Health Services Administration Commons^™

Concurrent Panel Session 2: Health Challenges Facing Las Vegas, Carlos Brandenburg, Shawn Gerstenberger, Zaven Khachaturian, John Mcdonald, Dennis Pirages, Thom Reilly, Kathy Silver, Bonnie Sorenson, Carolyn B. Yucha, Maurizio Trevisan

Shaping the Future of Southern Nevada: Economic, Environmental, and Social Sustainability

Moderator: Marcia Turner, NSHE Health Science System Scribe: Candace Griffith, UNLV Department of Sociology Conference white paper & Full summary of panel session, 8 pages

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

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

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

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

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

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

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 …

Jefferson Medical College Annual Report, 2007, Thomas J. Nasca

Jefferson Medical College Administrative Documents and Reports

No abstract provided.

Not Again!, David B. Nash

Selected Works of David B. Nash, MD, MBA

No abstract provided.

Insights From The 2007 Disease Management Colloquium., David B Nash, Tine Hansen-Turton, Tracey Moorhead, Harry Leider, Donald F Wilson

College of Population Health Faculty Papers

No abstract provided.

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.

Sustainable Antenatal Care Services In An Urban Indigenous Community: The Townsville Experience, Kathryn S. Panaretto, Melvina R. Mitchell, Lynette Anderson, Sarah L. Larkins, Vivienne Manessis, Petra G. Buettner, David Watson

Aboriginal Policy Research Consortium International (APRCi)

Objective: To evaluate the impact of a sustained, community-based collaborative approach to antenatal care services for Indigenous women.

Design: Prospective quality improvement intervention, the Mums and Babies program, in a cohort of women attending Townsville Aboriginal and Islanders Health Service, 1 January 2000 – 31 December 2005 (MB group), compared with a historical control group (PreMB group), 1 January 1998 – 30 June 1999.

Main outcome measures: Proportion of women having inadequate antenatal care and

screening; perinatal indicators. Results: Thenumberofantenatalvisitsperpregnancyincreasedfromthree

(interquartilerange[IQR],twotosix)inthePreMBgrouptosix(IQR,fourtoten)inthe MB group (P < 0.001). There were significant improvements in care planning, completion of cycle-of-care, and antenatal education activities throughout the study period. About 90% of all women attending for antenatal care were screened for sexually transmitted diseases, 89% had measurement of haemoglobin level, and serological tests for hepatitis B and syphilis (minimum antenatal screening). There was increased attendance for dating and morphology scans. In the MB group compared with the PreMB group, there was a significant reduction in perinatal mortality (14 v 60 per 1000 births; P=0.014). Conclusion: Sustained access to a community-based, integrated, shared antenatal service has improved perinatal outcomes among Indigenous women in Townsville.

Redefining Healthcare Education: Perspectives And Accomplishments, Brian G. Harrison, Robert L. Barchi

Thomas Jefferson University Administrative Documents and Reports

2007 Annual report of Thomas Jefferson University.

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

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 …

Consumer Engagement, David B. Nash

Selected Works of David B. Nash, MD, MBA

No abstract provided.

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

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

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

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 …

Healthcast 2020, David B. Nash

Selected Works of David B. Nash, MD, MBA

No abstract provided.

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

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 …

Medicare And P4p, David B. Nash

Selected Works of David B. Nash, MD, MBA

No abstract provided.

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

An Administrator's Guide To Implementing Effective Dual Immersion Programs, Melanie Dawn Mcgrath

Theses Digitization Project

This project fills a void in the area of dual immersion program implementation. Although there are general guidelines that exist, there is a paucity of specific guidelines that explicitly delineate the implementation of these critical components in the current accountability climate. We need to move beyond general categories and tailor them to the unique needs program models within situated contexts.

Development Of A Vascular Diagnostics Center At Downtown Hospital: A Feasibility Study, Roland Jason Fargo

Theses Digitization Project

The scope of this analysis encompasses the feasibility of establishing a vascular diagnostics laboratory at Downtown hospital.

A Feasibility Study For Establishing A Dedicated Breast Magnetic Resonance Imaging Center In The City Of Redlands, Hans Philip Saaty

Theses Digitization Project

This study is intended to determine the feasiblity of establishing a high-quality, free-standing MR imaging center dedicated to the breast in or about the City of Redlands.

The Use Of Telehealth For Diabetes Management: A Qualitative Study Of Telehealth Provider Perceptions, Faith P. Hopp, Mary M. Hogan, Peter A. Woodbridge, Julie C. Lowery

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Monitoring and Messaging Devices (MMDs) are telehealth systems used by patients in their homes, and are designed to promote patient self-management, patient education, and clinical monitoring and follow-up activities. Although these systems have been widely promoted by health care systems, including the Veterans Health Administration, very little information is available on factors that facilitate use of the MMD system, or on barriers to use.

Methods

We conducted in-depth qualitative interviews with clinicians using MMD-based telehealth programs at two Veterans Affairs Medical Centers in the Midwestern United States.

Results

Findings suggest that MMD program enrollment is limited by both …