Meeting States' Needs for High-Quality, Timely Information

As a leader in health services research, Mathematica is committed to helping state decision makers solve their most pressing health policy problems. We design and evaluate health care programs, applying qualitative and quantitative techniques in a flexible way to meet each state's needs. We combine our expertise in health policy research, data collection and analysis, consulting, and technical assistance to help states and others deal with health policy issues in a wide range of areas.

Our staff understands state issues and programs. Whether the task at hand is program design, implementation, evaluation, or data collection, we bring experience, credibility, and objectivity to projects.

Examining Medicaid and SCHIP Programs

State policymakers need high-quality and up-to-date information about how Medicaid and SCHIP programs are working. Our studies focus on evaluations of SCHIP; Medicaid and SCHIP managed care; consulting and technical assistance; services for special needs children and adults with disabilities; and the role of Medicaid in local marketplaces. We also deliver executive education and strategic and technical assistance for Medicaid and SCHIP administrators and staff to help them develop, purchase, monitor, and improve the services they provide.

SCHIP Evaluations. SCHIP offers states enhanced federal matching funds to expand health insurance coverage for low-income, uninsured children. We are conducting two national evaluations of SCHIP—one for the Centers for Medicare & Medicaid Services, and the other for the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.

Medicaid and SCHIP Managed Care. After years of slow growth, Medicaid managed care is being widely implemented. We are evaluating many statewide demonstrations, looking at how they operate and are financed, how managed care affects beneficiaries, and what effects special programs have on people with disabilities. By working with state officials, we are helping improve purchasing practices and administrative structures. We also have conducted case studies and surveys to examine how managed care affects access to care and traditional Medicaid and safety net providers. We are looking at strategies community health centers use under managed care, as well as innovative state efforts to monitor quality and access. In addition, we measured progress in Tennessee's Early and Periodic Screening, Diagnostic, and Treatment program, Medicaid's comprehensive health program for those under age 21.

Special Needs Children and Adults with Disabilities. One of the greatest challenges facing the Medicaid program is to deliver care effectively to children and working-age beneficiaries who have a disability or chronic illness. Effective care plans help ensure people with disabilities or chronic illnesses can live reasonably full lives. Our research has looked at enhancing care for these groups and nonelderly Medicaid beneficiaries, improving services for those with developmental disabilities and their families, and maintaining Medicaid eligibility for people just released from corrections facilities or institutions. We have also conducted special studies of utilization and expenditures for children in foster care, demonstrating the high rate of mental health conditions in this population.

Monitoring Health Care Markets. The Community Tracking Study, a longitudinal study of changes in the health care system in 60 communities across the country, is the flagship study of our research partner, the Center for Studying Health System Change. We are working with the Center to explore changes in health care organization, financing, and delivery at the community level, including the role of Medicaid and SCHIP. The study consists of biennial visits to 12 communities and periodic national surveys of households, physicians, and employers.

Expanding Coverage

About 41 million Americans are without health insurance, which may prevent them from accessing needed health care. We provide technical assistance to help states expand coverage through improvements in public policy and health care financing. We help states identify options for expanding coverage, tailoring our analyses to the unique demographic, economic, and health care environments in each state. In Maine, we simulated a single-payer plan and examined its impacts on different groups as well as the state economy. We evaluate ambitious programs to improve the health and well-being of low-income children, including a county-level California program that offers virtually universal health insurance coverage regardless of immigration status. Our staff have compared affordability, accessibility, and quality of health insurance in different states. We have estimated Medicaid savings if the 24-month waiting period for Medicare coverage for people with disabilities were eliminated. We also analyzed programs that allow people with disabilities to retain Medicaid coverage when they go to work.

Regulating Private Insurance

Private health insurance premiums continue to rise at a staggering rate, and consumers are increasingly held responsible for more of these costs. We looked at how a nonprofit affiliate of a health care provider might expand its community benefit mission in the Washington, DC, area. We examined the impact of different state market reform after the enactment of the Health Insurance Portability and Accountability Act of 1996. We also explored the role of high-risk pools in supporting private individual health insurance and evaluated the effects of mental health and substance abuse parity on access, utilization, and spending in Vermont and California.

Working with States on Health Care Reform

Many states have been testing new options for expanding access, with some considering universal coverage for their insured populations. We helped inform this discussion by simulating a single-payer plan in Maine and examining its impacts on different groups as well as the state economy. This work helped pave the way for the state's new Dirigo Health Plan, which groups individuals and employees of small businesses into an affordable health insurance pool, while the state subsidizes its poorest residents. We are currently evaluating the first two years of DirigoChoice implementation. To help understand the consequences of parity legislation, we evaluated how these laws affect employer coverage as well as access, utilization, and spending for mental health services in several states. We also developed a summary of the health care marketplace in Indiana, identifying trends and cost drivers with a view to understanding market issues that increase health care costs and the number of uninsured in the state.

Public Health

We have a long history of working with states to strengthen their disease prevention and health promotion priorities. Our national evaluation of the Healthy Start program is determining factors related to successful program implementation, as well as its effect on maternal and infant health outcomes. We are developing best practices and outreach tools for the WISEWOMAN program, a CDC initiative to improve the health of underserved women. Focusing on two widespread health concerns, we are developing a clearinghouse of heart disease and stroke prevention policies and evaluating a diabetes prevention and control program to develop targeted interventions. In addition, we used data collected from the National Public Health Performance Standards program to analyze performance variations across state and local public health jurisdictions.

Shedding Light on Dual Eligibles

Medicare beneficiaries who are also eligible for Medicaid, the so-called “dual eligibles,” are vulnerable because of their high medical and long-term care needs and their low incomes. They are more likely than other Medicare beneficiaries to live in poverty and have severe health conditions. Little is known about their characteristics and the respective roles of Medicare and Medicaid in paying for their care. We have provided state-level descriptive statistics on dual eligibles, reported on their risk adjustment in managed care, and examined their use of Medicaid pharmacy benefits. We are currently studying the role of Medicare and Medicaid in financing home health care for dual eligibles and each program’s share of expenditures for this population in nursing homes.

Controlling the Cost of Prescription Drugs

Rapid growth in state spending for Medicaid prescription benefits, coupled with serious state budget problems, have fueled debate over controlling costs. Yet states must also monitor the effect of any changes on access for vulnerable beneficiaries. We are evaluating the Behavioral Pharmacy Management system to determine whether educational interventions are an effective way to encourage more appropriate use of psychotropic drugs. We developed a chartbook that provides a state-by-state overview of Medicaid prescription drug use. In addition, we have explored variation in use of the Medicaid pharmacy benefit by different groups of dual eligibles.

Examining Physician Participation and Incentives

Medicaid recipients face limited access to private physicians, and their access to care may vary depending on where they live. We are working to understand barriers to care to help states better serve this population. We are examining the use of physician incentives to improve access and quality in Medicaid managed care. We are addressing how to optimize the impact of the National Health Service Corps, a program to attract providers to underserved areas. In addition, we are evaluating a demonstration aimed at improving children's health care through financial and nonfinancial incentives.

Maintaining the Safety Net

The medical and social safety net has been stretched thin for the uninsured and underinsured. Providers have been experiencing a shift in patient flows, changes in capacity, and financial instability as a result of managed care and welfare and immigration reform. Although private physicians may play an important role in serving these populations, little information is available on the volume and types of services they provide, distribution of services across care settings, value of services, and ways of enhancing private physicians' contributions. We are working to ensure that states have up-to-date information to work effectively within these ever-changing environments. Our work includes evaluating capacity to provide care to the uninsured through charity care and other methods.

Enhancing Care Coordination and Disease Management

Beneficiaries with chronic illnesses account for a large share of Medicaid and Medicare costs, which may be due, in part, to lack of coordination among the multiple providers serving them. This can also result in adverse health consequences. A number of entities, including managed care organizations, private insurers, commercial firms, and academic medical centers, have developed methods of managing and coordinating patient care, but evidence on which of these methods work is limited. We are examining efforts in both Medicaid and Medicare to understand how to improve care, enhance self-care, and control costs. Our work is illuminating what works and what lessons have been learned to date, as well as areas where further research is needed.

Improving Options for Long-Term Care

To meet the needs of an aging population, we are analyzing long-term care issues. We are looking at the growing need for long-term care and the necessary infrastructure, including innovative approaches for integrating care for Medicare managed care enrollees who are sick or frail. We also are examining consumer-directed care, an option states introduced in response to demand from people with disabilities who want to manage their own care. Our survey of the long-term care workforce is shedding light on whether the supply and training of workers will need to expand in the future. A parallel study is examining community-based long-term care systems.

State Health Data

Now more than ever, health care data systems and data quality are critically important, as delivery systems shift and the health system changes. We are helping states build and analyze the data sets needed for studying the changing health care environment. For example, we are developing State Health Expenditure Account (SHEA) estimates for the Maryland Health Care Commission. SHEA measures total health care expenditures by Maryland residents by type of service and payer category, and helps state policymakers and stakeholders understand changes in spending.

Measuring Performance

Performance measurement helps managers clarify goals and progress toward achieving them, so that better results can be realized. Mathematica helps clients monitor, assess, and improve their health care programs using performance measures, benchmarking against national data, and other tools. Using secondary data from our national SCHIP evaluation, we helped states determine whether program design influences performance. We are working with the National Health Service Corps on maximizing its resources to achieve the best possible outcomes. We also have extensive experience monitoring the performance of health care plans nationwide.