Acute and Chronic Health Care

Acute and Chronic Health was the primary focus of the Schneider Institutes for Health Policy (SIHP) at the time of its inception over 25 years ago. For the first ten years, SIHP was largely focused on public and private financing, and to a lesser extent, the health care delivery system. Since most of the initial funding for SIHP came from a Federal government agency (now the Center for Medicaid and Medicare Services - CMS), the research performed was mainly focused on a broad range of issues related to financing, mostly related to hospital and physician payment systems. However, opportunities were provided by Centers for Medicare and Medicaid Services (CMS) and a growing number of foundations to design new financing and delivery models for the populations most at risk.

The Schneider Institutes created national demonstrations: the Social/HMO and End Stage Renal Disease (ESRD) demonstrations. The Social/HMO demonstration was designed in 1979-80 with expanded benefits including pharmaceuticals, care management for the frail or at risk populations, and appropriate payments for the population enrolled. Many of these features are now incorporated in the Medicare Advantage program, which expands the healthcare options for Medicare beneficiaries.

In the 1980's, the need for risk adjustment and the alternatives in capitation payments were a major concern, leading SIHP to propose the first set of risk adjustors based on prior use. Over time, more of the research activities have explored the structure of the medical care delivery system. In the 1990's SIHP developed the Group Practice Demonstration Program for CMS, using a blend of fee-for-service and incentives derived from expected per-capita costs to encourage the appropriate access and service use.

Currently, we are directing our own Agency for Healthcare Research and Quality (AHRQ) training program, and many SIHP research projects seek to better understand how the different levels of health care organizations interact and shape one another and impact on cost and quality outcomes. As a result of the various research projects, SIHP's research staff and areas of competency have grown, resulting in a significant capacity to address health financing, organization, and outcomes for all populations, particularly those at greatest risk.