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View Research by Author - Barbara A. Ormond


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Evaluation of the Medicaid Health Home Option for Beneficiaries with Chronic Conditions: Final Annual Report - Base Year (Research Report)
Brenda C. Spillman, Barbara A. Ormond, Elizabeth Richardson

Medicaid health homes is a new optional benefit for high-need, high-cost beneficiaries with chronic physical conditions or serious mental illness, authorized in Section 2703 of the Affordable Care Act. Distinctive features of the model include the elevated importance placed on integrating physical health care with behavioral/mental health care and on linking enrollees to social services and other community supports. The Urban Institute is conducting the 5-year long-term evaluation for the DHHS Assistant Secretary of Planning and Evaluation. This initial report examines the context, design, and initial implementation challenges and successes of six programs in Missouri, Rhode Island, New York, and Oregon, the first four states with approved programs.

Posted to Web: May 19, 2014Publication Date: December 01, 2012

Integrating Community Health Workers into a Reformed Health Care System (Research Report)
Randall R. Bovbjerg, Lauren Eyster, Barbara A. Ormond, Theresa Anderson, Elizabeth Richardson

Community health workers (CHWs) can help to achieve the goals of the Affordable Care Act—better health, better care, and lower costs. CHWs are typically laypeople whose close connections with a community enable them to win trust and improve health and health services for those they serve. However, challenges with financing structures, workforce training, and service organization can hinder the expansion of the CHW workforce. This paper highlights the roles played by CHWs, assesses evidence of their achievements, describes the increasing opportunities for them under health care reform, and considers productive next steps for growing the CHW workforce.

Posted to Web: March 26, 2014Publication Date: March 26, 2014

Opportunities for Community Health Workers in the Era of Health Reform (Research Report)
Randall R. Bovbjerg, Lauren Eyster, Barbara A. Ormond, Theresa Anderson, Elizabeth Richardson

Health reform has created a watershed moment for community health workers (CHWs). Both coverage expansions and a new focus on creating value in health care offer new opportunities for CHWs. This paper assesses existing impediments to and enablers of the expansion of CHW employment. It catalogues how the ACA and other health reform efforts affect prospects for sustainable employment for CHWs. It also looks at workforce issues, insurance enrollment needs, affordability and accessibility of services, and changes in approaches to public health and prevention. The paper concludes by highlighting particular promising opportunities for CHWs in both public and private sectors.

Posted to Web: March 26, 2014Publication Date: March 26, 2014

The Evolution, Expansion, and Effectiveness of Community Health Workers (Research Report)
Randall R. Bovbjerg, Lauren Eyster, Barbara A. Ormond, Theresa Anderson, Elizabeth Richardson

In the past decade, the community health worker (CHW) profession in the United States has increased its visibility, but its potential contributions remain underappreciated and more permanent financing is elusive. This paper describes the current state of knowledge about how and where CHWs can contribute effectively, where barriers inhibit efficient deployment of CHWs, and what business models could support change. Observations come from literature reviews, key stakeholder interviews, case studies of CHW initiatives, and a convening of practitioners, employers, advocates, policymakers, and other experts.

Posted to Web: March 26, 2014Publication Date: March 26, 2014

Health Homes in Medicaid: The Promise and the Challenge (Research Brief)
Barbara A. Ormond, Elizabeth Richardson, Brenda C. Spillman, Judy Feder

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.

Posted to Web: February 18, 2014Publication Date: February 18, 2014

EHRs, Consensus Standards, and the EPSDT Benefit: Care for Children with Mental or Behavioral Health Problems or Developmental Disabilities (Policy Briefs/Health Policy Briefs)
Barbara A. Ormond, Mary Tierney, Juliana Macri

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.

Posted to Web: October 19, 2012Publication Date: October 19, 2012

Potential Savings Through Prevention of Avoidable Chronic Illness Among CalPERS State Active Members (Research Report)
Timothy Waidmann, Barbara A. Ormond, Brenda C. Spillman

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.

Posted to Web: April 30, 2012Publication Date: April 30, 2012

Assuring Access to Care Under Health Reform: The Key Role of Workforce Policy (Policy Briefs)
Barbara A. Ormond, Randall R. Bovbjerg

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.

Posted to Web: December 21, 2011Publication Date: October 01, 2011

What Directions for Public Health under the Affordable Care Act? (Policy Briefs)
Randall R. Bovbjerg, Barbara A. Ormond, Timothy Waidmann

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.

Posted to Web: November 08, 2011Publication Date: November 08, 2011

The Role of Prevention in Bending the Cost Curve (Policy Briefs)
Timothy Waidmann, Barbara A. Ormond, Randall R. Bovbjerg

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.

Posted to Web: October 27, 2011Publication Date: October 27, 2011

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