Health Policy Center Authors
Publications by Nicole Cafarella Lallemand for Health Policy Center
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More about Nicole Cafarella Lallemand's areas of expertise can be found on this Urban Institute expert's page.
Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration (Research Report)
Stephen Zuckerman, Kelly J. Devers, Robert A. Berenson, Rachel A. Burton, Nicole Cafarella Lallemand, Rebecca Peters
For the past three years, Medicare, Medicaid, and private payers in eight states have been paying certified medical home practices monthly care management fees and providing additional support (e.g., data feedback, learning collaboratives, practice coaching) through the Multi-payer Advanced Primary Care Demonstration. In its first year, the demonstration included 3,800 health care providers, 700 practices, and 400,000 Medicare beneficiaries, and produced net savings for the Medicare program that totaled $4.2 million. Interviewees reported that demonstration payments provided needed support to help practices transform the way they deliver care – by adding nurse care managers, adopting electronic disease registries, and enhancing access to care after hours, as well as making other changes.
Realign Physician Payment Incentives in Medicare to Achieve Payment Equity among Specialties, Expand the Supply of Primary Care Physicians, and Improve the Value of Care for Beneficiaries (Research Report)
Stephen Zuckerman, Katie Merrell, Robert A. Berenson, Nicole Cafarella Lallemand, Jonathan Sunshine
This report includes a number of studies related to promoting primary care access, addressing rising health care costs and improving value in the Medicare Physician Fee Schedule. One study showed that alternative methods for allocating Relative Value Units (RVUs) related to practice expenses would not result in a major payment shift to primary care providers. A second study examined the introduction of new codes and the effects of physician productivity changes on the distribution of work RVUs across services. The final study examined approaches promoting primary care services through payment reform, outside of the Medicare Resource Based Relative Value Scale.
How Local Context Affects Providers' Adoption and Use of Interoperable Health Information Technology (Research Report)
Fredric Blavin, Arnav Shah, Nicole Cafarella Lallemand, Kelly J. Devers, Christal Ramos
These issue briefs explore how local context affects HITECH program implementation as well as providers' incentives and ability to achieve Meaningful Use. These briefs identify the influence that state governments and policies, local grantees charged with implementing particular HITECH programs, health care market and community characteristics, and current health care reform efforts are having on providers' incentives and ability to meaningfully use EHRs and qualify for Medicare and Medicaid incentive payments.
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.
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.
Reducing Waste in Health Care (Research Report)
Nicole Cafarella Lallemand
A recent study by former Centers for Medicare and Medicaid Services administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that waste may constitute a third of US health spending. This policy brief examines waste in health care that may result from poor delivery of care, failed care coordination, overtreatment, administrative complexity, and uncompetitive pricing. The author concludes with presenting opportunities and challenges associated with efforts to eliminate waste in health care without harming consumers or reducing the quality of care provided.
Why Premium Support? Restructure Medicare Advantage, Not Medicare (Policy Briefs)
Judy Feder, Stephen Zuckerman, Nicole Cafarella Lallemand, Brian Biles
Premium support proponents argue that replacing public insurance with vouchers to purchase private (or public) coverage will harness market forces to contain costs. But the debate often ignores traditional Medicare's administrative efficiency, purchasing power and the rewards to risk selection that accompany competition among plans. We show that despite Medicare Advantage (MA) plans' success in enrolling beneficiaries, they have been unsuccessful in lowering costs. Except in 15 percent of counties, MA costs per beneficiary exceed costs for traditional Medicare. Fiscal prudence warrants limiting MA payments to 100 percent of traditional Medicare costs, while keeping payments to MA plans below traditional Medicare in the highest cost counties.
The Center for Medicare and Medicaid Innovation: Activity on Many Fronts (Policy Briefs/Timely Analysis of Health Policy Issues)
Robert A. Berenson, Nicole Cafarella Lallemand
This Robert Wood Johnson Foundation-funded paper by Robert Berenson and Nicole Cafarella provides a status report on the Innovation Center's activities to date—including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’s traditional demonstration programs. The paper describes the Center's major initiatives to date, including those that address primary care redesign, bundled payments, ACOs, dual-eligible beneficiaries, and the health care system's capacity for spreading innovative ideas. The authors note that some observers have expressed concern that the Innovation Center's fast-paced approach may be overwhelming to smaller delivery systems.