Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Each year, Medicare allocates tens of billions of dollars for indirect practice expense (PE) across services on the basis of data from the Physician Practice Information (PPI) Survey, which reflects 2006 expenses. Because these data are not regularly updated, and because there have been significant changes in the U.S. economy and health care system since 2006, there are concerns that continued reliance on PPI Survey data might result in PE payments that do not accurately capture the resources that are typically required to provide services. In this final report of the second phase of a study on PE methodology, the authors address how the Centers for Medicare & Medicaid Services (CMS) might improve the methodology used in PE rate-setting, update data that inform PE rates, or both. The authors conclude that this information is best provided by a survey; therefore, they focus on the advantages and disadvantages of survey-based approaches. They also describe the use of a lean model survey instrument, as well as partnering with another agency to collect data. Finally, the authors describe a virtual town hall meeting held in June 2021 to give stakeholders an opportunity to provide feedback on PE data collection and rate-setting. The system of data and methods that CMS uses to support PE rate-setting is complex; thus, CMS must take into account a number of competing priorities when considering changes to the system. With this in mind, the authors offer a number of near- and longer-term recommendations.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

TRICARE, the U.S. Department of Defense insurance program for eligible service members and their dependents, provides health care coverage to nearly 2 million children under the age of 18. Survey data and prior evaluations indicate that TRICARE-covered children face challenges in accessing pediatric health care, with the greatest challenges among children who have experienced frequent relocations and children with special health care needs. However, TRICARE has not measured pediatric patient experiences in accessing care since 2010. To fill this gap, RAND researchers analyzed national survey data on the experiences of caregivers of TRICARE-covered children and children with commercial insurance, public insurance, and no insurance to identify differences in access to pediatric care, necessary referrals, care coordination support, ability to pay medical bills, and other factors. Additional analyses highlight variations between children with different TRICARE plans, between children who have changed addresses more and less frequently, and between children with special health care needs and those without. The findings should help inform efforts to increase access to care for children across the Military Health System, as well as improvements to programs designed to support military families during relocations and those with children who have special health care needs.

Children of military personnel --- Families of military personnel --- Medical care --- Services for --- Evaluation

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Victims of sexual assault and sexual harassment often experience a variety of psychological outcomes and mental health symptoms related to posttraumatic stress disorder (PTSD), depression, anxiety, substance abuse, suicidal ideation, and self-harm. Sexual trauma also might affect careers. Despite a need to address these harms, some service members have reported that connecting to health care or mental health services following sexual assault or sexual harassment can be difficult—in part because of a lack of leadership support. Given these persistent challenges, the Psychological Health Center of Excellence identified an urgent need to better understand research that is pertinent to sexual assault and sexual harassment during military service so that the U.S. Department of Defense and the military services can improve the health care response for service members. RAND researchers investigated and synthesized relevant research in three topic areas: (1) the effectiveness of psychotherapy treatments designed for adult victims of sexual assault or sexual harassment in military settings; (2) barriers faced by U.S. military members to accessing and remaining in mental health care settings; and (3) associations between sexual assault or sexual harassment and mental health conditions.