Health Policy Commons^™

Strategies For Improving Access To Comprehensive Obesity Prevention And Treatment Services For Medicaid-Enrolled Children, Sara E. Wilensky, Ramona Whittington, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This policy brief builds on our prior work for the Robert Wood Johnson Foundation. In 2005, The George Washington University School of Public Health and Health Services (GW) evaluated the role of public and private insurance in financing preventive care and treatment for at-risk and obese children. One of the key findings from that report was that Medicaid's existing Early and Periodic Screening Diagnostic and Treatment (EPSDT) coverage standards provide for comprehensive, obesity-related pediatric health care interventions. Using data drawn from state Medicaid programs, this report examines the extent to which state programs use the Medicaid EPSDT benefit to address …

The Heart Of The Matter: The Relationship Between Communities, Cardiovascular Services, And Racial And Ethnic Gaps In Care, Marsha Regenstein, Holly Mead, Anthony Lara

Health Policy and Management Faculty Publications

Racial and ethnic disparities in cardiovascular care are greatly influenced by market factors and how the health care system is organized. This study examines key health system factors that contribute to disparities in cardiac care among racial and ethnic minorities in the United States. A market assessment, consisting of site visits, interviews, and data collection from key health care providers in 10 communities, was undertaken to identify common characteristics in the health care markets and to explore how these factors may drive disparities in cardiac care.

Health Information Technology In The United States: The Information Base For Progress, David Blumenthal, Catherine M. Desroches, Karen Donelan, Sara J. Rosenbaum, Timothy Ferris

Health Policy and Management Faculty Publications

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities …

Accès Aux Médicaments À Madagascar : L’Etat, La Pharmacie, Et L’Usager, Peter Olds

Independent Study Project (ISP) Collection

No abstract provided.

Payments To Medicare Advantage Plans Exceed Fee-For-Service Costs: Options For Medicare Savings From 2007 Through 2011, Brian Biles, Emily Adrion

Health Policy and Management Faculty Publications

The Medicare Modernization Act of 2003 (MMA) and the Deficit Reduction Act (DRA) of 2005 include provision intended to increase the role of private health plans in Medicare. These provisions set Medicare Advantage plan payment rates at levels higher than average costs would be 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 provisions is projected at $5.7 billion in 2007 and nearly $30 billion over the five year period, 2007 to 2011.

This briefing paper outlines the specific MMA and DRA provisions that generate these …

Defined-Contribution Plans And Limited-Benefit Arrangements: Implications For Medicaid Beneficiaries, Sara J. Rosenbaum

Health Policy and Management Issue Briefs

This Policy Brief explores the implications of state Medicaid reforms – whether implemented either as §1115 demonstrations or as part of state plan flexibility measures under the Deficit Reduction Act of 2005 (P.L. 109-171) – that limit benefits, coverage, and payments for medically necessary health care. Following a background and overview, the Policy Brief identifies a series of considerations that come into play when states approach the issue of benefit re-design, particularly in the context of developing coverage innovations that utilize "consumerdriven" and "defined-contribution" arrangements. As used in this Policy Brief, the term "defined-contribution" means the payment of a flat, …

Update On The Status Of The Medicaid Prospective Payment System In The States, Roger Schwartz, Peter Shin, Megan Reilly

Health Policy and Management Faculty Publications

The Benefits Improvement and Protection Act of 2000 replaced the traditional cost-based reimbursement system for federally-qualified health centers (FQHCs) with a new prospective payment system. States were also allowed to implement an alternative payment methodology (APM) as long as it did not pay less than what FQHCs would have received under PPS and the affected FQHC agreed to the APM. Although changes in payment policies were to take effect in 2001, states were slow to implement them and most only did so after one or two years. With little or no oversight by the federal government, the National Association of …

Minority Women In The Healthcare Workforce In New England, Carol Hardy-Fanta, Erika Kates, Helen Levine, Kate Peery-Wolf

Publications from the Center for Women in Politics and Public Policy

Research on health disparities affecting people of color typically focuses on their health status, health treatment and health outcomes with a particular emphasis on the relatively high rates of morbidity and mortality from selected diseases for ethnic and racial minority groups. This fact sheet offers a different but related focus on gender and race/ethnicity in the health care workforce. Our rationale is that the Sullivan Commission on Diversity in the Healthcare Workforce concluded that the lack of minority doctors, nurses and dentists is a significant cause of racial/ethnic health disparities and that the ability to recruit, train and retain minority …

International Medical Graduates In Family Medicine In The United States Of America: An Exploration Of Professional Characteristics And Attitudes, Amanda L. Morris, Robert L. Phillips, George E. Fryer, Larry A. Green, Fitzhugh Mullan

Health Policy and Management Faculty Publications

Background

The number of international medical graduates (IMGs) entering family medicine in the United States of America has steadily increased since 1997. Previous research has examined practice locations of these IMGs and their role in providing care to underserved populations. To our knowledge, research does not exist comparing professional profiles, credentials and attitudes among IMG and United States medical graduate (USMG) family physicians in the United States. The objective of this study is to determine, at the time when a large influx of IMGs into family medicine began, whether differences existed between USMG and IMG family physicians in regard to …

Pursuing Cost Containment In A Pluralistic Payer Environment: From The Aftermath Of Clinton’S Failure At Health Care Reform To The Balanced Budget Act Of 1997, Rick Mayes, Robert E. Hurley

Political Science Faculty Publications

Following a decade in which Medicare operated as the leading ‘change agent’ within the US health care system, the private sector rose to the fore in the mid 1990s. The failure of President Clinton’s attempt at comprehensive, public sector-led reform left managed care as the solution for cost control. And for a period it worked, largely because managed care organizations were able to both squeeze payments to selective networks of medical providers and significantly reduce inpatient hospital stays. There was a lot of ‘fat’ in the nation’s convoluted health care system that could be (and was) eliminated through competitive negotiations …

Taking Liberties, Matt Kozusko

English Faculty Publications

The 'place' scholars have assigned to the stage in early modern London is as much a reflection of the procedures of contemporary literary criticism as a reflection of the cultural function of popular drama in the early modern period. Modern critics are often not engaged in re-examining available data, preferring instead to rest on a conjectural paradigm or heuristic that has hardened, over the past couple of decades, into a New Historicist version of 'fact'. Critics have collapsed boundaries and important distinctions in London jurisdiction and geography in the interest of a unified critical narrative that characterizes the theatre as …

The Legality Of Collecting And Disclosing Patient Race And Ethnicity Data, Sara J. Rosenbaum, Taylor Burke, Sonia W. Nath, Jennifer Santos, Dana Thomas

Health Policy and Management Issue Briefs

This policy brief weighs whether the collection of patient data by race or ethnicity, as part of a program of quality improvement, violates the law.

Managed Care And Medi-Cal Beneficiaries With Disabilities: Assessing Current State Practice In A Changing Federal Policy Environment, Sara J. Rosenbaum, Sara E. Wilensky, Peter Shin, Ramona Whittington

Health Policy and Management Faculty Publications

This analysis, prepared for The California Endowment, is a follow-on report to our earlier work that raised issues to be considered before moving persons with disabilities into compulsory Medicaid managed care plans and reviewed the extent to which California's legal framework addressed the concerns identified. In this report, the George Washington University School of Public Health and Health Services examines how other states have addressed issues that arise in designing, implementing and overseeing compulsory managed care systems for persons with disabilities and serious and chronic health conditions. The experiences of other states that have developed these types of arrangements offer …

Laying The Foundation: Health System Reform In New York State And The Primary Care Imperative, Sara J. Rosenbaum, Peter Shin, Ramona Whittington

Health Policy and Management Faculty Publications

New York State has embarked on a substantial effort to restructure its health care system as a result of rapidly escalating health care expenditures, especially with respect to Medicaid expenditures for institutional health care. But it is impossible to alter these high cost health expenditures without strengthening and expanding the primary care foundation on which New York's health system rests.

Language Barriers To Health Care Access Among Medicare Beneficiaries, Ninez A. Ponce, Leighton C. Ku, William E. Cunningham, E. Richard Brown

Health Policy and Management Faculty Publications

This study examined language barriers to health care access among a population-based sample of Medicare seniors in California in 2001 and 2003. Results indicate that Medicare beneficiaries with limited English proficiency (LEP) had less access to a usual source of care and were less likely to receive preventive cancer screening tests. LEP Medicare beneficiaries who also were covered by Medicaid tended to fare better than those without Medicaid. This could be due to federal civil rights rules that require Medicaid health care providers to offer free language assistance, but exclude from these requirements physicians who provide only Medicare services. Findings …

Creating Progam Logic Models: A Toolkit For State Flex Programs, John A. Gale Ms, Andrew F. Coburn Phd, Stephanie Loux Ms

Population Health & Health Policy

A logic modeling toolkit developed by the Flex Monitoring Team is available for use by state Medicare Rural Hospital Flexibility Programs (Flex Programs) in planning for and managing their Flex programs. The use of the Program Logic Model (PLM) Toolkit will provide states with a tool to assist in:

Planning, managing, reporting on, and assessing their Flex Program goals, activities, and accomplishments;

• Developing buy-in among key Flex Program stakeholders;
• Clarifying the underlying program assumptions;
• Identifying and defining measurable outcomes;
• Linking state-level Flex Program strategies and activities to specific and measurable outcomes; and
• Reporting program results to both internal and external …

Data Integration And Storage: Managing And Using Home And Community-Based Services Data For Quality Improvement, Carolyn E. Gray Mph, Maureen Booth Mrp, Ma

Disability & Aging

This paper reports on data integration from a program manager’s perspective. The paper is not meant to be an exhaustive research document, nor does it single out any one correct approach. The paper is meant to facilitate communication between program units and analytic staff and serve as one reference for states as they continue to improve upon data collection techniques and use this information for ongoing quality management and improvement.

Health Centers Reauthorization: An Overview Of Achievements And Challenges, Sara J. Rosenbaum, Peter Shin

Health Policy and Management Faculty Publications

Since the establishment of the first health center in 1965, health centers have evolved into an essential component of the health care safety net. Today, over 1,000 federally funded and "look-alike" health centers serve 14.3 million people, three-quarters of whom are uninsured or covered by Medicaid. As the nation's largest primary care system, health centers care for one in five low-income uninsured persons and one in nine Medicaid beneficiaries.

Survey Findings: Children Served By Mainecare, 2005, Catherine Ormond, Deborah Thayer

Disability & Aging

No abstract provided.

Indigenous Healing Practices Among Rural Elderly African Americans, Debra A. Harley

Aboriginal Policy Research Consortium International (APRCi)

Elderly African Americans residing in rural areas have practiced and continue to practice indige- nous healing practices for various reasons. In addition to the belief in the value of such practices, many of these individuals practice indigenous healing because it is cost effective. In this article information is presented on the history of research on indigenous healing practices, theories and models of indigenous healing in the United States, cultural influence, and views of health care providers regarding such practices. This article concludes with a discussion of the relevance of indigenous healing practices across disciplines and approaches, and recommendations of using …

Priority Setting For Reproductive Health At The District Level In The Context Of Health Sector Reforms In Ghana, Harriet Birungi, Philomena Nyarko, Ian Askew, Ayorinde Ajayi, Gifty Addico, Edward Addai, Caroline Jehu-Appiah

Reproductive Health

This report outlines results of an in-depth assessment carried out in Ghana in order to provide a better understanding of key factors affecting reproductive health (RH) prioritization at the district level; and to make recommendations for policy dialogue, advocacy, resource allocation, and RH program implementation. In particular, the study examined whether or not districts are connecting to the central process of priority setting and reasons for not doing so. The report includes recommendations for bridging the policy implementation gap, including: ensuring that RH advocates participate in national policy dialogue; investing in systems development for procurement and delivery of drugs and …

The Origins Of And Economic Momentum Behind "Pay For Performance" Reimbursement, Rick Mayes

Political Science Faculty Publications

"Pay for performance," a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes, is enormously controversial. Disputes invariably arise over how "quality" should (or even can) be measured. Nevertheless, differentiating between medical providers, financially, lies at the heart of this new reimbursement innovation developed by insurance companies and employers. Its two main objectives are: (1) to increase the overall quality of health care that patients receive, and (2) to encourage behavioral change on the …

From Schip Benefit Design To Individual Coverage Decisions, Anne R. Markus, Sara J. Rosenbaum, Ruth E. K. Stein, Jill Joseph

Health Policy and Management Issue Briefs

The majority of states have implemented separate SCHIP (S-SCHIP) programs that significantly depart from Medicaid and resemble less comprehensive commercial products. This difference in program design may result in S-SCHIP potentially being less responsive to children with special needs (CSHCNs). This study explores how responsive insurers are to these higher than average needs. We found that, with one exception, insurers did not agree on the coverage of any specific service, but overall they provided coverage beyond state limits and exclusions. Second, the less acute the childhood condition, the more frequently insurers imposed exclusions. Finally, in the majority of states, some …

Medicaid And Health Information: Current And Emerging Legal Issues, Sara J. Rosenbaum, Patricia Mactaggart, Phyllis Borzi

Health Policy and Management Faculty Publications

Legal questions are an inevitable byproduct of significant technology change in health care such as that underway as a result of health information technology (HIT). This article examines several important existing and emerging legal questions in a Medicaid context. First, do the Centers for Medicare & Medicaid Services (CMS) and State Medicaid agencies, have a fiduciary obligation to adopt and fully use health information technology given its potential to improve health care quality while reducing racial, ethnic, and socioeconomic disparities in health and health care? Second, how can Medicaid privacy standards be reconciled with the Health Insurance Portability and Accountability …

Race, Ethnicity, And Language Of Patients: Hospital Practices Regarding Collection Of Information To Address Disparities In Health Care, Marsha Regenstein, Donna Sickler

Health Policy and Management Faculty Publications

2003 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, identified strong evidence of disparities in the health care of racial and ethnic minorities not explained by differences in health insurance coverage and income. Among ways to eliminate these inequalities the IOM report recommended enhanced collection of patient race and ethnicity data. National Public Health and Hospital Institute researchers surveyed 500 non-federal acute care hospitals on their collection of patient race, ethnicity and preferred language information to understand data collection practices in the U.S. hospital industry. The researchers also surveyed 64 safety net hospitals …

A Dose Of Reality: Assessing The Federal Trade Commission/Department Of Justice Report In An Uninsured, Underserved, And Vulnerable Population Context, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Despite the size of their report, the Federal Trade Commission and Department of Justice pay virtually no attention to tens of millions of uninsured and underinsured persons. By focusing on an increasingly rarified group of health care customers—healthy, affluent, and highly insured—the report takes on an untethered quality, with only the slightest tip of the hat to its own limitations. Furthermore, the report overstates the extent of legal constraints on the market, in particular, the degree to which the market is free to select its customers and tailor its goods and services to the best risks. By miscasting the legal …

Designing Employer-Sponsored Mental Health Benefits, Rachel Sethi, Joanne Jee, Lisa Chimento, D. Richard Mauery

Health Policy and Management Faculty Publications

No abstract provided.

Land Use And Transportation Planning To Promote Physical Activity In North Carolina, Semra Aytur

Health Management & Policy

With national and state agencies as well as leading public health foundations providing impetus, efforts to improve the understanding of policy and environmental attributes that may support active lifestyles have become a promising area for collaboration between planning and public health professionals. This article highlights the results of work performed at the University of North Carolina at Chapel Hill examining the relationship between planning policies and physical activity and the prevalence of land use policies and implementation tools that might support the viability of non-motorized modes. With the hope of bridging research and practice, it discusses fi ndings most relevant …

The North Carolina Physical Activity Policy Research Center: Making Connections With North Carolina Planners, Kelly R. Evenson, Carrie Fesperman, Semra Aytur, Austin Brown, Daniel A. Rodriguez, David Salveson

Health Management & Policy

Physical activity participation for youth and adults is suboptimal in North Carolina. There is growing interest among policy makers to promote physical activity, yet research in this area is limited. The North Carolina Physical Activity Policy Research Center was established in 2004 to conduct research on physical activity and policy. This cross-disciplinary center brings together faculty and researchers from the University of North Carolina School of Public Health and the College of Arts and Sciences. Current projects include understanding and documenting polices that affect walking and bicycling to school, trail development, and community planning decisions related to physical activity.

Operations Research To Improve Financial Sustainability In Three Bolivian Ngos, Martha Merida, Javier Arce, Douglas Moscoso, Carlo Ramirez, Patricia Riveros, John H. Bratt

Reproductive Health

The FRONTIERS project worked with three Bolivian NGOs (Prosalud, the Center for Research, Education and Services or CIES, and the Association of Rural Health Programs or APSAR) to improve their ability to conduct research on market analysis and cost recovery. Following a one-week workshop on conducting cost studies, staff from the three NGOs designed operations research studies to help with decisions on planning and cost recovery. Study findings showed that cost recovery varied from high (Prosalud, 83-109%) to low (CIES, 38-46%) and very low (APSAR, 10-25%), depending on the service. All three studies focused on alternative options to client fees, …