New Publications
Care for Chronic Conditions
 "Coordinating Care for Medicare Beneficiaries: Early Experiences of 15 Demonstration Programs, Their Patients, and Providers. Report to Congress." Randall Brown, Jennifer Schore, Nancy Archibald, Arnold Chen, Deborah Peikes, Karen Sautter, Sherry Aliotta, and Todd Ensor, May 2004. Chronic illnesses such as arthritis, heart disease, and diabetes afflict many individuals and create major costs for Medicare. Most Medicare HMOs have developed programs or contracted with disease management or case management providers for programs designed to improve care for people with chronic illnesses. This report provides an early look at 15 demonstration programs designed to test whether these approaches can achieve similar results in Medicare fee-for-service. Although it is too early in the study to estimate effects on service use or costs, the authors note that clients and physicians have been responding favorably to the programs. Compared with a control group, program clients report better access to information and appointments, better communication among providers, and greater understanding of their conditions. A majority of physicians for participating clients thought that the program improved patient care, helping them identify previously unknown client problems and influencing their clinical decisions in some cases.
 “Evaluation of the Program for Elders in Managed Care.” Marsha Gold, Timothy Lake, and William Black, March 2005. Elders who are frail because of disability, multiple chronic conditions, and other factors account for a growing share of the population, yet they are often poorly served by a health care system that is focused on acute care episodes. This report for the California HealthCare Foundation examines its Program for Elders in Managed Care, a five-year $15 million initiative begun in 1997 to encourage better linkages between plans, providers, and community organizations to improve care delivery. Findings show that flaws in concept, design, and implementation made it challenging to achieve intended goals, especially those involving cost and utilization reductions.
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State Health Care Issues
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“The Demand for Dialysis Care in Vermont: 2005-2014.” Robert Schmitz, So Sasigant Limpa-Amara, and Amy O’Sullivan, March 2005. Analyzing the demand for dialysis care in Vermont over the next 10 years, Mathematica’s researchers found that demand will grow between 75 and 136 percent; most state dialysis centers will be oversubscribed by 2014 even with the addition of a new center in Newport; the addition of a Newport center aids in reducing travel time in some counties, but travel time would still exceed 60 minutes for a couple of counties (the standard specified in Vermont’s certificate of need guideline); and the number and proportion of patients projected to receive dialysis treatment out of state will increase steadily over time. Consequently, Vermont may have to consider further expansion of capacity to meet potential growth in demand. Available in print only; call 609-275-2350.
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Covering Kids
 “Evaluation of the San Mateo County Children’s Health Initiative: First Annual Report.” Embry Howell (Urban Institute), Dana Hughes (University of California San Francisco), Holly Stockdale (Urban Institute), and Martha Kovac (Mathematica), April 2004. Launched in January 2003, the Children's Health Initiative is designed to ensure that 100 percent of the county’s children have access to comprehensive health insurance coverage through increasing the number of children enrolled in existing public health insurance programs (Healthy Families and Medi-Cal) and establishing a new insurance product, Healthy Kids, for children not eligible for public- or employer-based insurance. Early findings from the five-year evaluation include rapid enrollment growth in Healthy Kids, with most of the children coming from poor immigrant families; low rates of service use for Healthy Kids compared to Healthy Families and Medi-Cal; some decline in hospital admissions and emergency room visits for uninsured children; and strengthened communitywide collaboration to address issues of the uninsured.
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Race, Poverty, and Domestic Policy
 "Earnings of Black and White Youth and Their Relation to Poverty." Philip M. Gleason and Glen G. Cain. In Race, Poverty, and Domestic Policy, edited by C. Michael Henry, 2004. The paper examines how unemployment among African American teenage males influences rates of family poverty. The authors suggest that, if the employment and earnings of young black males were similar to those of young white males, the poverty rate among black families would be substantially reduced.
"How Much More Can They Work? Setting Realistic Expectations for Welfare Mothers." LaDonna Pavetti. In Race, Poverty, and Domestic Policy, edited by C. Michael Henry, 2004. This paper uses data from the National Longitudinal Survey of Youth to examine young women's work experiences over a fixed period to gauge how much additional work can be realistically expected from young welfare recipients. The analysis suggests that, even if states succeed in getting the most disadvantaged young welfare recipients into the labor market, the women are likely to continue to experience substantial periods of joblessness and may continue to need access to a safety net for an extended period.
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