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Children's Behavioral Health Services In Baltimore: Walking The Continuum, Jennifer Ryan
Children's Behavioral Health Services In Baltimore: Walking The Continuum, Jennifer Ryan
National Health Policy Forum
This site visit explored the range of behavioral health services available for children in the city of Baltimore and in the state more broadly. Like many states, the policy community in Maryland has been working hard to meet the challenges of providing an effective continuum of care in the context of complex financing incentives and an overburdened educational and public health care system. Several promising practices have emerged, including the Wraparound practice model that offers individualized, comprehensive services and natural supports to achieve a positive set of outcomes for the child and family. The wraparound model incorporates both traditional services …
Medicare Advantage Payment Policy, Mark Merlis
Medicare Advantage Payment Policy, Mark Merlis
National Health Policy Forum
Medicare Advantage (MA) plans have become a source of supplemental benefits for many Medicare beneficiaries. In many cases, MA plans are able to finance these extra benefits only because Medicare is paying them more than it would have spent to cover the same beneficiaries on a fee-for-service basis. As Congress considers curbing MA plan payments, this background paper explains how MA plans are paid and reviews recent trends in plan participation and enrollment. It then considers key issues raised by proposals to change the payment system.
Physician Profiling: Can Medicare Paint An Accurate Picture?, Laura A. Dummit
Physician Profiling: Can Medicare Paint An Accurate Picture?, Laura A. Dummit
National Health Policy Forum
Physician profiling, that is, the comparison of the health care services used by a physician’s patients to average service use or another benchmark, has been proposed as a way to improve Medicare. It has been used by private health plans and physician groups to identify both efficient practice patterns and the physicians who practice efficiently. The Medicare Payment Advisory Commission (MedPAC) and the Government Accountability Office (GAO) have recommended that Medicare adopt physician profiling to slow spending growth and improve efficiency. Recent legislation would mandate that Medicare employ profiling. This issue brief reviews MedPAC and GAO’s analyses of profiling, concerns …
Medicare's Use Of Risk Adjustment, Gerald F. Kominski
Medicare's Use Of Risk Adjustment, Gerald F. Kominski
National Health Policy Forum
Medicare accounts for expected differences in resource needs of patients or health plan enrollees by risk-adjusting the payments it makes to health care facilities, such as hospitals, skilled nursing facilities, and home health agencies, and the premiums it pays to health plans. Risk adjustment is intended to ensure that payments or premiums are adequate for patients or plan enrollees who require more resources than average in order to protect beneficiary access as well as the financial condition of the provider or plan. At the same time, risk adjustment lowers payments or premiums for beneficiaries who are expected to use fewer …
Medicaid And State Budgets: Clearing Storm, Foggy Forecast, Courtney Burke
Medicaid And State Budgets: Clearing Storm, Foggy Forecast, Courtney Burke
National Health Policy Forum
This issue brief examines the recent history and trends in state budgets and considers how those trends have influenced the role of the Medicaid program. The paper offers several indicators for predicting the future of states’ fiscal standing, cautioning that, although the “stormy” period from 2001 to 2003 is over, states face many challenges in the near future. This issue brief also poses several questions regarding the appropriate roles of state and federal governments in administering the Medicaid program. These questions become particularly important as the population ages and states increasingly take the lead in developing solutions for covering the …
Community-Based Long-Term Care: Wisconsin Stays Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague
Community-Based Long-Term Care: Wisconsin Stays Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague
National Health Policy Forum
This report describes a site visit to Wisconsin in August 2007 that focused on the use of home and community-based services, both public and private, to delay or avoid the need for institutional care. Wisconsin was chosen because it has long been a leader among states in developing such services for the elderly and persons with disabilities. At the time of the visit, a managed long-term care program, Family Care, was operating on a pilot basis in five counties. The Partnership Program, a four-site demonstration integrating acute and long-term care for the dual eligible population (both frail elderly and younger …
Shrinking Inpatient Psychiatric Capacity: Cause For Celebration Or Concern?, Eileen Salinsky, Christopher Loftis
Shrinking Inpatient Psychiatric Capacity: Cause For Celebration Or Concern?, Eileen Salinsky, Christopher Loftis
National Health Policy Forum
This issue brief examines reported capacity constraints in inpatient psychiatric services and describes how these services fit within the continuum of care for mental health treatment. The paper summarizes the type and range of acute care services used to intervene in mental health crises, including both traditional hospital-based services and alternative crisis interventions, such as mobile response teams. It reviews historical trends in the supply of inpatient psychiatric beds and explores the anticipated influence of prospective payment for inpatient psychiatric services under Medicare. The paper also considers other forces that may affect the need for and supply of acute mental …
Health Information Technology Adoption Among Health Centers: A Digital Divide In The Making?, Adil Moiduddin, Daniel S. Gaylin
Health Information Technology Adoption Among Health Centers: A Digital Divide In The Making?, Adil Moiduddin, Daniel S. Gaylin
National Health Policy Forum
This background paper describes the current status of efforts to implement health information technology in community health centers. It summarizes the benefits experienced by health centers that have pioneered the use of information technology and examines the challenges that have hindered wider adoption. The paper identifies a range of policy options that have been considered to promote broader use of information technology by health centers.
Trading Places: Real Choice Systems Change Grants And The Movement To Community-Based Long-Term Care Supports, Cynthia Shirk
Trading Places: Real Choice Systems Change Grants And The Movement To Community-Based Long-Term Care Supports, Cynthia Shirk
National Health Policy Forum
The Real Choice Systems Change grant program was created to help states transform their long-term care service systems from ones that rely on institutions to ones that are more community-based. The grants are intended to help states develop the infrastructure needed for seniors and individuals with disabilities to live in integrated community settings. This issue brief provides information about Systems Change grants and the kinds of activities state Medicaid agencies have undertaken to transform their institutionally based systems. In addition, this paper reports on some of the qualitative and quantitative responses to the changes. This brief also raises critical policy …
The Prescription Drug Safety Net: Access To Pharmaceuticals For The Uninsured, Jack Hoadley
The Prescription Drug Safety Net: Access To Pharmaceuticals For The Uninsured, Jack Hoadley
National Health Policy Forum
This background paper provides an overview of organized programs that provide access to prescription drug products for uninsured persons, with an emphasis on manufacturer-sponsored pharmacy assistance programs (PAPs) and the federal 340B drug pricing program. It summarizes the chief characteristics of these programs and reviews concerns regarding the reach and efficiency of these efforts. The paper begins with a brief examination of the number of people who lack insurance coverage for prescription drugs and discusses the influence of this gap in coverage on health status. The paper also describes informal mechanisms providers frequently use to help uninsured patients fill their …
The Fundamentals Of Health Savings Accounts And High-Deductible Health Plans, Beth Fuchs, Lisa Potetz
The Fundamentals Of Health Savings Accounts And High-Deductible Health Plans, Beth Fuchs, Lisa Potetz
National Health Policy Forum
This background paper updates and expands on a previous NHPF document that looked at the fundamentals of health savings accounts (HSAs) and high-deductible health plans (HDHPs), their intellectual and legislative origins, and the ways they work. In addition to updating information on the HDHP/HSA marketplace, this paper presents a description of how the HDHP combined with the HSA works for enrollees. Using a question and-answer format, it then addresses some of the more complicated details of these arrangements, looking first at the HDHPs and then the HSAs. This closer examination suggests some potential policy challenges for lawmakers, the focus of …
What Have You Done For Me Lately? Assessing Hospital Community Benefit, Eileen Salinsky
What Have You Done For Me Lately? Assessing Hospital Community Benefit, Eileen Salinsky
National Health Policy Forum
This issue brief reviews key aspects of the ongoing policy debate related to not-for-profit hospitals, the advantages they derive from tax exemption, and the benefits they provide to communities served. It provides a historical context for how federal standards for assessing hospitals’ tax-exempt status have evolved and describes recent activities to explore additional policy changes. Legislative and regulatory actions at the state and local level are also examined. Evidence on the performance of not-for-profit hospitals in comparison to their for-profit competitors on measures of cost, quality, and access is summarized, and perspectives on the need to preserve a not-for-profit presence …
Review Of Access And Quality Of Care In Schip Using Standardized National Performance Measures, Terence A. Partridge
Review Of Access And Quality Of Care In Schip Using Standardized National Performance Measures, Terence A. Partridge
National Health Policy Forum
The State Children's Health Insurance Program (SCHIP) has proven to be a critical addition to public coverage programs for low-income children since its inception ten years ago. Tracking the number of children enrolled, however, is only part of the story. This technical paper reviews access and quality for children enrolled in SCHIP by examining information on four primary and preventive care health measures submitted to the Centers for Medicare & Medicaid Services by states in their 2005 annual reports. The paper concludes that the data examined for this paper indicate that children enrolled in SCHIP are receiving not only coverage …
Competition And Collaboration: The Spirit Of St. Louis, Laura A. Dummit, Lisa Sprague
Competition And Collaboration: The Spirit Of St. Louis, Laura A. Dummit, Lisa Sprague
National Health Policy Forum
The National Health Policy Forum sponsored a site visit to St. Louis, Missouri, on April 3-5, 2007, to consider the relationships between hospitals and physicians—and the degree of alignment in their financial, organizational, and policy goals—as a foundation for a new round of discussions on how to reform the health care system. St. Louis offered an interesting venue for these investigations because it is home to two major medical schools, three large hospital systems, and a physician community dominated by small practices. Site visit participants were able to converse with community, business, medical school, hospital, and physician leaders to learn …
Health Care Price Transparency And Price Competition, Mark Merlis
Health Care Price Transparency And Price Competition, Mark Merlis
National Health Policy Forum
Growing numbers of consumers are in health plans that give them incentives to be more cost-conscious. Yet complex pricing systems and limited information may make it hard to choose among providers and treatment options. This report examines steps that insurers and others have taken to make better price information available, possible government measures to further promote price transparency or to simplify price comparisons, and the likely effects on consumer behavior and provider competition.
Fairfax County's Commitment: A Housing And Health Continuum For Seniors, Judith D. Moore, Lisa Sprague
Fairfax County's Commitment: A Housing And Health Continuum For Seniors, Judith D. Moore, Lisa Sprague
National Health Policy Forum
This one-day site visit focused on the range of services made available to seniors by Fairfax County, Virginia, including senior centers, adult day health care, and assisted living and independent housing. Services to low-income residents were emphasized. Participants were introduced to the different agencies and funding streams involved and were able to observe how county officials have acted on a stated commitment to help seniors who wish to age in place, staying in the county and in their own homes rather than in a nursing home or other institution. The day included tours of two Fairfax County multiservice sites, in …
Abortion Access And Risky Sex Among Teens: Parental Involvement Laws And Sexually Transmitted Diseases, Jonathan Klick, Thomas Stratmann
Abortion Access And Risky Sex Among Teens: Parental Involvement Laws And Sexually Transmitted Diseases, Jonathan Klick, Thomas Stratmann
All Faculty Scholarship
Laws requiring minors to seek parental consent or to notify a parent prior to obtaining an abortion raise the cost of risky sex for teenagers. Assuming choices to engage in risky sex are made rationally, parental involvement laws should lead to less risky sex among teens, either because of a reduction of sexual activity altogether or because teens will be more fastidious in the use of birth control ex ante. Using gonorrhea rates among older women to control for unobserved heterogeneity across states, our results indicate that the enactment of parental involvement laws significantly reduces risky sexual activity among teenage …