Health Policy Commons^™

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.

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 …

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 …

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 …

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 …

Model Managed Care Contract For Health Professionals And Clinical Providers Of Mental Illness And Addiction Disorder Treatment And Prevention Services, Sara J. Rosenbaum, Joel B. Teitelbaum, Brian Kamoie, D. Richard Mauery

Health Policy and Management Faculty Publications

The contracting process is one that health care professionals oftentimes find complex and confusing. Furthermore, studies of managed care service contracts between managed care organizations and health professionals who furnish mental illness and addiction disorder prevention and treatment services have found that these contracts often heavily favor the managed care organization by allowing the MCO broad latitude over a network professional's service responsibilities, the rate of payment for covered benefits and extensive discretion over treatment decision-making.

As an aid to its members, the American Medical Association (AMA) has drafted a "model" provider agreement that gives physicians in both individual and …

Child Development Programs In Community Health Centers, Sara J. Rosenbaum, Michelle Proser, Peter Shin, Sara E. Wilensky, Colleen Sonosky

Health Policy and Management Faculty Publications

This report, the third in a series that reviews federal health policy related to child development, examines the role of community health centers in providing child development programs for children age 3 and younger. It also presents an analysis of health centers using the Uniform Data System, a database maintained by the federal Bureau of Primary Health Care (BPHC) that contains user, utilization, and financial information on each reporting center. In addition, the report presents findings from a 2000 survey of four categories of child development programs at 79 health centers; examines the new prospective payment system for health centers …

Access To Pediatric Services Under Medicaid Managed Care In The District Of Columbia, Karen Shaw, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

No abstract provided.

The Ticket To Work And Work Incentives Improvement Act Of 1999: Implications For The Design And Support Of Comprehensive Integrated Health Systems For Persons With Mental Illness And Addiction Disorder Disabilities, Sara J. Rosenbaum, Joel B. Teitelbaum, Brian Kamoie

Health Policy and Management Faculty Publications

This report is designed to provide an overview of the Medicaid provisions of the Ticket to Work and Work Incentives Improvement Act of 1999, Public Law 106-170. This report considers the implications of the Act for the design and support of comprehensive, Medicaid-financed systems of health care for workers with severe disabilities and impairments, with a specific focus on persons with mental illness and addiction disorder disabilities. The Act, described by advocates for persons with disabilities as the most important piece of disability-related legislation since the enactment of the Americans with Disabilities Act of 1990, expands the availability of health …

The Devolution Of Managed Care Contractor Duties: Analysis And Implications For Public Policy In Managed Behavioral Health Care, Sara J. Rosenbaum, Anne R. Markus, Joel B. Teitelbaum, Marcie Zakheim, Michael Golde

Health Policy and Management Faculty Publications

This study, undertaken by the Center for Health Services Research and Policy at the George Washington University (GWU) School of Public Health and Health Services for the United States Department of Health and Human Services' Substance Abuse and Mental Health Services Administration, analyzes the devolution of the legal duties assumed by managed care organizations (MCOs) in their contracts with group purchasers. Specifically, this study examines the delegation of MCO contractual duties related to member care and services to individual network providers by comparing the language used in master contracts between purchasers and MCOs with the language contained in agreements with …

Pegram V Herdrich: Implications For Consumer Protections In Managed Care, Sara J. Rosenbaum, Joel B. Teitelbaum

Health Policy and Management Faculty Publications

This Report, prepared for the Substance Abuse and Mental Health Services Administration, provides a brief overview of the United States Supreme Court's landmark decision in Pegram v Herdrich (hereinafter referred to as Herdrich). This report begins with a brief overview of the debate in the courts over how to distinguish between legal challenges to the conduct of managed care companies in which all state remedies are preempted by ERISA and those that may proceed under state law. It then summarizes the facts of the Herdrich case and the Court's holding. The report concludes with a discussion of the implications of …

Mental Illness And Addiction Disorders And Medicaid Managed Care, Sara J. Rosenbaum, Joel B. Teitelbaum, D. Richard Mauery

Health Policy and Management Faculty Publications

This Special Report on mental illness and addiction disorders is part of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts, now in its third edition. Negotiating the New Health System is a nationwide point-in-time study of agreements between state Medicaid agencies and managed care organizations (MCOs) offering general or specialized managed behavioral health care products. Each individual edition of Negotiating the New Health System is a point-in-time study or "snapshot" of these agreements for a particular year. However, the current series of editions, taken together, are beginning to form a longitudinal basis for reviewing the …

Health Centers' Role As Safety Net Providers For Medicaid Patients And The Uninsured, Sara J. Rosenbaum, Peter Shin, Anne R. Markus, Julie S. Darnell, Rachel Garfield, David Rousseau

Health Policy and Management Faculty Publications

In order to understand the role of health centers as safety net providers, as well as the potential impact of these trends, this issue paper provides an in-depth examination of federally-funded health centers. Using data from the Uniform Data System (UDS), a government-maintained system that collects extensive patient, revenue, and service data on a calendar-year basis from health centers that receive federal grants, this issue paper profiles federally-funded health centers. It presents information on health center patients and revenue sources and analyzes similarities and differences both between health centers and private practices and among health centers. Health centers perform a …

Sub-State Purchasing Of Managed Behavioral Health Care: An Analysis Of County-Level Managed Care Contracts, Joel B. Teitelbaum, D. Richard Mauery, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

For this study, SAMHSA asked us to analyze county-level managed health care contracts that include behavioral health services. SAMHSA has indicated that sub-state entities, particularly counties, are beginning to explore the feasibility of contracting with managed care organizations, both to control costs and to improve coordination of services for the mental health or substance abuse systems they manage. In commissioning these various contract studies, SAMHSA was primarily interested in tracking the development of these new types of managed behavioral health care procurements and contracting practices, as well as determining whether there were exemplary commercial behavioral health provisions that could be …

The Continuing Decline In Medicaid Coverage, Leighton Ku, Brian K. Bruen

Health Policy and Management Faculty Publications

No abstract provided.

Mental Illness And Addiction Disorder Treatment And Prevention, Sara J. Rosenbaum, Peter Shin, Marcie Zakheim, Karen Shaw, Joel B. Teitelbaum, Kay Johnson

Health Policy and Management Faculty Publications

This Special Report of Negotiating the New Health System: A Nationwide Study of Medicaid Managed Care Contracts (2d Ed.) analyzes Medicaid managed care contract provisions related to mental illness and addiction disorders (MI/AD). The analysis is based on 54 contracts and related documents (including 12 managed behavioral health care contracts) which were in effect as of the beginning of 1997. While this Special Report considers Medicaid contracts, its findings have implications for other public purchasers of managed care services for persons with MI/AD because, like Medicaid, other sources of third-party financing have traditionally supported services and activities that may not …

An Evaluation Of Contracts Between Managed Care Organizations And Community Mental Health And Substance Abuse Treatment And Prevention Agencies, Sara J. Rosenbaum, Karen Silver, Elizabeth Wehr

Health Policy and Management Faculty Publications

This study represents a descriptive, point-in-time examination of the structure and content of provider network agreements between managed care organizations (MCOs) and community mental health and substance abuse (MH/SA) treatment and prevention agencies. This is not a study of the quality of managed care systems. Instead, this analysis is designed to assess provider contracts (one of the basic legal instruments on which the managed care system rests) and to identify the meaning of these instruments for MH/SA service providers, group purchasers, MCOs, individual consumers and their families, and public policy.