Measuring the Value of Prevention within the SMP Program

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Educating consumers to prevent health care fraud is the essence of the mission and message of the Administration for Community Living’s (ACL) Senior Medicare Patrol (SMP) program. The SMP mission is to empower and assist Medicare beneficiaries, their families, and caregivers to prevent, detect, and report healthcare fraud, errors, and abuse through outreach, counseling, and education. The 54 SMP projects recruit and train volunteers to educate Medicare beneficiaries about how to protect their Medicare numbers, examine their Medicare Summary Notices to detect discrepancies, and report suspicious activity when detected. The SMP program seeks to empower seniors through increased awareness and understanding of health care programs to protect them from the economic and health-related consequences associated with Medicare fraud, error, and abuse. The SMP program, like many other federal, state, and local programs, must estimate the benefits that the program provides. However, since there is not currently a way to quantify the effects of prevention education, measuring the impact of the SMP program on the extent and cost of fraud and abuse is difficult. For that reason, with this Funding Opportunity Announcement, ACL seeks applications that will describe how to best conduct research on prevention education, such as that conducted by the SMP program, to determine how to best measure and quantify the effects of these efforts. This research may include, but is not limited to, identification of methodologies for measuring cost savings or avoidance associated with SMP’s fraud prevention efforts. Specifically, ACL is interested in reviewing and supporting applications that will describe how the applicant will: · Conduct a literature review of methods to quantify the effects of community education on prevention to identify an appropriate methodology for measuring these efforts in general and within the SMP context; · Determine how to best measure and estimate the effects of community education on health care fraud prevention according to the identified methodology; and · Develop and implement, in conjunction with selected volunteer SMP project grantees, a pilot study to demonstrate the above developed measures and tools using the SMP program and the program’s Medicare fraud prevention efforts. ACL plans to fund one (1) cooperative agreement at the federal funding level of $200,000 per year, over a three (3) year project period, pending availability of federal funds.

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