Health Policy Center Authors
Publications by Fredric Blavin for Health Policy Center
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More about Fredric Blavin's areas of expertise can be found on this Urban Institute expert's page.
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.
An Early Look at the Impact of Express Lane Eligibility on Medicaid and Children's Health Insurance Program Enrollment: (Research Report)
Fredric Blavin, Genevieve M. Kenney, Michael Huntress
With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public coverage. Using 2007 to 2011 quarterly enrollment data, we estimate difference-in-difference equations with quarter and state fixed effects to measure the effect of ELE on enrollment. The estimated impacts of ELE on Medicaid enrollment were consistently positive across model specifications, ranging between 4.0 and 7.3 percent. The analysis also finds that ELE increased Medicaid/CHIP enrollment. Our results imply that ELE has been an effective way for states to increase new enrollment or improve retention among eligible children.
CHIPRA Mandated Evaluation of Express Lane Eligibility: First Year Findings (Research Report)
Sheila Hoag, Sean Orzol, Margaret Colby, Adam Swinburn, Fredric Blavin, Genevieve M. Kenney, Michael Huntress
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) reauthorized CHIP and funded it through 2013. Under CHIPRA, Congress provided states with new policy tools to address shortfalls in enrollment and retention, one of which is Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public health coverage. This evaluation describes existing state ELE programs including the administrative costs and ELE enrollment trends, estimates the impact of ELE adoption on total enrollment, and previews the issues that will be examined through future evaluation activities.
Uninsured New Yorkers After Full Implementation of the Affordable Care Act: Source of Health Insurance Coverage by Individual Characteristics and Sub-State Geographic Area (Research Report)
Fredric Blavin, Linda J. Blumberg, Matthew Buettgens
The Urban Institute developed a New York state-specific version of its Health Insurance Reform Simulation Model (HIPSM) to support to the state in its effort to assess the implications of the implementation of the Affordable Care Act (ACA). Initial findings from this work were made available in March of 2012.The tables presented here provide sub-state analyses, focusing on those without insurance coverage of any kind prior to reform. We show the share of uninsured expected to gain coverage under the ACA, and include the distribution of characteristics for those anticipated to gain insurance of each type whenever sample sizes allow.
Uninsurance Is Not Just a Minority Issue: White Americans Are a Large Share of the Growth from 2000 to 2010 (Research Report)
Fredric Blavin, John Holahan, Genevieve M. Kenney, Megan McGrath
This brief compares changes in health insurance coverage from 2000 to 2010 across nonelderly racial and ethnic groups. We find that employer-sponsored insurance deteriorated among all groups, with whites and blacks experiencing larger percentage point declines relative to Hispanics and Asians/other. The uninsured rate increased by four percentage points among whites and blacks, while remaining constant for the Hispanic and Asian/other populations as Medicaid/CHIP enrollment gains were large enough to offset ESI declines for these groups. These general patterns were found across all income groups, with more pronounced deterioration in coverage among those with income below 400 percent of FPL.
Trends in U.S. Health Care Spending Leading Up to Health Reform (Research Report)
Fredric Blavin, Linda J. Blumberg, Timothy Waidmann, Lokendra Phadera
Using the 2001-2009 MEPS, we examine a variety of trends that illustrate patterns of health care use in the U.S. and find that growth rates in per capita spending varied by type of service. We decompose trends into changes in the fraction using services, the intensity of utilization among users, and the cost per unit. We also decompose spending changes into changes in the distribution of individuals' socio-economic characteristics, health insurance status, and prevalence of chronic conditions. We find the majority of the increase in per capita health spending over the decade is explained by factors (e.g., technology growth) outside our model.
Deteriorating Health Insurance Coverage from 2000 to 2010: Coverage Takes the Biggest Hit in the South and Midwest (Research Report)
Fredric Blavin, John Holahan, Genevieve M. Kenney, Vicki Chen
This study creates a pre-reform baseline trend for an evaluation of the Affordable Care Act's (ACA) impact on health insurance coverage in the United States. Using the 2000 to 2010 Current Population Survey (CPS), this brief analyzes coverage trends among children, parents, and childless adults, overall and by ACA-relevant income groups. We find that over the past decade, rates of employer-sponsored insurance (ESI) have steadily deteriorated across these population groups, with more substantial declines occurring among the lower-income categories; all three population groups saw increases in Medicaid/CHIP coverage, with children experiencing the largest increase; and the percent of parents and childless adults without health insurance steadily increased whereas the percent of children without health insurance has slightly decreased.
Massachusetts under the Affordable Care Act: Employer-Related Issues and Policy Options (Research Report)
Fredric Blavin, Linda J. Blumberg, Matthew Buettgens, Jeremy Roth
Using the Health Insurance Policy Simulation Model, this report analyzes four policy options for assessing employers who do not provide affordable health insurance to their workers as Massachusetts brings its health reform law into compliance with the Affordable Care Act (ACA). Overall coverage and costs are similar across all options, but replacing the state's Fair Share Contribution (FSC) requirement with the ACA assessment would eliminate a source of state revenue. Similarly, maintaining the FSC for small employers only would raise one-fifth as much revenue as leaving the current assessment in place.
Health Reform Could Greatly Reduce Racial and Ethnic Differentials in Insurance Coverage (Research Report)
Lisa Clemans-Cope, Genevieve M. Kenney, Matthew Buettgens, Caitlin Carroll, Fredric Blavin
Racial and ethnic differentials in uninsurance rates could be greatly reduced under the Affordable Care Act, potentially cutting the black-white differential by more than half and the Hispanic-white differential by just under one-quarter. Improving coverage for these populations will depend on states adopting policies that promote high enrollment in Medicaid/CHIP and new insurance exchanges. Coverage gains among Hispanics will depend on policies in California and Texas (where almost half of Hispanics live). If the projected coverage gains are realized, long-standing racial and ethnic differentials in access to care and health status could shrink considerably. This research was funded in part by the Annie E. Casey Foundation.
The Coverage and Cost Effects of Implementation of the Affordable Care Act in New York State (Research Report)
Fredric Blavin, Linda J. Blumberg, Matthew Buettgens, Jeremy Roth
The Affordable Care Act provides states with the opportunity to develop health benefit exchanges – structured marketplaces for the purchase of health insurance coverage by small employers and individual purchasers. The law provides an array of design choices to the states in an effort to allow the exchanges to reflect varying preferences across the country. This analysis uses the Health Insurance Policy Simulation Model (HIPSM) to delineate the cost and coverage implications of a standard implementation of the ACA in New York compared to the no reform case, along with the differential effects of a number of alternative design options.