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Using Qualitative Comparative Analysis (QCA) to Study Patient-Centered Medical Homes (Research Report)
Kelly J. Devers, Nicole Cafarella Lallemand, Rachel A. Burton, Stephen Zuckerman, Additional Authors
This guide provides an in-depth introduction to using qualitative comparative analysis (QCA) – an approach based on set theory and Boolean algebra – in patient-centered medical home evaluations. Specifically, QCA can be used to identify practice-level "conditions" (e.g., practice characteristics, medical home care processes) that are linked to an outcome of interest (e.g., improved care quality, higher patient satisfaction ratings, or reduced health care utilization or expenditures). The guide includes a description of key analytic steps involved in the QCA approach.
Stabilizing Premiums Under the Affordable Care Act: State Efforts to Reduce Adverse Selection (Research Report)
Linda J. Blumberg, Shanna Rifkin, Sabrina Corlette, Additional Authors
As a consequence of the ACA's reformed nongroup insurance market, some have raised concerns about short-term "rate shock" — an increase in premiums as a result of enhanced consumer protections and more risk-sharing compared with the pre-reform market – as well as longer-term instability due to adverse selection, the phenomenon by which particular insurance plans or markets attract an enrollment with higher than average health care risks. While the ACA includes strategies intended to mitigate these effects, some states are introducing additional strategies to strengthen the protections. This paper explores policies designed to address these concerns being implemented in 11 states.
How the CHIPRA quality demonstration elevated children on State health policy agendas (Research Brief)
Nicole Cafarella Lallemand, Elizabeth Richardson, Kelly J. Devers, Additional Authors
This Evaluation Highlight is the fourth in a series that presents descriptive and analytic findings from the national evaluation of the CHIPRA Quality Demonstration Grant Program. The CHIPRA quality demonstration grants have provided a unique opportunity not only to advance child health quality in the short term, but also to link child health quality issues to broader Federal and State health reforms. In this Highlight, we give examples of activities in five States—Maine, Maryland, Massachusetts, Vermont, and Oregon—and how they used their CHIPRA quality demonstration grants to elevate children's health care issues on their States' health policy agendas.
Health Status, Risk Factors, and Medical Conditions Among Persons Enrolled in Medicaid vs Uninsured Low-Income Adults Potentially Eligible for Medicaid Under the Affordable Care Act (Research Brief)
Genevieve M. Kenney, Sharon K. Long, Additional Authors
Under the Affordable Care Act (ACA), states can extend Medicaid eligibility to more low-income adults, but little is known about the health care needs and health risks of these individuals. In this study, Kenney, Long and colleagues, Sandra Decker and Deliana Kostova from the National Center for Health Statistics, use data from the National Health and Nutrition Examination Survey and find that compared with adults currently enrolled in Medicaid, uninsured low-income adults potentially eligible to enroll in Medicaid under the ACA have a lower prevalence of many chronic conditions but that the uninsured adults with these chronic conditions are less likely to be aware that they have them and less likely to have the condition under control. The rates of undiagnosed and uncontrolled chronic health problems indicate that millions of low-income uninsured adults are currently at risk of premature mortality and other significant health issues. These findings provide new evidence of the potential health benefits associated with the Medicaid expansion under the ACA.
Lessons From Early Medicaid Expansions Under The Affordable Care Act (Blog Posting)
Genevieve M. Kenney, Additional Authors
In this Health Affairs Blog, Kenney and colleagues present preliminary findings from their study of six states – California, Connecticut, the District of Columbia, Minnesota, New Jersey, and Washington – that have already expanded Medicaid to cover some or all of the low-income adults targeted for coverage under the Affordable Care Act. Through in-depth interviews with high-ranking Medicaid officials across all six states, the researchers, led by Ben Sommers gained insights on the impacts of such expansions and identified several key policy lessons that can help elucidate the opportunities and challenges of expanding Medicaid under health reform in other states.
Expanding Medicaid in Ohio: Analysis of Likely Effects (Research Report)
Stan Dorn, Matthew Buettgens, Caitlin Carroll, Additional Authors
Adding Medicaid expansion to the remainder of the Patient Protection and Affordable Care Act (ACA) would increase Ohio’s Medicaid costs between $2.4 and $2.5 billion during FY 2014 to 2022. The state could reduce $1.5 billion in spending on medically needy adults, inpatient prison costs, and other services to the poor uninsured. Expansion would yield $2.7 and $2.8 billion in new revenue, including premium taxes, general revenue from economic activity generated by increased federal Medicaid dollars, and prescription drug rebates. Altogether, expansion would generate between $1.8 and $1.9 billion in net state budget gains while covering more than 400,000 uninsured.
Health Reforms as Examples of Multilevel Interventions in Cancer Care (Research Report)
Kelly J. Devers, Additional Authors
The implementation of the Patient Protection and Affordable Care Act will profoundly impact cancer care. Its components will influence multiple levels of the health-care environment including states, communities, health-care organizations, and individuals seeking care. To illustrate these influences, two reforms are considered: 1) accountable care organizations and 2) insurance-based reforms to gather evidence about effectiveness. We discuss these reforms using three facets of multilevel interventions: 1) their intended and unintended consequences, 2) the importance of timing, and 3) their implications for cancer care and research. Successful implementation of multilevel interventions depends on understanding the political setting and goals of health-care reform.
How are CHIPRA demonstration States approaching practice level quality measurement and what are they learning? (Research Report)
Kelly J. Devers, Additional Authors
This Evaluation Highlight is the first in a series that presents descriptive and analytic findings from the 18-state evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA)'s Quality Demonstration Grants. In this Highlight, we discuss the early accomplishments, challenges, and lessons learned from the following four States pursuing practice-level quality measurement: Maine, Massachusetts, North Carolina, and Pennsylvania. Our analysis is based on work completed by the States during the first two years of their five-year demonstration projects. These two years included a one-year planning period followed by a year of implementation.
Obtaining Providers' 'Buy-In' And Establishing Effective Means Of Information Exchange Will Be Critical To HITECH's Success (Research Report)
Kelly J. Devers, Robert A. Berenson, Randall R. Bovbjerg, Additional Authors
In a March 2012 article in Health Affairs, a team of authors from the Urban Institute and Mathematica Policy Research finds that achieving ambitious goals for the adoption of electronic health records and the nationwide exchange of electronic health information will require overcoming a number of hurdles. First and foremost, providers and patients have to be persuaded of the value of exchanging information and have to be supportive of steps to make it possible. For example, there are broad concerns about the tradeoffs between sharing information electronically and safeguarding the privacy and security of patients’ health care data. A case in point: existing federal law provides for the use of a single identification number for every US patient, but Congress has blocked the use of federal funds to develop this ID system because of privacy concerns.
The Diversity of Dual Eligible Beneficiaries: An Examination of Services and Spending for People Eligible for Both Medicaid and Medicare (Research Report)
Additional Authors, Teresa A. Coughlin, Lokendra Phadera, Timothy Waidmann
Nationwide, 9 million individuals are dually eligible for Medicaid and Medicare services and are among the country's most vulnerable. Despite their policy importance, limited work has been done that examines combined Medicaid and Medicare service use and spending patterns for duals. In this brief, we present findings based on analysis of linked 2007 Medicare and Medicaid data, and examine characteristics, health status, utilization, and spending for duals compared to the non-dual Medicare population. We find, among other things, considerable diversity among duals' spending. Results show that being a dual is not synonymous with high-spending, and factors that make duals more expensive than other Medicare beneficiaries are not the same factors that make them expensive relative to other Medicaid beneficiaries. Results suggest that decision-makers should adopt a multi-pronged approach in developing approaches to improve care delivery and efficiency for duals.