Health Policy Research

Reports

• "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.
• "Consumer Voices for Coverage: Advocacy Evaluation Toolkit." Consumer Voices for Coverage Evaluation. Debra A. Strong, Todd Honeycutt, and Judith Wooldridge, October 2011. This toolkit is designed to help advocacy organizations, evaluators, and other groups collect and analyze data using the instruments and methods Mathematica used in its Consumer Voices for Coverage evaluation. It includes surveys of advocacy coalition members, interviews with policymakers, and measures of coalition advocacy capacity.
• "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.
• "Money Follows the Person 2010 Annual Evaluation Report." Carol Irvin, Debra Lipson, Audra Wenzlow, Samuel Simon, Alex Bohl, Matthew Hodges, and John Schurrer, October 2011. This is the second annual report on the Money Follows the Person (MFP) demonstration, a federal initiative to help states reduce their reliance on institutional care for people needing long-term care and expand options for elderly people and individuals with disabilities to receive care in the community. During 2010, MFP increased the number of Medicaid beneficiaries transitioned by more than 50 percent over the previous year and expanded into 13 additional states. By the end of 2010, nearly 12,000 beneficiaries transitioned to community living through MFP programs, and participants generally fared well in the community and improved their quality of life.
• "Long-Term Care Utilization and Expenditures Among American Indian/Alaska Native Medicaid Recipients." Laura Ruttner and Carol Irvin, May 2011. This report uses Medicaid Analytic eXtract data to provide basic information about American Indian and Alaska Native Medicaid enrollees and their use of Medicaid-financed long-term care services. The data suggest that American Indian/Alaska Native Medicaid recipients use long-term care services at a slightly lower rate than the general Medicaid population, and home and community-based services account for a greater percentage of their long-term care expenditures, compared to other Medicaid recipients.
• "Association Health Plans and Community-Rated Small Group Health Insurance in Washington State." Deborah Chollet, Jessica Nysenbaum, Allison Barrett, Eric Morris, and James Matthisen, September 2011. In Washington State, association health plans operate under different regulations from the traditional insurance market, allowing carriers to separate and select risk. To help assess the relationship between these plans and the community-rated small-group market, this report offers an analysis of information on enrollment trends, premiums, and medical costs provided by carriers to the Office of the Insurance Commissioner supplemented with additional carrier and association information reported to the National Association of Insurance Commissioners and the U.S. Department of Labor.
• "Massachusetts Health Care Cost Trends: Price Variation in Health Care Services." Analytics and research provided by division staff, Mathematica Policy Research, and Freedman Associates, May 2011, revised June 2011. This report examines prices that private health plans paid for high-volume inpatient hospital services, outpatient hospital services, and physician and other professional services, finding significant price variation for every service. For selected inpatient services with quality measures available, the research team found no variation in hospital quality corresponding to differences in price. Medicaid rates were consistently lower than the prices private payers paid for both inpatient services and physician and professional services. Private payer prices generally were higher than Medicare rates and did not correlate with Medicare's cost-based prices. The report also estimates the potential impacts of alternative models to reduce or eliminate the current level of price variation.
• "Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2007." Ann D. Bagchi, James Verdier, and Dominick Esposito, May 2011. This chartbook, prepared for the Centers for Medicare & Medicaid Services, presents highlights and key comparisons from the state-by-state and national tables in the statistical compendium on Medicaid pharmacy benefit use and reimbursement in 2007.
• "Reducing Hospital Readmissions in New York State: A Simulation Analysis of Alternative Payment Incentives." Deborah Chollet, Allison Barrett, and Timothy Lake, September 2011. This report estimates the effects of reimbursement strategies and provider-level interventions to reduce hospital readmissions. Several quality-improvement interventions have proved effective in reducing readmission rates, but relatively few hospitals have adopted these programs, in large part due to lack of financial incentives. The report examines whether new pay-for-performance and episode-based payment approaches provide incentives for these programs. The report also explores an alternative direct payment model that could be more effective than current strategies.
• "Evaluation of Healthy San Francisco." Catherine McLaughlin, Margaret Colby, Erin Taylor, Mary Harrington, Tricia Higgins, Vivian Byrd, and Laurie Felland, August 2011. This report summarizes a comprehensive evaluation of Healthy San Francisco, a program for uninsured adults ages 18 to 64. The evaluation found that program participants regularly receive outpatient care at their medical homes, including recommended preventive services; are using fewer emergency department services; and appreciate improved access to primary care and less uncertainty in meeting their health care needs. In general, providers also expressed satisfaction with the program and intended to continue participating.

Journal Articles

• "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.
• "Regulating Abortion: Impact on Patients and Providers in Texas." Silvie Colman and Ted Joyce. Journal of Policy Analysis and Management, July 2011 (subscription required). This article describes the effects of enforcement of the Woman's Right to Know Act, a Texas law requiring that all abortions at or after 16 weeks' gestation be performed in an ambulatory surgical center. In the month the law went into effect, none of the 54 nonhospital abortion providers in Texas met the requirements of a surgical center. The number of abortions performed in Texas at or after 16 weeks' gestation dropped 88 percent, from 3,642 in 2003 to 446 in 2004, and the number of residents who left the state for a late abortion almost quadrupled. By 2006, abortions at or after 16 weeks' gestation in a nonhospital setting were available in four major cities in Texas (down from nine in 2003), and the abortion rate at or after 16 weeks' gestation remained 50 percent below its pre-act level.
• "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.
• "Progress Toward Meaningful Use: Hospitals' Adoption of Electronic Health Records." Ashish K. Jha, Matthew F. Burke, Catherine DesRoches, Maulik S. Joshi, Peter D. Kralovec, Eric G. Campbell, and Melinda B. Buntin. The American Journal of Managed Care, December 2011 (subscription required). This article found that more than 15 percent of U.S. hospitals have adopted at least a basic electronic health record (EHR), representing nearly 75 percent growth since 2008. Approximately two-thirds plan to apply for meaningful use before 2013. However, only 4.4 percent had implemented each of the core meaningful use functionalities measured. Overall, hospitals will have to accelerate adoption of EHRs above the current pace to participate in meaningful use.
• "Health Information Exchange Among US Hospitals." Julia Adler-Milstein, Catherine M. DesRoches, and Ashish K. Jha. The American Journal of Managed Care, November 2011 (subscription required). At the start of implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act, this article found that a minority of U.S. hospitals, 10.7 percent, exchange clinical data electronically with unaffiliated providers.
• "Rethinking the Mental Health Treatment Skills of Primary Care Staff: A Framework for Training and Research." Jonathan D. Brown and Lawrence S. Wissow. Administration and Policy in Mental Health and Mental Health Services Research, September 2011 (subscription required). Health care reform may provide opportunities to enhance the mental health treatment capacity of primary care, but capitalizing on these opportunities might require bolstering the clinical skills of the primary care team. This article proposes a set of core mental health treatment and communication skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians.
• "Unintended Pregnancy and Perinatal Depression Trajectories in Low-Income, High-Risk Hispanic Immigrants." Anna L. Christensen, Elizabeth A. Stuart, Deborah F. Perry, and Huynh-Nhu Le. Prevention Science, September 2011 (subscription required). This article identifies depressive symptom trajectories and heterogeneity in these trajectories during pregnancy and through the first year postpartum, and examines the association between unintended pregnancy and depressive symptoms among low-income Hispanic immigrants. Three distinct trajectory patterns of depressive symptoms were identified: high during pregnancy, but low postpartum; borderline during pregnancy, with a postpartum increase; and low throughout pregnancy and postpartum. Unintended pregnancy was associated with a nearly fourfold increase in the risk of postpartum depressive symptoms.
• "Correlates of Unintended Birth Among Low-Income Hispanic Immigrants at High Risk for Depression." Anna L. Christensen, Deborah F. Perry, Huynh-Nhu Le, and Saifuddin Ahmed. Journal of Immigrant and Minority Health, June 2011 (subscription required). This article examines the sociodemographic, including immigration-related, correlates of unintended birth among Hispanic immigrants. The study found that, similar to nationally representative findings, unintended birth was more common among younger women, single women and women not cohabiting with their partners, and women with more children. Additionally, women who had immigrated to the U.S. less than one year ago had almost a four times greater risk of a mistimed birth compared to women who had immigrated one to four years ago.
• "Economic Costs of Excessive Alcohol Consumption in the U.S., 2006." Ellen E. Bouchery, Henrick J. Harwood, Jeffrey J. Sacks, Carol J. Simon, and Robert D. Brewer. American Journal of Preventive Medicine, November 2011. Excessive alcohol drinking is the third leading cause of death in the United States, leading to 79,000 premature deaths annually. It is also the cause of increased disease and injury. Although the public health impacts of binge drinking are known, its economic cost has not been assessed for the United States since 1998. Using data from 2006, a new study by Mathematica assessed costs for health care, productivity losses, and other effects, including property damage, from excessive drinking. On a per-capita basis, the economic impact of excessive alcohol consumption is approximately $746 per person, mostly attributable to binge drinking.
• "Workload and the Nurse Faculty Shortage: Implications for Policy and Research." Angela M. Gerolamo and Grace F. Roemer. Nursing Outlook, September 2011 (subscription required). Findings in this article indicate that little is known about the extent to which the workload of nursing faculty has contributed to the current nurse faculty shortage. The authors suggest that conducting an in-depth comparative analysis of the workload of nursing faculty and faculty from other academic disciplines would provide a more comprehensive picture. A better understanding of the workload and its influence on the nurse faculty shortage will facilitate prioritization of strategies to address the national shortage. If long-term solutions to the shortage are not identified, an inadequate nursing workforce will continue to contribute to the uncertainty of the U.S. health care system.
• "Health Information Technology in the Workplace: Findings from a 2010 National Survey of Registered Nurses." Catherine M. DesRoches, Paola Miralles, Peter Buerhaus, Robert Hess, and Karen Donelan. Journal of Nursing Administration, September 2011 (subscription required). This article examines registered nurses' experiences with health information technology and reports that their perceptions of its effect on quality of care and daily work were positive.
• "The Influence of Changes in Dental Care Coverage on Dental Care Utilization Among Retirees and Near-Retirees in the United States, 2004-2006." Richard J. Manski, John F. Moeller, Patricia A. St. Clair, Jody Schimmel, Halyan Chen, and John V. Pepper. American Journal of Public Health, October 2011 (subscription required). This article examines transitions in dental care insurance coverage and utilization between 2004 and 2006 among older adults in the United States. Using data from the Health and Retirement Study, it found that Americans age 51 years and older who lost coverage during the time period were more likely to stop using dental care, while those who gained coverage were more likely to start using dental care, compared with individuals who lacked coverage in both years.
• "Child Care in Outpatient Substance Abuse Treatment Facilities for Women: Findings from the 2008 National Survey of Substance Abuse Treatment Services." Jonathan David Brown, Sonya Vartivarian, and Cathie E. Alderks. Journal of Behavioral Health Services & Research, October 2011 (subscription required). This article examines the availability of child care in outpatient substance abuse treatment facilities and whether certain facility characteristics were associated with child care availability. Using data from the 2008 National Survey of Substance Abuse Treatment Services, 6.5 percent of outpatient substance abuse treatment facilities that served women provided child care. Child care was more common among facilities located in metropolitan areas, operated by nonprofit or government agencies, and those that received public funding or provided free or ancillary support services.
• "Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis." Leslie Jackson Conwell, Dominick Esposito, Susan Garavaglia, Eric S. Meadows, Margaret Colby, Vivian Herrera, Seth Goldfarb, Daniel Ball, and Martin Marciniak. American Journal of Geriatric Pharmacotherapy, August 2011. This article found that medication discontinuation and out-of-pocket costs among beneficiaries with osteoporosis were highest for those enrolled in Medicare Part D plans with a coverage gap.
• "Promising Therapies, Prohibitive Costs: A Qualitative Assessment of the Effects of the Medicare Part D Doughnut Hole on Access to Costly Cancer Medications." Leslie Jackson Conwell, Dominick Esposito, Margaret Colby, Daniel Ball, Eric S. Meadows, and Martin Marciniak. Community Oncology, March 2011. This article highlights financial barriers associated with the Medicare Part D doughnut hole gap and their effect on beneficiaries’ access to oral anticancer targeted therapies. In semistructured telephone discussions with oncology social workers and nurse practitioners, beneficiaries reported that high costs pose considerable financial barriers. Some cease therapy when they reach the doughnut hole, but others get assistance from copayment foundations or manufacturers’ patient assistance programs. Higher-income beneficiaries may draw on savings or incur debt. Furthermore, recently passed health care reform legislation may not fully address these barriers.
• "Physical Activity in U.S. Adults: Compliance with the Physical Activity Guidelines for Americans." Jared M. Tucker, Gregory J. Welk, and Nicholas K. Beyler. American Journal of Preventive Medicine, April 2011 (subscription required). This study assesses self-reported and objectively measured physical activity among U.S. adults according to the 2008 Physical Activity Guidelines for Americans. The National Health and Nutrition Examination Survey of 2005–2006 found that fewer than 10 percent of U.S. adults met the guidelines. However, physical activity estimates vary substantially depending on how they are reported and measured.
• "Successful Strategies for Educating Hard-to-Reach Populations: Lessons Learned from Massachusetts' Train-the-Trainer Project Using the Helping You Take Care of Yourself Curriculum." Melanie Besculides, Lisa Trebino, and Heather Nelson. Health Education Journal, online ahead of print, March 2011 (subscription required). This article found that implementing a “train-the-trainer” approach allowed community-based organizations to expand their reach in conducting a standardized health education curriculum on breast, cervical, and cardiovascular health educating more than 2,000 hard-to-reach women. The strategies employed can be applied to other health education programs.

Issue Briefs

• "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.
• "State Options for Integrating Physical and Behavioral Health Care." Integrated Care Resource Center Technical Assistance Brief. Allison Hamblin, James Verdier, and Melanie Au, October 2011. This brief, prepared by Mathematica and the Center for Health Care Strategies for the Centers for Medicare & Medicaid Services Integrated Care Resource Center, explores promising state options for integrating physical and behavioral health services for high-need, high-cost Medicaid populations within a variety of care management delivery systems. It includes examples of current state programs and critical considerations for implementation.
• "Improving Evaluations of the Medical Home." Patient-Centered Medical Home Decisionmaker Brief. David Meyers, Deborah Peikes, Stacy Dale, Eric Lundquist, and Janice Genevro, September 2011. This issue brief provides a concise description for decision makers of why and how to commission effective evaluations of patient-centered medical home demonstrations. The authors discuss what outcomes to assess, why to include comparison practices, and the importance of accounting for clustering.
• "Supporting Family Caregivers Through Title III of the OAA." Putting Data to Work for Older People Research Brief #5. Leslie Foster and Rebecca Kleinman, September 2011. This brief, the fifth in a series that presents findings from the Administration on Aging's National Survey of Older Americans Act (OAA) Program Participants, focuses on the National Family Caregiver Support Program. Authorized under OAA Title III in 2000, the program provides caregivers with information or help so they can connect with services and resources; training, education, counseling, and support groups; respite care; and supplemental goods and services.
• "Web-Based Screeners and Applications: Potential Tools for Improving Benefit Access and Program Efficiency." ASPE Issue Brief. Emily Sama-Miller and Jacqueline Kauff, September 2011. This issue brief draws on findings from eight case studies of web‐based benefit access tools and provides a framework for thinking about their design and operation in order to improve efficiencies and increase benefit access.
• "Prescription Drug Use and Cost Among Medicaid Beneficiaries with Disabilities and Chronic Illnesses." Issue Brief. James M. Verdier, Ann D. Bagchi, and Dominick Esposito, September 2011. This issue brief highlights a number of prescription drug issues that remain important for states after the shift of prescription drug coverage for Medicaid-Medicare dual eligibles to Medicare in 2006, including the use of antipsychotic drugs in nursing facilities and other settings. It focuses on Medicaid-only beneficiaries younger than 65 with disabilities and chronic illnesses, who now account for more than 60 percent of total Medicaid prescription drug spending and whose care is increasingly being provided through managed care organizations.
• "Consumer and Provider Perspectives on Shared Decision Making: A Systematic Review of the Peer-Reviewed Literature." Issue Brief. Nyna Williams and Chris Fleming, September 2011. This brief reports on findings from a systematic review of the peer-reviewed literature on consumer and provider perspectives on shared decision making, the process by which consumers join providers in the clinical decision-making process. The use of comparative effectiveness research rests on greater engagement in shared decision making by providers and consumers.
• "Medicare Advantage Enrollment Market Update." Medicare Advantage 2011 Data Spotlight Brief. Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman, September 2011. This data spotlight examines enrollment trends in Medicare Advantage plans in 2011 and finds that enrollment continued to rise and enrollees are paying lower premiums, on average, than they did in 2010. Preferred Provider Organizations gained more enrollees than any other plan type, while enrollment in private fee-for-service plans continued to decline.
• "Firm Perspectives on the Medicare Advantage Market." Issue Brief. Marsha Gold, Gretchen Jacobson, and Tricia Neuman, September 2011. Based on interviews with senior executives at 14 large firms, this issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that awards bonus payments to plans based on their quality standards.
• "Special Needs Plans: Availability and Enrollment." Medicare Advantage 2011 Data Spotlight Brief. Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman, September 2011. This data spotlight examines availability and enrollment trends for Medicare Advantage Special Needs Plans, which provide a managed care option for beneficiaries with significant or relatively specialized care needs. These plans account for a small share of Medicare enrollment today, but are viewed by some as a way to address coordination of care and costs issues for dual eligible beneficiaries enrolled in both Medicare and Medicaid.
• "A First Look at How MFP Participants Fare After Returning to the Community." The National Evaluation of the Money Follows the Person (MFP) Demonstration Grant Program, Reports from the Field #7. John Schurrer and Audra Wenzlow, July 2011. This report examines characteristics and outcomes for Money Follows the Person (MFP) participants in 25 states who returned to the community before March 2010. The report's findings indicate that reinstitutionalizations were most likely to occur in the first few months after transition, and that participants were more likely to remain in the community but tended to be younger than beneficiaries who transitioned prior to MFP.
• "Exploring the Promise of Population Health Management Programs to Improve Health." Issue Brief. Suzanne Felt-Lisk and Tricia Higgins, August 2011. Population health management programs—programs targeted to a defined population that use a variety of individual, organizational, and societal interventions to improve health outcomes—are increasingly being looked on by large employers as a promising practice for improving health and outcomes and "bending" the health care cost curve. Given the national focus on the Center for Medicare & Medicaid Services' administrator Donald Berwick's "triple aim" of improving population health and care as well as reducing per capita health care costs, a new issue brief looks at the state of population health management programs, highlights related evidence, examines desirable features, and explores their potential.
• "Multiple Chronic Conditions Among OAA Title III Program Participants." Putting Data to Work for Older People, Research Brief #4. Rebecca Kleinman and Leslie Foster, July 2011. This brief, the fourth in a series that presents findings from the Administration on Aging's National Survey of Older Americans Act Program Participants, explores the prevalence of and challenges associated with multiple chronic conditions among program participants.
• "Identifying, Monitoring, and Assessing Promising Innovations: Using Evaluation to Support Rapid-Cycle Change." The Commonwealth Fund Brief. Marsha Gold, David Helms, and Stuart Guterman, June 2011. This issue brief examines the mission of the Center for Medicare and Medicaid Innovation, as well as challenges in balancing relevance and rigor to learn how to improve payment and delivery.
• "Fostering Health Information Technology in Small Physician Practices: Lessons from Independent Practice Associations." National Institute for Health Care Reform Research Brief #5. Timothy K. Lake, Tricia Collins Higgins, and Paul B. Ginsburg, June 2011. This study found that independent practice associations—networks of small medical practices—can offer a useful model for helping small physician practices overcome barriers to health information technology adoption and use.
• "Strategies to Ensure HITECH Supports the Patient-Centered Medical Home." Patient-Centered Medical Home Decisionmaker Brief. Lorenzo Moreno, Deborah Peikes, and Amy Krilla, February 2011. To help transform primary care delivery and support the patient-centered medical home, the Health Information Technology for Economic and Clinical Health (HITECH) Act supports adoption and meaningful use of electronic health records. This brief offers policy options that could ensure health technology efforts are implemented in a way that help transform primary care.
• "The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care." Patient-Centered Medical Home Decisionmaker Brief. Deborah Peikes, Janice Genevro, Sarah Scholle, and Phyllis Torda, February 2011. This brief offers strategies for decision makers for the patient-centered medical home to respond to and reflect the goals, preferences, and needs of patients and their families. Patients' involvement in the medical home should take place on three levels: (1) engagement in their own care, (2) quality improvement in the primary care practice, and (3) development and implementation of policy and research.
• "Coordinating Care in the Medical Neighborhood: Critical Components and Available Mechanisms." Erin Fries Taylor, Timothy Lake, Jessica Nysenbaum, Greg Peterson, and David Meyers, June 2011. This white paper examines key components in the medical neighborhood and how the patient-centered medical home is situated within it. It also addresses barriers to a well-functioning neighborhood, the tools available to achieving one, and the strengths and weaknesses of each tool.
• "Choosing Wisely: Selecting Outcomes for Comparative Effectiveness Research on Services for Adults with Disabilities." Debra Lipson, Matthew Kehn, and Eugene Rich, July 2011. This issue brief lays out criteria to help researchers select and report on the outcomes that matter most to adults with disabilities and to the providers and others responsible for their care.
• “Matching Study Designs to Research Questions in Disability-Related Comparative Effectiveness Research." Jeffrey Ballou, Eugene Rich, and Matthew Kehn, July 2011. Individuals with disabilities have complex characteristics and health service needs, which can make strong study design and implementation a challenge. Because of this complexity, randomized controlled trials, the “gold standard” of study design to evaluate evidence, may not always be necessary or even ethical. This research brief offers strategies and guidance help researchers enlarge the set of study designs to help use comparative effectiveness to answer disability-relevant health care questions.
• "Comparative Effectiveness of Care Coordination for Adults with Disabilities." Melanie Au, Samuel Simon, Arnold Chen, Debra Lipson, Gilbert Gimm, and Eugene Rich, July 2011. Care coordination for adults with disabilities is typically marked by costly services delivered by a variety of providers, but comparative effectiveness research can help address these challenges. This research brief presents a framework for describing the range of personal characteristics, services, outcomes, and financing issues to consider in a systematic review of care coordination. It also presents key findings from a systematic review of the recent care coordination literature, summarizes what additional information is needed, and discusses implications for future research on which care coordination strategies work best for various disabled populations.

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

• "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.
• "Could There Be a Role for Home Telemedicine in the U.S. Medicare Program?" Lorenzo Moreno, Arnold Chen, Rachel Shapiro, and Stacy Dale. In Advances in Telemedicine: Technologies, Enabling Factors and Scenarios, edited by Georgi Graschew, March 2011. This book chapter looks at the CMS-funded Informatics for Diabetes Education and Telemedicine demonstration. The chapter summarizes participants’ use of the technology, intervention effects on intermediate clinical outcomes, intervention effects on Medicare services’ use and cost, and demonstration costs during the two phases. It also discusses policy implications of the findings in the context of health reform, particularly the potential role of home telemedicine in Medicare.
• "Prenatal Case Management of Pregnant Women: What Is the Evidence for Its Contribution to a Reduction of Disparities in Perinatal Outcomes?" L. Michele Issel, Jaime C. Slaughter, and Sarah G. Forrestal. In Reducing Racial/Ethnic Disparities in Reproductive and Perinatal Outcomes: The Evidence from Population-Based Interventions, edited by Arden Handler, Joan Kennelly, and Nadine Peacock, 2011. This chapter reviews studies of prenatal case management for vulnerable populations and assesses whether it improves birth outcomes and reduces racial and ethnic disparities in these outcomes.