R01AG075508

Primary Care Transformation in Puerto Rico's Physician Organizations Following Hurricane Maria - Project Summary/Abstract

In September 2017, Hurricane Maria brought unprecedented devastation to Puerto Rico. The hurricane's impact was disproportionately borne by elderly patients and residents of remote areas who were vulnerable to disruptions in healthcare services. Providers and policymakers are currently seeking to make major investments in Puerto Rico's primary care delivery system as outlined in the recovery plan. However, the ability of Puerto Rico's Physician Organizations (POs) to undertake large-scale primary care transformation remains unclear.

In particular, POs may differ widely in their existing primary care infrastructure and the level of support they typically receive to implement new infrastructure. This support may come from health systems or independent physicians associations, Medicare Advantage plans, Medicaid managed care organizations, or the federal government.

This proposed study, building on an existing collaboration between RAND and the University of Puerto Rico, will examine four models of physician organization in Puerto Rico: Federally Qualified Health Centers, small independent medical groups, large independent medical groups, and vertically-integrated medical groups. The study will use Medicare fee-for-service claims and Medicare Advantage encounter data to assess trends in the physician workforce providing care through these four delivery models, the Medicare beneficiaries who receive care through each model, and changes in these trends following Hurricane Maria.

The study will also assess changes in access, quality of care, and care coordination before and after Hurricane Maria to measure differences in performance across PO models. It aims to identify high-performing POs and low-performing POs in each model. Interviews will be conducted with leaders of 32 of the highest-performing and lowest-performing POs in each model to identify the advanced primary care infrastructure they have sought to implement, as well as implementation barriers.

Additionally, interviews will be conducted with Medicare beneficiaries living with Alzheimer's disease (or Alzheimer's disease-related dementias) and their caregivers to better understand their unmet care needs and how these needs differ across the four PO models. The research will be guided and supported by an advisory committee comprising representatives of two local provider associations and two local patient advocacy groups that represent older adults and people living with Alzheimer's disease and Alzheimer's disease-related dementias.

The study aims to identify specific models of physician organization that are associated with higher performance, which could help guide Puerto Rico's Hurricane Maria recovery effort. The findings could also assist stakeholders in prioritizing the expansion of specific services that could most directly improve the lives of patients with Alzheimer's disease or Alzheimer's disease-related dementias and their caregivers. Furthermore, the study aims to identify the types of POs that might need greater support to address current gaps.

RAND Corporation

TO ENCOURAGE BIOMEDICAL, SOCIAL, AND BEHAVIORAL RESEARCH AND RESEARCH TRAINING DIRECTED TOWARD GREATER UNDERSTANDING OF THE AGING PROCESS AND THE DISEASES, SPECIAL PROBLEMS, AND NEEDS OF PEOPLE AS THEY AGE. THE NATIONAL INSTITUTE ON AGING HAS ESTABLISHED PROGRAMS TO PURSUE THESE GOALS. THE DIVISION OF AGING BIOLOGY EMPHASIZES UNDERSTANDING THE BASIC BIOLOGICAL PROCESSES OF AGING. THE DIVISION OF GERIATRICS AND CLINICAL GERONTOLOGY SUPPORTS RESEARCH TO IMPROVE THE ABILITIES OF HEALTH CARE PRACTITIONERS TO RESPOND TO THE DISEASES AND OTHER CLINICAL PROBLEMS OF OLDER PEOPLE. THE DIVISION OF BEHAVIORAL AND SOCIAL RESEARCH SUPPORTS RESEARCH THAT WILL LEAD TO GREATER UNDERSTANDING OF THE SOCIAL, CULTURAL, ECONOMIC AND PSYCHOLOGICAL FACTORS THAT AFFECT BOTH THE PROCESS OF GROWING OLD AND THE PLACE OF OLDER PEOPLE IN SOCIETY. THE DIVISION OF NEUROSCIENCE FOSTERS RESEARCH CONCERNED WITH THE AGE-RELATED CHANGES IN THE NERVOUS SYSTEM AS WELL AS THE RELATED SENSORY, PERCEPTUAL, AND COGNITIVE PROCESSES ASSOCIATED WITH AGING AND HAS A SPECIAL EMPHASIS ON ALZHEIMER'S DISEASE. SMALL BUSINESS INNOVATION RESEARCH (SBIR) PROGRAM: TO EXPAND AND IMPROVE THE SBIR PROGRAM, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, TO INCREASE SMALL BUSINESS PARTICIPATION IN FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION. SMALL BUSINESS TECHNOLOGY TRANSFER (STTR) PROGRAM: TO STIMULATE AND FOSTER SCIENTIFIC AND TECHNOLOGICAL INNOVATION THROUGH COOPERATIVE RESEARCH DEVELOPMENT CARRIED OUT BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO FOSTER TECHNOLOGY TRANSFER BETWEEN SMALL BUSINESS CONCERNS AND RESEARCH INSTITUTIONS, TO INCREASE PRIVATE SECTOR COMMERCIALIZATION OF INNOVATIONS DERIVED FROM FEDERAL RESEARCH AND DEVELOPMENT, AND TO FOSTER AND ENCOURAGE PARTICIPATION OF SOCIALLY AND ECONOMICALLY DISADVANTAGED SMALL BUSINESS CONCERNS AND WOMEN-OWNED SMALL BUSINESS CONCERNS IN TECHNOLOGICAL INNOVATION.

93.866 - Aging Research

National Institute on Aging (NIA) [HHS - NIH]

Virginia United States

State-Wide

Long-Term Effects of Disasters on Health Care Systems Serving Health Disparity Populations (R01- Clinical Trial Optional) (PA-20-172)

Amendment Since initial award the total obligations have increased 289% from $775,772 to $3,019,786.