Publications by Juliana Macri for Health Policy Center

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More about Juliana Macri's areas of expertise can be found on this Urban Institute expert's page.

This paper discusses how the Affordable Care Act (ACA) places new emphasis on measuring patients' experiences of care and using that information to improve care. The paper traces the way in which listening to the patient's voice has grown from an ethical demand of the patient rights movement into a series of specific, measurable behaviors characterized by use of patient experience surveys. The paper examines patient engagement, patient experience of care, and overall patient centeredness within the context of the ACA and its mandates. It outlines the growing evidence of benefits from better communication between providers and patients and involving patients more closely in their care, including greater adherence to medical advice, fewer complaints, fewer malpractice claims, and improvement in patient health.

This paper discusses how the Affordable Care Act (ACA) places new emphasis on measuring patients' experiences of care and using that information to improve care. The paper traces the way in which listening to the patient's voice has grown from an ethical demand of the patient rights movement into a series of specific, measurable behaviors characterized by use of patient experience surveys. The paper examines patient engagement, patient experience of care, and overall patient centeredness within the context of the ACA and its mandates. It outlines the growing evidence of benefits from better communication between providers and patients and involving patients more closely in their care, including greater adherence to medical advice, fewer complaints, fewer malpractice claims, and improvement in patient health.

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.

This report provides detailed demographic information on Virginia's uninsured population in 2009, including data on their income, employment status, race, ethnicity, age and citizenship, and region of residence. Between 2008 and 2009, 47,000 nonelderly adults in Virginia became newly uninsured, though there was no significant change in the number of uninsured children, due in part to increased coverage through Medicaid and CHIP. Overall, 13.2 percent of Virginians (889,000 total) under the age of 65 lacked health insurance in 2009. The majority of Virginia's uninsured are US citizens and live in working families, but most are in low-income families.

A number of states have used the flexibility of the Medicaid program to develop innovative payment and delivery systems designed to coordinate and improve quality of care. This brief, based on site visits from Nov. 2009 through March 2010, highlights care coordination and related efforts in five states: Alabama, Oklahoma, Oregon, Pennsylvania and Washington State. Such efforts by states to realign the provider payment and delivery systems are key to improving Medicaid and to successfully implementing coverage expansions under the health reform law.

This chart book provides national and state level estimates of uninsured rates and of the number of uninsured children based on 2008 data from the American Community Survey. The chart book documents the substantial variation in uninsured rates across states with uninsured rates among children ranging from a low of 1.7 percent in Massachusetts to a high of 20.1 percent in Nevada. The chart book also shows variation in uninsured rates across geographic areas within each state and compares the characteristics of uninsured children to those of insured children within the same state.

Time-limited ARRA subsidies to laid-off workers for COBRA continuation coverage have substantially raised enrollment, even though layoffs sharply cut household income. The two largest data sets reviewed here showed average rises in take-up rates of 43 percent and 100 percent. However, rates varied widely across employers, and tax-subsidy claims to the IRS are thus far running much lower than expected. Coming closer to universal coverage for this population or for all Americans would require higher subsidy and possibly also a mandate to obtain coverage-two features that increase COBRA participation in a separate Massachusetts program for unemployed residents.

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