Consortium on Complex Chronic Illness, Quality, and Equity

The Consortium on Complex Chronic Illness, Quality and Equity is a public-private research enterprise aimed at studying patients with multiple chronic illnesses, assessing the impact of the clustering of chronic illnesses on outcomes and costs, and identifying new levers for quality improvement – all with a focus on disparities in burden of illness, quality of care and outcomes.The overarching goal of the Consortium is to improve the quality of care, reduce disparities and improve access to care for persons with multiple chronic illnesses.  Specific objectives pursuant to realizing this mission include the following:

  1. Develop the capacity to conduct national, policy-relevant, cross-cutting analyses of the quality of care provided to persons with complex chronic illness in multiple settings and systems of care using a national, all-payer patient-level database that includes privately insured, Medicaid, VA and Medicare data – thereby identifying characteristics of health delivery systems associated with increased quality and decreased disparities;
     

  2. Develop a national research agenda that addresses the intersection of quality, equity and complex chronic illness (to include not only state-of-the-art assessment of quality, cost-effectiveness and outcomes, but also equity with respect to access to new, beneficial treatments, such as injectable biologics and genetic-based therapies);
     

  3. Develop improved measures of access and quality of care for key chronic conditions that take into account the presence of multiple co-morbidities;
     

  4. Implement the national research agenda through conducting and facilitating original research addressing variations in access, quality of care and related outcomes across systems of care, with a particular focus on equitable treatment of vulnerable sub-populations;
     

  5. Provide quality measurement tools and technical assistance to health plans and Medicaid programs interested improving the quality of care for all persons with complex chronic illness and using these measures to track efforts to reduce disparities in the quality of care provided.

Data Resources

The Consortium has access to a vast database of claims data that includes:

  • Medstat MarketScan:
    • Commercial – more than 7M covered lives, longitudinal since 1988.
    • Medicaid – approximately 12M covered lives  (5 states up thus far; permission in place for 12), longitudinal data 1999 forward.
  • Veterans Affairs Data: Over 60 million encounters recorded in the datasets from 1999 forward.
  • Ingenix (United HealthCare) Data: More than 14M covered lives (22M by 2006); electronic lab data for more than 4M.

Consortium Projects

Consortium on Complex Chronic Illness: Improving Health Care Experiences and Quality of Care Among Military Health System (MHS) Beneficiaries Living with Chronic Illness, Task Order #1

  • The overall objective of this project was to provide the Department of Defense (DoD) with the essential data needed to identify and prioritize opportunities for quality improvement in caring for those MHS beneficiaries with complex chronic illness.  We focused on the disease burden within the four different systems (TRICARE, Private Insurance, Medicaid and the VA) and then the relative quality of care and expenditures as measured by key indicators that can be estimated with available electronic data (administrative claims and encounter data).

Consortium on Complex Chronic Illness: Improving Health Care Experiences and Quality of Care Among Military Health System (MHS) Beneficiaries Living with Chronic Illness, Task Order #1

  • Among TRICARE beneficiaries under age 65, we are examining the patterns of TRICARE purchased care utilization relative to direct care (Military Treatment Facility, MTF) utilization for select categories of service and/or conditions, and to characterize the types of care most likely to “migrate” to purchased care settings/providers and the cost implications of such patterns for the Department of Defense (DoD).

Related Publications

  • Shields A.E., Comstock C., Finkelstein J.A., Weiss K.B. Comparing asthma care provided to Medicaid-enrolled children in a primary care case manager plan and a staff model HMO.    Ambulatory Pediatrics. 2003; 3(5):253-262. PMID: 12974661.
  • Shields A.E., Comstock C., Weiss K.B.  Variations in asthma care by race/ethnicity among children enrolled in a state Medicaid program. Pediatrics. 2004; 113(3): 496-504. PMID: 14993540.
  • Shields A.E. Trends in private insurance, Medicaid/SCHIP, and the health care safety net: Implications for asthma disparities. Chest; 2007. 132:818S-830S. PMID: 17998346.
  • Vogeli C., Shields A.E., Lee T.A., Gibson T.B., Marder W.D., Weiss K.B., Blumenthal D. Multiple chronic conditions: Prevalence, health consequences and implications for quality, care management and costs. Journal of General Internal Medicine. 2007; 22 Suppl 3:391-395. PMID: 18026807.
  • Lee T., Shields A.E., Vogeli C., Gibson T., Woong-Sohn M., Marder W.D., Blumenthal D., Weiss, K.B. Mortality rates in veterans with multiple chronic conditions. Journal of General Internal Medicine. 2007; 22 Suppl 3:403-407. PMID: 18026809.
  • Shields A.E., McGinn-Shapiro, M, Fronstin, P. Trends in private insurance, Medicaid/State Children’s Health Insurance Program, and the health safety net: Implications for vulnerable populations and health disparities. Annals of the New York Academy of Sciences. 2008; 1136: 137-48. PMID: 18579880.
  • Gibson T.B., Lee T.A., Vogeli C., Hidalgo J., Carls G.S., Sredl K., DesHarnais S., Marder W.D., Weiss K.B., Williams T.V., Shields A.E. A four-system comparison of patients with chronic illness: the Military Health System, Veterans Health Administration, Medicaid, and commercial plans.  Military Medicine. 2009; 174(9): 936-943. PMID: 19780368.