Public Health Commons^™

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 …

Medical Malpractice Reform: A Societal Crisis Or Fear Marketing?, Phil Rutsohn, Andrew Sikula Sr.

Management Faculty Research

This paper explores the primary issues surrounding the malpractice crisis currently facing the healthcare system and asks the question ‘is it truly a crisis or is it an effective marketing campaign waged by interested parties?’ The authors discuss the primary issues presented by both the supporters of tort reform and the opposition to tort reform. As is true for many issues in healthcare, final analysis suggests that tort reform is needed or not needed depends on the analysts' role in the system. The authors argue that the evidence suggests malpractice reform will produce desired results if the goal is to …

Inside Unlv, Diane Russell, Shane Bevell, David Ashley, Lori Bachand, Grace Russell, Mamie Peers

Inside UNLV

No abstract provided.

A Report From The Forum Session "Complexity, Coordination And Compromise: States And The Medicare Drug Benefit" (August 4, 2006), Lee Partridge

National Health Policy Forum

This National Health Policy Forum meeting report reviews a technical session that took place on August 4, 2006. The invitation-only meeting was designed to discuss implementation issues related to the new Medicare drug benefit, with special consideration of state activities, problems, and concerns. This meeting followed similar ones sponsored by the Forum in 2004 and 2005 in which the state perspective was the primary focus of conversation. Participants, including current and former state Medicaid directors, other state officials and experts, federal officials, Medicare drug plan representatives, and beneficiary advocates, described their experiences during the implementation process and addressed continuing challenges. …

Personal Health Records: The People's Choice?, Lisa Sprague

National Health Policy Forum

Information technology (IT), especially in the form of an electronic health record (EHR), is touted by many as a key component of meaningful improvement in health care delivery and outcomes. A personal health record (PHR) may be an element of an EHR or a stand-alone record. Proponents of PHRs see them as tools that will improve consumers’ ability to manage their care and will also enlist consumers as advocates for widespread health IT adoption. This issue brief explores what a PHR is, the extent of demand for it, issues that need to be resolved before such records can be expected …

Value-Based Coverage Policy In The United States And The United Kingdom: Different Paths To A Common Goal, Wilhelmine Miller

National Health Policy Forum

This background paper traces the development within American health care of two interrelated trends and activities: an evidence-based approach to medical practice and the critical evaluation of new technologies with respect to their costs and effectiveness. Over the past 35 years each of these developments has increasingly shaped the coverage decisions of public and private health insurers, and their importance for coverage policy is certain to grow. The paper also contrasts the different approaches to such “evidence-” or “value-based” coverage policy in the mixed public and private U.S. health care enterprise with the approach taken in Great Britain’s single-payer National …

Medicare And Mental Health: The Fundamentals, Christopher Loftis, Eileen Salinsky

National Health Policy Forum

This background paper provides a review of mental health coverage in the Medicare program. It examines the prevalence of mental disorders among Medicare beneficiaries, treatment available through Medicare, and the cost of such treatment. A brief summary of relevant policy issues is provided, including Medicare’s outpatient mental health limitation and the potential effect of the prescription drug benefit on the provision of mental health services.

Epsdt: Medicaid's Critical But Controversial Benefits Program For Children, Christie Provost Peters

National Health Policy Forum

The Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program under Medicaid provides the most comprehensive set of health benefits for children and adolescents in the public or private sector. A cornerstone of early childhood preventive and treatment services in the nation’s health care “safety net,” the EPSDT program serves nearly 30 million low-income children, including children with disabilities and special needs. Over the years, states have expressed frustration with the administrative burdens of EPSDT requirements. Rising Medicaid costs have put all Medicaid benefits, including the EPSDT program, in the budgetary crosshairs. This issue brief reviews the fundamental characteristics of …

Updating Medicare's Physician Fees: The Sustainable Growth Rate Methodology, Laura A. Dummit

National Health Policy Forum

Medicare’s method to annually update the fees it pays physicians has been under fire for some time—specifically, since the method determined that physician fees should be reduced rather than increased. The update method, called the sustainable growth rate (SGR), was implemented to control the growth in Medicare physician spending. Yet Congress, in response to physician concerns about beneficiary access to care, has acted to avert physician fee cuts since 2003. Although this signals dissatisfaction with the SGR methodology, there is yet to be a widely accepted physician fee update proposal that balances federal budgetary realities with the need to ensure …

The Nuts And Bolts Of Pdps, Mary Ellen Stahlman

National Health Policy Forum

This issue brief provides an overview of Medicare prescription drug plans (PDPs), with a focus on fundamentals such as enrollment, premiums, formularies, cost sharing, prices, payment, cost management, and appeals and grievance processes. It also highlights major changes to the PDP landscape between 2006 and 2007.

Updating The Wic Food Packages: It's About Time, Jessamyn Taylor

National Health Policy Forum

This issue brief reviews key revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program proposed by the USDA, which are based substantially on recommendations by the Institute of Medicine. Should the changes become regulation, they will be the most significant revision of the WIC food packages in over 25 years. This brief describes the changes, the impetus for their consideration, and possible implementation issues from the perspectives of vendors, state and local WIC agencies, and participants.

Medicare Physician Payments And Spending, Laura A. Dummit

National Health Policy Forum

The Medicare program’s physician payment method is intended to control spending while ensuring beneficiary access to physician services, but there are signs that it may not be working. The physician’s role in the health care delivery system as the primary source of information and treatment options, together with growing demand for services and the imperfect state of knowledge about appropriate service use, challenge Medicare’s ability to achieve these two goals. This issue brief describes the history of physician spending and the contribution of escalating service use and intensity of services to the rise in Medicare outlays, setting the stage for …

Effects Of Food Marketing To Kids: I'M Lovin' It?, Eileen Salinsky

National Health Policy Forum

This issue brief reviews key findings and recommendations from the Institute of Medicine study on food marketing and its effects on childhood obesity. The brief describes the childhood obesity epidemic, discusses key trends associated with rising childhood obesity rates, and considers the relative role of marketing practices on diet and obesity within the broader context of complex contributory factors. The brief also summarizes the current legal framework for regulating marketing directed at children; discusses voluntary, self-regulatory mechanisms; and highlights proposals to re-orient marketing practices to combat childhood obesity.

A Closer Look At The Medicare Part D Low–Income Benchmark Premium: How Low Can It Go?, Mary Ellen Stahlman

National Health Policy Forum

This issue brief explains how the Medicare Part D low–income benchmark premium is calculated, what factors influence the level of the low-income benchmark premium in any given year, and the implications of the benchmark amount for Medicare drug plans and beneficiaries as it changes from year to year. The paper provides a simplified, two-year example of how the low-income benchmark premium is calculated in order to illustrate the key factors that influence it.

Applying Lean Manufacturing Techniques To Improve The Performance Of An Emergency Department, Ramesh Pondhe

All-Inclusive List of Electronic Theses and Dissertations

The research was an attempt to apply lean manufacturing (LM) techniques, to the healthcare setting specifically to Emergency Department (ED) of a local hospital and to improve its performance. An ED is meant to attend/provide immediate care to a patient who needs medical care immediately and also balancing the care to patients with lesser acuity who arrive at the ED for treatment. The data was collected from the ED by direct observation. The data was statistically analyzed to find out the bottlenecks in the process during the course of a patient's treatment to further provide solutions and improve the performance …

Premium Assistance In Medicaid And Schip: Ace In The Hole Or House Of Cards?, Cynthia Shirk, Jennifer Ryan

National Health Policy Forum

This issue brief explores the use of premium assistance in publicly financed health insurance coverage programs. In the context of Medicaid and the State Children’s Health Insurance Program (SCHIP), premium assistance entails using federal and state funds to subsidize the premiums for the purchase of private insurance coverage for eligible individuals. This paper considers the evolution of premium assistance and some of the statutory and administrative limitations, as well as private market factors, that have prevented widespread enrollment in Medicaid or SCHIP premium assistance programs. Finally, this issue brief offers some ideas for potential legislative and/or programmatic changes that could …

Don't Bring Me Your Tired, Your Poor: The Crowded State Of America's Emergency Departments, Jessamyn Taylor

National Health Policy Forum

If the time comes, people expect that the emergency department (ED) will have the resources necessary to treat them in a timely, high-quality manner. Increasingly, however, EDs may not be able to meet that expectation. Hospitals in urban areas with large populations, high population growth, and higher-than-average numbers of uninsured are particularly crowded: ambulances are often diverted to other hospitals and patients are frequently forced to “board” in the hallways (while they wait to be transferred to another facility or part of the hospital). This issue brief places EDs in the context of the U.S. health care system and its …

The Electronic Health Record In Practice: Why, How, And What Next?, Lisa Sprague, Sally Coberly

National Health Policy Forum

This local site visit was intended to allow participants to observe the electronic health record (EHR) as used in practice by two U.S. leaders in technology and quality, the Veterans Health Administration (VHA) and Kaiser Permanente (KP). The VHA has employed an EHR system since 1997; KP is in the process of implementing a standard system for all clinicians nationwide. The site visit was designed to provide an opportunity for participants to explore both the expected benefits from EHR adoption and the specific lessons these two large, integrated delivery systems have learned in their transition from paper to electronic records. …

La Story: Improving Care Management For The Chronically Ill And Chronically Underserved, Eileen Salinsky, Jessamyn Taylor

National Health Policy Forum

This Los Angeles-based site visit examined safety net and private sector efforts to improve care coordination for underserved and vulnerable populations, including the homeless, the uninsured, the undocumented, and individuals with chronic conditions like diabetes, asthma, and severe mental illness. The visit highlighted challenges and innovations in the use of disease management programs, information systems, performance incentives, and managed care as tools for improving care coordination.

Creating Progam Logic Models: A Toolkit For State Flex Programs, John A. Gale Ms, Andrew F. Coburn Phd, Stephanie Loux Ms

Population Health & Health Policy

A logic modeling toolkit developed by the Flex Monitoring Team is available for use by state Medicare Rural Hospital Flexibility Programs (Flex Programs) in planning for and managing their Flex programs. The use of the Program Logic Model (PLM) Toolkit will provide states with a tool to assist in:

Planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments;

• Developing buy-in among key Flex Program stakeholders;
• Clarifying the underlying program assumptions;
• Identifying and defining measurable outcomes;
• Linking state-level Flex Program strategies and activities to specific and measurable outcomes; and
• Reporting program results to both internal and external …

Medicaid In 2006: A Trip Down The Yellow Brick Road?, Jennifer Ryan

National Health Policy Forum

This issue brief explores the continuing evolution of the Medicaid program on several fronts. It discusses the benefits and cost-sharing flexibility that is included in the Deficit Reduction Act of 2005 (DRA) and examines the implications of these provisions for states, beneficiaries, and providers. The paper also explores recent trends in section 1115 waiver development and considers the use of waivers as a vehicle for restructuring Medicaid financing systems and for testing completely new approaches to health care delivery. The role of section 1115 waivers in the context of the DRA and as a mechanism for continued state innovation is …

Rebalancing Long-Term Care: The Role Of The Medicaid Hcbs Waiver Program, Cynthia Shirk

National Health Policy Forum

This paper reviews the history and background of the Medicaid home and community-based services (HCBS) waiver program. It describes the eligibility, benefits, and financing structure, as well as the trends in program expenditures over time. The paper considers the contribution of the HCBS waiver program toward improving access to community-based care for Medicaid beneficiaries who are elderly and disabled and discusses the barriers that remain. This paper also summarizes the provisions included in the recently enacted Deficit Reduction Act of 2005 that may further expand Medicaid HCBS and considers how it may continue the process of redefining the concept of …

Fitness, Knowledge, Progress: Assessing Physician Qualification, Lisa Sprague

National Health Policy Forum

The informed and empowered consumer is an ideal invoked by many would-be health care reformers. An actual consumer wishing to don the mantle of power may be hindered by the scarcity of information available, particularly with respect to choosing among physicians. How is one to know who is best qualified? This issue brief looks at the basics of physician qualification and the processes by which physicians are licensed, credentialed, and board-certified. It examines how the evolution of these processes (for example, the move from lifetime certification to ongoing maintenance of certification) affects clinicians and their patients. The rise of quality …

Health Benefits In Retirement: Set For Extinction?, Mark Merlis

National Health Policy Forum

Nearly 18 million people rely on employer-provided retiree health benefits to fill gaps in Medicare’s coverage or to provide basic insurance until they reach Medicare age. Rising costs have led many employers to limit benefits, require participants to pay a larger share of the costs, or stop offering coverage at all for workers who have not yet retired. This background paper describes recent developments in retiree health benefits, possible future trends, and policy options for slowing the erosion of coverage or providing alternative ways for retirees to meet their expected medical expenses.

The Vaccine Industry: Does It Need A Shot In The Arm?, Eileen Salinsky, Cole Werble

National Health Policy Forum

This paper broadly examines the scientific, regulatory, and economic factors that contribute to constrained vaccine production capacity, periodic vaccine shortages, and perceptions of inadequate investment in new vaccine product development. It describes the vaccine development and production processes and summarizes how regulatory requirements influence these activities. Market dynamics related to vaccine supply and demand are also explored, including an examination of the industry’s cost structure, potential market size, and purchaser price sensitivity. A broad range of policy interventions designed to address shortcomings of the vaccine market are considered.

Mental Illness And Barriers To Health Care Access, Charlene Powell

MPA/MPP/MPFM Capstone Projects

Statement of Problem

Access to health care in the United States is major concern, despite the fact that the country spends more per capita on health care than any other country. Individuals with mental illness may face greater access problems than the general population.

Research Question

• Does mental illness predict greater difficulties with access to health care?

Methodology

The 2004 National Health Interview Survey (NHIS) was used to examine the barriers to health care among individuals reporting a mental illness diagnosis. Nine questions relating to health access problems were drawn from the survey and combined into an access index. Multivariate …

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 …

The Perceptions Of Roles And Practices Of Preceptors And Their Expectations For Students In The Coordinated Program In Dietetics At Indiana State University, Carin R. Aloisio

All-Inclusive List of Electronic Theses and Dissertations

Dietetics education requires a minimum of a baccalaureate degree and 900 hours of supervised practice for eligibility of candidates to sit for the Registration Exam. The primary goals of this study are to determine perceptions of preceptors of supervised practice about their roles and practices and their expectations for students, and to compare and/or contrast these between the three main areas of dietetics: clinical, community and food service management.

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

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 …