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Health Services Administration Commons

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Himmelfarb Health Sciences Library, The George Washington University

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Articles 181 - 210 of 420

Full-Text Articles in Health Services Administration

Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham Aug 2009

Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham

National Health Policy Forum

The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish health IT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government’s leadership role in promoting health IT. But successful adoption and utilization across the health system will …


The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman Jul 2009

The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman

National Health Policy Forum

The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries—almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have little choice of plans (while non-low-income beneficiaries have dozens of choices), unless they pay out-of-pocket for premium amounts above what the subsidy covers. And third, millions of those who have enrolled in the benefit face the prospect each year of switching drug plans …


A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis Jun 2009

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 Jun 2009

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 May 2009

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 …


The Children's Health Insurance Program (Chip): The Fundamentals, Jennifer Ryan Apr 2009

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 …


Show Me The Money: The Implications Of Schedule H, Eileen Salinsky Apr 2009

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 Apr 2009

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 Apr 2009

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 Apr 2009

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.


Health Care-Associated Infections: Is There An End In Sight?, Lisa Sprague Mar 2009

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 …


Reauthorizing Schip: A Summary Of Selected Issues, Jennifer Ryan, Cynthia Shirk Jan 2009

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.


Medicaid Financing: How The Fmap Formula Works And Why It Falls Short, Christie Provost Peters Dec 2008

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 …


Visioning The Future: Schoolbased Wellness Centers In Delaware: The Next 25 Years, Center For Health And Health Care In Schools Dec 2008

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 Nov 2008

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 …


Tending To Richmond's Children: Community Strategies To Bridge Service Gaps, Judith D. Moore, Jessamyn Taylor Oct 2008

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 Oct 2008

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.


Covering All Kids: States Setting The Pace, Jennifer Ryan, Safiya Mojerie Sep 2008

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 …


Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague Aug 2008

Community-Based Long-Term Care In Milwaukee: Wisconsin Still Ahead, Judith D. Moore, Carol O'Shaughnessy, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum has made two site visits to Wisconsin in two years. The first, in August 2007, focused on an overview of Family Care, the state's managed long-term care program, and looking at service delivery in a rural setting. The August 2008 site visit focused on the operations of MCOs and Family Care service providers in the urban environment of Milwaukee. Issues examined included the link between housing and social services, care management, capitation and rate-setting, measuring quality, and integrating people with disabilities into a program that initially targeted the elderly.


Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky Aug 2008

Strong As The Weakest Link: Medical Response To A Catastrophic Event, Eileen Salinsky

National Health Policy Forum

Natural disasters and acts of terrorism have placed a spotlight on the ability of health care providers to surge in response to catastrophic conditions. This paper reviews the status of efforts to develop the capacity and capabilities of the health care system to respond to disasters and other mass casualty events. Strategies for adapting routine medical practices and protocols to the demands posed by extraordinary circumstances and scarce resources are summarized. Existing federal roles, responsibilities, and assets relative to the contributions of state and local government and the private sector are described, including specific programmatic activities such as the Strategic …


Medicare Demonstrations, Amanda Cassidy Jul 2008

Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

This publication provides an overview of Medicare demonstration projects, including what they are, how and by whom they are initiated, and how they differ from research projects. This document highlights several significant demonstrations in Medicare history and outlines several current demonstration projects. Key considerations in designing, implementing and evaluating demonstrations are mentioned.


Medicaid And Schip Waivers, Cynthia Shirk Jul 2008

Medicaid And Schip Waivers, Cynthia Shirk

National Health Policy Forum

No abstract provided.


The Fundamentals Of Medicare Demonstrations, Amanda Cassidy Jul 2008

The Fundamentals Of Medicare Demonstrations, Amanda Cassidy

National Health Policy Forum

Demonstrations are experiments that test Medicare policy changes without permanently changing the Medicare program. They allow policymakers to learn about the potential impact and operational challenges of a proposed modification to Medicare, but in a more controlled environment and on a limited basis. Since demonstrations can affect hundreds of thousands of beneficiaries and providers and involve millions of dollars, they are often controversial. This paper describes the basics of Medicare demonstrations, including what they are, how they are initiated, and why they are undertaken. The paper also explores the relationship between demonstrations and other research projects. The primary challenges in …


Shaping Medicaid And Schip Through Waivers: The Fundamentals, Cynthia Shirk Jul 2008

Shaping Medicaid And Schip Through Waivers: The Fundamentals, Cynthia Shirk

National Health Policy Forum

The use of waivers has become one of the key vehicles for innovation in Medicaid and the State Children’s Health Insurance Program (SCHIP). This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care and long-term care services. The paper reviews the statutory basis and mechanics of demonstrations and program waivers, as well as their history and political context in shaping Medicaid and SCHIP. It also explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy. Finally, …


Screening And Assessing Immigrant And Refugee Youth In School-Based Mental Health Programs, Dina Birman, Wing-Yi Chan May 2008

Screening And Assessing Immigrant And Refugee Youth In School-Based Mental Health Programs, Dina Birman, Wing-Yi Chan

Center for Health and Health Care in Schools

According to the 2000 Census, 1 of every 5 children in the United States is a child of immigrants – either a child who is an immigrant or has at least one immigrant parent. While most children who experience mental health problems have limited access to help, children who have migrated to this country, especially under difficult circumstances, face particular challenges. Providers may be unfamiliar with their culture or the way that their culture understands mental health issues; children and their caregivers may not speak English, and the tools developed to identify and treat children with mental health needs may …


The Aging Services Network: Accomplishments And Challenges In Serving A Growing Elderly Population, Carol O'Shaughnessy Apr 2008

The Aging Services Network: Accomplishments And Challenges In Serving A Growing Elderly Population, Carol O'Shaughnessy

National Health Policy Forum

In 1965, Congress enacted the Older Americans Act, establishing a federal agency and state agencies to address the social services needs of the aging population. The mission of the Older Americans Act is broad: to help older people maintain maximum independence in their homes and communities and to promote a continuum of care for the vulnerable elderly. In successive amendments, the Act created area agencies on aging and a host of service programs. The “aging services network,” broadly described, refers to the agencies, programs, and activities that are sponsored by the Older Americans Act. The Act’s funding for services is …


Competition And Collaboration, Chicago-Style, Laura A. Dummit, Lisa Sprague Mar 2008

Competition And Collaboration, Chicago-Style, Laura A. Dummit, Lisa Sprague

National Health Policy Forum

The National Health Policy Forum sponsored a site visit to Chicago, Illinois, March 16-18, 2008 to consider how competition and collaboration have shaped Chicago?s health care market. Chicago is a study of contrasts between wealth and poverty and between large, internationally known facilities and struggling community hospitals. The stressed state of the county health system concerned all of the stakeholders and may be an impetus for increased cooperation among the haves and the have nots. No longer waiting for state health reform efforts, key players were working to shore up needed providers and develop a more equitable distribution of resources, …


Completing The Recipe For Children's Health: New Variations On Key Ingredients: A Report From The Workshop On June 28, 2007, Jennifer Ryan Mar 2008

Completing The Recipe For Children's Health: New Variations On Key Ingredients: A Report From The Workshop On June 28, 2007, Jennifer Ryan

National Health Policy Forum

This paper offers a broad overview of the issues surrounding the social and environmental determinants of children’s health. These issues were explored during a discussion convened by the National Health Policy Forum on June 28, 2007, among a group of individuals concerned about the influences beyond medical care on the health of children. The paper considers the policy and financing tensions that exist across programs and populations that make addressing the full range of influences challenging. It also highlights some of the community-based initiatives that have been successful in providing services to children and families, as described during the workshop. …


Pharmacogenomics: A Primer For Policymakers, Leslie Tucker Jan 2008

Pharmacogenomics: A Primer For Policymakers, Leslie Tucker

National Health Policy Forum

Researchers are exploring how genetic variations among individuals may help explain why a drug can work well in some people and poorly (or not at all) in others, including those who appear to have the same disease. Pharmacogenomics, as this new field is called, aims to help physicians make use of genetic tests to distinguish among patients whose genetic characteristics predispose them to respond in certain ways to certain medicines. If physicians can use this information to quickly and reliably choose the appropriate drug at the most effective dose for each patient, they may produce better patient outcomes and save …


Children's Behavioral Health Services In Baltimore: Walking The Continuum, Jennifer Ryan Sep 2007

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 …