Health Policy Commons^™

Medicaid And Case Management To Promote Healthy Child Development, Sara J. Rosenbaum, Kay Johnson, Emily Jones, Anne R. Markus

Health Policy and Management Faculty Publications

This policy brief presents options for financing and delivering case management services to low-income and special-needs children in Medicaid. The analysis builds on a literature review of case management, a review of the legal underpinnings of Medicaid case management, and consultation with experts in the fields of health care finance and program operations. It aims to inform the policy community about the importance of case management for assuring the health and development of our youngest and most vulnerable children.

Financing Community Health Centers As Patient- And Community-Centered Medical Homes: A Primer, Peter Shin, Leighton C. Ku, Emily Jones, Brad Finnegan, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

This policy brief is part of a Commonwealth Fund-supported project that examines community health centers in the context of the patient-centered medical home (PCMH) movement. Community health centers—non-profit primary care facilities that provide care to patients regardless of their ability to pay—are widely lauded as critical components of the health care safety net, providing comprehensive primary care for lowincome, high-risk populations in both urban and rural areas. Since their inception, health centers have directed their activities at improving patient care—through comprehensive primary health care, coordination with specialty care, and the provision of enabling services—as well as improving population-level health status …

The Continuing Cost Of Privatization: Extra Payments To Medicare Advantage Plans Jump To $11.4 Billion In 2009, Brian Biles, Jonah Pozen, Stuart Guterman

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, MA plans have, for the past six years, been paid more for their enrollees than they would be expected to cost in traditional fee-for-service Medicare. Payments to MA plans in 2009 are projected to be 13 percent greater than the corresponding costs in traditional Medicare—an average of $1,138 per MA plan enrollee, for a total of $11.4 billion. Although the extra payments are used to provide enrollees additional benefits, those benefits are not available to all beneficiaries—but they are financed by …

The H1n1 Influenza A Virus: A Test Case For A Global Response, Rebecca L. Katz, Karyn Feiden

Health Policy and Management Faculty Publications

The threat of widespread infection from the new H1N1 influenza A virus (also known as a swine flu virus) provides the first real-time test of the global and domestic preparedness activities that have moved forward over the past few years. The World Health Organization has declared the event a "public health emergency of international concern," the first time that designation has been used under the revised International Health Regulations. A public health emergency has also been declared in the United States.

Those steps have pushed influenza plans at the local, state, national, and global levels into motion. This paper reviews …

Children’S Health Care: Health Information Technology And Electronic Health Records, David M. Stevens

Health Policy and Management Faculty Publications

The panel addressed: Why pediatric electronic health records are different from adult EHRs; How HIT/EHRs can be helpful in the area of prevention with pediatric populations; How using HIT/EHRs can help improve quality and outcome measures for children and underserved communities; Barriers to getting HIT/EHRs into underserved communities and ways to overcome these challenges; Opportunities for stimulus funds to support HIT access for underserved pediatric populations; and Privacy and confidetiality concerns regarding pediatric EHRs.

U.S. District Court Directs Fda To Reevaluate Previous Plan B Decision, Susan F. Wood, D. Richard Mauery

Health Policy and Management Faculty Publications

Judge Edward R. Korman of the U.S. District Court, Eastern District of New York, issued a decision today (Mar. 23, 2009) in the case of Annie Tummino et al v. Frank M. Torti, Acting Commissioner of the Food and Drug Administration. The case involved plaintiffs' claims that the FDA, in deciding that Plan B, known as emergency contraception or the morning-after pill, be made available over-the-counter (OTC) only with age restrictions, was unduly and inappropriately influenced by pressures from the White House among other factors.

An Overview Of Major Health Information Technology, Public Health, Medicaid, And Cobra Provisions Of The American Recovery And Reinvestment Act Of 2009, Sara J. Rosenbaum, Melissa M. Goldstein, Taylor Burke, Phyllis Borzi, Lara Cartwright-Smith

Health Policy and Management Faculty Publications

A detailed side-by-side analysis of the individual components of the American Recovery and Reinvestment Act of 2009 (ARRA), signed into law on February 17, 2009. One of the most sweeping pieces of economic legislation ever enacted, ARRA not only provides hundreds of billions of dollars in new health and health care spending but also makes comprehensive reforms in health law and policy, particularly in the area of health information law, including health information technology (HIT) adoption and health information privacy.

Community Health Centers In An Era Of Health System Reform And Economic Downturn: Prospects And Challenges, Sara J. Rosenbaum, Brad Finnegan, Peter Shin

Health Policy and Management Faculty Publications

This Policy Brief examines the role of health centers in the U.S. health care system, assessing their current and future roles in an era of both great promise and challenge. On one hand, government is poised perhaps more sharply than any time in nearly a generation to undertake a comprehensive effort at national health reform, addressing not only coverage but also access, quality, prevention, and the reinvigoration of primary health care, particularly for populations who face the highest health risks. On the other hand, the nation is facing the most severe economic recession in years, with lower income families and …

Vaccines And Autism: The Evidence And The Law, Alexandra M. Stewart

Health Policy and Management Faculty Publications

A potential link between the measles-mumps-rubella vaccine and autism was dismissed by a federal vaccine court in February 2009. The U.S. Department of Health and Human Services said the findings demonstrate a lack of medical evidence for any association, while Autism Speaks, a patient advocacy group, said questions remain about potential risks for certain subgroups.

Other legal actions are pending as the scientific and patient advocacy communities debate the need to conduct further research on the vaccine-autism link. Meanwhile, public health advocates worry that continuing concerns about the safety of vaccines may depress the population immunization rate. A small rise …

How Is The Primary Care Safety Net Faring In Massachusetts? Community Health Centers In The Midst Of Health Reform, Leighton C. Ku, Emily Jones, Brad Finnegan, Peter Shin, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Massachusetts' landmark 2006 health reform legislation sets an important precedent for national reform. Initial evaluations have demonstrated the law's success in dramatically expanding health insurance coverage and health care access, but less is known about its effects on community health centers, which serve one of every 13 residents and one in four low-income residents. This analysis evaluates the experiences of health centers with the Massachusetts reforms, using administrative data to examine finances and patient enrollment in addition to the qualitative results of in-depth interviews conducted during site visits in August 2008 and the results of a short survey of health …

Retiree Health Vebas: A New Twist On An Old Paradigm: Implications For Retirees, Unions And Employers, Phyllis Borzi

Health Policy and Management Faculty Publications

This issue brief provides an overview of stand-alone Voluntary Employees' Beneficiary Association trusts, through which employers have been able to rid themselves of future obligations to pay retiree health benefits in exchange for making a significant payment to designed to approximate the projected cost of these benefits. The paper include three case studies, including the VEBAs at the Big Three automakers.

Health Information Technology In The United States: On The Cusp Of Change, 2009, Sara J. Rosenbaum, Melissa M. Goldstein, Lee Repasch, Catherine M. Desroches, Ashish K. Jha

Health Policy and Management Faculty Publications

In this report we use the data collected for ONCHIT to focus on EHR adoption in the inpatient setting. We report on several important policy issues. These include the rate of adoption of EHRs among U.S. hospitals generally and among safety-net hospitals, changes in both state and federal policy, and the potential of EHRs to change the quality measurement enterprise.

Primary And Preventive Healthcare: A Critical Path To Healthcare Reform For Florida: The Role Of Florida's Fqhcs, Sara J. Rosenbaum, Peter Shin, Brad Finnegan, Ramona Whittington

Health Policy and Management Faculty Publications

Florida's health care system faces numerous challenges: a high proportion of residents without health insurance, a declining supply of primary care physicians at the same time that the state faces a growing need for high quality and cost efficient care for uninsured persons, and a growing emphasis on medical homes, especially for culturally diverse patients with complex chronic conditions. Nearly 3.8 million Florida residents lack health insurance, while more than 8 million lack access to a regular source of primary health care.

Assuring access to timely and high quality primary health care is a key dimension of any health reform …

Why Policy Matters, D. Richard Mauery

Health Policy and Management Faculty Publications

The Editors and Editorial Board of Women’s Health Issues are pleased to publish in this issue the first article in a new category of peer-reviewed manuscripts for our journal, ‘‘Policy Matters.’’

Diagnosing Death: Why Does It Remain "Well Settled And Persistently Unresolved"?, Melissa M. Goldstein

Health Policy and Management Faculty Publications

For ten days after Motl Brody had been declared dead by physicians, the 12-year-old boy lay in an intensive-care unit of Children's National Medical Center, sustained by drugs and a ventilator. His Orthodox Jewish parents insisted that, according to religious law, Motl remained alive because his heart continued to beat. District of Columbia law said he did not.

Although statutes on the books of every U.S. state allow a determination of death when all functions of the brain, including the brain stem, have irreversibly ceased, there is continued debate, especially in religious, philosophical, and bioethics contexts, about how, or even …

Ready Or Not? Protecting The Public's Health From Diseases, Disasters, And Bioterrorism, Jeffrey Levi, Serena Vinter, Rebecca St. Laurent, Laura M. Segal

Health Policy and Management Faculty Publications

While significant progress has been made to better protect the country from health emergencies, funding for essential programs has been cut, putting these improvements in jeopardy. Additionally, a number of critical areas of preparedness still have significant gaps, including surge capacity and biosurveillance systems, and these problems are less likely to be addressed as funding decreases.

Liability Protections For Emergency Volunteer Health Practitioners And Entities, Jennifer Lee, Orriel L. Richardson, Ross Margulies, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Twenty-four states and D.C. have statutes that extend some level of immunity to groups and/or organizations providing charitable, emergency, or disaster relief services, although these laws varied greatly among states.

Improving Medicaid: Assessment Of District Of Columbia Agencies' Claims Processes And Recommendations For Improvements In Efficiency And Customer Service, George Washington University, School Of Public Health And Health Services, Department Of Health Policy, Health Management Associates

Health Policy and Management Faculty Publications

The District of Columbia Department of Health Care Finance (DHCF), like other state Medicaid agencies, is constantly challenged to improve service delivery and reimbursement for Medicaid services. In the District, several governmental agencies ("Partner Agencies") play an instrumental role in Medicaid – either as a Medicaid provider or in operating a Medicaid program. Today, each Partner Agency may retain its own system and process for claims submission, provider enrollment, and administrative claiming as it relates to Medicaid. For these reasons, the DHCF initiated an assessment of the Medicaid claims processes for Partner Agencies. The purpose of the assessment is to …

Medicare Advantage's Private Fee-For-Service Plans: Paying For Coordinated Care Without The Coordination, Brian Biles, Emily Adrion, Stuart Guterman

Health Policy and Management Faculty Publications

Like the private managed care plans offered under Medicare Advantage, private fee-for-service (PFFS) plans are paid more per beneficiary than those individuals would be expected to cost if they were enrolled in traditional fee-for-service Medicare. However, PFFS plans are not required to provide the same type of coordinated care required of Medicare Advantage plans. Payments to PFFS plans in 2008 average 16.6 percent more than costs in traditional Medicare, or $1,248 for each of the 2 million enrollees in PFFS plans—a total of nearly $2.5 billion in extra payments. Recently, Congress has made significant revisions to policies that will affect …

Second-Generation Consumerism: Increasing Consumer Activation To Improve Health Outcomes And Lower Costs For Patients With Chronic Disease, Judith H. Hibbard, Katherine J. Hayes

Health Policy and Management Faculty Publications

With health care costs increasing, some policymakers have sought to make patients better health care consumers through increased cost-sharing linked with greater information on the cost of care. These may be successful cost containment strategies in the short term. But patients are just as likely to forgo necessary as unnecessary care, which ultimately leads to greater demand for more intensive and expensive care in the long term. Patients can, however, play an important role in preventing the onset of chronic conditions or preventing deterioration in health once they have been diagnosed with a chronic condition. In this chapter we discuss …

Slouching Toward Health Reform: Insights From The Battle Over Schip, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

For Asians Only? The Perils Of Ancestry-Based Drug Prescribing, Perry W. Payne

Health Policy and Management Faculty Publications

The article discusses various aspects of ancestry-based drug prescribing and contemporary medical ethics in the U.S. Ancestry has been used by researchers to identify a subgroup of people most likely to have a certain allele linked to an adverse drug response. Also discussed are carbamazepine labeling, the U.S. Food and Drug Administration's (FDA) Alert on drug prescribing based on allele testing and the ethics of genetically categorizing people.

The Continuing Cost Of Privatization: Extra Payments To Medicare Advantage Plans In 2008, Brian Biles, Emily Adrion, Stuart Guterman

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 explicitly increased Medicare payments to private Medicare Advantage (MA) plans. As a result, every MA plan in the nation is paid more for its enrollees than they would have been expected to cost in traditional fee-for-service Medicare. The authors calculate that payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare—an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004–2008, extra payments to MA plans are estimated to have totaled nearly $33 billion. Although …

Access Transformed: Building A Primary Care Workforce For The 21st Century, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Though access to primary care protects health and cuts costs, this report shows there aren't enough primary care doctors and nurses at health centers to meet the need, with some areas having almost none – a situation that cannot be solved just by expanding health insurance coverage. The report indicates the availability of a primary care workforce depends on where you live, and primary care clinicians are not locating in areas that need them most, especially low-income communities. The study includes state-level projections of growing patient needs expected to stretch the health care system in years ahead. It was conducted …

Monitoring And Assessing The Use Of External Quality Review Organizations To Improve Services For Young Children: A Toolkit For State Medicaid Agencies, Tara Krissik, Henry T. Ireys, Anne R. Markus, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Federal regulations encourage state Medicaid agencies to use external quality review organizations (EQROs) to help implement strategies for assessing and improving the quality of medical services provided to beneficiaries enrolled in managed care plans. However, many states have not availed themselves of this opportunity and may lack guidance on how to do so. This report provides agencies with specifications for developing a scope of work that will lead to conceptually and methodologically sound studies of the quality of preventive and developmental services for young children enrolled in Medicaid. Among other recommendations, the authors note that states may require EQROs to …

Medicare Competitive Acquisition: Implications For Persons With Diabetes, Sara J. Rosenbaum, Avi Dor, Brad Finnegan, Emily Jones

Health Policy and Management Faculty Publications

Nearly one in five Medicare beneficiaries has diabetes and these patients face major challenges in managing their health. The high diabetes rate among beneficiaries also means that the Medicare program itself is highly vulnerable to the high costs of uncontrolled diabetes. As a result, great care must be taken when implementing any new cost containment strategy that has the potential to disrupt access to preventive health care. This is particularly in the case of the Medicare Competitive Acquisition Program for Durable Medical Equipment and Supplies (DMEPOS), because of its potential impact on access to products needed for a basic preventive …

Baseline Evaluation Of The Dc Emergency Healthcare Coalition, Melissa A. Higdon, Peter Shin, Michael A. Stoto

Health Policy and Management Faculty Publications

The DC Healthcare Facilities Emergency Care Coalition, funded by a grant by the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response (ASPR), was designed to significantly improve the state of emergency preparedness in health care facilities in the District of Columbia (DC), and to create a model for emergency preparedness that can be used by other large cities or regions of care across the nation. Its goal is to provide a comprehensive, uniform, and consistent framework and infrastructure for emergency preparedness across the full continuum of patient care. Devised to address the inconsistencies, shortcomings, fragmentations, …

Primer On Medicare Advantage Payments In 2008, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) included provision intended to increase the role of private health plans in Medicare. These provisions, building on policies adopted earlier in 1997 and 2000, set Medicare Advantage (MA) plan benchmark rates at levels higher than average costs in tradition free-for-service Medicare in every county in the nation. The total amount of extra payments to Medicare Advantage plans resulting from these policies total over $8.5 billion in 2008 and over $82 billion over the five year period between 2009 and 2013.

This briefing paper outlines the three major Medicare policies that generate these extra …

Building A High-Quality Language Services Program Toolkit, Jennifer Trott, Catherine West, Priti Shah, Marsha Regenstein

Health Policy and Management Faculty Publications

Ten hospitals with racially and ethnically diverse patient populations participated in the Robert Wood Johnson Foundation's "Speaking Together: National Language Services Network," a program aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP). This toolkit provides advice to hospitals on improving quality and accessibility of language services.

Harnessing Knowledge To Ensure Food Safety: Opportunities To Improve The Nation's Food Safety Information Infrastructure, Michael R. Taylor, Michael B. Batz

Health Policy and Management Faculty Publications

Those working in the food industry face an abundance of information generated by diverse institutions and individuals.

Ensuring the safety of food is critically important to the public's health and a challenge for policy-makers seeking to enhance the government's role in this arena. Although the food industry has an inherent duty to make food safe, the effectiveness of what they do is highly dependent on the quality of the information they receive on potential hazards and good practices.

In this context, the Robert Wood Johnson Foundation funded a project under the auspices of the Food Safety Research Consortium to examine …