Health Policy Commons^™

Addressing The Challenges Of Reporting On Childhood Asthma In A Changing Health Care System: Building Better Evidence For High Performance, Meagan Lyon, Anne Rossier Markus, Maya Tuchman Gerstein, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Childhood asthma is a serious and costly chronic disease that burdens children and families as well as the health care systems that serve them. A key element to improving asthma outcomes is access to timely and useful data that can improve the quality of care and inform programs and policies to best serve those communities most burdened by asthma. This Policy Brief examines the nation’s data collection framework for childhood asthma and considers steps that might be taken to strengthen it, including the development, collection and refinement of community-level data to inform local health care systems. Through a review of …

Post-Hmo Health Care: Are Acos The Answer?, Zachary F. Meisel, Jesse M. Pines

Health Policy and Management Informal Communications

"Remember the 1990s" retrospective lists always include Nirvana, Monica Lewinsky and Wayne's World, but leave out another major product that defined American life in the '90s: the health maintenance organization, or HMO — that nefarious health-insurance plan that seemed expressly designed to prevent you from seeing the doctor of your choice or receiving the treatments recommended by doctors, all under the guise of lowering costs and "improving" medical care. Of course HMOs are still around, but they are no longer central to the national discussion on health care. Why? For the most part, HMOs have eased limits on patient choice …

An Overview Of The Administration's Aco Policy: Opportunities And Challenges, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

For nearly a century, proponents of health reform have advocated for greater clinical integration to improve quality, promote efficiencies, and control costs. A seminal 1932 report issued by the Committee on the Costs of Medical Care called for the provision of care through group practice arrangements as part of a broader set of recommendations that included universal coverage, extension of public health services to the entire population, and a major investment in health professions education. Resistance to its findings was a key factor in convincing the Roosevelt Administration to abandon national health insurance in the original Social Security Act.

The Promise And Potential Of Federal Incentives For Electronic Health Records, Brian K. Bruen, Leighton C. Ku, Matthew Burke, Melinda Buntin

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The View From New Hampshire: The Imperative Of Linking Health Care Reform To Economic And Job Growth, Maggie Wood Hassan

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Accountability And Social Mission: New Winds In Health Professions Education, Fitzhugh Mullan

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Measuring Primary Care: Theory, Policy, And Practice, Barbara Starfield

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The Right Care At The Right Time By The Right Professional, Mary Jean Schumann

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Medicare's Accountable Care Organization Regulations: How Will Medicare Beneficiaries Who Reside In Medically Underserved Communities Fare?, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On March 31, 2011, the Centers for Medicare and Medicaid Services (CMS) released proposed regulations implementing the Medicare Shared Savings Program (MSSP). The thrust of the MSSP is to promote savings to Medicare as well as the greater clinical integration of health care through incentive payments to accountable care organizations (ACOs) that meet Medicare standards for structure, performance, and health care outcomes. The effort to spur greater clinical integration through the MSSP was part of a broader set of reforms contained in the Affordable Care Act (ACA) whose aim was to improve health care quality and efficiency. Among these reforms …

Health Reform: Back To The Future, Christopher Jennings

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Health Care Outlook For 2011 And Beyond: The Legal, Policy And Political Landscape, Mark L. Hayes

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Medicaid And Access To The Courts, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Medicaid program is grounded in a statute that is one of the most complex of all federal laws. An insurer of more than 60 million people — and poised to begin serving 16 million more by 2019 — Medicaid will be reexamined this year, in all its legal complexities, by the U.S. Supreme Court, which has agreed to hear California's appeal in the case Maxwell-Jolly v. Independent Living Center of Southern California. The Court's ruling could fundamentally alter states' accountability to beneficiaries and providers when their official conduct allegedly violates Medicaid's essential federal requirements.

Why The Grey's Anatomy Myth Clouds The Real Value Of Emergency Care, Jesse M. Pines, Zachary F. Meisel

Health Policy and Management Informal Communications

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. Just a decade ago, patients were still being subjected to exploratory surgery, in which a surgeon cuts open the abdomen to look for problems; today, CT scans allow doctors to make diagnoses without a scalpel.

Teen Pregnancy: Lessons In Both Health Policy And Social Norms, Sarah Brown

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

Medicaid Statistical Information System (Msis): A Data Source For Quality Reporting For Medicaid And The Children's Health Insurance Program (Chip), Patricia Mactaggart, Ashley Foster, Anne R. Markus

Health Policy and Management Faculty Publications

Section 401 of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) requires the Department of Health and Human Services (HHS) to identify and publish healthcare quality measures for children enrolled in the Children's Health Insurance Program (CHIP) or Medicaid. CHIPRA also requires core measures to identify disparities by race and ethnicity, among other factors. State Medicaid and CHIP programs are currently facing significant budgetary pressures that are likely to increase with eligibility expansions and programmatic changes resulting from the Patient Protection and Affordable Care Act (PPACA). To limit the burden on states and increase the likelihood of states' …

Influenza Vaccination Of The Health Care Workforce: A Literature Review, Alexandra M. Stewart, Marisa A. Cox, Mallory O'Connor

Health Policy and Management Faculty Publications

Since 1981, the Centers for Disease Control and Prevention (CDC) has recommended that all health care workers (HCWs) receive an annual influenza vaccination. The Healthy People objectives aimed for 60% coverage of HCW influenza vaccination by 2010 and 90% coverage by 2020. Although influenza vaccine uptake among HCWs has trended upward over the past several years, the percentage of immunized HCWs has remained approximately 40% between 2004 and 2008.

In order to complete the literature review, researchers identified and analyzed peer reviewed literature, news articles, professional organization position statements, and institutional policies published between 1991 and 2011. In the absence …

The Role Of Community Health Centers In Addressing The Needs Of Uninsured Low-Income Workers: Implications Of Proposed Federal Funding Reductions, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The severe economic downturn over the past few years has demonstrated the heightened importance of strengthening the health care safety net, particularly for working Americans who may have lost their health insurance coverage or do not have access to employer-sponsored benefits. Both historically and most recently during the current recession, health centers have played a critical role in providing services to the working poor, assuring that they continue to receive timely preventive care that obviates the need for, and minimizes use of, more costly services. We estimate that 1 in 4 low income, uninsured working adults depend on health centers …

The Health Care Access And Cost Consequences Of Reducing Health Center Funding, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

For over four decades, community health centers have served a critical role in providing affordable access to quality care to some of the nation's most vulnerable populations. Health centers have historically enjoyed broad bipartisan support, based on the evidence documenting their high quality care, crucial role in both urban and rural communities, and ability to "bend the cost curve."

On February 20, 2011, the U.S. House of Representatives voted to reduce discretionary health center funding by $1.3 billion in FY 2011 alone. Although the spending bill was rejected by the U.S. Senate on March 10, 2011, final spending measures for …

The Essential Health Benefits Provisions Of The Affordable Care Act: Implications For People With Disabilities, Sara J. Rosenbaum, Joel B. Teitelbaum, Katherine J. Hayes

Health Policy and Management Faculty Publications

In establishing minimum coverage standards for health insurance plans, the Affordable Care Act includes an "essential health benefits" statute that directs the U.S. Secretary of Health and Human Services not to make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life. This issue brief examines how this statute will help Americans with disabilities, who currently are subject to discrimination by insurers based on health status and health care need. The authors also discuss the complex issues involved in implementing the essential benefits …

Why Doctors Order Too Many Tests (It's Not Just To Avoid Lawsuits), Jesse M. Pines, Zachary F. Meisel

Health Policy and Management Informal Communications

Advanced radiology tests such as CT scans, MRIs and ultrasounds have dramatically changed how patients are diagnosed and treated. Just a decade ago, patients were still being subjected to exploratory surgery, in which a surgeon cuts open the abdomen to look for problems; today, CT scans allow doctors to make diagnoses without a scalpel.

Who Are The Health Center Patients Who Risk Losing Care Under The House Of Representatives' Proposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

On February 20, 2011, the United States House of Representatives approved more than $61 billion in discretionary spending reductions for the remainder of FY 2011. The legislation includes $1.3 billion in direct spending cuts for community health centers. Using the NACHC patient estimates, we present evidence on the characteristics of patients whose continuing access to health center services is at risk. We arrived at these estimates using data from the Uniform Data System (UDS), the federal reporting system in which all health centers must participate, as well as national estimates from the Medical Expenditure Panel Survey (MEPS), and published reports …

Who Are The Health Center Pati Ents Who Risk Losing Care Under The House Of Representatives’ Pr Oposed Fy 2011 Spending Reductions?, Sara J. Rosenbaum, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

No abstract provided.

The States' Next Challenge--Securing Primary Care For Expanded Medicaid Populations, Leighton C. Ku, Karen Jones, Peter Shin, Brian K. Bruen, Katherine J. Hayes

Health Policy and Management Faculty Publications

In the coming years, the United States must address both an expansion of Medicaid coverage and an unexpected shortage of primary care physicians. Under the Patient Protection and Affordable Care Act (ACA), the Medicaid eligibility threshold for nonelderly adults will rise to 133% of the federal poverty level (about $30,000 for a family of four) in 2014. States with restrictive Medicaid eligibility requirements and high rates of uninsured residents will expand coverage substantially, while programs in states with higher current Medicaid eligibility thresholds and fewer uninsured residents will grow less. However, since many of the states with the largest anticipated …

Mcdonald's Medicine: Are We Too Impatient To Wait For Care?, Zachary F. Meisel, Jesse M. Pines

Health Policy and Management Informal Communications

The prospect of waiting for health care is not only distasteful to Americans, it's downright threatening: indeed, the specter of Canadian-style waiting lists for certain tests and procedures evoked enough American-style fear that it became a key Republican talking point to challenge the concept of government-subsidized health care.

Statement On Essential Benefits, Sara J. Rosenbaum

Health Policy and Management Faculty Posters and Presentations

The essential health benefits statute is unique. Because its legislative history is quite limited, the text itself takes on particular importance. The provisions of the statute differ significantly from the highly detailed coverage terms of Medicare Parts A and B. Similarly, its provisions differ from the coverage provisions of the Employee Retirement Income Security Act, which governs virtually all private employer-sponsored health benefit plans and which (with the important exception of the insured small group market) remains unaffected by the essential health benefits provision. In referencing broad benefit categories, the essential health benefits statute bears some resemblance to the structure …

Citizen-Centered Health Promotion: Building Collaboration To Facilitate Healthy Living, Steven H. Woolf, Mercedes M. Dekker, Fraser Rothenberg Byrne, Wilhelmine Miller

Health Policy and Management Faculty Publications

Unhealthy behaviors, notably tobacco use; unhealthy diets; and inadequate physical activity are major contributors to chronic disease in the U.S. and are more prevalent among socioeconomically disadvantaged groups. Differences in the prevalence of unhealthy behaviors among communities with different physical, social, and economic resources suggest that contextual environmental factors play an important causal role. Yet health promotion interventions often are undertaken in isolation and with inadequate attention to these holistic social and economic influences on lifestyle. For example, clinicians' advice to patients to stop smoking or lose weight can help motivate people to change behaviors, but their ability to take …

Issues In Health Reform: How Changes In Eligibility May Move Millions Back And Forth Between Medicaid And Insurance Exchanges, Benjamin D. Sommers, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The Affordable Care Act will extend health insurance coverage by both expanding Medicaid eligibility and offering premium subsidies for the purchase of private health insurance through state health insurance exchanges. But by definition, eligibility for these programs is sensitive to income and can change over time with fluctuating income and changes in family composition. The law specifies no minimum enrollment period, and subsidy levels will also change as income rises and falls. Using national survey data, we estimate that within six months, more than 35 percent of all adults with family incomes below 200 percent of the federal poverty level …

Healthcare Reform And Medical Data Security And Privacy, Patricia Mactaggart, Stephanie Fiore

Health Policy and Management Faculty Publications

U.S. health care delivery and administration have undergone transformations that create an expansive demand for health information technology. The concepts put forth in health care reform are reliant on an evolving health information technology infrastructure and the successes of both are dependent on consumer/patient "trust". Every action is interdependent. Each decision is a balance between ease of use, privacy and security concerns of consumers/patients, practicality, costs and political will. The goal is finding the best balance within an appropriate legal framework at the state and federal level so the pieces fit into one complete picture when implemented.

The Affordable Care Act, Medical Homes, And Childhood Asthma: A Key Opportunity For Progress, Meagan Lyon, Anne Rossier Markus, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The medical homes provisions of the Affordable Care Act offer a major opportunity to advance high quality, cost-efficient health care for children with asthma. This policy brief examines evolving national medical homes policy in a childhood asthma context. Following a brief background that examines childhood asthma and explores the origins and evolution of medical homes policy (a concept developed with children in mind), the brief then describes how the Affordable Care Act can advance the implementation of medical homes policies to improve health outcomes for children with asthma.

Hospice, Palliative Care And Health Care Reform: Beyond "End Of Life" To Quality Of Life, Dale Lupu

Health Policy and Management Faculty Posters and Presentations

No abstract provided.