Senior Research Associate
Health Policy Center
Barbara A. Ormond, Ph.D., joined the Health Policy Center in 1997. Her main area of interest is the effect of health system change on access to care by uninsured and publicly insured populations. She has studied the structure and financing of both urban and rural health care systems across the country and has worked extensively on health system issues in the District of Columbia. Current research interests also include the contribution of prevention to health care costs. Prior to joining the Urban Institute, she worked for the U.S. Agency for International Development with assignments both in Washington and abroad. She received her Ph.D in health economics from Johns Hopkins University.
Health Homes in Medicaid: The Promise and the Challenge (Research Brief)
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With the passage of the Affordable Care Act (ACA), health care providers and insurers are actively engaged in payment and delivery reform. Much of this reform focuses on integrating primary care and other aspects of health care. Medicaid Health homes, and option to states under the ACA, aims to improve the integration of physical health care needs with the broad range of mental health and social needs for high-cost, high-needs Medicaid beneficiaries. This brief draws on findings from Urban Institute's five-year evaluation of this new model of care, exploring the concept, as well as the challenges that must be overcome to achieve the desired results.
EHRs, Consensus Standards, and the EPSDT Benefit: Care for Children with Mental or Behavioral Health Problems or Developmental Disabilities (Policy Briefs/Health Policy Briefs)
|Posted to Web: February 18, 2014||Publication Date: February 18, 2014|
This report presents findings from interviews with national experts and state officials on the current state of development of standards to be incorporated into electronic health records (EHRs) to support care for children with special health care needs who are covered by the Medicaid program. Findings address national efforts to develop standards, the role of concurrent initiatives, the role of vendors, pediatric provider adoption of EHRs, practice-level issues, and the use of EHRs in the treatment of children with special needs.
Potential Savings Through Prevention of Avoidable Chronic Illness Among CalPERS State Active Members (Research Report)
|Posted to Web: October 19, 2012||Publication Date: October 19, 2012|
In this report, we present estimates of the burden of preventable chronic disease on active members of the California Public Employees Retirement System and describe the distribution of that burden by demographic characteristics, and across geographic areas, state agencies/departments, and participating health plans. The estimates show that a 1 percent reduction in the prevalence of the common conditions included in the analysis could save the state $3.6 million per year. The literature suggests that reductions of 5 to 15 percent are feasible, depending on how well-designed and targeted interventions are, indicating potential savings of $18 million to $54 million annually.
Assuring Access to Care Under Health Reform: The Key Role of Workforce Policy (Policy Briefs)
|Posted to Web: April 30, 2012||Publication Date: April 30, 2012|
This issue brief analyzes four non-mutually exclusive alternatives for meeting increases in demand for primary care prompted by coverage expansions. Institute researchers Barbara Ormond and Randall Bovbjerg conclude that educating more doctors and nurses is a logical but slow response to feared access problems. More promising for the near term is reorganizing practices to make more productive use of nurses and other more rapidly trainable clinicians and, for the longer term, transformation of medical care systems and medical education. Substantial change is needed to make primary care a more valuable resource for patients and a more attractive career for practitioners.
What Directions for Public Health under the Affordable Care Act? (Policy Briefs)
|Posted to Web: December 21, 2011||Publication Date: October 01, 2011|
The Affordable Care Act (ACA) presents opportunities to support what has often been called the “new public health.” This analysis of the ACA provisions suggests five interrelated issues of importance for the future of public health-defining a new paradigm, identifying reliable funding streams, developing the evidence base, establishing effective relationships with other actors, and communicating the value proposition of public health. The brief concludes by noting that much work must still be done to assure that the ACA becomes a wellspring of appreciation for public health’s value, rather than the high water mark for public health advocacy.
The Role of Prevention in Bending the Cost Curve (Policy Briefs)
|Posted to Web: November 08, 2011||Publication Date: November 08, 2011|
Among the health promotion and cost-control strategies included in the Affordable Care Act (ACA) is a focus on disease prevention. In addition to bolstering coverage of clinical preventive services the ACA includes new funding for evidence-based lifestyle interventions targeting chronic diseases like diabetes, hypertension, heart disease, stroke and renal disease, all of which are growing in prevalence in the U.S. This brief examines the budgetary implications of unchecked prevalence growth, describes promising approaches to reducing that growth, and estimates the potential return on investment in these approaches as envisioned in the ACA, finding ample justification for these efforts in a larger cost-control strategy.
State Budgets under Federal Health Reform: The Extent and Causes of Variations in Estimated Impacts (Research Report)
|Posted to Web: October 27, 2011||Publication Date: October 27, 2011|
This analysis examines the potential costs and savings that health reform may generate for state budgets. It discusses the major expected sources of costs and savings as the new law is implemented and explains why recent estimates of the likely state budgetary impact vary widely. It identifies many opportunities for states to offset costs related to Medicaid expansion, such as the reduced need for payments for uncompensated care as uninsurance declines. The review of state analyses found most reflected potential cost increases but did not account for the full range of potential savings. The actual impact on states will vary depending on current state coverage and on how each state chooses to implement the law.
Expanding Health Coverage in the District of Columbia: DC's Shift from Providing Services to Subsidizing Individuals and Its Continuing Challenges in Promoting Health, 1999-2009 (Research Report)
|Posted to Web: March 03, 2011||Publication Date: February 01, 2011|
In 2001 Washington, D.C. ceased paying for services to the uninsured via its underperforming public hospital and associated clinics. Instead, the District created a Medicaid-like coverage program known locally as the Alliance for people up to 200 percent of the federal poverty level who were not eligible for Medicaid. Low-income residents got better access to primary and specialty services, and budgetary costs were manageable. Enrollment reached over 50,000 and helped DC achieve among the lowest uninsured rates in the country. The Alliance also helped stabilize community health centers by giving them a more reliable revenue stream. Challenges remain in transforming the delivery system to meet population needs.
Potential National and State Medical Care Savings From Primary Disease Prevention (Research Report)
|Posted to Web: February 18, 2011||Publication Date: December 01, 2010|
The authors present national and state-level estimates of effects on medical spending over time of reductions in the prevalence of conditions amenable to primary prevention. Reducing diabetes and hypertension prevalence by 5% nationally would save approximately $8.2 billion annually in the near term. The resulting reductions in comorbidities could bring medium-term savings to approximately $26.8 billion annually. Returns are greatest in absolute terms for private payors, but greatest in percentage terms for public payors. State savings vary with demographic makeup and prevailing morbidity. We conclude that well-designed interventions that achieve improvements in lifestyle-related risk factors could result in sufficient savings to substantially offset intervention costs.
Beyond Cash and Counseling: The Second Generation of Individual Budget-based Community Long-Term Care Programs (Research Report)
|Posted to Web: January 13, 2011||Publication Date: November 01, 2010|
States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries' needs and preferences and to increase their ability to remain outside or leave nursing homes. The "individual budget" model is a service option that originated in the Cash and Counseling Demonstration in three states in the late 1990s. As of January 2006, the model had been implemented for elderly Medicaid beneficiaries in some form by an additional seven states, and 12 other states were in the process of implementing programs. This report describes the 10 operating individual budget model programs serving older persons, identifies four areas of program design that are of particular importance to the success of the model, and provides more detailed profiles of programs in three states.
|Posted to Web: July 14, 2010||Publication Date: January 01, 2007|
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