Health Policy Research

“Evidence of Trends, Risk Factors, and Intervention Strategies. A Report from the Healthy Start National Evaluation 2006: Racial and Ethnic Disparities in Infant Mortality.” So Sasigent O’Neil, Melanie Besculides, and Margo Rosenbach, June 2008. Experts believe that eliminating racial and ethnic disparities in birth outcomes is key to continued reduction in infant mortality in the United States. Healthy Start, a national initiative begun in 1991, is the largest program addressing disparities in birth outcomes. This paper provides an evidence base to support Healthy Start’s targeted interventions. It reviews risk factors that include prenatal care, folic acid use, periodontal care, infant sleeping position, breastfeeding, well-child care, interconceptional care, maternal smoking, alcohol and other drug use, adolescent pregnancy, perinatal depression, stress, domestic violence, and maternal birthweight.

"Report to Congress on the Evaluation of Medicare Disease Management Programs." Arnold Chen, Randall Brown, Dominick Esposito, Jennifer Schore, and Rachel Shapiro, February 2008. Before Medicare Part D, Congress authorized the Medicare disease management demonstration to evaluate whether disease management programs—in conjunction with a comprehensive prescription drug benefit—could improve health outcomes and reduce Medicare expenditures. The demonstration targeted fee-for-service Medicare beneficiaries with advanced congestive heart failure, diabetes, or coronary artery disease. This congressionally mandated study found that, based on the population-based random assignment design, none of the three demonstration programs had impacts on key outcomes of Medicare Part A and B expenditures and service use.

"Health Insurance Exchange Study." Deborah Chollet, Su Liu, Kate Stewart, Alison Wellington, Allison Barrett, Mila Kofman, and Amy M. Lischko, March 2008. In 2007, the state of Minnesota considered establishing a Health Insurance Exchange to serve small groups and individuals, facilitating access to coverage, choice among insurance products, portability of coverage, and affordability. Mathematica studied the coverage, cost, and fiscal impacts of a series of health reforms that might occur coincident with the implementation of the exchange—guaranteed issue and community rating of both small group and individual products, a mandate requiring all residents to obtain coverage, and a requirement that all employers with 11 or more employees offer a Section 125 or “cafeteria” plan. This report estimates the impacts of the reforms alone and in combination. In addition, it explores the range of implementation and legal issues that policymakers in Minnesota would need to address in order to develop an exchange.

“Health Care Access and Use Among Low-Income Children on Subsidized Insurance Programs in California.” Christopher Trenholm, Anna Saltzman, Shanna Shulman, Michael Cousineau, and Dana Hughes, May 2008. This paper summarizes the CaliforniaKids and Healthy Kids programs—county-based insurance programs in California for low-income children. The study examined features of both programs, use of basic health care services by the children enrolled, and typical experiences accessing inpatient and other high-cost care. Children enrolled in the two programs made substantial use of outpatient health care, despite important variation in program features. The study concludes with recommendations on how future research can more rigorously and precisely examine children's access and use of the programs.  

"A Profile of Medicaid Institutional and Community-Based Long-Term Care Service Use and Expenditures Among the Aged and Disabled Using MAX 2002." Audra T. Wenzlow, Robert Schmitz, and Kathy Shepperson, January 2008. This report examines how person-level data in the Medicaid Analytic eXtract (MAX) data system can be used to better understand long-term care service use and expenditures, and to evaluate the utility of MAX data for further study of long-term care. The authors compare expenditure and utilization-based measures of the balance of institutional and community-based long-term care services. They also examine long-term care expenditures and utilization for two key groups of enrollees—young disabled enrollees and enrollees ages 65 and older. The article decomposes community-based long-term care expenditures by type of service and summarizes other Medicaid services used and costs incurred in 2002. Executive Summary

"Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002." Audra T. Wenzlow, Robert Schmitz, and Jill Gurvey, January 2008. This report describes patterns of Medicaid nursing home utilization for each state and nationally. The authors address the following questions: (1) What are the characteristics of people who use Medicaid nursing home services? (2) How do these people become eligible for Medicaid? (3) How long do Medicaid-covered nursing home spells last and how often do individuals return to nursing homes? They also examine how state policies are associated with nursing home utilization. Executive Summary

More Reports

"Medicare Advantage in 2008." Marsha Gold, June 2008. Medicare Advantage (MA), a voluntary program that provides beneficiaries with an alternative way to access traditional Medicare benefits, replaced the Medicare+Choice program in 2004 and became fully operational in 2006. This issue brief reviews recent trends in the program and includes information trends in firm participation and market share, changes in beneficiary choice, and growth in MA plans available to employer groups. The brief notes that the number of Medicare beneficiaries in MA plans continues to grow, to 8.2 million at the end of 2007, up from 5.4 million in March 2005. In the first four months of 2008, enrollment increased by more than 800,000. Private fee-for-service plans account for more than half of this new growth. About one in five Medicare beneficiaries (19 percent) is enrolled in an MA plan. In addition, four main players—UnitedHealthcare, Humana, Kaiser, and Blue Cross Blue Shield—accounted for more than half of enrollment at the end of 2007.

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"Improving Processes and Increasing Efficiency: The Case for States Participating in a Process Improvement Collaborative." Sheila Hoag and Judith Wooldridge, September 2007. State Medicaid and SCHIP agencies provide vital health coverage to low-income populations and other groups, but they have limited administrative resources to support enrollment and renewal. This brief looks at experiences of some state Medicaid and SCHIP agencies in using a process change model to strengthen the way they approach enrollment and retention, concluding that committed leadership and resources are an effective model for changing Medicaid and SCHIP enrollment and retention processes rapidly and for sustaining improved processes. The brief also explores whether a process improvement collaborative is a worthwhile investment for states, finding that they have much to gain in terms of increased efficiency and savings using the model, which can be applied to any area of state administration.

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"Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families." In Brief #1. Christopher Trenholm, Embry Howell, Ian Hill, and Dana Hughes, November 2007. Since 2001, initiatives have emerged in 25 of California's 58 counties to expand health insurance coverage for children. These initiatives make use of a new insurance product, Healthy Kids, that covers children who are ineligible for Medi-Cal and Healthy Families, California's public programs for children in families with incomes up to 250 percent of the federal poverty level. This brief presents highlights from evaluations of Healthy Kids programs in Los Angeles, San Mateo, and Santa Clara counties. The brief notes that children's access to and use of medical care improved, unmet health care needs declined, and parents of children enrolled in Healthy Kids reported far more confidence that they could obtain care for their children.

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