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Health Care Systems and HMOs

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How Local Context Affects Providers' Adoption and Use of Interoperable Health Information Technology: Case Study Evidence from Four Communities in 2013 (Round Two) (Research Report)
Fredric Blavin, Arnav Shah, Nicole Cafarella Lallemand, Kelly J. Devers, Christal Ramos

These issue briefs explore how local context affects HITECH program implementation as well as providers' incentives and ability to achieve Meaningful Use. These briefs identify the influence that state governments and policies, local grantees charged with implementing particular HITECH programs, health care market and community characteristics, and current health care reform efforts are having on providers' incentives and ability to meaningfully use EHRs and qualify for Medicare and Medicaid incentive payments.

Posted to Web: October 02, 2014Publication Date: August 22, 2014

Factors that Influence Preventive Service Utilization among Children Covered by Medicaid and CHIP: Environmental Scan and Literature Review (Research Report)
Vanessa C. Forsberg, Rebecca Peters, Amanda I. Napoles, Arnav Shah, Christal Ramos, Kelly J. Devers

This environmental scan report compiles and assesses the available literature from the last 5 years on preventive health care services for child beneficiaries (including adolescents) in Medicaid and the Children's Health Insurance Program (CHIP). It addresses preventive service utilization patterns and barriers, cost and health outcomes associated with prevention, and activities designed to improve preventive service rates and outcomes. This report is intended to help inform the development and dissemination of resources for states to use in their efforts to increase the utilization of recommended preventive services by Medicaid and CHIP beneficiaries.

Posted to Web: September 17, 2014Publication Date: April 15, 2014

Potential Medicaid Cost Savings from Maternity Care Based at a Freestanding Birth Center (Article)
Embry M. Howell, Ashley Palmer, Sarah Benatar, Bowen Garrett

Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This article examines whether such care reduces Medicaid costs for low income women using results from a prior study of maternal and infant outcomes at the Family Health and Birth Center in Washington, D.C. Costs to Medicaid are derived from birth center data and from national sources. Birth center care could save an average of $1,163 per birth. Policy makers should consider a larger role for midwives and birth centers in maternity care for low-risk pregnant women with Medicaid.

Posted to Web: September 17, 2014Publication Date: September 09, 2014

Using Behavioral Economics to Inform the Integration of Human Services and Health Programs under the Affordable Care Act (Research Report)
Fredric Blavin, Stan Dorn, Jay Dev

Behavioral economics, which analyzes how behavior sometimes departs from the rational calculation of self-interest, can help Medicaid programs use targeted enrollment strategies more effectively by eliminating apparently modest procedural requirements, which can greatly reduce participation levels. It can also help health coverage applicants receive SNAP, even though demonstrating eligibility for health subsidies and choosing a health plan can tax many consumers' cognitive resources, making it hard to process information about SNAP. For example, health applicants could be given the option to have the state's food agency contact them later to complete a SNAP application by phone.

Posted to Web: September 15, 2014Publication Date: July 21, 2014

Early 2014 Stakeholder Experiences with Small-Business Marketplaces in Eight States (Survey Brief)
Linda J. Blumberg, Shanna Rifkin

Participation of employers in the small group Marketplaces, or Small Business Health Options Program (SHOP), has started very slowly. The reasons for this are largely consistent across the states, and many of them lend themselves to reversal or improvement. Significant challenges remain, but it would be inappropriate to judge the long term prospects of SHOP merely on its first-year experiences. This analysis of early implementation experiences is based on case study interviews in eight states: Colorado, Illinois, Maryland, Minnesota, New Mexico, New York, Oregon, and Rhode Island. Interviews were conducted with a broad array of stakeholders in each state.

Posted to Web: August 14, 2014Publication Date: August 14, 2014

In Pursuit of Health Equity: Comparing U.S. and EU Approaches to Eliminating Disparities (Policy Briefs/Timely Analysis of Health Policy Issues)
Elizabeth Docteur, Robert A. Berenson

Researchers compare and contrast the U.S. public policy approach to tackling the problem of health disparities with the European approach in this paper. They begin by providing an overview of the ways in which the issue of health disparities has been framed in American and European policy discourse. They next compare how health disparities have been addressed in policy statements produced by the U.S. Department of Health and Human Services and by the European Commission, the executive body of the European Union, emphasizing the US emphasis and race and ethnicity and the European orientation to economic status.

Posted to Web: June 30, 2014Publication Date: June 24, 2014

Strategies in 4 Safety-Net Hospitals to Adapt to the ACA (Research Brief)
Teresa A. Coughlin, Sharon K. Long, Rebecca Peters, Additional Authors

Safety-net hospitals have long played an essential role in the US health care system. The Affordable Care Act fundamentally changes the health care landscape and safety-net hospitals need to make major changes to compete. This report examines four safety-net hospitals to learn how they are preparing for health reform. While hospitals were employing strategies with different intensities, we found that the study hospitals had implemented an array of financial strategies focused on tapping Medicaid revenues. They also adopted delivery systems reforms, particularly ones related to developing community-based partners, and implemented changes in hospital leadership and management structure as well as efforts to better align physician incentives with hospitals and altering the culture of patient care to be more responsive to the shifting market.

Posted to Web: June 13, 2014Publication Date: June 11, 2014

Uncompensated Care for the Uninsured in 2013: A Detailed Examination (Research Report)
Teresa A. Coughlin, John Holahan, Kyle Caswell, Megan McGrath

Millions of uninsured people use health care services every year. We estimated providers’ uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers’ uncompensated care costs were offset by government payments designated to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

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

Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care (Research Report)
Sabrina Corlette, JoAnn Volk, Robert A. Berenson, Judy Feder

Consumers choosing health insurance plans inside and outside the new marketplaces may face a tradeoff: narrower provider networks may lower premiums, but they may also limit access to care or increase out-of-pocket costs. This policy brief assesses the benefits and risks of policy options open to federal and state policymakers now reviewing requirements for plans' network adequacy. The authors find that no single policy can achieve the appropriate balance between insurers' flexibility to negotiate with providers and consumers' confidence that plans will deliver on promised benefits. Accordingly, the authors call on policymakers to protect consumers with a combination of regulatory standards, up-to-date information to facilitate consumer choices, and active monitoring of plans' actual performance.

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

Trends in Prescription Drug Spending Leading Up to Health Reform (Article)
Fredric Blavin, Timothy Waidmann, Linda J. Blumberg, Jeremy Roth

Over the past decade, prescription drug expenditures grew faster than any other service category and comprised an increasing share of per capita health spending. Using the 2005 and 2009 Medical Expenditure Panel Surveys, this analysis identifies the sources of spending growth for prescription drugs among the nonelderly population. We find that prescription drug expenditures among the nonelderly increased by $14.9 billion (9.2%) from 2005 to 2009 and expenditures increased in 12 out of the 16 therapeutic classes. Changes in the number of users and expenditures per fill were the drivers of spending fluctuations in these categories. The main results also provide insight into generic entry, the price gap between brand and generic drugs, and from a health reform evaluation perspective, the importance of separating pre-policy secular trends in expenditures from changes attributable to specific forces, such as shifts toward generic versions of blockbuster drugs.

Posted to Web: May 19, 2014Publication Date: May 14, 2014

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