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Full-Text Articles in Medicine and Health Sciences
Redesigning Practice To Improve Care Delivery (Boston), Laura A. Dummit, Lisa Sprague
Redesigning Practice To Improve Care Delivery (Boston), Laura A. Dummit, Lisa Sprague
National Health Policy Forum
This site visit focused on how the practice of medicine is changing or can be changed to improve care delivery across the spectrum of patient populations. Regarded as a “medical Mecca,” Boston is home to the academic health centers and teaching hospitals where many of the nation’s physicians are trained. As a center of innovation, Boston prides itself on its high bar with respect to standards of care. Panels addressed the used of clinical information technology (IT) in the physician’s office, in the hospital, and community-wide. Participants observed how IT is being used to further the mission of community health …
Medicare Advantage Snps: A New Opportunity For Integrated Care?, Christie Provost Peters
Medicare Advantage Snps: A New Opportunity For Integrated Care?, Christie Provost Peters
National Health Policy Forum
Medicare Advantage special needs plans (SNPs) are a new type of coordinated care plan established by the Medicare Prescription Drug, Improvement and Modernization Act. SNPs were created to encourage greater access to Medicare managed care for certain special needs populations: the institutionalized, persons dually eligible for Medicare and Medicaid, and the chronically ill. Some view SNPs as a new opportunity to integrate acute and long-term care services as well as Medicare and Medicaid financing. Others, however, question the degree to which full integration will become a widespread reality. This issue brief examines the SNP option and the promises and challenges …
A Report From The Forum Session “Implementing The Medicare Prescription Drug Benefit: Continuing Challenges For States”, Lee Partridge
A Report From The Forum Session “Implementing The Medicare Prescription Drug Benefit: Continuing Challenges For States”, Lee Partridge
National Health Policy Forum
This National Health Policy Forum Meeting Report provides an overview and discussion of a technical session that took place on July 12, 2005. The meeting was designed to re-visit issues discussed at a similar meeting in July 2004, which was intended to offer a state perspective on the implementation of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the new Medicare prescription drug benefit. This report provides an update on the implementation issues identified in 2004—including outreach, education and enrollment; coordination of care for individuals who are “dually eligible” for Medicare and Medicaid; and the cost …
One Pill, Many Prices: Variation In Prescription Drug Prices In Selected Government Programs, Dawn Gencarelli
One Pill, Many Prices: Variation In Prescription Drug Prices In Selected Government Programs, Dawn Gencarelli
National Health Policy Forum
This paper updates a June 2002 National Health Policy Forum Issue Brief, "Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?" Since the release of that paper, Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003, which created a new, comprehensive outpatient prescription drug benefit and reduced Medicare’s reliance on the average wholesale price (AWP) in paying for prescription drugs. This paper discusses the continued use of AWP as well as other pricing benchmarks that pertain to prescription drugs. It explains the relevance of these pricing mechanisms to different government programs and …
Clinical Preventive Services: When Is The Juice Worth The Squeeze?, Eileen Salinsky
Clinical Preventive Services: When Is The Juice Worth The Squeeze?, Eileen Salinsky
National Health Policy Forum
This paper provides an overview of clinical preventive services, including a definition of such services and the role of the U.S. Preventive Services Task Force in recommending which services should be routinely offered to patients. It also describes efforts to analyze the cost effectiveness of clinical preventive services and reviews the insurance coverage policies of private and public payers. Barriers to increased uptake of appropriate services are discussed and policy relevant issues are summarized.
Caring For "Ryan White": The Fundamentals Of Hiv/Aids Treatment Policy, Jessamyn Taylor
Caring For "Ryan White": The Fundamentals Of Hiv/Aids Treatment Policy, Jessamyn Taylor
National Health Policy Forum
This background paper provides an overview of the HIV/ AIDS epidemic in the United States and discusses how treatment of the disease and the populations most affected by it have changed over time. The federal government’s domestic and global efforts in prevention, research, and treatment of the disease are highlighted. The paper outlines the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, a set of programs that fund treatment services for uninsured and underinsured individuals living with HIV/AIDS, and places it in the context of other federal programs that fund treatment for HIV/AIDS. Policy issues for Ryan White’s potential congressional …
Keeping Track Of Care: Quality And Technology At Lifebridge Health System (Baltimore), Judith Moore
Keeping Track Of Care: Quality And Technology At Lifebridge Health System (Baltimore), Judith Moore
National Health Policy Forum
This one-day site visit focused on quality and technology in acute, post-acute and long-term care at Sinai Hospital and Levindale Hebrew Geriatric Center and Hospital, both components of LifeBridge Health System in Baltimore. Participants traced the treatment paths of hypothetical cardiac and cancer patients through the hospital and explored the range of home- and community-based as well as institutional care available through the geriatric center. The role of clinical information technology was highlighted in both settings.
Mental Health And Juvenile Justice: Moving Toward More Effective Systems Of Care, Jane Koppelman
Mental Health And Juvenile Justice: Moving Toward More Effective Systems Of Care, Jane Koppelman
National Health Policy Forum
This issue brief discusses the mental health needs of youth who are involved with the juvenile justice system, how they come into contact with the system, and the evidence of the availability and quality of mental health services for such youth. The paper also explores public policy options for avoiding dependence on the juvenile justice system as a last resort for treating youth with mental disorders.
Specialty Hospitals: Can General Hospitals Compete?, Laura A. Dummit
Specialty Hospitals: Can General Hospitals Compete?, Laura A. Dummit
National Health Policy Forum
The rapid increase in specialty cardiac, surgical, and orthopedic hospitals has captured the attention of general hospitals and policymakers. Although the number of specialty hospitals remains small in absolute terms, their entry into certain health care markets has fueled arguments about the rules of “fair” competition among health care providers. To allow the smoke to clear, Congress effectively stalled the growth in new specialty hospitals by temporarily prohibiting physicians from referring Medicare or Medicaid patients to specialty hospitals in which they had an ownership interest. During this 18-month moratorium, which expired June 8, 2005, two mandated studies of specialty hospitals …
Local Coverage Initiatives: Solution Or Band-Aid For The Uninsured?, Jennifer Ryan
Local Coverage Initiatives: Solution Or Band-Aid For The Uninsured?, Jennifer Ryan
National Health Policy Forum
This issue brief surveys health coverage expansion initiatives that are operating on the county or local level, often without the benefit of federal funding. The paper explores the circumstances that have made these initiatives possible and considers the ongoing barriers that local policymakers face in sustaining the programs. Descriptions of four initiatives illustrate the range and variety of programs in operation today and offer both best practices and lessons learned for other communities. The paper also includes a brief analysis of the key elements that make up a successful coverage initiative. Finally, this issue brief considers the role of local …
Children With Special Health Care Needs: Minding The Gaps, Christie Provost Peters
Children With Special Health Care Needs: Minding The Gaps, Christie Provost Peters
National Health Policy Forum
This background paper examines the issue of children with special health care needs and their interaction with the health care system. Results from recent national and state surveys and studies were used to review the medical expenditures, utilization, and insurance coverage of these children. The paper also discusses weaknesses within the private and public delivery and financing systems that may hinder the access of certain families with children with special health care needs to important services.
Hospital Oversight In Medicare: Accreditation And Deeming Authority, Lisa Sprague
Hospital Oversight In Medicare: Accreditation And Deeming Authority, Lisa Sprague
National Health Policy Forum
To be eligible to receive payment from Medicare, hospitals must be certified to meet certain conditions. Hospitals may gain such credentials by choosing to be reviewed by a state certification agency under contract to the Centers for Medicare & Medicaid Services or to be accredited by either the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association. This issue brief looks at how accreditation of hospitals developed and how it continues to change. It considers the legal and practical reasons that a majority of hospitals choose accreditation and why some hospitals do not, along with broader consideration …
Health Insurance Coverage For Small Employers, Dawn Gencarelli
Health Insurance Coverage For Small Employers, Dawn Gencarelli
National Health Policy Forum
For workers of small employers, access to affordable health insurance coverage is a growing concern. This paper examines the problems these firms and their employees face in obtaining health insurance coverage they can afford. The degree to which these challenges become obstacles varies greatly, depending on, for instance, the size of the employer and the characteristics of its employees. Reviewed here are these challenges to access, as well as some of the efforts made through state and federal reforms to address them, including rules regarding guaranteed issue and guaranteed renewability. This paper also explores some of the more recent initiatives …
Fundamentals Of Underwriting In The Nongroup Health Insurance Market: Access To Coverage And Options For Reform, Mark Merlis
Fundamentals Of Underwriting In The Nongroup Health Insurance Market: Access To Coverage And Options For Reform, Mark Merlis
National Health Policy Forum
Although the majority of Americans with health insurance obtain coverage through their employers, many individuals must negotiate the nongroup insurance market alone. Insurers use a process called medical underwriting to identify applicants with current or recent medical problems. Because these applicants are likely to cost the insurer more in claims than a healthier person, insurers may charge them higher premiums or restrict or deny coverage. This background paper reviews the practice of underwriting, state and federal regulation of insurers offering nongroup health coverage, and several proposed options for improving access to coverage for applicants who are in poor health.
Health Savings Accounts: The Fundamentals, Beth Fuchs, Julie A. James
Health Savings Accounts: The Fundamentals, Beth Fuchs, Julie A. James
National Health Policy Forum
This paper explores the fundamentals of health savings accounts (HSAs). While not intended to be an exhaustive review of these accounts, it describes their intellectual and legislative origins and the mechanics of how they work, explores the early returns on how they are faring in the insurance market, and identifies major issues and controversies that they raise. The paper looks specifically at the basic rules for HSAs and the requirements for health insurance that qualifies as a high-deductible health plan (HDHP) for HSA purposes. Also considered are issues related to provider payments under HSAs and the administration of the benefit …
Exploring California's Rural Health System: From The Redwood Forests To The Baja Border, Eileen Salinsky, Jessamyn Taylor
Exploring California's Rural Health System: From The Redwood Forests To The Baja Border, Eileen Salinsky, Jessamyn Taylor
National Health Policy Forum
This three day site visit to California explored the state’s rural health system with a particular focus on the financial health of inpatient and outpatient providers and how that affects access to care. The role of telemedicine as a tool for expanding access was explored as well as the special needs of vulnerable populations such as farmworkers. Participants learned how state and federal regulation and payment policies and state budget deficits impact the viability of rural health systems.