Digital Commons Network^™

Saving Money: The Massachusetts Tobacco Cessation Medicaid Benefit: A Policy Paper, Leighton C. Ku, David Zauche, E. Ripley Forbes

Health Policy and Management Faculty Publications

In the United States, about 70% of smokers want to quit and 50% make a quit attempt each year. Unfortunately, only a small percent are successful, due in part to the lack of easy access to tobacco dependence treatments that have been proven effective. In light of the societal costs of tobacco-related illness, government must do everything it can to encourage and enable smokers to quit.

The tobacco use landscape in this country has changed in recent years -- people with lower income and education levels have a much higher probability of smoking. For instance, the smoking rate for those …

The Return On Investment Of A Medicaid Tobacco Cessation Program In Massachusetts, Patrick Richard, Kristina West, Leighton Ku

Health Policy and Management Faculty Publications

Background and Objective

A high proportion of low-income people insured by the Medicaid program smoke. Earlier research concerning a comprehensive tobacco cessation program implemented by the state of Massachusetts indicated that it was successful in reducing smoking prevalence and those who received tobacco cessation benefits had lower rates of in-patient admissions for cardiovascular conditions, including acute myocardial infarction, coronary atherosclerosis and non-specific chest pain. This study estimates the costs of the tobacco cessation benefit and the short-term Medicaid savings attributable to the aversion of inpatient hospitalization for cardiovascular conditions.

Methods

A cost-benefit analysis approach was used to estimate the program's …

Gender And Race Wage Gaps Attributable To Obesity, Avi Dor, Christine Ferguson, Ellen Tan, Lucas Divine, Jo Palmer

Health Policy and Management Faculty Publications

Currently, two out of three Americans are overweight or obese. In less than 20 years, roughly half of the population will be obese. Furthermore, obesity costs $168.4 billion a year, a number which is projected to increase by $48-66 billion per year. The societal costs of obesity are clear and staggering and the individual costs are equally chilling for most of those who are obese – particularly for Hispanic men and Caucasian and Hispanic women.

Bending The Health Care Cost Curve In North Carolina: The Experience Of Community Health Centers, Patrick Richard, Peter Shin, Kristina Vasilkovska, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

North Carolina is known for innovative practices in primary care delivery and education, and accordingly one might expect to see greater efficiencies overall in care delivery, and less direct, measurable impact by community health centers on cost and outcome. Of interest is whether community health centers (CHCs) are cost effective providers in states with a sophisticated primary care infrastructure and focus on the needs of medically underserved communities. Building on the large body of health services research literature that has documented the quality and cost-effectiveness of federally-funded primary health centers nationwide, as well as estimates of national savings that are …

Why The Grey's Anatomy Myth Clouds The Real Value Of Emergency Care, Jesse M. Pines, Zachary F. Meisel

Health Policy and Management Informal Communications

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. Just a decade ago, patients were still being subjected to exploratory surgery, in which a surgeon cuts open the abdomen to look for problems; today, CT scans allow doctors to make diagnoses without a scalpel.

Why Doctors Order Too Many Tests (It's Not Just To Avoid Lawsuits), Jesse M. Pines, Zachary F. Meisel

Health Policy and Management Informal Communications

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. Just a decade ago, patients were still being subjected to exploratory surgery, in which a surgeon cuts open the abdomen to look for problems; today, CT scans allow doctors to make diagnoses without a scalpel.

Who Are The Health Center Patients Who Risk Losing Care Under The House Of Representatives' Proposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On February 20, 2011, the United States House of Representatives approved more than $61 billion in discretionary spending reductions for the remainder of FY 2011. The legislation includes $1.3 billion in direct spending cuts for community health centers. Using the NACHC patient estimates, we present evidence on the characteristics of patients whose continuing access to health center services is at risk. We arrived at these estimates using data from the Uniform Data System (UDS), the federal reporting system in which all health centers must participate, as well as national estimates from the Medical Expenditure Panel Survey (MEPS), and published reports …

Strengthening Primary Care To Bend The Cost Curve: The Expansion Of Community Health Centers Through Health Reform, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The recent enactment of health reform sets into motion important changes that will expand health insurance coverage, increase funding for community health centers and alter the way that health centers are paid. These reforms will have a major impact on two major challenges of health reform: bolstering the capacity of the nation's primary care system and reducing the long term growth in health care costs.

Our analyses examine the impact of the new health reform law on the number of patients who will receive primary care services at community health centers and the effect of the service expansions on overall …

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

The Economic Burden Of Health Inequalities In The United States, Thomas A. Laveist, Darrell J. Gaskin, Patrick Richard

Health Policy and Management Faculty Publications

This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides important insight into how much of a financial burden racial disparities are putting on our health care system and society at large. The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death.

Do Medicaid And Chip Measure Errors Correctly?, Leighton C. Ku

Health Policy and Management Issue Briefs

Measuring and reducing errors in Medicaid and CHIP is important, but the current program and the proposed regulatory provisions are flawed and misleading. Reducing errors should involve not only reducing payments that are issued in error, but reducing the rate at which eligible applicants are erroneously denied Medicaid coverage. CMS should give develop a better, more valid approach to error determination when there are cases of missing or insufficient provider or eligibility data and issue a new proposed rule that offers a new approach or approaches.

Primary And Preventive Healthcare: A Critical Path To Healthcare Reform For Florida: The Role Of Florida's Fqhcs, Sara J. Rosenbaum, Peter Shin, Brad Finnegan, Ramona Whittington

Health Policy and Management Faculty Publications

Florida's health care system faces numerous challenges: a high proportion of residents without health insurance, a declining supply of primary care physicians at the same time that the state faces a growing need for high quality and cost efficient care for uninsured persons, and a growing emphasis on medical homes, especially for culturally diverse patients with complex chronic conditions. Nearly 3.8 million Florida residents lack health insurance, while more than 8 million lack access to a regular source of primary health care.

Assuring access to timely and high quality primary health care is a key dimension of any health reform …

Second-Generation Consumerism: Increasing Consumer Activation To Improve Health Outcomes And Lower Costs For Patients With Chronic Disease, Judith H. Hibbard, Katherine J. Hayes

Health Policy and Management Faculty Publications

With health care costs increasing, some policymakers have sought to make patients better health care consumers through increased cost-sharing linked with greater information on the cost of care. These may be successful cost containment strategies in the short term. But patients are just as likely to forgo necessary as unnecessary care, which ultimately leads to greater demand for more intensive and expensive care in the long term. Patients can, however, play an important role in preventing the onset of chronic conditions or preventing deterioration in health once they have been diagnosed with a chronic condition. In this chapter we discuss …

Primer On Medicare Advantage Payments In 2008, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) included provision intended to increase the role of private health plans in Medicare. These provisions, building on policies adopted earlier in 1997 and 2000, set Medicare Advantage (MA) plan benchmark rates at levels higher than average costs in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these policies total over $8.5 billion in 2008 and over $82 billion over the five year period between 2009 and 2013.

This briefing paper outlines the three major Medicare policies that generate these extra …

Ensuring The Use Of Federal Assets In Public Health Emergencies: The Role Of The Federal Tort Claims Act In Enabling The Responsiveness Of Federally Funded Community Health Centers, Rebecca L. Katz, Melissa M. Goldstein, A. Seiji Hayashi

Health Policy and Management Faculty Publications

No abstract provided.

Monitoring The Health Care Safety Net: Developing Data-Driven Capabilities To Support Policymaking, Robin M. Weinick, Peter Shin

Health Policy and Management Faculty Publications

Health care organizations are now emphasizing evidence-based medicine, which involves using research findings on the effectiveness of various practices to help make treatment decisions for patients. A parallel practice that is receiving increased attention is using data and the findings from data analysis to inform the policymaking process. The data-driven policy framework presented here involves an explicit statement of priorities and policy questions to be answered by new and existing data and provides general guidance for using data to support the process of developing policy options for the health care safety net.

Covering The Uninsured: What Is It Worth?, Wilhelmine Miller, Elizabeth Richardson Vigdor, Willard G. Manning

Health Policy and Management Faculty Publications

One out of six Americans under age sixty-five lacks health insurance, a situation that imposes sizable hidden costs upon society. The poorer health and shorter lives of those without coverage account for most of these costs. Other impacts are manifested by Medicare and disability support payments, demands on the public health infrastructure, and losses of local health service capacity. We conclude that the estimated value of health forgone each year because of uninsurance ($65?$130 billion) constitutes a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally.

Health Coverage In Massachusetts: Far To Go, Farther To Fall, Sara J. Rosenbaum, Jeanne Lambrew, Peter Shin, Marsha Regenstein, Tanya Ehrmann, Dylan Roby

Health Policy and Management Faculty Publications

This analysis has been prepared to highlight the state's experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation's health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus …