Publications by Additional Authors for Health Policy Center

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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.

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.

With financial support from the Robert Wood Johnson Foundation, the Urban Institute is undertaking a comprehensive monitoring and tracking project to examine the implementation efforts and effects of the Affordable Care Act on 10 states—Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia. The second case study report draws on a site visit and key informant interviews, to provide an in-depth description of Rhode Island's efforts to implement health reform. The report chronicles Rhode Island's successes thus far, with a special look at exchange establishment, private market reforms, and preparations for Medicaid expansion.

When the Affordable Care Act is fully implemented, it will extend health insurance coverage to many uninsured adult Americans. New analysis projects that the ACA will also cut the number of uninsured children by about 40 percent and the number of uninsured parents by almost 50 percent, provided states continue their Medicaid and CHIP coverage for children. However, if the maintenance of effort requirement is rescinded and if Congress does not continue funding CHIP, the uninsurance rate for children could be higher than it is today.

The United States has embarked on a major effort to achieve "meaningful use" of health information technology (HIT) by clinicians and hospitals. This paper, from The Commonwealth Fund's international program, describes meaningful use in three countries with very high levels of HIT adoption—Denmark, New Zealand, and Sweden. None has reached 100 percent in all meaningful use categories, but providers share many kinds of information with other health care organizations and health authorities. Less information is shared with patients. Useful strategies have included providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.

This latest edition of our annual chartbook series for New York State features detailed information about differences in insurance coverage and uninsurance around New York State and within New York City. Overall, 12.9 percent of New Yorkers (889,000 total) under the age of 65 lacked health insurance in 2009, unchanged from the previous year despite an ongoing recession. Data for 14 separate regions across New York State, including the five boroughs of New York City and for 55 separate neighborhoods within the city itself show enormous variation in health insurance coverage across the state.

The economic downturn has been milder in Little Rock than elsewhere, but increased unemployment and an almost 15 percent uninsurance rate have strained the area's fragmented health care safety net. This is the lead finding from a new Community Report released by the Center for Studying Health System Change (HSC). The Urban Institute's Ian Hill was one of three team leaders who conducted a site visit to the Little Rock metropolitan area in May 2010 to interview over 40 health leaders to examine how health care is organized, financed, and delivered in the community. The report was developed as part of HSC's Community Tracking Study, a project that has monitored health system evolution in 12 communities (including Little Rock) since 1996.

This paper examines changes in children's receipt of well-child and preventive dental care in Medicaid/CHIP in two states that adopted policies aimed at promoting greater preventive care receipt. The authors find that policy changes such as reimbursement increases, incentives, and delivery system changes can lead to increases in preventive care use among children in Medicaid and CHIP, but that reported preventive care receipt still falls short of recommended levels.

In 2001 Washington, D.C. ceased paying for services to the uninsured via its underperforming public hospital and associated clinics. Instead, the District created a Medicaid-like coverage program known locally as the Alliance for people up to 200 percent of the federal poverty level who were not eligible for Medicaid. Low-income residents got better access to primary and specialty services, and budgetary costs were manageable. Enrollment reached over 50,000 and helped DC achieve among the lowest uninsured rates in the country. The Alliance also helped stabilize community health centers by giving them a more reliable revenue stream. Challenges remain in transforming the delivery system to meet population needs.

This Health Services Research article describes how administrative and health records (including electronic medical records) can be linked for comparative effectiveness and health services research, using cancer care research to illustrate points. The article notes challenges that may be encountered in the linkage process, and advocates fostering collaboration among institutions, researchers, and public and private components of the health care sector to ensure that data collected for clinical and transactional purposes can benefit the research community and, ultimately, the patient population.

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