. The projects completed by HPRC staff range from determining the potential effects of new initiatives and policies on various stakeholders to evaluating the outcomes and impacts of existing programs.

Through its rigorous quantitative and qualitative methods, thorough quality controls, and innovative implementation practices, the HPRC is contributing to national initiatives to improve quality of care and reduce waste in our nation’s health care system.

HPRC staff have expertise in the following subject areas:

  • Medicaid
  • Medicare
  • Fraud, waste, and abuse
  • Substance abuse
  • Managed care
  • Quality improvement and chronic care improvement programs
  • Prescription drug programs

HPRC staff have experience providing the following support:

  • Developing and implementing quality-of-care measures
  • Auditing contractors and programs for regulatory compliance
  • Conducting quasi-experimental design evaluations
  • Supporting local collaboratives
  • Conducting program and process evaluations
  • Conducting cost-benefit analysis
  • Providing technical assistance
  • Developing performance metrics

 

Sample Past Performances:

 

Office of the Medicare Ombudsman Support Contract

Optimal is the program support contractor for the CMS Office of the Medicare Ombudsman (OMO), supporting the OMO’s to improve Medicare for beneficiaries. Optimal developed the 2009, 2010, 2011, 2012, 2013, and 2014, 2015, and 2016 Reports to Congress (RTCs), and the RTCs are now awaiting HHS clearance. Optimal also supports the Issues Management process, the OMO’s tracking of recommendation implementation, and the development of the Competitive Acquisition Ombudsman (CAO) RTC. The contract requires management of a complex project with various overlapping and simultaneous tasks. Under this contract, Optimal provides support for beneficiaries in locations such as the Virgin Islands, Puerto Rico, Florida, Texas and American Samoa.

Evaluation and Oversight of Qualified Independent Contractors (QIC)

U.S Department of Health and Human Services, Centers for Medicare and Medicaid Services Optimal was contracted by CMS to evaluate the accuracy, timeliness, and quality of QICs’ decisions and processes. QICs, which are part of the Medicare appeals process, provide reconsideration decisions for claims appealed by providers, beneficiaries, or suppliers after a claim has been denied by a Medicare carrier, fiscal intermediary, or Medicare Administrative Contractor. For this contract, Optimal developed detailed protocols for measuring process management and the accuracy of coverage and medical decisions in the previous contract (HHSM-500-2007-00028C).

Take a look at some of our previous work.

For more information, e-mail us at [email protected].