New Publications
A Look at Medicaid Buy-In
 “Understanding Enrollment Trends and Participant Characteristics of the Medicaid Buy-In Program, 2003-2004.” William E. Black and Henry T. Ireys, January 2006. Although advances in medicine and technology, in addition to changes in social attitudes, have improved employment opportunities for people with disabilities, their employment rate has fallen since the early 1990s. Inadequate access to private health insurance, which can be expensive and may not cover needed services, is a critical barrier to employment. This report describes enrollment and participation in the Medicaid Buy-In program, part of the federal effort to make it easier for people with disabilities to work without losing health benefits. The report notes that enrollment in the Buy-In program continued growing steadily in 2003 and 2004 and that most program participants had experience with other disability-related public programs when they enrolled in the Buy-In program.
Medicaid Managed Care
 "The Medicaid Managed Care Program." Marsha Gold, Justin White, and Erin Fries Taylor. In To Improve Health and Health Care, Volume IX, 2005. In the 1990s, insurance companies and employers began to rely on managed care to control costs, and state governments followed suit by adopting managed care in Medicaid programs. To deal with the challenges associated with developing effective state Medicaid managed care programs, the Robert Wood Johnson Foundation developed the Medicaid Managed Care Initiative in 1995 to help states, health plans, and consumers build strong programs to reduce the cost and improve the quality of health care for low-income Americans. This chapter of the anthology describes the initiative and offers an assessment of it that builds on the program evaluation.
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 "Quality Improvement in Medicaid Managed Care: Experience of the Best Clinical and Administrative Practices Initiative." Marsha Gold, Tara Krissik, and Jessica Mittler. Journal on Quality and Patient Safety, February 2006. Although strategies such as pay-for-performance, accreditation, and consumer information to improve quality of care are proliferating, they are likely to be ineffective unless health plans and providers can respond by making appropriate changes and assessing the effectiveness of their interventions. This article describes and evaluates lessons from a recent initiative designed to help Medicaid managed care plans undertake such improvements—the Best Clinical and Administrative Practices initiative developed by the Center for Health Care Strategies and funded by the Robert Wood Johnson Foundation. The authors note that plans felt the collaborations helped them change the way they thought about quality improvement and take concrete steps to improve quality both in the short and long term. The initiative also highlighted challenges associated with change, including the need to enhance information technology to better measure and monitor the effects of interventions. |
Regional Differences in Early Care
 "Early Childhood Education: Regional Differences in Kindergarteners' Early Education Experiences." Emily Rosenthal, Amy Rathbun, and Jerry West. Education Statistics Quarterly, volume 7, 2006. Public funding for prekindergarten classes is growing, with most states currently supporting some type of prekindergarten initiative. This article describes kindergarteners' participation in preschool and kindergarten programs, as well as characteristics of the programs and the children who attended them, to provide a regional picture of their early learning experiences. It notes that certain child and family characteristics vary across regions, as do program characteristics and participation.
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Covering Kids and Families
 The Covering Kids and Families Program, an initiative of the Robert Wood Johnson Foundation, works to reduce the number of uninsured children and adults who are eligible for public health care coverage but who are not enrolled. By providing funds and technical assistance to community-based initiatives in every state, CKF helps states expand outreach, coordinate activities, and simplify application processes to enroll greater numbers of low-income children and families. Since August 2002, Mathematica has been evaluating the program. A number of reports on outreach, simplification, sustainability, coalitions, economic and political barriers, and access to care are available. Click here for details.
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Improving Health Care Quality
 "Hospital Responses to Public Reporting of Quality Data to CMS: 2005 Survey of Hospitals.” Mary Laschober, Myles Maxfield, Meredith Lee, Martha Kovac, Frank Potter, and Suzanne Felt-Lisk, October 2005. In April 2005, the Centers for Medicare & Medicaid Services and the Health Quality Alliance launched Hospital Compare, a web-based tool that helps acute care and critical access hospitals publish quality data for 17 clinical measures on heart attack, heart failure, and pneumonia. Approximately 4,200 hospitals across the country currently use Hospital Compare to disclose their scores for some or all of the 17 measures. On the basis of a nationally representative survey of senior hospital executives (typically the vice president of medical affairs or the chief medical officer) and directors of quality improvement departments, this report assesses how public reporting and Hospital Compare have affected hospitals. The assessment addresses experiences with public reporting; reactions of the media, payers, and purchasers to the data; changes in quality improvement efforts as a result of public reporting; and hospital leadership views on the federal role in future quality improvement programs, including pay for performance.
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Upcoming Presentations
Vice president Randy Brown will be presenting on consumer direction of home care and community-based services and implications for state and federal policy at the AcademyHealth policy seminar, "Building Bridges: Making a Difference in Long-Term Care." The event will be held on February 8 in Washington, DC. Get more information, or register. |
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