Health Policy Commons^™

Analysis Of Carefirst's Performance As A Charitable Not-For-Profit Health Insurance Company In The National Capital Area, Sara J. Rosenbaum, Brian Kamoie, Charlotte Collins, Ann Zuvekas, Judy Feder, Gary Claxton

Health Policy and Management Faculty Publications

The George Washington University School of Public Health and Health Services ("GWU") and the Georgetown University Institute for Health Care Research and Policy ("GU")conducted this analysis on behalf of the DC Appleseed Center for Law and Justice in order to examine whether, in its operations and business practices, CareFirst BlueCross BlueShield ("CareFirst") appears to be fulfilling its chartered mission for the National Capital Area. The study began as an analysis of the coverage and access implications for the region of a proposal made by CareFirst and WellPoint Health Networks, Inc. ("WellPoint") to convert CareFirst to for-profit status and permit its …

Public Health Communicable Disease Reporting Laws: Managed Care Organizations' Laboratory Contracting Practices And Their Implications For State Surveillance And Reporting Statutes, D. Richard Mauery, Brian Kamoie, Sarah C. Blake, Jeffrey Levi

Health Policy and Management Faculty Publications

This report, prepared for the U.S. Centers for Disease Control and Prevention by the GWU Center for Health Services Research & Policy (CHSRP), presents findings from analyses of contractual specifications related to public sector managed care contractors' duties and activities related to public health surveillance and education activities for communicable disease control, specifically HIV/AIDS, sexually transmitted diseases, and tuberculosis.

Medicare Prescription Drug Legislation: What It Means For Rural Beneficiaries, Jeanne Lambrew, Becky Briesacher

Health Policy and Management Faculty Publications

Congress is currently debating legislation that would not only add a prescription drug benefit to Medicare but create an unprecedented role for private health insurers in delivering all Medicare services. Such changes would have profound effects on the 41 million people covered by Medicare -- particularly the one in four who lives in rural America. Previous studies have shown that rural beneficiaries have different health care needs and delivery systems than their urban counterparts. Indeed, the bills that passed the House and Senate address payments to rural hospitals and other providers. However, less attention has been paid to the rural …

Reducing Racial And Ethnic Health Disparities: Estimating The Impact Of High Health Center Penetration In Low-Income Communities, Peter Shin, Karen Jones, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The health disparities literature suggests that although the lack of health insurance is the most basic barrier to health care, improved access to clinically appropriate care is key, particularly in the case of minority and low-income populations where the health risks are greatest. This study examines the relationship between health center penetration into medically underserved communities and the reduction of state-level health disparities. Health centers were developed with the express aim of serving medically underserved persons. Their doubling represents a significant health priority of the Bush Administration and one that enjoys bipartisan Congressional support.

The Epidemiology Of U.S. Immunization Law: Mandated Coverage Of Immunizations Under State Health Insurance Laws, Sara J. Rosenbaum, Alexandra M. Stewart, Marisa A. Cox, Shawnte Mitchell

Health Policy and Management Faculty Publications

Immunizations represent both basic clinical care as well as an essential public health activity with population-wide health implications, and for a number of reasons, the focus on national immunization policy has intensified in recent years. Insurers and employee health plans may cover immunization services as a matter of benefit design choice. Federal and state insurance laws also may mandate coverage of one or more classes of immunization services. For approximately 100 million persons who are members of state-regulated health insurance plans, state law plays a primary role in determining coverage. Thus the extent of state immunization health insurance mandates is …

Lessons From Medicare+Choice For Medicare Reform, Geraldine Dallek, Brian Biles, Lauren Hersch Nicholas

Health Policy and Management Faculty Publications

Medicare has a long history with private health plans, most importantly the 1997 creation of the Medicare+Choice (M+C) program. The objectives of M+C included expanding the types of plans available to Medicare beneficiaries, increasing payments to plans in low-cost areas, and fostering competition among private plans. HMOs have left the M+C program in large numbers. Although many private M+C plans perform well compared with fee-for-service Medicare on selected preventive health measures, on other measures—including access to care, stability of providers, simplicity of benefit structure, and costs to the Medicare program—the history of M+C is less positive.

Contracting For Coordination Of Behavioral Health Services In Privatized Child Welfare And Medicaid Managed Care, D. Richard Mauery, Julie Collins, Jan Mccarthy, Charlotte Mccullough, Sheila Pires

Health Policy and Management Faculty Publications

This study examined coordination between privatized child welfare initiatives and Medicaid managed care systems for the delivery of behavioral health care services for children and families in the child welfare system. Specific objectives: 1) to assess how states expectations as embodied in their contract documents are actually happening during program implementation; and 2) to identify promising approaches for delivery of coordinated behavioral health care services and contracting that can be shared with other stakeholders. The goal was to highlight the real world experiences and lessons learned that others may draw upon when designing and implementing similar contracts for systems of …

Medicare+Choice In Phoenix, Arizona: So Far So Good? Maricopa County Site Visit Report, May 7-9, 2003, Lauren Hersch Nicholas, Geraldine Dallek, Brian Biles

Health Policy and Management Faculty Publications

There is significant variation in experiences with M+C across the United States. In some areas of the country, beneficiaries have a choice of multiple managed care plans and M+C market penetration rates remain well above the national average. Phoenix, Arizona is one of the markets where M+C appears to be successful. Thirty-seven percent of eligible beneficiaries are enrolled in a managed care plan and beneficiaries can choose from eight plans offered by six firms. Success of M+C in Phoenix has been partially attributed to a long history of managed care in Maricopa County, especially in the Medicaid program. The new …

Health Centers As Safety Net Providers: An Overview And Assessment Of Medicaid's Role, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

In 2001, health centers provided health care services to nearly 12 million people at more than 4,000 sites across the United States. As such, the health center program is a crucial part of the health care safety net for low-income individuals and medically underserved communities. This policy brief looks at health centers in detail in order to illuminate the role they play as providers of care and to document the important nexus between health centers and Medicaid.

Maximizing Access To Medications Through Efficient Use Of Care Act Resources, Jeffrey Levi, Julia Hidalgo, John Palen, Blaine Parrish, Kendra Williams, Anthony Lara

Health Policy and Management Faculty Publications

HRSA's HIV/AIDS Bureau (HAB) contracted with the George Washington University to conduct a series of studies regarding various aspects of HIV medications funding through the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, including the Title II-funded AIDS Drug Assistance Program and Title I-funded AIDS Pharmaceutical Assistance Programs. The goal of the studies was to inform HAB regarding (1) opportunities to promote more efficient use of scarce resources for HIV-related medications and (2) policy options that might ensure equitable access to life-saving therapies for low-income people living with HIV (PLWH). The three key issues addressed and the related study questions …

A Sound Investment: Identifying And Treating Alcohol Problems, Jeffrey Hon

Health Policy and Management Faculty Publications

The direct cost of alcohol problems is nowhere more evident than in the nation's hospitals and emergency rooms. One-fourth of all people admitted to general hospitals have alcoholism and as many as 30 percent of emergency room patients are problem drinkers, people who may not be dependent on alcohol, but drink in ways that endanger health and well-being. But these individuals are seeking medical attention for alcohol related illness and injury, not for their drinking. As a result, untreated alcoholism is driving up healthcare costs for both the public and private sector.

2003 State Of The State Addresses: Governors' Discussions Of Budget And Health Care Issues, Sara E. Wilensky, Betsy Schipani

Health Policy and Management Faculty Publications

A series of tables examines State of the State addresses nationwide to examine the frequency and content of Governors' discussions of budget and health care issues.

Covering The Uninsured: What Is The Problem, Why Care?, Jeanne Lambrew

Health Policy and Management Faculty Posters and Presentations

Presentation for Covering the Uninsured Week event sponsored by GW's Health Advocacy Initiative and the Department of Health Policy.

Treating Alcoholism As A Chronic Disease, Jeffrey Hon

Health Policy and Management Faculty Publications

Nearly 14 million Americans have serious problems because of their drinking including eight million men and women who suffer from alcoholism, a chronic disease. Alcoholism can be clinically diagnosed and people with the disease typically experience many additional alcohol-related medical complications. Research demonstrates that treatment can save lives, restore families, reduce health care costs, increase productivity in the workplace and make our communities safer.

Access To Care For The Uninsured And Underserved: An Assessment Of The 20-County Service Area Of The Health Foundation Of Greater Cincinnati, Health Foundation Of Greater Cincinnati, Marsha Regenstein, Kyle Kenney, Lissette Vaquerano, Jennel Harvey, Sunga Carter, Cincinnati Health Network, Healthpoint Family Care, Southern Ohio Health Services Network

Health Policy and Management Faculty Publications

In 2002, The Health Foundation of Greater Cincinnati contracted with the Center for Health Services Research and Policy at The George Washington University to conduct a study of the Health Foundation's service area, looking specifically at issues related to access to healthcare for uninsured and underserved residents. This report provides information on the health and socioeconomic status of the population and the status of safety net providers in the region and identifies gaps in care that currently exist or are likely to surface in the near future. It also highlights areas that may be particularly sensitive to economic, political, or …

Managed Care Corporate Failures: An Overview Of Bankruptcy And Insurance Insolvency Procedures, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This Issue Brief examines managed care corporate failures and the legal process. Managed care organizations are corporate hybrids that possess the features of both insurance and health care. As a result, the question of whether the proper legal forum for addressing a failure is the federal bankruptcy process or state insurance insolvency procedures is a complex one. The answer to this question is more than academic: legal protections for purchasers, members, and health care providers differ significantly depending on which legal system is used.

Assessing The Need To Enact Medical Liability Reform, Sara J. Rosenbaum, Taylor Burke

Health Policy and Management Congressional Testimonies

Testimony which will focus on the scope of the legislation's proposed shield against noneconomic damages with respect to the plaintiffs whose claims would be affected, the corporate defendants that would benefit from the shield, and the types of injuries that would be shielded. This measure is so vast in scope that it reaches every conceivable health care claim against every health care corporation or manufacturer of health care products, regardless of whether the violation of law in question bears any relationship to what would reasonably be considered the types of injury commonly associated with the concept of medical liability. Because …

Reasonable Modification Or Fundamental Alteration? Recent Developments In Ada Caselaw And Implications For Behavioral Health Policy, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery, Alexandra M. Stewart

Center for Integrated Behavioral Health Policy

No abstract provided.

Reasonable Modification Or Fundamental Alteration? Recent Developments In Ada Caselaw And Implications For Behavioral Health Policy, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery, Alexandra M. Stewart

Health Policy and Management Issue Briefs

This issue brief examines the concept of fundamental alteration under the Americans with Disabilities Act (ADA); specifically it considers when proposed modifications of public programs under Title II of the ADA will be considered to amount to the type of fundamental alteration that lies beyond judicial power to compel. The issue of when a program change constitutes a fundamental alteration is important in state community integration planning efforts, since these types of changes will require legislative action.

The Effects Of State Dental Practice Laws Allowing Alternative Models Of Preventive Oral Health Care Delivery To Low-Income Children, Lea Nolan, Brian Kamoie, Jennel Harvey, Lissette Vaquerano, Sarah Blake, Satvinder Chawla, Jeffrey Levi, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The purpose of this project was to examine state dental practice laws and the extent to which they encourage alternative models of delivering preventive oral health care. This project encompassed two distinct study components: 1) an analysis of existing state dental statutes and regulations; and 2) case studies to examine the enactment of public health-oriented provisions encouraging alternative models of delivering preventive oral health care to low-income children; and the development and implementation of such alternative models.

Why Competition Law Matters To Health Care Quality, William M. Sage, David A. Hyman, Warren Greenberg

Health Policy and Management Faculty Publications

Competition law (encompassing both antitrust and consumer protection) is the forgotten stepchild of health care quality. This paper introduces readers to competition law and policy, describes its institutional features and analytic framework, surveys the ways in which competition law has influenced quality-based competition, and outlines some areas in need of further development. Competition law protects the competitive process--not individual competitors. It guides the structural features of the health care system and the conduct of providers as they navigate it. Competition law does not privilege quality over other competitive goals but honors consumers' preferences with respect to trade-offs among quality, price, …

An Analysis Of The Medicaid Imd Exclusion, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery

Health Policy and Management Faculty Publications

This report examines the Medicaid Institutions for Mental Disease (IMD) exclusion, one of the very few instances in which federal Medicaid law prohibits federal contribution to the cost of medically necessary care furnished by licensed medical care providers to enrolled program beneficiaries. The report begins with a brief overview of Medicaid's role in financing care for conditions and illnesses classified as "mental diseases" under professional medical guidelines and the allocation of state and federal funding responsibilities under Medicaid. The report then reviews the elements of the Medicaid IMD exclusion, as well as key judicial and administrative rulings related to the …

How Care Is Managed: A Descriptive Study Of Current And Future Trends In Care And Cost Management Practices Under Private Sector Employee Benefit Plans, Phyllis Borzi, Marsha Regenstein, Lee Repasch, Soeurette Cyprien, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

In the fall of 2001, the United States Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation (ASPE) asked the Center for Health Services Research and Policy in the School of Public Health and Health Services, The George Washington University Medical Center, to undertake a descriptive study of the current and future trends in cost and care management techniques used in the employment-based health insurance marketplace. The purpose of this study was to identify and report on (1) the cost and care management techniques currently in use in the private sector by health plans …

Hipaa's Electronic Transactions Rule: Implications For Behavioral Health Providers, Brian Kamoie

Health Policy and Management Issue Briefs

On August 17, 2000, the Department of Health and Human Services (HHS) adopted uniform national standards for electronic health transactions and code sets pursuant to the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Uniform standards hold the promise of improved efficiency in the health care system through standardized electronic transmission of health information.

Many behavioral health care organizations (e.g., the American Psychiatric Association, the National Association of State Mental Health Program Directors, and the National Association of State Alcohol/Drug Abuse Directors) have argued that the Rule's standards are insufficient for behavioral health providers. …

Behavioral Health And Managed Care Contracting Under Schip, Sara J. Rosenbaum, Colleen Sonosky, Karen Shaw, D. Richard Mauery

Health Policy and Management Issue Briefs

This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements, studying separate SCHIP managed care products sheds important light on how states might approach …

Erisa Health Plans: Key Structural Variations And Their Effect On Liability, Phyllis Borzi

Health Policy and Management Faculty Publications

No abstract provided.

Health Coverage In Massachusetts: Far To Go, Farther To Fall, Sara J. Rosenbaum, Jeanne Lambrew, Peter Shin, Marsha Regenstein, Tanya Ehrmann, Dylan Roby

Health Policy and Management Faculty Publications

This analysis has been prepared to highlight the state's experience in health reform and describe the challenges that it now faces. It recommends a renewed commitment to maintaining and strengthening the reforms that have made Massachusetts one of the nation's health policy leaders. This analysis does not focus on comprehensive health reform, although we believe that the cost and coverage problems that plague the Massachusetts health system (as well as that of every other state) would be most effectively addressed through broader restructuring aimed at achieving universal coverage and more decisive control over expenditures. In this report, we instead focus …

State Eligibility Rules Under Separate State Schip Programs--Implications For Children's Access To Health Care, Sara Rosenbaum, Anne Rossier Markus

Health Policy and Management Issue Briefs

This Policy Brief is the fourth in a series of reports1 issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children’s Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs.2 These Policy Briefs also consider the implications of states’ design choices for children’s access to health care.

School-Based Health Centers And Managed Care Arrangements: A Review Of State Models And Implementation Issues, Jennel Harvey, Lissette Vaquerano, Lea Nolan, Colleen Sonosky

Health Policy and Management Faculty Publications

No abstract provided.

The Impact Of The State Children's Health Insurance Program (Schip) On Community Health Centers, Lea Nolan, Jennel Harvey, Karen Jones, Lissette Vaquerano, Ann Zuvekas

Health Policy and Management Faculty Publications

Nearly 12 million children in the United States do not have health insurance, and therefore often lack access to health care. In response, Congress enacted the State Children’s Health Insurance Program (SCHIP) in August 1997, the largest expansion of health insurance coverage since the inception of the Medicare and Medicaid programs. The SCHIP provides states with federal matching funds for children’s insurance either by expanding the existing Medicaid program, by creating a separate state program, or a combination of both.

The George Washington University’s Center for Health Services Research and Policy (CHSRP) was funded by the Health Resources and Services …