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Health Policy Research
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 At a time when health care costs are consuming more than 15 percent
of our gross domestic product and straining state and federal budgets,
policymakers need timely and reliable information on the effectiveness
of health care investments and an accurate analysis of what needs remain
unmet. Our policy analysis for federal and state agencies and the health
care industry helps them respond to these challenges. Using the most current
and effective methods, we collect and analyze data, evaluate programs,
summarize policy implications, identify solutions, and translate results
into practice. Read more about our health research and our work on health reform. |
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Cash and Counseling Evaluation Team Wins HSR Award for High-Impact Research
 A study conducted by Mathematica won AcademyHealth's Health Services Research Impact Award for 2009. The study team was led by Randall Brown, principal investigator on the Evaluation of Three Cash & Counseling Programs, a three-state demonstration that tested an innovative form of expanded consumer direction for Medicaid beneficiaries who are frail or have disabilities. Read the release. |
Spotlight on National Health Care Reform: How Mathematica Informs the Debate
 Reforming our nation’s health care system will dominate much of the policy debate in 2009 and beyond. This system, which accounts for 16 percent of our economy, produces hundreds of life-saving marvels every day, yet fails to provide affordable health care for all Americans. Mathematica researchers have contributed to the base of research and data that will help guide the policy debate. Read more about our work on health care reform issues. |
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Reports: |
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"The National Health Plan Collaborative: Overview of Its Origins, Accomplishments, and Lessons Learned." Erin Fries Taylor and Marsha Gold, April 2009. The National Health Plan Collaborative (NHPC) was formed in 2004 to bring together national and regional health plans to reduce racial and ethnic disparities. This brief summarizes findings from Mathematica’s evaluation, provides background, and describes accomplishments. It also reviews the NHPC toolkit, which the group used to disseminate its work. Many plans improved organizational commitment to reducing disparities but barriers remain. The current recession may hamper work as financial and other concerns receive higher priority. Moreover, most employers are not attuned to disparities and may become less so in light of current economic conditions. Nonetheless, opportunities lie ahead.
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"An Illustrative Analysis of Medicare Options Compare: What’s There and What’s Not?" Marsha Gold, April 2009. Medicare Options Compare, a website maintained by the Centers for Medicare & Medicaid Services (CMS), helps beneficiaries choose among available Medicare Advantage plans. This AARP brief identifies strengths and weaknesses of the site. On one hand, it helps beneficiaries identify health plan choices available in their zip code and provides an extensive amount of information on these choices. On the other hand, beneficiaries might have trouble interpreting some of the information. Though the site limitations partly reflect the complexity of the program, CMS could enhance the website’s usefulness by restructuring some of the information to better support beneficiary choice.
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“Final Report to Congress on the Informatics for Diabetes Education and Telemedicine (IDEATel) Demonstration, Phases I and II.” Lorenzo Moreno, Rachel Shapiro, Stacy Dale, Leslie Foster, and Arnold Chen, September 2008. The IDEATel demonstration tested the effects of providing home-based telemedicine services to a large number of eligible Medicare beneficiaries who had diabetes and lived in medically underserved areas in New York City and upstate New York. This report updates two earlier reports to Congress and draws conclusions on demonstration impacts. The demonstration met the requirements set by Congress for implementation; however, as delivered, it was neither as intensive nor as technologically sophisticated as originally designed. The evaluation found IDEATel to be clinically effective in only one site and to have no effects on Medicare Total, Part A, and Part B expenditures or the use of expensive services, such as hospital care. The intervention’s costs were excessive (over $8,000 per person per year) compared to programs with similar-sized clinical impacts. Even if the intervention costs were halved and the program reduced hospitalizations by 50 percent (both unlikely scenarios), the program would still increase total costs to the government.
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"Third Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration." Deborah Peikes, Randall Brown, Arnold Chen, and Jennifer Schore, January 2008. Beneficiaries with chronic diseases account for nearly two-thirds of all Medicare expenditures. The mandated Medicare Coordinated Care Demonstration tested specifically whether care coordination programs reduced hospitalizations and Medicare expenditures and improved quality of care for chronically ill Medicare beneficiaries in 15 demonstration sites. This third report to Congress synthesizes findings from more than four years of the demonstration programs’ operations, and provides the most comprehensive and rigorous estimates ever presented on the effectiveness of care coordination interventions in a Medicare fee-for-service setting. Only 2 of the 15 programs resulted in reduced hospital admissions, and none of the programs generated net savings. There were few effects on beneficiaries’ adherence to prescribed medication, diet, or exercise regimens. The report describes ways in which the more successful programs differed from the unsuccessful ones and concludes that programs with these features could generate savings for Medicare if implemented for a high risk target population. Read the release.
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Journal Articles: |
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“Results of a Retrospective Claims Database Analysis of Differences in Antidepressant Treatment Persistence Associated with Escitalopram and Other Selective Serotonin Reuptake Inhibitors in the United States.” Dominick Esposito, Peter Wahl, Gregory Daniel, Michael A. Stoto, M. Haim Erder, and Thomas W. Croghan. Clinical Therapeutics, March 2009. Although previous studies have found no differences in response to antidepressant pharmacotherapy between selective serotonin reuptake inhibitors (SSRIs), some recent trials suggest benefits associated with more rapid onset of action. This article compares the likelihood that patients initiating treatment with branded escitalopram, rather than with any of three SSRIs available in generic formulations, would continue therapy with the initial medication after two and six months. Patients initiating treatment with escitalopram were more likely to continue and less likely to switch or augment treatment at two and six months of therapy.
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“The Effects of State Policy Decisions on the Employment and Earnings of Medicaid Buy-In Participants in 2006.” Henry Ireys, Gilbert Gimm, and Su Liu, Journal of Disability Policy Studies (subscription required), March 2009. This article examines the Medicaid Buy-In program, so named because workers with disabilities “buy into” Medicaid coverage with monthly premiums. In 2006, over 97,000 individuals were enrolled in 32 state Buy-In programs. States have taken different pathways toward the program’s dual objectives: expanding Medicaid coverage to vulnerable populations and promoting employment of working-age adults with disabilities. Analyses indicate that some states appear to have accomplished both objectives, whereas other states have emphasized one over the other. In addition, certain program features (such as higher earned-income limits) contribute to both larger percentages of Buy-In participants who are employed and higher earnings of employed participants.
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"Subjects’ Views of Obligations to Ensure Post-Trial Access to Drugs, Care and Information: Qualitative Results from the Experiences of Participants in Clinical Trials (EPIC) Study." N. Sofaer, C. Thiessen, S.D. Goold, J. Ballou, K.A. Getz, G. Koski, R.A. Krueger, and J.S. Weissman, Journal of Medical Ethics (subscription required), 2009. There is increasing interest in the question of what, if anything, research subjects are owed after their participation in a clinical trial ends. This article reports on 93 individuals who participated in 10 focus groups. Many participants thought researchers, sponsors, health insurers, and others should facilitate access to the drug, or a therapeutic equivalent after the trial has ended, if the drug benefited the subject. Some thought these groups should also provide transition care (referrals to nontrial physicians or other trials, limited followup, short-term drug supply) or care for long-term adverse events. In contrast, other participants felt these groups had no obligations regarding drugs or care. Participants generally agreed that subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, and results after a trial has ended). They cited health need, cost, relationships, reciprocity, free choice, and sponsor self-interest to support their views, and many of their reasons overlapped with those commonly discussed by bioethicists.
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Issue Briefs: |
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“Health Information Exchange: The Role of Safety-Net Providers.” Trends in Health Informatics, Issue Brief #5. Suzanne Felt-Lisk, Melanie Au, and Patricia Higgins, June 2009. Health information technology has great potential for improving health care through Health Information Exchange (HIE), the exchange of health-related information electronically across providers, with strong privacy, confidentiality, and security protections. If safety-net providers are to keep pace with other providers, organizations responsible for funding and facilitating expansion of HIE need a solid understanding of safety-net providers’ needs. A new brief reviews lessons learned from a 13-member panel convened to discuss barriers and catalysts safety-net providers face in integrating HIE. Read the release.
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“Considering a Health Insurance Exchange: Lessons from the Rhode Island Experience.” Deb Faulkner, Amy Lischko, and Deborah Chollet, June 2009. A health insurance exchange transforms the way health insurance is packaged, subsidized (for low-income individuals and families), and purchased. This brief describes the process followed in Rhode Island to explore establishing a health insurance exchange-like organization, HealthHub RI, based on the Massachusetts model. The RI experience demonstrated the importance of clearly defining the goals of an exchange, as well as understanding that exchanges may do little to constrain the growth of health care costs. States considering an exchange might want to consider an affordability-based mandate, requiring all state residents to have health insurance coverage that meets an exchange-specified standard, as long as it is deemed affordable.
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"Measuring Racial and Ethnic Disparities in Health Care: Efforts to Improve Data Collection." Patricia Collins Higgins and Erin Fries Taylor, May 2009. Disparities in the quality of health care contribute to higher rates of disease, disability, and mortality in racial and ethnic minority groups. A new policy brief examines recent federal and state activities aimed at strengthening the collection of health-related data on race, ethnicity, and primary language. It highlights three states—California, Massachusetts, and New Jersey—that implemented laws or regulations guiding data collection activities by hospitals, health plans, and government agencies.
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“Improving Access to Language Services in Health Care: A Look at National and State Efforts.” Melanie Au, Erin Fries Taylor, and Marsha Gold, April 2009. More than 23 million Americans have limited English proficiency, which complicates their ability to obtain quality health care. Language barriers in the health care setting can lead to miscommunications and cause medical errors, delay or denial of services, issues with medication management, and underutilization of preventive services. This brief assesses emerging national efforts to address language barriers and profiles work in three states—California, Minnesota, and New York—to highlight challenges, successes, and implications for future policy and activities related to providing language services.
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Other: |
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“Chartbook: Medicaid Pharmacy Benefit Use and Reimbursement in 2005.” Ann Bagchi, James Verdier, and Dominick Esposito, June 2009. This chartbook highlights national and state-by-state data on Medicaid prescription drug use and expenditures for 2005 by beneficiary characteristics (age, sex, and race), basis of eligibility (children, adults, disabled, and aged), and type of drug (brand vs. generic, top 10 drug groups, top 7 therapeutic categories, and drugs excluded by statute from Medicare Part D). Separate graphs highlight Medicare-Medicaid dual eligibles, whose drug coverage shifted to Medicare in 2006, and nondual beneficiaries, who continue to receive their drug coverage from Medicaid. The detailed state-by-state and national tables for 1999 and 2001-2005 on which the chartbook is based (statistical compendiums) are on the Centers for Medicare & Medicaid Services website.
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Recent media coverage, including a New Yorker article (June 1, 2009) on “The Cost Conundrum” has policymakers concerned about how per-capita health care costs vary widely across the country, what to make of this variation, and how to respond as health reform and Medicare spending dominate the health policy debate. For Robert Wood Johnson Foundation's Synthesis Project, Marsha Gold sought to help policymakers better understand these issues. Her review confirms the existence of wide variations in Medicare per capita spending across the nation that appear connected with differences in use of health services and not associated with improvements in outcomes. Framing an effective response is challenging because any solution will create winners and losers, and a lot remains unknown about why areas that appear to be similar actually differ. Simply lowering payments to high cost areas without changing the underlying dynamics of care delivery will not necessarily translate into more effective care. Policies that modify the culture of medical practice, the financial incentives embedded in the system, and the way doctors communicate with one another are likely to be critical to having all patients, wherever they live, gain access to appropriate care.
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“The Promise of Care Coordination: Models that Decrease Hospitalizations and Improve Outcomes for Medicare Beneficiaries with Chronic Illnesses.” Randall Brown, March 2009. Numerous studies have documented that a relatively small percent of Medicare beneficiaries with multiple chronic conditions account for the vast majority of Medicare spending. This paper synthesizes evidence on cost-effective interventions and their components, identifies issues that must be resolved for ongoing research, and presents recommendations for care coordination policies in health care reform that can be supported by available evidence. The author highlights three interventions that have reduced hospitalizations for the target population: transitional care, self-management education, and coordinated care. Policy recommendations include offering vehicles for physicians in small practices to participate in an effective care coordination intervention, targeting medical homes and care coordination interventions to beneficiaries at substantial risk of hospitalization in the coming year, and creating incentives for hospitals to participate in transitional care interventions. This paper was presented at the Aging in America conference in Las Vegas on March 17. Click here to listen to an interview with the author on this topic on the Philadelphia NPR affiliate. Full report. Executive summary.
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