Medicine and Health Sciences Commons^™

A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis

National Health Policy Forum

Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.

Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan

National Health Policy Forum

Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers' …

Resilience And Renaissance: Efforts To Rebuild A Healthier New Orleans, Michele J. Orza, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to New Orleans, Louisiana, in May 2009 to explore the city's health challenges, which are similar to those faced by other cities but were all greatly exacerbated by Hurricane Katrina and its aftermath. The agenda focused on three themes: primary care and behavioral health services availability and access, public health preparedness, and rebuilding healthier communities. It examined how these themes and others intersect in two distinct communities within New Orleans: the Holy Cross community surrounding the Lower Ninth Ward Center for Sustainable Engagement and Development and the community surrounding the Mary …

Information Interface - Volume 37, Issue 2 - May/June 2009, George Washington University, Himmelfarb Health Sciences Library

Information Interface (1976 - 2009)

News and information about Himmelfarb Health Sciences Library of interest to users. Includes articles on clinical information tools, Healthy DC, and the new GWU Historia Medicinae journal.

The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan

National Health Policy Forum

This background paper provides a brief overview of the fundamental elements of the Children’s Health Insurance Program (CHIP). CHIP, which served more than 7 million children in federal fiscal year 2008, is a jointly funded federal-state partnership that was originally enacted in 1997 as a complement to the Medicaid program. CHIP is designed to provide health insurance coverage for children in families who earn too much to qualify for Medicaid but cannot afford to purchase private insurance coverage. The program was reauthorized in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, which included several changes and additions to …

Examining The Experiences Of Puerto Rico's Community Health Centers Under The Government Health Insurance Plan, A. Seiji Hayashi, Brad Finnegan, Peter Shin, Emily Jones, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief examines the experiences of Puerto Rico's community health centers under the Commonwealth’s 1994 Government Health Insurance Plan (GHIP) – the Commonwealth's Medicaid program – also known as the Reforma. Of particular interest are the effects of Medicaid under-financing coupled with health centers' continuing obligations to furnish subsidized care for uninsured patients. To finance GHIP, the Commonwealth substantially curtailed its involvement with the direct provision of health care in both community and inpatient settings, transforming the former system of direct care provision into health insurance premium subsidies.

In 2007, the 47 operating sites of Puerto Rico's 19 federally …

Show Me The Money: The Implications Of Schedule H, Eileen Salinsky

National Health Policy Forum

Responding to policymakers' concerns, the Internal Revenue Service (IRS) implemented significant new hospital community benefit reporting under Schedule H of its revised Form 990, the return used by tax-exempt organizations. This issue brief considers the policy implications of the quantitative and qualitative information that hospitals are now mandated to report through Schedule H, including the costs associated with charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare. The paper examines unresolved issues related to the new reporting requirements, such as controversies regarding the scope of Schedule H, and considers the potential for these reports to influence IRS …

Schedule H: New Community Benefit Reporting Requirements For Hospitals, Eileen Salinsky

National Health Policy Forum

In recent years, some policymakers have questioned whether not-for-profit hospitals benefit the communities they serve at a level commensurate with the tax exemptions they receive as charitable organizations. This background paper reviews the new community benefit reporting requirements hospitals will face in 2009 under Schedule H of the Internal Revenue Service's revised Form 990 (the return used by organizations exempt from federal income tax). The paper provides a descriptive summary of the quantitative and qualitative information to be reported on Schedule H, such as charity care, bad debt, and the unreimbursed costs of Medicaid and Medicare.

Coordinating Care For People With Multiple Chronic Conditions: The Guided Care Model And Other Innovative Approaches, Judith D. Moore, Carol O'Shaughnessy

National Health Policy Forum

The Forum sponsored two site visits to explore the Johns Hopkins University's research and demonstration program on Guided Care, in April and August 2009. Guided Care is a patient-centered medical home model that uses an interdisciplinary approach to coordinating health care for older people with multiple chronic conditions. Guided Care nurses located in primary care practices work with Medicare patients on a long-term basis, coordinate their care among various providers, provide transitional care, and assist patients with self-management skills. Site visit participants learned about the complexities of caring for frail Medicare patients, some of whom see multiple physicians and other …

The Medicaid Drug Rebate Program, Christie Provost Peters

National Health Policy Forum

The Medicaid Drug Rebate Program helps lower Medicaid spending on outpatient prescription drugs by ensuring states receive discounts similar to those provided to private purchasers. Based on manufacturer reported pricing data, Medicaid drug rebates generate significant revenue for the states (and the federal government) that helps offset Medicaid prescription drug expenditures. This publication describes the Medicaid Drug Rebate Program and reviews how it works.

So You're Ready To Publish. Next Steps?, Anne Linton, Alexandra Gomes, Kathe Obrig

Himmelfarb Library Faculty Posters and Presentations

You've completed your research, analyzed the data, and written up your findings. Now you want to publish your results. What are the next steps? This poster is a "how to" guide to getting your article published in a scholarly journal.

Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague

National Health Policy Forum

Health care–associated infections (HAIs) have emerged as a significant concern in policy as well as clinical circles. An HAI is an infection acquired during treatment for another condition. Some of the HAI-causing bacteria have become drug-resistant; methicillin-resistant Staphylococcus aureus, or MRSA, is a familiar example. Tied to perhaps 100,000 deaths and $20 billion in health care costs each year, HAIs have given rise to state laws, legislative proposals at the federal level, public-private initiatives, and work at the hospital system and individual hospital level. However, much remains to be done. This issue brief reviews the prevalence of HAIs and the …

Restoring Medicaid And Schip Coverage To Legal Immigrant Children And Pregnant Women: Implications For Community Health And Health Care For Tomorrow's Citizens, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In the coming weeks, Congress will consider the reauthorization of the State Children's Health Insurance Program (SCHIP), whose legislative authorization will expire on March 31, 2009. SCHIP's overarching goal, in tandem with Medicaid, is to assure coverage of low-income children, regardless of race or national origin. As the proportion of uninsured immigrant children grows, a crucial question is whether the SCHIP reauthorization will address the need to restore eligibility for legal immigrant children and pregnant women. Although SCHIP and Medicaid have been successful in improving health insurance coverage for most low-income American children since the mid-1990s, the health coverage gaps …

Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk

National Health Policy Forum

This document provides a brief overview of some of the policy and programmatic issues that were addressed in legislation to reau¬thorize the State Children’s Health Insurance Program (Title XXI of the Social Security Act) during the summer and fall of 2007. This overview provides a background for understanding the elements for a second round of reauthorization that will likely be debated in the early days of the 111th Congress. The paper reviews several of the key issues under discussion and summarizes some of the related provisions in the reauthorization bills that were considered in 2007.

Fusion, 2009, George Washington University, William H. Beaumont Medical Research Honor Society

Fusion

No abstract provided.

Cuentos - 2009, George Washington University, Medical Faculty Associates

Cuentos

Cuentos is a literary magazine created by medical residents and faculty of the George Washington University Medical Faculty Associates.

Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters

National Health Policy Forum

Medicaid costs for health and long-term care services for low-income individuals are substantial. As a result, each state’s “match rate,” or federal medical assistance percentage (FMAP), which determines the share of Medicaid benefit costs the federal government pays, has enormous implications for state budgets and state economies, as well as for Medicaid beneficiaries and providers. Shifts in the FMAP from year to year, even minor ones, can mean the gain or loss of tens or hundreds of millions of federal matching dollars, depending on the size of the state’s Medicaid program. This paper explains the FMAP formula, examines the limitations …

Development Of Unicef Latin America/Caribbean (Lac) Well-Being Indicators, Mark Edberg

Prevention and Community Health Faculty Publications

No abstract provided.

Evaluation Of The Stability And Validity Of Participant Samples Recruited Over The Internet., Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

Research conducted via the Internet has the potential to reach important clinical populations of participants who would not participate in traditional studies. Concerns exist, however, about the validity of samples recruited in this manner, especially when participants are anonymous and never have contact with study staff. This study evaluated two anonymous samples that were recruited over the Internet to test an online program designed to help problem drinkers. The two studies were conducted 3 years apart, and different recruitment strategies were utilized. Despite these differences, the two samples were highly similar in demographic and clinical features. Correlations that have been …

Visioning The Future: Schoolbased Wellness Centers In Delaware: The Next 25 Years, Center For Health And Health Care In Schools

Center for Health and Health Care in Schools

In 2008, the Delaware Division of Public Health and Delaware Department of Education joined Nemours Prevention and Health Promotion in sponsoring a project to review 23 years of Wellness Center operations with the goal of identifying future directions for the program. The project was undertaken with a view towards determining what is the best health system and most effective wellness center strategies to support Delaware’s children. To assist with this work, the Center for Health and Health Care in Schools at George Washington University was asked to examine wellness center history, interview key participants in program and policy development, and …

Primary Care Physician Supply, Physician Compensation, And Medicare Fees: What Is The Connection?, Laura A. Dummit

National Health Policy Forum

Primary care, a cornerstone of several health reform efforts, is believed by many to be in a crisis because of inadequate supply to meet future demand. This belief has focused attention on the adequacy of primary care physician supply and ways to boost access to primary care. One suggested approach is to raise Medicare fees for primary care services. Whether higher Medicare fees would increase physician interest in primary care specialties by reducing compensation disparities between primary care and other specialties has not been established. Further, many questions remain about the assumptions underlying these policy concerns. Is there really a …

Information Interface - Volume 36, Issue 4 - November/December 2008, George Washington University, Himmelfarb Health Sciences Library

Information Interface (1976 - 2009)

News and information about Himmelfarb Health Sciences Library of interest to users.

Tending To Richmond's Children: Community Strategies To Bridge Service Gaps, Judith D. Moore, Jessamyn Taylor

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Richmond, Virginia, in October 2008 to explore social and environmental determinants of children’s health, including the impacts that poverty and exposure to lead-based paint have on birth outcomes, child development, and school readiness; and the community's efforts to address them. Though not large in population terms, Richmond faces many of the social and economic problems often common in larger urban areas—concentrated poverty, migration of wealth and services to the surrounding counties, a high infant mortality rate, and troubled schools. The site visit explored community strategies to improve birth outcomes and …

Medicaid And Mental Health Services, Cynthia Shirk

National Health Policy Forum

Medicaid is the largest payer of mental health services in the United States, contributing more than any other private or public source of funding. This background paper highlights the variety of services and supports needed by individuals with mental illness and Medicaid’s increasing role in mental health coverage. It provides an overview of Medicaid coverage of mental health services and identifies some of the key challenges in providing that coverage.

Assessing The Effects Of Medicaid Documentation Requirements On Health Centers And Their Patients: Results Of A "Second Wave" Survey, Lee Repasch, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This report represents a "second wave" follow-up to a "first wave" study whose purpose was to measure the effects of the Deficit Reduction Act's citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This "second wave" survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, …

Reaching High And Far To Improve The Value Of The Library's Website, Alexandra Gomes, Elizabeth Palena Hall

Himmelfarb Library Faculty Posters and Presentations

To improve the library's website, Himmelfarb Health Sciences Library set out to accomplish a complete website re-design. This poster presentation displays the process, challenges, and the final outcome of the new library website.

Opportunities To Uncover, Locate, And Learn: The Library Orientation Scavenger Hunt, Alexandra Gomes, Elaine Sullo

Himmelfarb Library Faculty Posters and Presentations

Himmelfarb Health Sciences Library implemented a Library Orientation Scavenger Hunt for new medical students. This poster presentation describes the details of the scavenger hunt and the resulting benefits for the library users and staff.

Covering All Kids: States Setting The Pace, Jennifer Ryan, Safiya Mojerie

National Health Policy Forum

Providing health insurance coverage for the uninsured is a challenge that has remained unresolved for decades. In the absence of a national solution, states have initiated their own efforts to expand access to health insurance coverage, particularly for children. This issue brief provides a history and status of state universal children’s coverage initiatives and features several states that appear to be setting the pace by developing successful strategies for expansion and cultivating the political will and leadership needed to institute them. In highlighting some of the key lessons that can be learned from states’ experiences, this paper may inform the …

Designation Of Medically Underserved And Health Professional Shortage Areas: Analysis Of The Public Comments On The Withdrawn Proposed Regulation, Emily Jones, Leighton C. Ku, Joseph Lippi, Ramona Whittington, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

In February 2008, the Health Resources and Services Administration (HRSA) proposed new regulations that would have modified and combined the Health Professional Shortage Area (HPSA) and Medically Underserved Area/Population (MUA/P) designation processes. The comment period was extended twice in response to the large volume of comments, through June 30th. On July 23rd, HRSA effectively withdrew the proposed rule, announcing that in light of its preliminary review of comments, the agency had elected to develop a new proposal. This Research Brief highlights some of the salient issues surrounding the proposed rule, based on an analysis of the public comments by researchers …

Uninsured And Medicaid Patients' Access To Preventive Care: Comparison Of Health Centers And Other Primary Care Providers, Avi Dor, Yuriy Pylypchuck, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This issue of Research Briefs examines health centers' role in reducing disparities in preventive health care access by medically vulnerable and high risk populations. The analysis uses information from several national data sources to examine differences in the provision of preventive health care to Medicaid and uninsured patients between health centers and other primary care providers.

Key Findings:

• Compared to those treated by other primary care providers, Medicaid and uninsured patients treated by health centers are significantly poorer, in significantly worse health, and in the case of uninsured patients, more likely to be members of racial and ethnic minority groups. …