Health Policy Commons^™

The Social Mission Of Medical Education: Ranking The Schools, Fitzhugh Mullan, Candice Chen, Stephen Petterson, Gretchen Kolsky, Michael Spagnola

Health Policy and Management Faculty Publications

The study proposes a new method of ranking medical schools through the creation of a "social mission" score, reflecting that many believe that medical schools should be accountable to society and have a social mission to train physicians to care for the population as a whole, taking into account such issues as whether schools produce physicians who practice primary care, work in underserved areas, and represent the diversity of the population.

Workplace Screening & Brief Intervention: The Big (Brief Intervention Group) Initiative, Eric Goplerud, Tracy Mcpherson

Health Policy and Management Faculty Publications

To realize the full value of their investment in Employee Assistance Program (EAP), employers should attend to the opportunities to drive down health and productivity costs by encouraging their EAPs to engage and treat workers who drink in unhealthy ways. Nationwide, EAPs engage only about one worker in twenty who has a serious alcohol problem. The lost productivity, absenteeism, excess emergency department and hospital use by the other 19 out of 20 workers with alcohol problems who are not treated add $61 billion (or approximately $200 for every man, woman and child in the United States) to the nation's health …

Implementation Of Eaps, Mark Attridge, Patricia Herlihy, Dave Sharar, Tom Amaral, Tracy Mcpherson, Diane Stephenson, Tom Bjornson, Rich Paul, Lisa Teems, Eric Goplerud, Sandra Routledge

Health Policy and Management Faculty Publications

This Research Note describes how to effectively implement employee assistance program services in an organization.

Consumer Consent Options For Electronic Health Information Exchange: Policy Considerations And Analysis, Melissa M. Goldstein, Alison L. Rein

Health Policy and Management Faculty Publications

The issue of whether, to what extent, and how individuals should have the ability to exercise control over their health information represents one of the foremost policy challenges related to the electronic exchange of health information. The current landscape of possible consent models is varied, and the factors involved in choosing among them are complex. States and other entities engaged in facilitating the exchange of electronic health information are struggling with a host of challenges, chief among them the establishment of policies and procedures for patient participation in their exchange efforts. While some have adopted policies enabling patients to exercise …

Accountable Care Organizations: Implications For Antitrust Policy, Taylor Burke, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines accountable care organizations (ACOs) and assesses their implications for antitrust policy. Consideration of the antitrust implications of ACOs is timely. Both the House and Senate health reform measures contemplate the creation of ACOs as a new class of Medicare provider while providing parallel legal authority under Medicaid.

Changing Policy: The Elements For Improving Childhood Asthma Outcomes, Anne R. Markus, Meagan Lyon, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This report lays out the facts and offers specific policy recommendations for success that could change the face of childhood asthma in America. These recommendations aim to make better use of programs and policies already in place, such as Medicaid and the Children's Health Insurance Program (CHIP), as well as private sector insurance coverage and existing public health programs. The recommendations also underscore the importance of careful research -- scientific, practical, and community-based -- in order to continue to learn what works best and strengthen knowledge for future action. In a reformed health system, these initial efforts are not wasted …

Can States Pick Up The Health Reform Torch?, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

The Role Of Medicaid In Promoting Access To High-Quality, High-Value Maternity Care, Anne R. Markus, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

The main purpose of this article is to analyze and describe the role of Medicaid in facilitating access to care for pregnant women and ensuring high-quality maternity care that is affordable. It first summarizes the federal Medicaid requirements regarding eligibility, coverage of benefits, financing, and service delivery, with a special emphasis on existing quality provisions. Then, it discusses current issues and recommends several Medicaid reforms, particularly in the area of quality assessment and improvement. All reforms, including Medicaid reforms, should seek to support the IOM-identified aims. Much of the emphais in Medicaid policy development has been focused on access to …

The Diabetes Primary Prevention Initiative Interventions Focus Area: A Case Study And Recommendations, Deborah S. Porterfield, Laurie Hinnant, David M. Stevens, Ernest Moy, Dppi-Ifa Case Study Group

Health Policy and Management Faculty Publications

Background: In 2005, CDC began the Diabetes Primary Prevention Initiative Interventions Focus Area (DPPI-IFA), which funded fıve state Diabetes Prevention and Control Programs (DPCPs) to translate diabetes primary prevention trials into real-world settings by developing and implementing a framework for state-level diabetes primary prevention.

Purpose: The purpose of this case study, conducted in 2007, was to describe DPPI-IFA implementation, including facilitators and challenges to the initiative. Methods: Case studies of the fıve DPCPs in the DPPI-IFA involving site visits with key informant interviews of state staff and partners and archival record collection.

Results: Partners recruited for DPPI-IFA activities included …

The Health Information Technology Provisions In The American Recovery And Reinvestment Act Of 2009, Taylor Burke

Health Policy and Management Faculty Publications

This installment of Law and the Public’s Health explores the comprehensive reforms contained in the American Recovery and Reinvestment Act of 2009, whose implementation is expected to transform the use of health information technology as part of Medicare, Medicaid, and public health practice.

Can The Deployment Of Community Health Workers For The Delivery Of Hiv Services Represent An Effective And Sustainable Response To Health Workforce Shortages? Results Of A Multicountry Study, Francesca Celletti, Anna Wright, John Palen, Seble Frehywot, Anne R. Markus, Alan E. Greenberg, Rafael Augusto Teixeira De Aguiar, Francisco Campos, Eric Buch, Badara Samb

Health Policy and Management Faculty Publications

In countries severely affected by HIV/AIDS, shortages of health workers present a major obstacle to scaling up HIV services. Adopting a task shifting approach for the deployment of community health workers (CHWs) represents one strategy for rapid expansion of the health workforce. This study aimed to evaluate the contribution of CHWs with a focus on identifying the critical elements of an enabling environment that can ensure they provide quality services in a manner that is sustainable. The method of work included a collection of primary data in five countries: Brazil, Ethiopia, Malawi, Namibia, and Uganda. The findings show that delegation …

Challenges In Language Services: Identifying And Responding To Patients' Needs, Marsha Regenstein, Holly Mead, Kathryn E. Muessig, Jennifer Huang

Health Policy and Management Faculty Publications

Objective: Identify characteristics of hospitalbased language services (LS), and describe practices of identifying patients with limited English proficiency (LEP) and interpreter training.

Participants: Seventy-one hospitals applied to participate in a national initiative. Applicants were non-federal, acute care hospitals with substantial LEP populations, at least 10,000 discharges, and in-person interpreters.

Methods: Descriptive statistics were generated on language, collection of language data, LEP volume and service utilization, staffing and training requirements and organizational structure. The relationship between admissions and encounters was analyzed.

Results Ninety percent of hospitals collect primary language data. Spanish is the most common language (93% of hospitals). …

Racial/Ethnic Disparities In Access To Care Among Children: How Does Medicaid Do In Closing The Gaps?, Marsha Lillie-Blanton, Julia Paradise, Megan Thomas, Paul D. Jacobs, Bianca Dijulio

Health Policy and Management Faculty Publications

While Medicaid and the Children's Health Insurance Program (CHIP) have become increasingly important sources of health coverage for low-income children in all racial and ethnic groups, the program plays an especially large role for children of color, who are more likely than white children to be low-income. In 2007, Medicaid and CHIP covered nearly one in five white children, but roughly two in five African American and Hispanic children.

As policymakers engaged in health reform consider the merits of public and private approaches to expanding coverage, this report provides an assessment of Medicaid's relative impact on racial and ethnic disparities …

Leveling The Field--Ensuring Equity Through National Health Care Reform, Bruce Siegel, Lea Nolan

Health Policy and Management Faculty Publications

Members of minority groups have higher rates of disease, poorer health, and more limited access to care than their white counterparts. They account for half of the uninsured population and 58% of the low-income uninsured population. Even when they have coverage, minority patients are at risk for receiving lower-quality medical and surgical care than white patients. The factors underlying these inequities are complex and go far beyond the health care system,but any meaningful reform must, at a minimum, confront disparities in care. Health care reform provides a unique opportunity to reversea legacy of inequality in health and health care. This …

Analysis Of State Medicaid Agency Performance In Relation To Incentivizing The Provision Of H1n1 Immunizations To Eligible Populations, Nancy Lopez, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This analysis examines the extent to which state Medicaid agencies have translated a recent CMS guidance on vaccine coverage into clear information for participating providers clarifying payment for costs associated with the administration of H1N1 vaccines. This clarification may be particularly important in states that do not otherwise cover and pay for recommended immunizations as part of treating adult patients.

Mandatory Vaccination Of Health Care Workers, Alexandra M. Stewart

Health Policy and Management Faculty Publications

New York State’s regulations require health care workers who have direct contact with patients or who may expose patients to disease to be vaccinated against seasonal and H1N1 influenza. Courts must take into account Constitutional guarantees of personal autonomy, freedom of contract, and freedom of religion when reviewing the current lawsuits. These rights, however, have been constrained when they conflict with government measures that are intended to protect the community’s health and safety. Health care workers have a profound effect on patients’ health. Although they have the same rights as all private citizens, it is likely that courts will continue …

An Analysis Of The Implications Of The Stupak/Pitts Amendment For Coverage Of Medically Indicated Abortions, Sara J. Rosenbaum, Lara Cartwright-Smith, Ross Margulies, Susan F. Wood, D. Richard Mauery

Health Policy and Management Faculty Publications

This analysis examines the implications for coverage of medically indicated abortions under the Stupak/Pitts Amendment (Stupak/Pitts) to H.R. 3962, the Affordable Health Care for America Act. In this analysis we focus on the Amendment's implications for the health benefit services industry as a whole. We also consider the Amendment's implications for the growth of a market for public or private supplemental coverage of medically indicated abortions. Finally, we examine the issues that may arise as insurers attempt to implement coverage determinations in which abortion may be a consequence of a condition, rather than the primary basis of treatment.

Analysis Of The Extent To Which State Insurance Laws Mandate Coverage And Payment Of Vaccines And Vaccine Administration Fees During Periods Of Declared Public Health Emergencies, Sara J. Rosenbaum, Nancy Lopez, Ross Margulies

Health Policy and Management Faculty Publications

This analysis examines whether state insurance laws require health insurers, as a condition of doing business, to pay the costs associated with the administration of immunizations during declared public health emergencies. As is the case with the current H1N1 emergency, a public health emergency triggers nationwide distribution of free vaccine. But even when vaccine is distributed free of charge, its administration poses costs to private physicians and charges can be significant. As a result, the Institute of Medicine has identified vaccine administration as a potential financial barrier to care. Most communities have limited numbers of public health workers and professional …

State Medicaid Coverage Of Perinatal Services: Summary Of State Survey Findings, Usha Ranji, Alina Salganicoff, Alexandra M. Stewart, Marisa A Cox, Lauren Doamekpor

Health Policy and Management Faculty Publications

No abstract provided.

Health Care Fraud, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

Adequate safeguards against health care fraud are essential to the proper functioning of any health care system. This analysis examines health care fraud in the U.S., and its findings underscore the importance to national health reform of comprehensive anti-fraud protections covering both public and private health insurance industry. This analysis, funded by the Robert Wood Johnson Foundation, examines health care fraud in a national policy context.

The Economic Burden Of Health Inequalities In The United States, Thomas A. Laveist, Darrell J. Gaskin, Patrick Richard

Health Policy and Management Faculty Publications

This study, commissioned by the Joint Center for Political and Economic Studies and carried out by leading researchers from Johns Hopkins University and the University of Maryland, provides important insight into how much of a financial burden racial disparities are putting on our health care system and society at large. The researchers examined the direct costs associated with the provision of care to a sicker and more disadvantaged population, as well as the indirect costs of health inequities such as lost productivity, lost wages, absenteeism, family leave, and premature death.

Use Of Revised International Health Regulations During Influenza A (H1n1) Epidemic, 2009, Rebecca L. Katz

Health Policy and Management Faculty Publications

Strong international health agreements and good planning created a structure and common procedure for nations involved in detection and evaluation of the emergence of influenza A (H1N1). This report describes a timeline of events that led to the determination of the epidemic as a public health emergency of international concern, following the agreed-upon procedures of the International Health Regulations. These events illustrate the need for sound international health agreements and should be a call to action for all nations to implement these agreements to the best of their abilities.

Emergency Department Operations In Top-Performing Safety-Net Hospitals, Lea Nolan, Marsha Regenstein, Donna Anthony, Bruce Siegel

Health Policy and Management Faculty Publications

This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that …

Fair Process In Physician Performance Rating Systems: Overview And Analysis Of Colorado's Physician Designation Disclosure Act, Lara Cartwright-Smith, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Programs to rate, grade, rank, or tier physicians based on quality or other measures are becoming more commonplace as the demand for greater transparency and accountability in the nation’s health care system intensifies. For many years, the preferred provider organization (PPO) reflected the most basic form of tiering—physicians were either included or excluded from the PPO network. However, this approach has become more refined as the tools for evaluating physician performance have evolved.

Antitrust Aspects Of Health Information Sharing By Public And Private Health Insurers, Taylor Burke, Lara Cartwright-Smith, Erica Pereira, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy brief is the first of two to address antitrust considerations that arise in health system transformation aimed at producing greater clinical integration and greater levels of information about the quality and cost of care. The second policy brief will discuss the implications of several recent Federal Trade Commission rulings on physician joint contracting to achieve clinical integration and greater health information accountability. These rulings have significant implications for growing efforts, as part of health reform, to create entities known as accountable care organizations.

Insurance Discrimination On The Basis Of Health Status: An Overview Of Discrimination Practices, Federal Law, And Federal Reform Options, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Actuarial underwriting, or discrimination based on an individual's health status, is a business feature of the voluntary private insurance market. The term "discrimination" in this paper is not intended to convey the concept of unfair treatment, but rather how the insurance industry differentiates among individuals in designing and administering health insurance and employee health benefit products. Discrimination can occur at the point of enrollment, coverage design, or decisions regarding scope of coverage. Several major federal laws aimed at regulating insurance discrimination based on health status focus at the point of enrollment. However, because of multiple exceptions and loopholes, these laws …

Improving Medicaid's Continuity Of Coverage And Quality Of Care, Leighton C. Ku, Patricia Mactaggart, Fouad Pervez, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Medicaid provides health insurance coverage to tens of millions of low-income children, parents, seniors and people with disabilities. Unfortunately, Medicaid enrollment is like a leaky sieve; every year millions of people enroll, only to subsequently lose their coverage, despite still being eligible, because of inefficient and cumbersome paperwork requirements. The interruptions in coverage affect the continuity and effectiveness of health care received. Interruptions also impair quality monitoring and improvement activities because many Medicaid enrollees were not enrolled long enough to assess the quality of their care. The presumption is that people who have been enrolled for less than a year …

Paying Medicare Private Plans By Competitive Bidding: Not The Same As Costs In Regular Medicare, Brian Biles, Jonah Pozen

Health Policy and Management Faculty Publications

Medicare Advantage plans are now paid $11 billion a year, and $150 billion over 10 years, more than costs in regular fee-for-service (FFS) Medicare. In the past two years there have been discussions about reducing MA payments to the level of 100 percent of average costs in FFS and using the savings to offset the costs of new Federal health initiatives such as health care reform. Earlier this year, OMB proposed "reducing Medicare overpayments to private insurers through competitive payments." Under this proposal, MA plan "payments would be based on an average of plans' bids submitted to Medicare." This issue …

Women's Health And Health Care Reform: The Economic Burden Of Disease In Women, Susan F. Wood, Avi Dor, Rebekah E. Gee, Alison Harms, D. Richard Mauery, Sara J. Rosenbaum, Ellen Tan

Health Policy and Management Faculty Publications

This report estimates the direct and indirect costs of care for women for the major chronic diseases and conditions that women face across the lifespan. It also identifies the key primary care and preventive services that can lead to prevention, early detection or early intervention for these conditions. Health care screening, counseling, early diagnosis, and early intervention health care services are important for women at each stage of their lives. But women typically seek care in primary care settings for family planning services and cancer screening prior to becoming pregnant. As a result, high quality care during the reproductive years …

Health Insurance Fraud: An Overview, Sara J. Rosenbaum, Nancy Lopez, Scott Stifler

Health Policy and Management Faculty Publications

In 2007, the U.S. spent nearly $2.3 trillion on health care and public and private insurers processed more than 4 billion health insurance claims. The National Health Care Anti-Fraud Association (NHCAA) has estimated that, conservatively, 3% of all health care spending—or $68 billion—is lost to health care fraud. Other estimates by government and law enforcement agencies place fraud-related losses as high as 10% of annual health care spending; at this rate, the losses in 2007 alone – over $220 billion – would have been enough to cover the uninsured.

This report, funded by the Robert Wood Johnson Foundation, delves into …