Health Policy Research

Reports

• "The Medicaid Analytic eXtract 2008 Chartbook." Rosemary Borck, Allison Hedley Dodd, Ashley Zlatinov, Shinu Verghese, Rosalie Malsberger, and Cara Petroski, February 2012. A new Medicaid Analytic eXtract (MAX) chartbook summarizes the Medicaid program and the MAX data system. Developed for state Medicaid directors, policymakers, researchers, and others interested in the Medicaid program, the chartbook is a research tool and reference guide on Medicaid enrollees and their Medicaid experiences in 2008. It consists of illustrative graphs, descriptive text, and an extensive data appendix with summary national- and state-level information on enrollees' demographic and eligibility characteristics, Medicaid service use, and Medicaid expenditures in 2008, as well as trends in key enrollment and utilization patterns over time.
• "Movement of Children Between Medicaid and CHIP, 2005 to 2007." John L. Czajka, January 2012. This report uses Medicaid administrative records rather than survey data to examine children's movement between Medicaid and the Children's Health Insurance Program from 2005 through 2007. These data capture true changes in eligibility and provide a better source for estimating how often enrollment changes over time in a population of program participants.
• "Integrating Care for Dual Eligibles in New York: Issues and Options." James M. Verdier, Jenna Libersky, and Jessica Gillooly, February 2012. This report for the New York State Health Foundation provides recommendations for New York State as it works to improve the coordination and integration of care dual eligibles receive through Medicare and Medicaid. Key recommendations include using the federal dual eligible demonstration to support and enhance current state initiatives for dual eligibles and encouraging greater integration of all Medicaid and Medicare services in capitated managed care programs.
• "Medicare Contractor Provider Satisfaction Survey (MCPSS) Public Report." Bob Schmitz and Karen Bogen, July 2011, Revised December 2011. Each year, the Centers for Medicare & Medicaid Services conducts a survey of Medicare fee-for-service providers and suppliers to measure satisfaction with contractor performance, as required by the Medicare Prescription Drug, Improvement and Modernization Act of 2003. The MCPSS elicits information from all types of Medicare providers, such as hospitals, physicians, skilled nursing facilities, and laboratories, among others.
• "Children's Health Insurance Program: An Evaluation (1997-2010)." Interim Report to Congress. Sheila Hoag, Mary Harrington, Cara Orfield, Victoria Peebles, Kimberly Smith, Adam Swinburn, Matthew Hodges, Kenneth Finegold, Sean Orzol, and Wilma Robinson, December 2011. This interim report, the first of two reports to Congress, uses qualitative and quantitative data to document the development of the Children's Health Insurance Program (CHIP), particularly focusing on changes states have made since Congress reauthorized CHIP in 2009. The report found that CHIP and Medicaid have contributed to reducing the number and percentage of children without insurance. States have also made great progress in enrolling and retaining eligible children, but there is still room for improvement in program retention.

Journal Articles

• "Using Social Network Analysis to Predict Early Collaboration Within Health Advocacy Coalitions." Todd C. Honeycutt and Debra A. Strong. American Journal of Evaluation, June 2012 (subscription required). In consumer advocacy coalitions formed to advance health insurance coverage expansions, engaging in united advocacy activities soon after formation might be an important first step to effectively shape policy. This article uses social network analysis to examine how organizational characteristics and interorganizational relationships relate to early collaboration on advocacy activities. Findings suggest that organizations that have not worked together before can become engaged in collaborative activities at a relatively early stage. Furthermore, social network analysis techniques can be applied to advocacy evaluations.
• "Defining, Building, and Measuring Capacity: Findings from an Advocacy Evaluation." Debra A. Strong and Jung Y. Kim. The Foundation Review, March 2012 (subscription required). This article describes an evaluation of the Robert Wood Johnson Foundation's Consumer Voices for Coverage, an initiative supporting consumer health advocacy coalitions in 12 states, and suggests approaches to building and measuring capacity for advocacy or other nonprofit activities for funders to consider. The foundation based part of the program's strategy on a study that identified six core advocacy capacities, and designed it to strengthen these capacities. The level of funding, substantial and targeted technical assistance, and the program's three-year time frame contributed to observed increases in five capacities. Fundraising remained the lowest-rated capacity for most of the coalitions and may require different strategies.
• "Small, Nonteaching, and Rural Hospitals Continue to be Slow in Adopting Electronic Health Record Systems." Catherine M. DesRoches, Chantal Worzala, Maulik S. Joshi, Peter D. Kralovec, and Ashish K. Jha. Health Affairs, May 2012 (subscription required). In 2011, the federal government adopted new incentives to promote the meaningful use of health information technology. Correspondingly, from 2010 to 2011, the number of hospitals with an electronic health record system increased from 15 percent to nearly 27 percent. Depending on the type of hospital, however, the news is mixed. Researchers found substantial gaps in adoption rates of at least a basic electronic record system over the past four years based on hospital size, teaching status, and location. Small, nonteaching, and rural hospitals continue to adopt electronic health record systems more slowly than other types of hospitals.
• "Linkages to Care for Newly Diagnosed Individuals Who Test HIV Positive in Nonprimary Care Settings." Boyd Gilman, Julia Hidalgo, Cicely Thomas, Melanie Au, and Margaret Hargreaves. AIDS Patient Care and STDs, March 2012 (subscription required).This article examines successful models used by hospital emergency departments, health department outpatient clinics, and other nonprimary care providers for testing, linking, and engaging newly diagnosed HIV-positive racial and ethnic minorities into medical care. Effective linkage programs are low-cost, intensive, time-limited, unique, and flexible.
• "How Are the Costs of Care for Medical Falls Distributed? The Costs of Medical Falls by Component of Cost, Timing, and Injury Severity." Alex A. Bohl, Elizabeth A. Phelan, Paul. A. Fishman, and Jeffrey R. Harris. The Gerontologist, March 2012, online ahead of print (subscription required). This article examines the cost components that drive increased total costs after a medical fall over time, by severity of injury. The study found that large cost increases after a fall that resulted in hospitalization are mainly associated with inpatient and postacute care, while cost spikes after a fall that did not result in hospitalization are due to outpatient, ambulatory surgery, and community health services. However, the components driving cost increases varied throughout the year after the medical fall.
• "Obtaining Providers' 'Buy-In' and Establishing Effective Means of Information Exchange Will be Critical to HITECH's Success." Marsha R. Gold, Catherine G. McLaughlin, Kelly J. Devers, Robert A. Berenson, and Randall R. Bovbjerg. Health Affairs, March 2012 (subscription required). This article examines factors influencing the adoption and meaningful use of health information technology, as well as outstanding challenges to the long-term success of the Health Information Technology for Economic and Clinical Health (HITECH) provisions in the American Recovery and Reinvestment Act. Provider and patient support—as well as confidence that the technological capacity for the exchange of health information will evolve among diverse providers and geographic locales—are essential to achieving HITECH's goals. Despite early indications that HITECH has helped to expand both the use of electronic health records and practices that meet the initial federal standards for the meaningful use of health information technology, the ability to fulfill the goals behind the legislation depends heavily on sustaining stakeholder and policymaker support.
• "Medicare Advantage: Lessons for Medicare's Future." Marsha Gold. New England Journal of Medicine, March 2012. This article examines the lessons and limits of Medicare Advantage, private health plans, and market competition as proposed solutions to traditional Medicare's rising costs and growing eligibility rolls. Gold reviews Medicare's 30-year experience with voluntary private-plan enrollment—initially through HMOs and currently through Medicare Advantage plans—as an alternative to traditional Medicare.
• "Early Evaluations of the Medical Home: Building on a Promising Start." Deborah Peikes, Aparajita Zutshi, Janice L. Genevro, Michael L. Parchman, and David S. Meyers. The American Journal of Managed Care, February 2012 (subscription required). A new systematic review of evidence examines the effectiveness of the patient-centered medical home (PCMH) model on quality of care, affordability, and patient and professional experience. The review informs health care reform policy and program efforts and offers guidance on how to structure future evaluations. Although the evidence on PCMH precursors is inconclusive because of inadequacies in evaluation designs or analytic methods, the review found some favorable evidence on quality of care, hospital use, and patient experience among older, sicker patients served by these precursors.
• "Assessing Cultural Perspectives on Healthcare Quality." Ann D. Bagchi, Raquel af Ursin, and Alicia Leonard. Journal of Immigrant and Minority Health, February 2012 (subscription required). This article explores cultural differences in perceptions of quality of care and examines whether existing surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) questionnaires, adequately capture conceptions of care quality among members of racial or ethnic minority groups. The study found that members of racial and ethnic minority groups are more likely than whites to identify demonstrating cultural competency and providing a holistic approach to care as important to care quality, concepts not included in the core CAHPS^® questionnaire.
• "Organizing Care for Complex Patients in the Patient-Centered Medical Home." Eugene C. Rich, Debra Lipson, Jenna Libersky, Deborah N. Peikes, and Michael L. Parchman. Annals of Family Medicine, January/February 2012. Drawing on a white paper and brief for the Agency for Healthcare Research & Quality, this article summarizes strategies to help smaller primary care practices transform into medical homes that effectively serve patients with complex needs, particularly the frail elderly and working-age adults with disabilities.

Issue Briefs

• "Applying Advocacy Skills in Tumultuous Times: Adaptive Capacity of Insuring America's Children Grantees." Insuring America's Children States Leading the Way Evaluation Brief #3. Jung Y. Kim, Victoria Peebles, and Christopher A. Trenholm, April 2012. In 2007, the David and Lucile Packard Foundation established Insuring America's Children to help secure health care for all children. A new brief and executive summary document how state-based grantees responded and adapted to unprecedented changes in children's coverage over the past several years. As state economic and political contexts shifted, grantees adapted strategic partnerships, assuming new and expanded leadership roles in state-based coalitions and forging partnerships with nontraditional groups, such as the business community. With support from the national technical assistance center, they also strengthened their reach by serving as sources of timely and reliable analysis for state policymakers and other stakeholders. And they carried out campaigns, both public and behind-the-scenes, in support of their long-term goal of covering all children, focusing on consistent, positive messages to break through the gloomy economy and sometimes combative political atmosphere.
• "Orthogonal Design: A Powerful Method for Comparative Effectiveness Research with Multiple Interventions." Issue Brief. Jelena Zurovac and Randy Brown, April 2012. Orthogonal design affords an opportunity to design interventions in real-world settings and to study intervention components that can be implemented in various ways. This issue brief introduces orthogonal design, describes key design and implementation considerations, and illustrates how it can be applied in comparative effectiveness research studies.
• "Paying More for Primary Care: Can It Help Bend the Medicare Cost Curve?" Issue Brief. James D. Reschovsky, Arkadipta Ghosh, Kate Stewart, and Deborah Chollet, March 2012. This issue brief evaluates the effects of a permanent 10 percent increase in Medicare fees for primary care ambulatory visits on Medicare costs. Using a simulation model with real-world parameters, the study found that, in spite of raising the overall cost of primary care visits, such a fee increase would yield more than a sixfold annual return in lower total Medicare costs—mostly for inpatient and postacute care—after the full effects on treatment patterns are realized. Technical Appendices
• "Selection in Massachusetts' Commonwealth Care Program: Lessons for State Basic Health Plans." State Health Access Reform Evaluation (SHARE) Brief. Deborah Chollet, Allison Barrett, and Amy Lischko, February 2012. This brief analyzes risk selection over time in Massachusetts' Commonwealth Care program, which serves low-income adults ineligible for Medicaid, much like a Basic Health Plan under the Affordable Care Act. The authors offer lessons for other states considering whether to form a Basic Health Plan, looking at questions of program design, impacts on the commercial market, financing, and operations.
• "Health-e-App Public Access: A New Online Path to Children's Health Care Coverage in California. An Overview of the First Year." Study of Health-e-App Public Access, Research Brief #1. Leslie Foster, March 2012. Health-e-App Public Access (HeA PA) is a self-service, online application for California's Healthy Families Program. This research brief describes the potential benefits of HeA PA for applicants and the state enrollment system, as well as use of the tool during its first year. The study found that in 2011 about 50,000 applicants used HeA PA (about 19 percent of all applications).
• "Medicare Advantage 2012 Spotlight: Plan Availability and Premiums." Medicare Policy Data Spotlight. Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman, November 2011. This Data Spotlight reviews trends in Medicare Advantage plan offerings, choices available to beneficiaries, and the premiums and selected characteristics of the available plans in 2012. Despite concerns about the potential effects of reductions in payments included in the 2010 health reform plan, the number and type of Medicare Advantage plans offered in 2012 and premiums charged for them will be similar to those offered in 2011.
• "Using Data to Drive State Improvement in Enrollment and Retention Performance." Maximizing Enrollment: Transforming State Health Coverage Issue Brief. Christopher Trenholm, Mary Harrington, Andrew Snyder, and Alice M. Weiss, November 2011. The Maximizing Enrollment program has worked with eight states to help them use Medicaid and Children's Health Insurance Program enrollment and retention data to monitor and improve performance in enrolling and retaining eligible individuals. This issue brief summarizes 12 core performance measures that states can use to monitor how long individuals stay covered once they are enrolled, track the results of eligibility-related policy changes, determine trends in program performance, and track progress as they implement changes in eligibility and retention policies under health reform.

Working Papers

• "RDD Unplugged: Findings from a Household Survey Using a Cell Overlap Design." John Hall, Barbara Lepidus Carlson, and Karen CyBulski, December 2011. This working paper presents methodological findings from the latest round of the Health Tracking Household Survey, which added a cell phone sample to the existing landline sample of random telephone numbers to increase the coverage of the U.S. population.
• "An Assessment of the Effectiveness of Anti-Poverty Programs in the United States." Yonatan Ben-Shalom, Robert A. Moffitt, and John Karl Scholz, May 2011. This paper assesses the effectiveness of means-tested and social insurance programs in the United States. The U.S. benefit system has a major impact on poverty rates, reducing the percentage of the poor in 2004 from 29 to 13.5 percent. The system reduces poverty the most for persons with disabilities and the elderly and least for several groups among the nonelderly and nondisabled. While there are significant behavioral side effects of many programs, their aggregate impact is very small and does not affect the magnitude of the aggregate poverty impact of the system.

Other

• "Coordinating Care for Adults with Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions." White Paper. Eugene Rich, Debra Lipson, Jenna Libersky, and Michael Parchman, January 2012. Patients with complex health needs require both medical and social services and support from multiple providers and caregivers, and the patient-centered medical home (PCMH) offers a promising model for providing them comprehensive, coordinated care. Smaller practices, however, face challenges in coordinating care for these patients. This white paper for the Agency for Healthcare Research and Quality explores the current landscape of PCMH services for patients with complex needs. It details five programs that have addressed the challenges of caring for these patients, and offers programmatic and policy changes that can help smaller practices better deliver services to all patients, including those with the most complex health needs.
• "Developing and Running a Primary Care Practice Facilitation Program: A How-To Guide." Lyndee Knox, Erin Fries Taylor, Kristin Geonnotti, Rachel Machta, Jung Kim, Jessica Nysenbaum, and Michael Parchman, December 2011. Working with the Agency for Healthcare Research and Quality and LA Net, we developed a manual on creating and implementing successful practice implementation programs. This guide provides information on how to start and run a program to work with primary care practices on quality improvement, with an emphasis on redesign and transformation. It covers how to develop, design, and administer programs.
• "Building the Evidence Base for the Medical Home: What Sample and Sample Size Do Studies Need?" White Paper. Deborah Peikes, Stacy Dale, Eric Lundquist, Janice Genevro, and David Meyers, October 2011. Evaluations of the patient-centered medical home, a model that redesigns primary care, should account for clustering of patients within practices. This paper describes why and how to do this, and what samples of patients and practices are needed for studies to achieve adequate statistical power.