SPHERE has several teams dedicated to auditing and validating health care program data to promote compliance with and integrity of various Medicare programs. This work often involves auditing the accuracy and availability of marketed plan benefits and services and reviewing marketing materials and communication to enrollees to ensure that health plans are meeting compliance standards.

When introducing new programs and policies to the public, clients often require data and analytic support throughout the development and implementation phases. SPHERE is an industry expert in supporting the design and implementation of public health care delivery programs and payment systems. Our expertise encompasses a wide range of care settings, including nursing facilities (NFs), skilled nursing facilities (SNFs), long-term care hospitals (LTCHs), and inpatient rehabilitation facilities (IRFs), as well as outpatient services, physician reimbursement, and disease-specific Medicare benefits, such as the End-Stage Renal Disease (ESRD) benefit.

Policymakers, providers, and consumers use health care measures to incentivize effective care, and to evaluate provider performance with regard to cost, quality, and other domains. SPHERE has extensive experience developing, reporting, and evaluating health care performance measures, with a particular focus on cost and quality measures. Our group currently develops and reports episode-based cost measures and quality measures for clinicians, hospitals, and post-acute care providers.

As Federal, state, and local agencies continue to test improvements to their health care systems, robust evaluations are necessary to evaluate their impact and determine best practices. SPHERE has significant experience designing and implementing flexible and insightful evaluations of federal and state health care programs, specifically programs testing innovations related to payment policy and care delivery. Our group conducts a wide range of mixed methods and quantitative program evaluations to assess the programs’ impact on health care costs, standards of care, and patient health and quality of life.

SPHERE’s staff includes a broad and expanding network of clinicians who take on varying roles in SPHERE’s work. They serve in managerial roles on projects requiring significant clinical expertise and in consulting or supporting roles in nearly all of SPHERE’s work. These clinicians come from a diverse range of medical specialties and backgrounds, all with Medicare population experience, understanding of policy implications, and expertise in health services and administrative claims research.

SPHERE’s data systems programmers and statisticians play an integral role in supporting SPHERE’s research staff and their clients and work to provide research-ready data resources to the entire firm. Our group’s data and statistical support staff update and maintain large databases, including all Medicare, Medicaid, and commercial health care claims data used across projects teams, and streamline the processes for querying datasets. SPHERE’s statisticians also work with our group’s research teams in the development of statistical methods for complex analyses.

Our data visualization specialists work directly with our research teams to elicit requirements, develop specifications, and design appropriate solutions. These products are designed to answer applicable research questions in a visually intuitive interface, allowing our clients to easily extract needed information.