Health: Latest Work

Reports

"Research Design Report for the Evaluation of the Money Follows the Person (MFP) Grant Program." Randall Brown, Carol Irvin, Debra Lipson, Sam Simon, and Audra Wenzlow, October 2008. This report presents the research design for the evaluation of the Money Follows the Person program implementation and effects on participants and the long-term care system. Under the program, 31 participating states are providing enhanced services to help interested Medicaid beneficiaries in long-term care institutions move back to the community. States receive funds from the program’s augmented federal matching rate for support services provided to those who make the transition. States are expected to use these funds to improve long-term care systems and options for beneficiaries wishing to remain in the community.

"State Efforts to Address the Healthy People 2010 Goal to Eliminate Health Disparities: Two Case Studies." Leslie Conwell, Melissa Neuman, and Marsha Gold, September 2008. Healthy People 2010 identified eliminating health disparities as one of two overarching goals for the U.S., along with increasing quality and years of healthy life. This report examines North Carolina and Washington, two states that are making notable use of data to address disparities. Washington’s initiative is in the early stages, while North Carolina’s has existed since the early 1990s. Case studies in this report illustrate how data are being used to identify health disparities and develop initiatives to eliminate them.

“Evidence of Trends, Risk Factors, and Intervention Strategies. A Report from the Healthy Start National Evaluation 2006: Racial and Ethnic Disparities in Infant Mortality.” So Sasigent O’Neil, Melanie Besculides, and Margo Rosenbach, June 2008. Experts believe that eliminating racial and ethnic disparities in birth outcomes is key to continued reduction in infant mortality in the United States. Healthy Start, a national initiative begun in 1991, is the largest program addressing disparities in birth outcomes. This paper provides an evidence base to support Healthy Start’s targeted interventions. It reviews risk factors that include prenatal care, folic acid use, periodontal care, infant sleeping position, breastfeeding, well-child care, interconceptional care, maternal smoking, alcohol and other drug use, adolescent pregnancy, perinatal depression, stress, domestic violence, and maternal birthweight.

"Report to Congress on the Evaluation of Medicare Disease Management Programs." Arnold Chen, Randall Brown, Dominick Esposito, Jennifer Schore, and Rachel Shapiro, February 2008. Before Medicare Part D, Congress authorized the Medicare disease management demonstration to evaluate whether disease management programs—in conjunction with a comprehensive prescription drug benefit—could improve health outcomes and reduce Medicare expenditures. The demonstration targeted fee-for-service Medicare beneficiaries with advanced congestive heart failure, diabetes, or coronary artery disease. This congressionally mandated study found that, based on the population-based random assignment design, none of the three demonstration programs had impacts on key outcomes of Medicare Part A and B expenditures and service use.

"Health Insurance Exchange Study." Deborah Chollet, Su Liu, Kate Stewart, Alison Wellington, Allison Barrett, Mila Kofman, and Amy M. Lischko, March 2008. In 2007, the state of Minnesota considered establishing a Health Insurance Exchange to serve small groups and individuals, facilitating access to coverage, choice among insurance products, portability of coverage, and affordability. Mathematica studied the coverage, cost, and fiscal impacts of a series of health reforms that might occur coincident with the implementation of the exchange—guaranteed issue and community rating of both small group and individual products, a mandate requiring all residents to obtain coverage, and a requirement that all employers with 11 or more employees offer a Section 125 or “cafeteria” plan. This report estimates the impacts of the reforms alone and in combination. In addition, it explores the range of implementation and legal issues that policymakers in Minnesota would need to address in order to develop an exchange.

"Options for Expanding Coverage in Missouri: State Offer of a Small Group Product." Deborah Chollet and Su Liu, July 2007. Researchers investigated whether a subsidized state health insurance purchasing arrangement for small employers could be useful in reducing the high and growing number of uninsured workers and dependents in Missouri. This report discusses eligibility, enrollment scenarios, cost, and other considerations.

"Quantitative and Comparative Analysis of Reform Options for Extending Health Care Coverage in New Mexico." Deborah Chollet, Su Liu, Beth Gillia, Paul Biderman, Lee Reynis, and William Wiese, July 2007. Mathematica estimated the cost of the current health care system in New Mexico and the relative cost of three alternative strategies to ensure that all New Mexicans become and remain insured. This report discusses the strategies in depth and raises issues for further consideration

"Health Care Access and Use Among Low-Income Children on Subsidized Insurance Programs in California.” Christopher Trenholm, Anna Saltzman, Shanna Shulman, Michael Cousineau, and Dana Hughes, May 2008. This paper summarizes the CaliforniaKids and Healthy Kids programs—county-based insurance programs in California for low-income children. The study examined features of both programs, use of basic health care services by the children enrolled, and typical experiences accessing inpatient and other high-cost care. Children enrolled in the two programs made substantial use of outpatient health care, despite important variation in program features. The study concludes with recommendations on how future research can more rigorously and precisely examine children's access and use of the programs.

"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002." Audra T. Wenzlow, Robert Schmitz, and Kathy Shepperson, January 2008. This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. The authors compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services. They also examine long-term care expenditures and utilization for two key groups of enrollees—young disabled enrollees and enrollees ages 65 and older. The article decomposes community-based long-term care expenditures by type of service and summarizes other Medicaid services used and costs incurred in 2002. Executive Summary

"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." Audra T. Wenzlow, Robert Schmitz, and Jill Gurvey, January 2008. This report describes patterns of Medicaid nursing home utilization for each state and nationally. The authors address the following questions: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do these people become eligible for Medicaid? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? They also examine how state policies are associated with nursing home utilization. Executive Summary

"Federal Medical and Disability Program Costs Associated with Diabetes, 2005. Summary of Methods and Key Findings." Marsha Gold, Craig Thornton, Allison Hedley, Cheryl Fahlman, Suzanne Felt-Lisk, Bob Weathers, and Thomas Croghan, September 2007. Diabetes is a growing threat to the nation's health that has serious and costly complications. This paper looks behind the $79.7 billion estimates for 2005 of medical and disability costs to the federal government cited in Mathematica's main study. The estimates include $2.5 billion in disability payments associated with diabetes and $77.2 billion in increased medical costs. Nearly 80 percent of the medical costs to the federal government were incurred in the Medicare program. Without enhanced efforts to control blood glucose, reduce the risk of complications, and prevent the onset of diabetes, federal costs related to diabetes will grow in the future.

"Health Plans' Use of Physician Resource Use and Quality Measures." Timothy Lake, Margaret Colby, and Stephanie Peterson, October 2007. In recent years, health plans have developed measures of health service resource use to assess the efficiency of care that physicians and other providers deliver—primarily relying on tools commonly known as “episode groupers.” This report investigates the use of episode grouper-based measures in the private sector in four health markets around the country: Austin, Boston, Cleveland, and Seattle. Health plans included in the study have multiple years of technical experience implementing physician resource use and quality measures; however, most are still in the early stages of determining the best ways to use these measures in their local markets. The report includes lessons for future quality measurement efforts in Medicare and other programs.

"Assessment of State Capacity to Identify and Track Disparities in the Leading Health Indicators."Allison Hedley Dodd, Melissa Neuman, and Marsha Gold, December 2007. Assessing health status is a core function of public health on the state level. This report summarizes the data available in each state for health assessment, a necessary step in achieving public health goals. Using the leading indicators from Healthy People 2010, the authors found that while data generally are available across all states, gaps do exist. Across states, data sometimes are not available for a few specific health objectives and for certain age groups.

"Leading the Way? Maine's Initial Experience in Expanding Coverage Through Dirigo Health Reforms." Debra J. Lipson, James M. Verdier, Lynn Quincy, Robert Hurley, Elizabeth Seif, Shanna Shulman, and Matt Sloan, December 2007. Since enacting comprehensive health care reform in 2003, Maine's Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives—DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children. While these programs are making health coverage more affordable to low-income individuals, small firms, and sole proprietors, with subsidies targeting those most in need, by late 2006 the initiatives had enrolled less than 10 percent of previously uninsured residents. To pay for this expanded coverage, Maine has utilized savings in the overall health care system due to lower uncompensated care and cost controls. However, the funds raised thus far are insufficient to pay for greater subsidized enrollment in Dirigo programs, leading to a search for other financing sources to sustain the program.

"Administration of Mental Health Services by Medicaid Agencies." James Verdier, Allison Barrett, and Sarah Davis, 2007. Medicaid spending for mental health care accounted for 26 percent of total mental health expenditures by all public and private payers combined in 2003, and 10 percent of all Medicaid dollars were spent on mental health services in that year. Medicaid now funds more than half of all mental health services administered by states and could account for two-thirds of such spending by 2017. This report, based on telephone interviews with state Medicaid directors in all 50 states and the District of Columbia between July 2005 and February 2006, provides state-by-state comparative information on how Medicaid and mental health agencies are structured, the degree and extent of their collaboration, how they share authority, and how Medicaid mental health services are funded.

"National Evaluation of the State Children's Health Insurance Program: A Decade of Expanding Coverage and Improving Access." Margo Rosenbach, Carol Irvin, Angela Merrill, Shanna Shulman, John Czajka, Christopher Trenholm, Susan Williams, So Sasigant Limpa-Amara, and Anna Katz, September 2007. Expanding health coverage for children is at the center of policy debates as reauthorization of the 10-year-old State Children's Health Insurance Program (SCHIP) continues. This report presents findings from Mathematica's comprehensive seven-year evaluation of SCHIP for the Centers for Medicare & Medicaid Services. The report highlights states' progress in conducting outreach, averting substitution, improving access, and reducing the number of uninsured low-income children. The study found that SCHIP reduced both the number and rate of uninsured children and improved children's access to health care. From 1997 to 2003, the percentage of uninsured low-income children fell from 25 percent to 20 percent. Enrollment climbed to 6 million children in 2003 and reached 6.6 million in 2006. In addition, access to care improved, although some gaps remain for children with special health care needs and children of minority race/ethnicity. Issue Brief

"SCHIP at 10: A Synthesis of the Evidence on Substitution of SCHIP for Other Coverage." So Limpa-Amara, Angela Merrill, and Margo Rosenbach, September 2007. When SCHIP was enacted in 1997, policymakers sought to safeguard against the substitution of SCHIP for other insurance coverage. This report synthesizes and assesses evidence from published and unpublished literature and state SCHIP annual reports on the magnitude of substitution in SCHIP. Wide-ranging estimates across studies are explained as a function of differences in purposes, methods, and analytic perspectives.

Journal Articles

“Impacts of a Disease Management Program for Dually Eligible Beneficiaries.” Dominick Esposito, Randall Brown, Arnold Chen, Jennifer Schore, and Rachel Shapiro, Health Care Financing Review, fall 2008. This articles examines interim impacts of a disease management demonstration for Medicare fee-for-service beneficiaries also enrolled in Medicaid (dual eligibles). The study randomly assigned dual eligibles with congestive heart failure, coronary artery disease, and/or diabetes to treatment or control groups for a population-based program that provides telephone patient education and monitoring services. Findings during the first 18 months show virtually no overall impacts on hospital or emergency room use, Medicare expenditures, quality of care, or prescription drug use for the 33,000 enrollees. However, for beneficiaries with congestive heart failure who resided in high-cost counties, the program reduced Medicare expenditures by 9.6 percent.

“Availability of Data to Measure Disparities in Leading Health Indicators at the State and Local Levels.” Marsha Gold, Allison Hedley Dodd, and Melissa Neuman, Journal of Public Health Management and Practice, November 2008. Healthy People 2010 identifies the elimination of health disparities as a critical national goal. This article analyzes the availability of state and local data to support this goal. Researchers assessed data availability for the 10 leading health indicators, comprising a set of 26 measures, and based their analysis on a mid-2007 review of federal and state websites. They conclude that some relevant state-level disparities data exist, major gaps remain, local estimates are limited, and some states make better use of data than others. Federal leadership and support are critical to states’ abilities to address the Healthy People 2010’s disparities goal.

"How Medicaid Agencies Administer Mental Health Services: Results from a 50-State Survey." James Verdier and Allison Barrett, Psychiatric Services (subscription required), October 2008. This report describes notable variations in how state Medicaid agencies administer and fund Medicaid mental health services. It is based on telephone interviews with all state and District of Columbia Medicaid directors or their designees. Medicaid and mental health agencies are located in the same umbrella agency in 28 states, potentially facilitating collaboration. Mental health agencies provide funding for some Medicaid mental health services in 32 states, and counties provide funding in 22 states. The increasing role of Medicaid in funding state mental health services underscores the importance of interagency collaboration and better alignment of Medicaid and mental health responsibilities.

"Antidepressant Use in Black and White Populations in the United States." Hector M. González, Thomas Croghan, Brady West, David Williams, Randolph Nesse, Wassim Tarraf, Robert Taylor, Ladson Hintion, and Harold Neig, Psychiatric Services (subscription required), October 2008. This article estimates the prevalence and correlates of antidepressant use by black and white Americans, using data from the Collaborative Psychiatric Epidemiology Surveys. Among individuals with depressive and anxiety disorders in the past year, black respondents (14.6 percent) had significantly lower antidepressant use than white respondents (32.4 percent). Higher depression severity was associated with more antidepressant use for white but not for black respondents. Antidepressant use was associated with medical conditions related to vascular disease, and use of antidepressants in these medical conditions was independent of coexisting psychiatric conditions. The results also indicate patients without a diagnosable psychiatric disorder use antidepressants frequently.

"15-Site Randomized Trial of Coordinated Care in Medicare Fee-for-Service." Randall Brown, Deborah Peikes, Arnold Chen, and Jennifer Schore, Health Care Financing Review, fall 2008. This study randomly assigned Medicare fee-for-service beneficiaries who had chronic illnesses and volunteered to participate in 15 care coordination programs to treatment or control status. Nurses provided patient education (mostly by telephone) to improve adherence and ability to communicate with physicians. The findings after two years show that few programs improved patient behaviors, health, or quality of care. The treatment group had significantly fewer hospitalizations in only one program; no program reduced gross or net expenditures. However, effects may be observed after four years of followup are available and sample sizes increase.

"Understanding the Variation in Costs Among HIV Primary Care Providers." Boyd Gilman and Jeremy Green, AIDS Care (subscription required), October 2008. This paper uses a hybrid cost model to identify determinants of cost variation among programs that offer early intervention services to people living with HIV/AIDS. The model combines the effects of input price and output volume from traditional economic cost functions with institutional factors based on program and patient characteristics on the cost of providing primary medical care. The impact of economic factors conforms to conventional theory and reveals the potential for cost savings through greater economies of scale and substitutability of low-cost for high-cost labor inputs. Similarly, programs that use staff more efficiently and share an affiliation with other organizations exhibit lower costs than more labor intensive and non-affiliated providers. In addition, patient characteristics are equally important cost determinants.

"Impact of Critical Access Hospital Conversion on Beneficiary Liability." Boyd Gilman, Journal of Rural Health (subscription required), fall 2008. The Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, but it puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare Part B benefit. This paper examines the impact of hospital conversion to CAH status on beneficiary out-of-pocket coinsurance payments for hospital outpatient services. Conversion is associated with an increase in beneficiary coinsurance payments per outpatient visit of $17.19, equivalent to 34 percent of mean out-of-pocket Part B payments for the study sample as a whole. However, CAH designation had no significant effect on the share of outpatient costs paid by the beneficiary.

"The Effects of Complications and Comorbidities on the Quality of Preventive Diabetes Care: A Literature Review." Leslie Jackson Conwell and Chad Boult, Population Health Management, August 2008. Although concurrent conditions such as complications and comorbidities are common in people with diabetes, studies of the quality of diabetes preventive care often omit both. This review of the quality of diabetes preventive care assesses not only trends in reporting of and adjusting for complications and comorbidities, but also looks at limitations of current measures of complications and comorbidities. The review identified 34 studies that assessed the quality of diabetes preventive care with process measures and reported complications or comorbidities. The authors conclude that current reported measures may not address constructs related to quality, underscoring the need for a better methodology than the approaches now documented.

"Prevalence of Unclaimed Prescriptions at Military Pharmacies." Dominick Esposito, Eric Schone, Thomas Williams, Su Liu, Karen CyBulski, Rita Stapulonis, and Nancy Clusen, Journal of Managed Care Pharmacy, July/August 2008. Prescriptions ordered by physicians but not picked up by patients offer an opportunity for quality improvement in health systems. In the military system, prescriptions filled at military pharmacies are dispensed with no co-payment, providing an opportunity to examine factors other than out-of-pocket cost that contribute to unclaimed prescriptions. The authors noted an 8 percent self-reported rate for not picking up a prescription—with previous research noting rates of between 0.45 and 22 percent in nonmilitary populations. Although reasons for not picking up a prescription were generally consistent with those identified in previous studies, they were only partially consistent with the military pharmacy literature, which also noted that patients did not know they had a prescription waiting or already had some prescribed medicine at home.

“Understanding a Collaborative Effort to Reduce Racial and Ethnic Disparities in Health Care: Contributions from Social Network Analysis.” Marsha Gold, Patrick Doreian, and Erin Fries Taylor. Social Science & Medicine, September 2008. Quality improvement collaboratives have become a common strategy for improving health care. This paper uses social network analysis to study the relationships among organizations participating in a large-scale, public-private collaboration among major health plans to reduce racial and ethnic disparities in health care. Existing ties, collaborations, and participants’ contributions and organizational standing were examined. Findings suggest that sponsors and support organizations, along with a few health plans, act as the “glue” that holds a collaboration together. Most health plans (and a few support organizations) are on the periphery. Health plans do not interact much with one another, but their interactions with core organizations help achieve disparities goals. The findings illustrate the role sponsors can play in encouraging organizations to work together to achieve social ends while also highlighting challenges that should be addressed.

"A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care." Larry Wissow, Bruno Anthony, Jonathan Brown, Susan DosReis, Anne Gadomski, Golda Ginsburg, and Mark Riddle, Administration and Policy in Mental Health, July 2008. Strategies used to treat children's mental health problems in primary care have several limitations. This article proposes a new clinical model for delivering mental health services in pediatric primary care and suggests that physicians can efficiently learn a core set of treatment skills and apply them to a broad range of mental health problems. The authors review how implementation of this model would impact the delivery, organization, and funding of pediatric primary care and propose a research agenda to test the model.

“Neo-Materialist Theory and the Temporal Relationship Between Income Inequality and Longevity Change.” Andrew Clarkwest, Social Science & Medicine, May 2008. The author challenges prior fixed effects analyses of the relationship between income inequality and population health. He argues that the temporal relationships are likely to be complex and that fixed effects approaches, though important for addressing confounding, are poorly equipped to capture potential real impacts. Longevity improved less in states with higher levels of inequality, and there is a strong negative association between change in inequality and change in longevity after adjusting for initial levels of state characteristics.

"Convergence and Dissonance: Evolution in Private-Sector Approaches to Disease Management and Care Coordination." Glen P. Mays, Melanie Au, and Gary Claxton, Health Affairs, November/December 2007. Disease management approaches survived the 1990s backlash against managed care because of their potential for consumer-friendly cost containment, but purchasers have been cautious about investing heavily in them because of uncertainty about return on investment. This article examines how private-sector approaches to disease management have evolved over the past two years in the midst of the movement toward consumer-driven health care. Findings indicate that these programs have become standard features of health plan design, despite a thin evidence base concerning their effectiveness.

"Receiving Advice About Child Mental Health from a Primary Care Provider: African American and Hispanic Parent Attitudes." Jonathan D. Brown, Lawrence S. Wissow, Ciara Zachary, and Benjamin L. Cook, Medical Care, November 2007. African American and Hispanic youth with mental health problems are less likely than their Caucasian counterparts to receive mental health services. Primary care providers are often the source of mental health care for children and may play a role in reducing disparities. This research investigated parent attitudes associated with receiving advice about child mental health in primary care and whether attitudes differed according to race and ethnicity during 773 visits to 54 providers in 13 clinics. Hispanics were more likely than non-Hispanics to agree that primary care providers should treat child mental health and were more willing to allow their child to receive medications or visit a therapist for a mental health problem if recommended by the provider. African American parents were significantly less willing than Caucasians and Hispanics to allow their child to receive medications for mental health but did not differ in their willingness to visit a therapist. These findings suggest that African American parents are generally as willing as Caucasian parents to have their child's mental health needs addressed in primary care and that primary care may be a particularly good point of intervention for Hispanic youth with mental health problems.

Issue Briefs

"Improving Public Coverage for Children: Lessons from CKF in New Jersey." Chioma Uzoigwe, Sheila Hoag, and Judith Wooldridge, August 2008. Health insurance coverage in New Jersey is threatened on all sides: private insurance coverage is eroding; the number of uninsured individuals is growing; and state budget pressure, combined with federal policy pressure, could lead to public insurance coverage cutbacks. This issue brief presents a historical review of the Robert Wood Johnson Foundation's Covering Kids & Families program in the state. The review shows that advocates for insurance coverage, working in concert with state officials, can positively impact public insurance policy and procedures, and can sustain this work even after funding ends.

“Three Independent Evaluations of Healthy Kids Programs Find Substantial Gains in Children’s Dental Health Care.” In Brief #2. Dana Hughes, Embry Howell, Christopher Trenholm, Ian Hill, and Lisa Dubay, September 2008. This brief highlights rigorous, independent evaluations of the Healthy Kids programs in three California counties: Los Angeles, San Mateo, and Santa Clara. It describes some of the many positive impacts that Healthy Kids programs have had on children’s access and use of dental services. For children enrolled in the program, access to dental care improved and unmet need for dental care declined.

"Medicaid Prescription Drug Use by Dual Eligibles: Issue for Medicare Part D." James Verdier, Ann Bagchi, and Dominick Esposito, August 2008. New data, prepared for the Centers for Medicare & Medicaid Services, provide detailed state-by-state and national information on prescription drug cost and utilization in 2003 for Medicaid beneficiaries enrolled in both Medicaid and Medicare (“dual eligibles”), whose drug coverage shifted from Medicaid to Medicare Part D in 2006. This brief highlights key data on drug use and spending in 2003 for dual eligibles, as well as Part D issues that these data can help to inform. Sixty-five percent of the 6.7 million dual eligibles who received drug coverage from Medicaid in 2003 were age 65 or older; the rest were under 65 and disabled. Among dual eligibles as a whole, the most costly drug group was antipsychotics, accounting for over $2.3 billion in expenditures in 2003. Ulcer drugs were the next most costly group ($1.38 billion), followed by antidepressants ($1.18 billion).

"Medicare Advantage in 2008." Marsha Gold, June 2008. Medicare Advantage (MA), a voluntary program that provides beneficiaries with an alternative way to access traditional Medicare benefits, replaced the Medicare+Choice program in 2004 and became fully operational in 2006. This issue brief reviews recent trends in the program and includes information trends in firm participation and market share, changes in beneficiary choice, and growth in MA plans available to employer groups. The brief notes that the number of Medicare beneficiaries in MA plans continues to grow, to 8.2 million at the end of 2007, up from 5.4 million in March 2005. In the first four months of 2008, enrollment increased by more than 800,000. Private fee-for-service plans account for more than half of this new growth. About one in five Medicare beneficiaries (19 percent) is enrolled in an MA plan. In addition, four main players—UnitedHealthcare, Humana, Kaiser, and Blue Cross Blue Shield—accounted for more than half of enrollment at the end of 2007.

"Improving Processes and Increasing Efficiency: The Case for States Participating in a Process Improvement Collaborative." Sheila Hoag and Judith Wooldridge, September 2007. State Medicaid and SCHIP agencies provide vital health coverage to low-income populations and other groups, but they have limited administrative resources to support enrollment and renewal. This brief looks at experiences of some state Medicaid and SCHIP agencies in using a process change model to strengthen the way they approach enrollment and retention, concluding that committed leadership and resources are an effective model for changing Medicaid and SCHIP enrollment and retention processes rapidly and for sustaining improved processes. The brief also explores whether a process improvement collaborative is a worthwhile investment for states, finding that they have much to gain in terms of increased efficiency and savings using the model, which can be applied to any area of state administration.

"Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families." In Brief #1. Christopher Trenholm, Embry Howell, Ian Hill, and Dana Hughes, November 2007. Since 2001, initiatives have emerged in 25 of California's 58 counties to expand health insurance coverage for children. These initiatives make use of a new insurance product, Healthy Kids, that covers children who are ineligible for Medi-Cal and Healthy Families, California's public programs for children in families with incomes up to 250 percent of the federal poverty level. This brief presents highlights from evaluations of Healthy Kids programs in Los Angeles, San Mateo, and Santa Clara counties. The brief notes that children's access to and use of medical care improved, unmet health care needs declined, and parents of children enrolled in Healthy Kids reported far more confidence that they could obtain care for their children.

Other

"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 Rossier Markus, and Sara Rosenbaum, July 2008. 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 outline strategies for states to contract with EQROs to conduct performance measurement and quality improvement projects that focus directly on improving the quality of preventive and developmental services.

"Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2003." Jim Verdier, Ann Bagchi, and Dominick Esposito, April 2008. This chartbook, prepared for the Centers for Medicare & Medicaid Services, provides a snapshot of Medicaid pharmacy benefit use and reimbursement in 2003 and shows key trends from 1999 to 2003.

"New Hospital Information Technology: Is It Helping to Improve Quality?" Suzanne Felt-Lisk, in Hospital Management New Initiatives/Dimensions, 2008. Although health information technology (IT) is at the center of efforts to improve the nation’s health care system by enhancing patient safety and reducing inefficiencies, little evidence exists to link IT to quality improvements and efficiency gains. This book chapter reprints a May 2006 issue brief reporting on how six types of information technology have affected hospital quality, based on interviews with senior hospital executives. The findings suggest that IT has been an important factor in enhancing quality, particularly in terms of more timely clinical information, diagnosis, and treatment.

"State Comprehensive Access Initiatives." Deborah Chollet, March 2008. Testimony before a House Appropriations Subcommittee at a hearing on Expanding Health Care Access.

"The Medicaid Analytic eXtract (MAX) Chartbook." Audra T. Wenzlow, Dan Finkelstein, Ben Le Cook, Kathy Shepperson, Christine Yip, and David Baugh, 2007. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experience in 2002. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollee demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2002. Appendix Tables

To find all health-related publications, please go to the Publications Search page.

			Home \| About Us \| Employment \| Contact \| Site Map \| Publications


Education	Labor	Health	Disability	Welfare	Nutrition	Early Childhood	International