Health Services Research, Medicare, and Medicaid: A Deep Bow and a Rechartered Agenda.

Abstract

F rom their inception, Medicare and Medicaid have been shaped and guided by health services research (HSR) and its people. The linkages are numerous: ideas (like Diagnostic Related Groups, or DRGs, Resource-Based Relative Value Scale, or RBRVS, and Accountable Care Organizations, or ACOs), tools (like those from the RAND Health Insurance Experiment, the Medical Outcome Study, and the HCAHPS family), frameworks, and, of course, people who oscillated between academia and government, to the benefit of both. As administrator of the Centers for Medicare and Medicaid Services (CMS) from 2010 to 2011, I saw productive contributions of HSR to CMS policy, regulation, and operations every day. That is a track record to be proud of. But there are gaps, some big ones, and a rechartered agenda for HSR could help boost American health care to its next and needed levels of performance. The following are 10 suggested topics for HSR to focus on in the next decade, more understanding of which would help health care leaders, including CMS, to move more rapidly toward better care for individuals, better health for populations, and lower per capita cost through improvement: the “Triple Aim.”1,2