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Health and Health Care

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Narrow Networks, Access to Hospitals and Premiums: An Analysis of Marketplace Products in Six Cities (Research Report)
Rebecca Peters, John Holahan

This report examines which hospitals are included within marketplace plans in six cities (Denver; New York City (Manhattan); Portland, Ore.; Providence; Baltimore; and Richmond, Va.). The report finds that nearly all insurers offering plans through the insurance Marketplaces in six cities include many highly ranked hospitals within their provider networks. The report also concludes that every hospital in the cities studied is included in at least one Marketplace plan network. The authors also looked at how the size of a plan's provider network affected the cost of premiums. The report shows that the size of a plan's network is not necessarily tied to premiums. The authors note that although narrowing networks (i.e., limiting the amount of providers covered under a specific plan) generally led to more-competitive, lower-cost premiums, some plans with broader networks had low premiums and some plans with narrow networks had high premiums.

Posted to Web: October 31, 2014Publication Date: October 31, 2014

Designing a Home Visiting Framework for Families in Public and Mixed-Income Communities (Research Report)
Marla McDaniel, Caroline Heller, Gina Adams, Susan J. Popkin

Though young children in public and mixed-income housing are exposed to some of the deepest poverty and developmental and educational risks in the United States, they are usually out of reach of many interventions that might help. Home visiting programs hold promise for helping vulnerable families, but most are not designed to fully address the needs of public and mixed-income housing residents. This brief describes important issues that program planners and early childhood leaders should consider when designing appropriate and responsive home visiting programs that reach young children in these communities.

Posted to Web: October 30, 2014Publication Date: October 30, 2014

Is Bigger Better? The Implications of Health Care Provider Consolidation: An Interview with Atul Gawande (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Atul Gawande

In this paper, the Urban Institute's Robert Berenson interviews surgeon and The New Yorker columnist Atul Gawande to explore the potential benefits and drawbacks of "Big Medicine"—standardized, evidence-based health care delivered by large health care chains.

Posted to Web: October 29, 2014Publication Date: October 29, 2014

Federal and State Policy Toward Association Health Plans in Oregon (Research Report)
Kevin Lucia, Sandy Ahn, Sabrina Corlette

Under the ACA, health insurance sold through an Association Health Plan (AHP) to small employers must meet the same insurance standards of coverage sold in the small-group market. However, research indicates that some AHPs are now claiming single large-group health plan status under ERISA, thus sidestepping the ACA requirements for the small-group market. Through interviews with state regulatory officials, health benefit consultants, association representatives and insurers, this paper examines the experience of the AHP market in Oregon. It finds that the AHP market continues to exist for small employers in Oregon and may be positioned for growth.

Posted to Web: October 28, 2014Publication Date: October 28, 2014

CHIPRA Mandated Evaluation of the Children's Health Insurance Program: Final Findings (Research Report)
Genevieve M. Kenney, Lisa Clemans-Cope, Ian Hill, Stacey McMorrow, Jennifer M. Haley, Timothy Waidmann, Sarah Benatar, Matthew Buettgens, Victoria Lynch, Nathaniel Anderson, Additional Authors

This report presents findings from an evaluation of CHIP mandated by CHIPRA and patterned after an earlier evaluation. Some of the evaluation findings are at the national level, while others focus on the 10 states selected for more intensive study: Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia. The evaluation included a large survey conducted in 2012 of CHIP enrollees and disenrollees in the 10 states, and Medicaid enrollees and disenrollees in three of these states. It also included case studies conducted in each of the 10 survey states in 2012 and a national telephone survey of CHIP administrators conducted in early 2013.

Posted to Web: October 24, 2014Publication Date: August 01, 2014

Ebola US Patient Zero: Lessons on Misdiagnosis and Effective Use Of Electronic Health Records (Article)
Divvy Upadhyay, Additional Authors

On September 30th, 2014, the US Centers for Disease Control and Prevention (CDC) confirmed the first travel-associated case of US Ebola in Dallas, TX. The events surrounding the care of this first case of Ebola in the US uncovered one of the biggest vulnerabilities of outpatient medicine – misdiagnosis. The case also illustrated how the use of electronic health records (EHRs) can become a potential barrier to making a correct or timely diagnosis. In this paper, we analyze the case, discuss several missed opportunities and outline key challenges facing diagnostic decision-making in EHR-enabled health care. Until recently, diagnostic errors have not received the respect and attention they deserve and have only now begun to find a possible place on the policy agenda.

Posted to Web: October 23, 2014Publication Date: October 23, 2014

Monitoring the Impact of the Affordable Care Act on Employers: Literature Review (Research Report)
Fredric Blavin, Bowen Garrett, Linda J. Blumberg, Matthew Buettgens, Sarah Gadsden, Shanna Rifkin

In this report, we analyze recent trends in the employer health insurance market and the anticipated effects of the Affordable Care Act on employers, with a particular focus on small firms with fewer than 50 workers. We first present a detailed picture of the employer market by identifying preexisting trends in key outcomes that could be incorrectly attributed to the Affordable Care Act. We also analyze the literature to identify economic factors that are important in current employer and employee decisions regarding health coverage.

Posted to Web: October 23, 2014Publication Date: October 23, 2014

CHIPRA Express Lane Eligibility Evaluation: Case Study of Louisiana's Express Lane Eligibility (Research Report)
Stan Dorn, Margaret Wilkinson, Sarah Benatar

With Express Lane Eligibility (ELE), a state's Medicaid and CHIP programs can rely on another agency's eligibility findings to qualify children for health coverage. This report examines Louisiana's experience with ELE, finding that Louisiana increased children's coverage and saved significant administrative costs. The first state to implement ELE's auto-enrollment option, Louisiana found that almost the same percentage of children obtained care, whether they enrolled (1) via standard Medicaid methods or (2) via ELE, with parents who consented to enrollment by accessing services. When the state changed procedures and required parents to consent by checking a box, enrollment declined by 62%.

Posted to Web: October 22, 2014Publication Date: January 12, 2014

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