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Primary Care Access for New Patients on the Eve of Health Care Reform (Article)
Genevieve M. Kenney, Douglas A. Wissoker, Additional Authors
This study uses a simulated patient approach to assess appointment availability and wait times for new primary care appointments in late 2012/early 2013 by insurance status and state. Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. Outreach programs are needed, not only to help patients enroll but also to identify practices accepting new patients within each plan's network. Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act.
New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions (Article)
Genevieve M. Kenney, Additional Authors
The Affordable Care Act expands Medicaid in 2014 to millions of low-income adults in states that choose to participate in the expansion. Since 2010 California, Connecticut, Minnesota, and Washington, D.C., have expanded coverage earlier to a portion of low-income childless adults. Using administrative records, the authors document that the ramp-up of enrollment was gradual over time in California, Connecticut, and D.C. Survey data on the two earliest expansions show strong evidence of increased Medicaid coverage in Connecticut and positive but weaker evidence of increased coverage in D.C. Medicaid enrollment rates were highest among people with health-related limitations. In Connecticut, evidence of some crowd-out of private coverage as well as a positive spillover effect on Medicaid enrollment among previously eligible parents was found.
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.
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.
Behavioral Adaptation and Late-Life Disability: A New Spectrum for Assessing Public Health Impacts (Article)
Brenda Spillman, Additional Authors
Only about a third of Americans ages 65 and older are fully able to manage all daily activities independently, according to new research from the 2011 National Health and Aging Trends Study (NHATS). Another 30 percent are able to accommodate declining health or functioning by using assistive devices or scaling back their activities, 18 percent have trouble managing even with any devices they may use, and 21 percent receive help. These findings are based on innovative data NHATS collected for a nationally representative sample of 8,077 older Medicare beneficiaries. The data allow a more nuanced look at late life function than previously has been possible and can contribute to better understanding of ways older adults adapt to disability and to development of public health policies to maximize the quality of life for older Americans.
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.