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Health Care Systems and HMOs

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

Risk-Based Managed Care in Kentucky: A Second Year Implementation Report and Assessment of Beneficiary Perceptions (Research Report)
Ashley Palmer, Embry M. Howell, Genevieve M. Kenney, Additional Authors

This report summarizes findings from a qualitative assessment of implementation of Kentucky Medicaid managed care. It provides an update on the implementation issues identified in our year one report based on 18 stakeholder interviews and document review, and incorporates information obtained in ten focus groups across the state to provide insights about beneficiary experiences and their perceptions of changes to care. We find that many implementation issues identified in our year one report have stabilized over time. Focus group participants report few problems gaining access to health care services, though access to prescription drugs and behavioral health services remain areas of concern.

Posted to Web: December 20, 2013Publication Date: December 20, 2013

Nine States' Use of Collaboratives to Improve Children's Health Care Quality in Medicaid and CHIP (Article)
Kelly J. Devers, Additional Authors

We examine quality improvement (QI) collaboratives in 9 states participating in the Children's Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS's Initial Core Set of Children's Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used workforce augmentation. Overall, practice staff highly valued aspects of the collaboratives and supplemental strategies but also reported a variety of challenges.

Posted to Web: December 19, 2013Publication Date: December 01, 2013

Testimony Before the Committee on Oversight and Government Reform U.S. House of Representatives (Testimony)
Judy Feder

In this testimony before the US House Oversight and Government Reform Committee on the Affordable Care Act's (ACA) impact on premiums and provider networks, Feder concludes that by filling the gaps in the current financing structure and slowing the growth in health care costs, the ACA has enormous potential to address the flaws in the country's health care system. The biggest barrier Feder sees to realizing the law’s potential is the political resistance to the law’s implementation.

Posted to Web: December 12, 2013Publication Date: December 12, 2013

Lessons from the Literature on Electronic Health Record Implementation (Research Report)
Fredric Blavin, Christal Ramos, Arnav Shah, Kelly J. Devers

This report summarizes the findings of 75 articles that identify best practices for implementing and optimizing electronic health records (EHRs). The report includes a conceptual framework to structure the analysis and describe lessons learned for organizations that might be facing EHR implementation obstacles. Throughout the EHR implementation process, planning and modifications are continually needed to address technological, professional, and organizational perspectives. These perspectives must be incorporated at each stage to promote implementation and optimization of a system that is technically functional, integrated into the workflow of its users, and is part of a larger strategy to meet organizational goals.

Posted to Web: October 04, 2013Publication Date: August 01, 2013

Opportunities for Information Sharing to Enhance Health and Public Safety Outcomes (Research Report)
Scott Parker, Kamala Mallik-Kane, Aaron Horvath

Justice-involved populations are more likely to suffer from chronic physical and behavioral health conditions. These conditions can jeopardize employment prospects and lead to reoffending and reincarceration. Information exchanges between the justice and health systems can help both criminal justice and community-based practitioners address these health conditions more effectively to improve outcomes. This report identifies 34 potential information exchanges and provides a blueprint for implementing effective justice-health information exchanges.

Posted to Web: September 05, 2013Publication Date: September 05, 2013

How are States and Evaluators Measuring Medical Homeness in the CHIPRA Quality Demonstration Grant Program? (Research Report)
Stacey McMorrow, Anna Christensen, Brenda Natzke, Kelly J. Devers, Rebecca Peters

Many Medicaid and CHIP programs and private health plans are pursuing medical home initiatives aimed at improving the quality of health care, but varying conceptual definitions and measurement goals have led to the development of a number of different medical home measurement tools. This Evaluation Highlight, funded by the U.S. Department of Health and Human Services, examines the measurement of "medical homeness" in selected CHIPRA Quality Demonstration projects, describes the development of the Medical Home Index-Revised Short Form (an adaptation of the Medical Home Index survey), and presents preliminary statistics on medical homeness for demonstration practices in six States.

Posted to Web: June 14, 2013Publication Date: June 14, 2013

Achieving the Potential of Health Care Performance Measures (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Peter J. Pronovost, Harlan M. Krumholz

There is a consensus that evaluating and reporting on the performance of health care providers can be instrumental in improving value in U.S. health care. But the growth of performance measurement has been accompanied by increasing concerns about the scientific rigor, transparency, and limitations of available measure sets, and how measures should be used to provide incentives to improve performance. This Robert Wood Johnson Foundation-funded paper describes the current state of performance measurement and reporting, details what’s wrong, and outlines seven policy recommendations that offer a path to achieving the promise of performance measurement while avoiding its adverse consequences.

Posted to Web: May 23, 2013Publication Date: May 23, 2013

Reducing Waste in Health Care (Research Report)
Nicole Cafarella Lallemand

A recent study by former Centers for Medicare and Medicaid Services administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that waste may constitute a third of US health spending. This policy brief examines waste in health care that may result from poor delivery of care, failed care coordination, overtreatment, administrative complexity, and uncompetitive pricing. The author concludes with presenting opportunities and challenges associated with efforts to eliminate waste in health care without harming consumers or reducing the quality of care provided.

Posted to Web: February 21, 2013Publication Date: February 21, 2013

Will There Be Enough Providers to Meet the Need? Provider Capacity and the ACA (Research Report)
Ian Hill

Much of the success of the Affordable Care Act (ACA) will hinge on issues surrounding access to care, particularly as millions of individuals become newly-insured and strain the capacity of provider systems. New service delivery reforms in state Medicaid programs and the private sector, as well as provisions in the ACA focused on increasing primary care reimbursement and provider supply, and increasing funding for Community Health Centers, hold promise to improve access to quality care. Drawing on the experiences of ten study states participating in the Robert Wood Johnson Foundation’s health reform monitoring and implementation project, this brief examines how states are addressing the complex issues of provider capacity and access to care.

Posted to Web: November 20, 2012Publication Date: November 20, 2012

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