Health Policy Center Authors
Publications by Ashley Palmer for Health Policy Center
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More about Ashley Palmer's areas of expertise can be found on this Urban Institute expert's page.
Risk-Based Managed Care in New Hampshire's Medicaid Program (Research Report)
Ashley Palmer, Stacey McMorrow, Genevieve M. Kenney
In December 2013, New Hampshire began the statewide transition to risk-based managed care in its Medicaid program. This report provides an overview of managed care implementation for Medicaid acute care services, drawing upon a case study conducted in July 2014. We found that initial implementation of managed care went relatively smoothly, due in part to the state’s active oversight role. However, both providers and Medicaid beneficiaries reported significant problems with prior authorization processes. As Medicaid managed care continues to evolve in New Hampshire, we will continue monitoring these and other issues as part of an ongoing evaluation.
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.
Factors that Influence Preventive Service Utilization among Adults Covered by Medicaid (Research Report)
Christal Ramos, Anna C. Spencer, Arnav Shah, Ashley Palmer, Vanessa C. Forsberg, Kelly J. Devers
This environmental scan report compiles and assesses the available literature from the last 5 years on preventive health care services for adult beneficiaries in Medicaid. 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.
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.
Midwifery Care at a Freestanding Birth Center: A Safe and Effective Alternative to Conventional Maternity Care (Research Report)
Sarah Benatar, Bowen Garrett, Embry M. Howell, Ashley Palmer
The Family Health and Birth Center in Washington, D.C. provides accessible, culturally appropriate prenatal care and delivery services to low income women. This study of the outcomes of care at that center improves on previous research by controlling for risk selection into birth center care. We find that women who receive at least two prenatal visits from birth center midwives regardless of whether they deliver at the center or in a hospital—are less likely to have a C-section and less likely to have an induced delivery. They have fewer preterm babies and their babies have higher birth weights.
Evaluation of Statewide Risk-Based Managed Care in Kentucky: A First Year Implementation Report (Research Report)
Ashley Palmer, Embry M. Howell, Julia F. Costich, Genevieve M. Kenney
This report is the first of a series of reports that will be prepared during a three-year evaluation of the statewide implementation of risk-based managed care in Kentucky's Medicaid program. The evaluation will assess the short- and medium-term effects of risk-based managed care implementation on the major partners- beneficiaries, providers, plans, and the Cabinet- with an eye toward understanding the impacts on costs and on the provision of care. In this report, we provide an overview of managed care implementation in Kentucky as of mid-2012 based on our case study analysis, conducted about eight months after the state began enrolling Medicaid beneficiaries in risk-based managed care state-wide.
Medicaid and CHIP Risk-Based Managed Care in 20 States (Research Report)
Embry M. Howell, Ashley Palmer, Fiona Adams
Over the first decade of the 21st century the role of risk-based managed health care for publicly insured beneficiaries has expanded substantially. This report examines this form of health care delivery in 20 states for both Medicaid and CHIP non-elderly adults and children, including people with disabilities. The 20 states were chosen because they include over 80 percent of both Medicaid and CHIP beneficiaries who are enrolled in risk-based managed care. Findings are based on interviews with state Medicaid and CHIP officials, as well as representatives from 40 Managed Care Organizations (MCOs) serving Medicaid and CHIP beneficiaries, and 40 health care providers or provider organizations. In addition, the report contains published data from various sources, including measures of access to care, quality of care, and satisfaction with care over the study period (2001-2010).
Improving the Efficiency of Primary Care in Safety Net Clinics: San Mateo County's System Redesign (Policy Briefs)
Embry M. Howell, Ashley Palmer
San Mateo County is one of a small number of innovative local jurisdictions that is expanding coverage for uninsured adults and at the same time undertaking a reform of its safety net primary care system. We evaluated the impact of the systems redesign by comparing outcomes for a group of people served at the largest county safety net clinic prior to systems redesign (2006) to those served at the clinic after systems redesign (2009). Use of any preventive care services in a year climbed from 25.9 percent to 33.3 percent. Continuity of care also rose significantly, and emergency room use declined. The county's experience provides an example for other communities to follow as they improve the efficiency of health care services for the most vulnerable members of society.
Evaluation of the San Mateo County Adult Coverage and Systems Redesign Initiative (Research Report)
Embry M. Howell, Dana Hughes, Sarah Benatar, Genevieve M. Kenney, Ashley Palmer, Christine Coyer
In 2008 San Mateo County, California launched its Adult Coverage Expansion and Systems Redesign Initiative. The initiative expanded coverage for all uninsured adults below 200 percent of the poverty level and redesigned care in county safety net clinics. The program substantially improved access to care for uninsured adults, as well as improved continuity and quality of care for those served by county safety net clinics. However, access remains a problem for new enrollees, due to restrained provider supply and the economic recession. The report provides lessons for other counties as they expand coverage under national health reform.
Assessing the Train-the-Trainer Model: An Evaluation of the Data & Democracy II Project (Research Report)
Ian Hill, Ashley Palmer, Ariel Klein, Embry M. Howell, Jennifer Pelletier
This report concludes a comprehensive evaluation of The Data & Democracy II project, a program funded by The California Endowment and implemented by UCLA. These organizations sought to increase the capacity of local community-based organizations (CBOs) to collect, analyze, and interpret data to identify and prioritize areas for action. The program was structured after the Train-the-Trainer model, in which a group from local CBOs is trained in these skills and required to disseminate the information by conducting workshops in their own communities. We examine the program's effectiveness, long-term impacts, and challenges through observations, surveys and case studies.