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Health Policy Research

For more than 40 years, Mathematica staff have been informing health policy debates and addressing decision makers’ information needs regarding longstanding critical issues. Read more about the work done by our 200 health policy staff or select the area that interests you from the list of topics to the left.



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Medicaid Data Analytics: Spotlight on Colorado's Accountable Care

A new issue brief focuses on Colorado's Medicaid reform initiative, the Accountable Care Collaborative, and one of its three core components, the Statewide Data Analytics Contractor. This component supports primary care providers networked to seven regional care collaboratives and provides data to support care management and improvement. Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author the brief, the first of three planned studies.

Patient-Centered Medical Home Research Methods Series

New briefs, part of a series from the Agency for Healthcare Research & Quality, expand awareness of methods to evaluate and refine PCMH models and other health care interventions. Evaluators and implementers can use also these briefs to meet evidence needs of stakeholders more effectively. Each brief describes a method, outlines advantages and limitations, and provides resources for researchers to learn more.

  • "Developing a Health Care Information Portal for California Children's Services Providers: Functions, Models, and Issues." Deborah J. Chollet, December 2013. This study for the Lucile Packard Foundation for Children's Health describes the California Children's Services program's current information technology systems and presents alternative models for enhanced functionality.
  • "CHIPRA Mandated Evaluation of Express Lane Eligibility: Final Findings." Sheila Hoag, Adam Swinburn, Sean Orzol, Michael Barna, Maggie Colby, Brenda Natzke, Christopher Trenholm, Fredric Blavin, Genevieve M. Kenney, Michale Huntress, and Others, December 2013. As part of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), Congress permitted Express Lane Eligibility (ELE), which allows state Medicaid and/or CHIP programs to rely on another public agency's eligibility determination to qualify children for public health coverage or renew their coverage. The study found that ELE can increase enrollment, but gains vary depending on how states implement the policy. Automatic ELE processes served the most individuals, produced the greatest administrative savings, and eliminated procedural barriers to coverage for families. Evaluators also found that ELE enrollees use health care services, though fewer than those who enroll through standard routes. The evaluation was funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services.
  • "Money Follows the Person 2012 Annual Evaluation Report." Carol V. Irvin, Noelle Denny-Brown, Matthew Kehn, Rebecca Sweetland Lester, Debra Lipson, Wilfredo Lim, Jessica Ross, Alex Bohl, Victoria Peebles, Samuel Simon, Bailey Orshan, Susan R. Williams, Eric Morris, and Christal Stone, October 2013. The fourth annual report of the Money Follows the Person (MFP) Evaluation includes analyses on (1) program implementation for the first five years; (2) descriptions of MFP participants and costs and types of services received; (3) trend analyses to detect shifts in the balance of state long-term care systems that may have occurred; and (4) an assessment of how participant quality of life changes after they leave the program. Executive summary.
  • Case Studies for CHIPRA Express Lane Eligibility Processes

    In the CHIP Reauthorization Act (CHIPRA) of 2009, Congress gave states new tools to address enrollment and retention shortfalls, including a policy called Express Lane Eligibility (ELE). With ELE, a state's Medicaid and/or CHIP program can rely on another agency's eligibility findings to qualify children for public health insurance coverage, even when programs use different methods to assess income or otherwise determine eligibility. New case studies examine CHIPRA Express Lane Eligibility processes for Iowa, Maryland, New Jersey, and Oregon, and examine an alternate simplification, online enrollment, in Oklahoma.
  • "Medicaid Analytic Extract Provider Characteristics (MAXPC) Evaluation Report, 2010." Deo Bencio, July 2013. This report describes the motivation for creating the MAXPC file and its design and content. It also examines the quality and completeness of each of the six types of provider IDs (inpatient billing provider, long-term care billing provider, other services billing and servicing provider, and prescription drug billing and prescribing providers). The analysis focuses on the 45 states that had the requisite Medicaid Statistical Information System files available for calendar year 2010 services (Idaho, Kansas, Maine, New Jersey, North Dakota, and Utah are excluded). The quality and completeness vary substantially by state and type of provider ID.
  • "Proven Strategies for Missouri Health Care Covergage: Program Outreach and Enrollment." Sean Orzol, June 2013. This report presents findings from a study on outreach and Medicaid enrollment best practices to meet Missouri’s insurance expansions under the Affordable Care Act. The study found that mobilizing a broad network of local partners is key; new messages and partners will be needed to reach a diverse, newly eligible population. Broad enrollment access points, customer-focused assistance, and paperless eligibility determination procedures can also simplify the process. Finally, states should start developing a comprehensive approach to implementing expanded eligibility and modernizing enrollment systems today.
  • "Medicaid Analytic Extract Date of Death (MAX DOD) Master File, 2009 Update." Julie Sykes and Shinu Verghese, June 2013. This report describes the creation of the MAX DOD 2009 update file and the MAX DOD 1999–2009 master file. It provides a brief synopsis of the data sources used in this process and presents quality control statistics about both files. The appendices include the file layout, data dictionary, data processing steps, and some frequently asked questions about the DOD information.
  • "Structuring Payment to Medical Homes After the Affordable Care Act." Samuel T. Edwards, Melinda K. Abrams, Richard J. Baron, Robert A. Berenson, Eugene C. Rich, Gary E. Rosenthal, Meredith B. Rosenthal, and Bruce E. Landon. Journal of General Internal Medicine, April 2014. The patient-centered medical home (PCMH) and the accountable care organization (ACO) are models of delivery system reform. Although there is theoretical alignment between PCMHs and ACOs, the discussion of physician payment within each model has remained distinct. This article compares payment for the two models, considers opportunities for integration, and discusses implications for policymakers and payers considering promoting primary care through ACOs.
  • "Staffing Patterns of Primary Care Practices in the Comprehensive Primary Care Initiative." Deborah N. Peikes, Robert J. Reid, Timothy J. Day, Derekh D. F. Cornwell, Stacy B. Dale, Richard J. Baron, Randall S. Brown, and Rachel J. Shapiro. Annals of Family Medicine, March/April 2014. This article describes staffing patterns for nearly 500 primary care practices in the Centers for Medicare & Medicaid Services Comprehensive Primary Care initiative before the initiative began. The study found most of the practices used traditional staffing models and did not report having dedicated staff who may be integral to new primary care models, such as care coordinators, health educators, behavioral health specialists, and pharmacists. The authors note that this restricted staff composition is not surprising given the current fee-for-service payment environment. They conclude that without access to such staff–and payment for their services–practices are unlikely to deliver comprehensive, coordinated, and accessible care at a sustainable cost.
  • "Advancing Geriatrics Research, Education, and Practice: Policy Challenges After the Great Recession." Judy T. Zerzan and Eugene C. Rich. Journal of General Internal Medicine, March 2014. This article highlights the policy challenges that confront geriatrics research, education, and clinical programs following the "great recession." The authors describe relevant new federal and state initiatives and note how academic geriatrics and general internal medicine can join forces with public and private interests to secure the resources needed to advance the agenda for geriatrics clinical care, health professional training, and research.
  • "Optimizing Health for Complex Adults in Primary Care: Current Challenges and a Way Forward." Hollis Day, Elizabeth Eckstrom, Sei Lee, Heidi Wald, Steven Counsell, and Eugene Rich. Journal of General Internal Medicine, March 2014. This perspectives piece sets forth a research agenda in the area of implementation science at the intersection of geriatrics and general internal medicine. It notes how, as the population ages and patients with multiple complex conditions consume more care, the need for research on new approaches to this type of medicine will continue to grow.
  • "Does Location Determine Medical Practice Patterns?" James Reschovsky. Virtual Mentor, February 2014. This opinion piece critiques the large body of geographic variations research, finding much of it flawed or uninformative for policy. The author posits that wide geographic variation in fee-for-service Medicare spending and care delivery could be mitigated by reforming the payment system to promote better outcomes and greater value, rather than fees for service; fighting fraud and abuse; better defining and communicating best clinical practices; and encouraging physicians to enter integrated systems of care that provide greater care coordination and management.
  • "Understanding Differences Between High- and Low-Price Hospitals: Implications for Efforts to Rein in Costs." Chapin White, James D. Reschovsky, and Amelia M. Bond. Health Affairs, February 2014 (subscription required). A study examining the relationship between hospital characteristics and hospital prices can help inform the debate on controlling health care costs. Compared to other hospitals, high-price hospitals tend to be larger, be major teaching hospitals, belong to systems with large market shares, provide specialized services, and receive significant revenues from nonpatient sources. However, quality indicators for high-price hospitals were mixed. Although these hospitals fared better than other hospitals on U.S. News & World Report rankings, which are largely based on reputation, they generally scored worse on objective measures of quality, such as postsurgical mortality rates.
  • "State and Demographic Variation in Use of Depot Antipsychotics by Medicaid Beneficiaries with Schizophrenia." Jonathan D. Brown, Allison Barrett, Emily Caffery, Kerianne Hourihan, and Henry T. Ireys. Psychiatric Services, January 2014 (subscription required). This study found the use of injectable antipsychotics varied substantially among state Medicaid programs. African Americans received a disproportionate share in many states.
  • "Using Multifactorial Experiments for Comparative Effectiveness Research in Physician Practices with Electronic Health Record." Jelena Zurovac, Lorenzo Moreno, Jesse Crosson, Randall Brown, and Robert Schmitz. eGEMS, December 2013.This paper identifies opportunities for using multifactorial designs and electronic health record data to evaluate quality improvement efforts in physicians' practices. Examples include using multifactorial designs to evaluate clinical decision support features and studying components of a patient-centered medical home.
  • "Migration Patterns for Medicaid Enrollees 2005-2007." David K. Baugh and Shinu Verghese. Medicare & Medicaid Research Review, December 2013. This study used unduplicated Medicaid enrollment records from 2005 to 2007 to examine enrollees' migration across states. Over the study period, only 3.7 percent moved to another state at least once. This provides a benchmark for adjusting national Medicaid statistics to reduce over-counting. Most moves were not associated with enrollment gaps, but 8.2 percent of moves were associated with short-term gaps. These gaps could indicate a lack of health insurance coverage, leading to concerns about patients' outcomes and higher systemwide costs.
  • "Does Health Information Exchange Reduce Redundant Imaging? Evidence From Emergency Departments." Eric J. Lammers,Julia Adler-Milstein, and Keith E. Kocher. Medical Care, December 2013, published online ahead of print (subscription required). This study is among the first of its kind to find empirical support for the anticipated benefit of health information exchange (HIE) to lower health care costs by reducing repeat medical tests. It found that HIE, in which patients' clinical data follow them across care delivery settings, is associated with decreases in repeat imaging in emergency departments.
  • "Using Medicare Data to Assess Nurse Practitioner-Provided Care." Catherine M. DesRoches, Jennifer Gaudet, Jennifer Perloff, Karen Donelan, Lisa I. Iezzoni, and Peter Buerhaus. Nursing Outlook, November 2013 (subscription required).This study examines the geographic distribution and county characteristics of nurse practitioners (NPs) billing Medicare, compares the types and quantities of primary care services provided to Medicare beneficiaries by NPs and primary care physicians, and analyzes the characteristics of beneficiaries receiving primary care from each type of clinician. The study found approximately 45,000 NPs provided services to beneficiaries and billed under their own provider numbers in 2008. Aspects of NP practice patterns differed from those of primary care physicians, and NPs appeared more likely to provide services to disadvantaged Medicare beneficiaries.
  • "The Effect of Hospital-Physician Integration on Health Information Technology Adoption." Eric Lammers. Health Economics, October 2013. Hospitals have greater administrative control over the actions and resources of physicians they employ, enabling the implementation of new technology and initiatives. This study tested for and found that hospital employment of physicians is associated with significant increases in the probability of physicians using hospital health information technology.
  • EHR Adoption to Transform Health Care and Delivery

    The Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act of 2009 set ambitious goals for using health information technology (HIT) to improve health care delivery and make care more efficient and effective. Mathematica's health experts authored two recent articles in the American Journal of Managed Care (subscription required) examining the progress of nationwide adoption of electronic health records (EHRs) and electronic health information exchanges to support delivery improvements and transform care. One study examines the availability of vendor products offering EHRs to eligible professionals, especially in office-based practices, to meet the demand for HITECH-relevant ambulatory EHRs; the second analysis examines the link between HIT infrastructure and transforming health care delivery.
  • "Misdiagnosis: An Emerging Priority for Comparative Effectiveness Research." Eugene C. Rich. Journal of Comparative Effectiveness Research, November 2013 (subscription required). This article discusses the implications of diagnostic errors for comparative effectiveness research (CER). It notes the potential role of CER studies for improving diagnosis and treatment decisions and the value of expanding the CER agenda to address misdiagnosis.
  • "Universal Mental Health Screening in Pediatric Primary Care: A Systematic Review." Lawrence S. Wissow, Jonathan Brown, Kate E. Fothergill, Anne Gadomski, Karen Hacker, Peter Salmon, and Rachel Zelkowitz, Journal of the American Academy of Child & Adolescent Psychiatry, November 2013 (subscription required). A systematic review examined universal mental health screening in pediatric primary care, and found little research has addressed patients' engagement in the process or how clinicians can best use screening results.
  • "Examine Critical Access Hospital Payment Policies Within the Context of Integrated Systems." JudyAnn Bigby. JAMA Internal Medicine, November 2013, online ahead of print (subscription required). To prevent closings of critical access hospitals (CAHs), or rural hospitals, Congress authorized cost-based rather than prospective payments. This commentary responds to research suggesting that when CAHs join integrated systems, the relative portion of a system's costs of shared services attributed to CAHs increased by 40 percent. The finding highlights the need to examine payments to integrated delivery systems that support CAHs as part of a continuum of care in rural communities.
  • "Utilization of Dental Services Among Medicaid-Enrolled Children." Ellen Bouchery. Medicare & Medicaid Research Review, September 2013. This study reviews dental services among Medicaid-enrolled children in nine states identified characteristics associated with underutilization of dental services, including age, length of Medicaid enrollment, and disability status.
  • "State Costs of Excessive Alcohol Consumption, 2006." Jeffrey J. Sacks, Jim Roeber, Ellen E. Bouchery, Katherine Gonzales, Frank J. Chaloupka, and Robert D. Brewer. American Journal of Preventive Medicine, October 2013. A new study finds excessive alcohol use causes a large economic burden to states and the District of Columbia. The study found that excessive alcohol use cost states and the District a median of $2.9 billion in 2006, ranging from $420 million in North Dakota to $32 billion in California. This means the median cost per state for each alcoholic drink consumed was almost $2.
  • "Association Between Outpatient Visits Following Hospital Discharge and Readmissions Among Medicare Beneficiaries with Atrial Fibrillation and Other Chronic Conditions." Mai Hubbard, Sloane Frost, Kimberly Siu, Nicole Quon, and Dominick Esposito. American Journal of Medical Quality, July 2013 (subscription required). A retrospective analysis of Medicare claims data examined the relationship between outpatient visits within 14 days after hospital discharge and readmission for beneficiaries with atrial fibrillation or other chronic conditions. About half of those beneficiaries with a hospitalization had an outpatient visit within 14 days of discharge. Readmission rates were 11 to 24 percent lower for beneficiaries with an outpatient visit than for those without one. These findings suggest that follow-up care shortly after discharge may lower readmissions for patients with atrial fibrillation or other chronic conditions.
  • "Medication Discontinuation and Reinitiation Among Medicare Part D Beneficiaries Taking Costly Medications." Margaret S. Colby, Dominick Esposito, Seth Goldfarb, Daniel E. Ball, Vivian Herrera, Leslie J. Conwell, Susan B. Garavaglia, Eric S. Meadows, and Martin D. Marciniak. American Journal of Pharmacy Benefits, May/June 2013. This study looked at the impact of Medicare Part D coverage gaps by examining drug discontinuation and reinitiation among Medicare beneficiaries using medications for cancer or rheumatoid arthritis. The study found that patients in the arthritis or cancer groups—28 and 21 percent, respectively—discontinued medications for these conditions in 2006; about three-fourths reinitiated therapy in the first 90 days of 2007. Although medication discontinuation is often temporary, the effect is complex. Some patients might discontinue before reaching the coverage gap to avoid out-of-pocket costs. For those who spend into or through the coverage gap before discontinuing, cumulative out-of-pocket expenditures might be too high to resume treatment the following year.
  • "Some Hospitals are Falling Behind in Meeting 'Meaningful Use' Criteria and Could be Vuleralbe to Penalties in 2015." Catherine M. DesRoches, Chantal Worzala, and Scott Bates. Health Affairs, August 2013. This article cite progress on the adoption of health information technology (HIT) that meets Medicare’s criteria for “meaningful use.” Through an analysis of Medicare data, the study found a substantial increase in the percentage of hospitals receiving electronic health record incentive payments between 2011 (17.4 percent) and 2012 (36.8 percent). However, critical-access, smaller, and publicly owned or nonprofit hospitals appeared to be at risk of failing to meet the criteria.
  • "Medication Continuity Among Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder." Jonathan D. Brown, Allison Barrett, Emily Caffery, Kerianne Hourihan, and Henry T. Ireys. Psychiatric Services in Advance, June 2013. This study examines whether medication continuity among Medicaid beneficiaries with schizophrenia and bipolar disorder was associated with medication utilization management practices (prior authorization, copayment amounts, and refill and pill quantity limits); managed care enrollment; and other state and beneficiary characteristics. The study found that prior-authorization requirements and copayments for medications can present barriers to refilling medications for Medicaid beneficiaries with schizophrenia or bipolar disorder.
  • "The Healthy Weight Collaborative: Using Learning Collaboratives to Enhance Community-Based Prevention Initiatives Addressing Childhood Obesity." Margaret B. Hargreaves, Todd Honeycutt, Cara Orfield, Michaela Vine, Charlotte Cabili, Michaella Morzuch, Sylvia K. Fisher, and Ronette Briefel. Jounal of Health Care for the Poor and Underserved, May 2013. This report from the field describes the design, implementation, and early evaluation results of the Healthy Weight Collaborative, a federally supported learning collaborative to develop, test, and disseminate an integrated change package of six promising, evidence-based clinical and community-based strategies to prevent and treat obesity for children and families.
  • "Patterns of Older Americans' Health Care Utilization Over Time." Richard J. Manski, John F. Moeller, Haiyan Chen, Jody Schimmel, Patricia A. St. Clair, and John V. Pepper. American Journal of Public Health, July 2013. This study examined the use of physician, inpatient hospital, home health, and outpatient surgery for Americans more than 50 years of age. The study found that overall health and changes in health are more strongly correlated with seeking and using health care over time than financial status or changes to one’s financial status.
  • "Adoption of Electronic Health Records Grows Rapidly, But Fewer Than Half of US Hosptials had at Least a Basic System in 2012." Catherine M. DesRoches, Dustin Charles, Michael F. Furukawa, Maulik S. Joshi, Peter Kralovec, Farzad Mostashari, Chantal Worzala and Ashish K. Jha. Health Affairs, July 2013 (subscription required). This article measured current hospital use of electronic health record (EHR) systems using data from the 2012 health IT supplement to the American Hospital Association’s annual survey. According to the data, 44 percent of hospitals report having at least a basic EHR system, a 17 percent increase from 2011 and a near-tripling of the 2010 adoption rate. Also, large urban hospitals continued to outpace rural and nonteaching hospitals. Although 42.2 percent of all hospitals met all the stage 1 meaningful-use criteria, only 5.1 percent had advanced to stage 2. While considerable progress has been made, findings suggest a need for a focus on hospitals still trailing behind, notably small and rural institutions. This focus is especially important as stage 2 meaningful-use criteria become the rule, and positive incentives are replaced by penalties for noncompliance.
  • "Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians." Catherine M. DesRoches, Anne-Marie Audet, Michale Painter, and Karen Donelan. Annals of Internal Medicine, June 2013 (subscription required). More than 40 percent of the nation’s physicians have access to a basic electronic health record (EHR) system; however, implementation of advanced functions for patient management and care coordination is not widespread, according to a study led by Mathematica and the Mongan Institute for Health Policy at Massachusetts General Hospital. Furthermore, when these tools are available, physicians report they are complicated and difficult to use. Many EHR functions, such as electronic data exchange, will be required for physicians to meet the meaningful use criteria of the Centers for Medicare & Medicaid Services (CMS) for EHRs. CMS established these criteria to ensure that physicians use EHRs to improve patient care; physicians participating in the meaningful use program receive financial incentives when they meet the criteria.
  • "Reducing Health Care Disparities: Where Are We Now?" Issue Brief. Marsha Gold, March 2014. This issue brief for the Robert Wood Johnson Foundation gives an overview of how the field of health care disparities has evolved in recent years to identify emerging perspectives, progress and current activity, and outstanding needs. The paper focuses specifically on health care disparities, while recognizing that these are obviously also intertwined with broader efforts to reduce health disparities.
  • "Inpatient Hospital Prices Drive Spending Variation for Episodes of Care for Privately Insured Patients." Research Brief #14. Chapin White, James D. Reschovsky, and Amelia M. Bond, February 2014. This issue brief finds that when episodes of care involving hospitalizations, similar to Model 2 of the ongoing Centers for Medicare & Medicaid Services Bundled Payment for Care Improvement demonstration, are applied to privately insured patients, inpatient prices drive the bulk of episode-spending variation. Hospitals with high spending for one service line tend to have high spending for other service lines. The study used 2011 claims data for 590,000 active and retired nonelderly autoworkers and dependents.
  • "How are CHIPRA Quality Demonstration States Designing and Implementing Caregiver Peer Support Programs?" Evaluation Highlight No. 7. Grace A. Ferry, Henry Ireys, Dana Petersen, and Joseph Zickafoose, February 2014. This brief focuses on efforts in four states—Georgia, Idaho, Maryland, and Utah—to expand access to peer support for caregivers of children with special health care needs.
  • "How are CHIPRA Quality Demonstration States Working Together to Improve the Quality of Health Care for Children?" Evaluation Highlight No. 6. Dana Petersen, Henry Ireys, Grace Ferry, and Leslie Foster, January 2014. This evaluation highlight illustrates how six grantees use multistate partnerships to improve the quality of children's health care. It describes the strategies that states use to create and maintain cross-state relationships, as well as the benefits and challenges of partnering.
  • "Leveraging Medicaid in a Multi-Payer Medical Home Program: Spotlight on Rhode Island's Chronic Care Sustainability Initiative." Julia Paradise, Marsha Gold, and Winnie Wang, November 2013. This brief, the last of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, focuses on Rhode Island's Chronic Care Sustainability Initiative. This multi-payer, patient-centered medical home initiative includes the one Medicaid health plan in the state and commercial health plans.
  • "Findings from HeA PA and Implications for ACA Implementation." Health-E-App Public Access: A New Online Path to Children's Health Care Coverage in California, Research Brief #5. Leslie Foster, Adam Dunn, and Maggie Colby, October 2013. California's Health-e-App Public Access (HeA PA) system enables low-income families to apply online for publicly funded children's health insurance. Findings from a study funded by the California Healthcare Foundation and the David and Lucile Packard Foundation have implications for Affordable Care Act implementation in California and other states. HeA PA contributed to growth in program applications, was used and well received by a segment of Internet-connected applicants, and complemented the system of assisted-online applications that many applicants used.
  • "Managing Care Transitions in Medicaid: Spotlight on Community Care of North Carolina." Marsha Gold, Winnie Wang, and Julia Paradise, October 2013. Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author this brief, the second of three case studies examining key operational aspects of coordinated care initiatives in Medicaid, which focuses on the Transitional Care Program conducted by Community Care of North Carolina (CCNC). CCNC is a medical home program that serves 83% of all North Carolina Medicaid beneficiaries. The Transitional Care Program identifies high-risk enrollees when they are admitted to a hospital, and plans, coordinates, and arranges their transition back to the community.
  • "Data Analytics in Medicaid: Spotlight on Colorado's Accountable Care Collaborative." Julia Paradise, Marsha Gold, and Winnie Wang, October 2013. This issue brief focuses on Colorado's Medicaid reform initiative, the Accountable Care Collaborative, and one of its three core components, the Statewide Data Analytics Contractor. This component supports primary care providers networked to seven regional care collaboratives and provides data to support care management and improvement. Mathematica health experts collaborated with staff at the Kaiser Commission for Medicaid and the Uninsured to author the brief, the first of three planned studies.
  • "Home- and Community-Based Service Use Among Medicare-Medicaid Enrollees with Functional Limitations, 2007-2008." MAX Medicaid Policy Brief #20. Allison Hedley Dodd and Rosalie Malsberger, September 2013. This issue brief presents the results of the first study conducted using data from Medicaid Analytic eXtract (MAX) data and the Medicare Current Beneficiary Survey to assess the use of home- and community-based services by the presence and level of functional limitations, as measured by limitations in activities of daily living.
  • "The HCBS Taxonomy: A New Language for Classifying Home- and Community-Based Services." MAX Medicaid Policy Brief #19. Victoria Peebles and Alex Bohl, August 2013. This brief describes the home and community-based services (HCBS) taxonomy—a uniform classification system composed of 18 categories and more than 60 services—and presents findings on expenditures and users for the 28 states whose MAX data files were approved by June 1, 2013.
  • "Perspectives on HeA PA from Certified Application Assistants." Health-E-App Public Access: A New Online Path to Children's Health Care Coverage in California, Research Brief #4. Adam Dunn, Dana Petersen, and Leslie Foster, July 2013. This brief presents the views of certified application assistants on barriers to the use of California's Health-e-App Public Access, a self-service online enrollment system for Healthy Families and Medicaid, and the potential role they could play in raising awareness of the system.
  • "Translating Modified Adjusted Gross Income (MAGI) to Current Monthly Income." SHARE Brief #3. John L. Czajka, May 2013. This brief considers the process by which modified adjusted gross income—an annual measure of income specified by the ACA for use in determining both Medicaid and subsidy eligibility—can be converted to a measure of current monthly income for the purpose of Medicaid eligibility determination.
  • "Income Eligibility for Assistance Under the ACA: The Question of Monthly vs. Annual Income." SHARE Brief #2. John L. Czajka, May 2013. This brief examines the practical coverage continuity issues raised by determining Medicaid eligibility on a monthly basis while determining subsidy eligibility on an annual basis.
  • "Implications of State Methods for Offering Personal Assistance Services." MAX Medicaid Policy Brief #18. Laura Ruttner and Carol V. Irvin, June 2013. This brief examines the differences in the use and cost of personal assistance services in states that do and do not provide these services through their state plans. States that offer these services through their state plans appear to provide them to a greater number of beneficiaries at a lower cost per beneficiary than states that do not. The states that offer services also have long-term care systems that are more balanced toward home- and community-based rather than institutional long-term care services.
  • "Medicare Advantage 2013 Spotlight: Enrollment Market Update." Issue Brief. Marsha Gold, Gretchen Jacobson, Anthony Damico, and Tricia Neuman, June 2013. This data spotlight, prepared by Mathematica and Kaiser Family Foundation health experts, provides an overview of Medicare Advantage enrollment patterns in March 2013 and examines variations by plan type, state, and firm. It also analyzes trends in premiums paid by beneficiaries enrolled in Medicare Advantage plans, including variations by plan type, and describes the out-of-pocket limits and prescription drug coverage in the Part D "donut hole."
  • "Do Financial Incentives Increase the Use of Electronic Health Records? Findings from an Experiment." Lorenzo Moreno, Suzanne Felt-Lisk, and Stacy Dale, September 2013. This working paper reviews impacts of the Electronic Health Records Demonstration implemented by the Centers for Medicare & Medicaid Services, finding that moderate incentive payments did not lead to universal electronic health record (EHR) adoption and use in a two-year time frame. However, the demonstration showed that incentives can influence physician use of EHRs.
  • "The ACA, Health Care Costs, and Disparities in Employer-Sponsored Health Insurance." Nan L. Maxwell, March 2013. This working paper examines the potential changes in the disparities in employer-sponsored health insurance (ESI) and other benefits between low- and high-wage workers under health reform. The analysis suggests that potential changes firms make in compensation could decrease disparities between low- and high-skilled workers in the quality of ESI and increase the disparities in the offering of benefits other than ESI, if the legislation does not slow rising health care costs.
  • "Perceptions of Electronic Health Records and Their Effect on the Quality of Care: Results from a Survey of Patients in Four States." Jelena Zurovac, Stacy Dale, and Martha Kovac, November 2012. Using data from patients surveyed after primary care provider visits, this working paper found patients had favorable perceptions of electronic health records (EHRs). Patients believed that EHRs improved the quality of care, and most were not concerned with confidentiality of records. Adopters' patients rated the quality of care higher than nonadopters' patients did. There was also no detrimental effect of EHR use on patient–provider communication and no relationship between the way in which physicians interacted with the computer and patients' perceptions of care.
  • "Paying Wisely: Reforming Incentives to Promote Evidence-Based Decisions at the Point of Care." Eugene C. Rich, Tim Lake, and Christal Stone Valenzano, October 2012. This white paper describes how current financial incentives in the fee-for-service (FFS) system can lead to the over- and underuse of services at the point of care by physicians and other clinicians. It explores prominent payment reform models and concludes that no single approach consistently rewards evidence-based care. The paper also suggests that more targeted use of these models—grounded in recalibrated FFS—might be the most effective way to neutralize incentives and facilitate evidence-based decision making at the point of care.
  • "Rewarding Physicians for Their Patients' Health Outcomes: What Can Medicare Learn from Education's Value-Added Models?" Greg Peterson and Eric Schone, June 2012. This working paper examines how value-added models of performance measurement used in education can apply to health care when measuring and rewarding physician performance, particularly in the Medicare system. The paper finds that value-added models used to measure teacher effects on student test scores may have useful applications in Medicare because the models provide opportunities to identify impacts on outcomes while controlling for factors that are beyond physicians' control, such as severity of illness or adherence to a treatment plan. The working paper also identifies limitations and challenges associated with value-added measures and discusses potential approaches to address these challenges.
  • "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.

World Congress Annual Leadership Summit on Medicaid Managed Care—Evolving Managed Care Systems for Better Access, Integration, and Cost Efficiency—Washington, DC—February 25-26, 2014
Jenna Libersky and James Verdier: "Financial Considerations: Rate Setting for Medicaid Managed Long Term Services and Supports (MLTSS) in Integrated Care Programs"
James Verdier: "Implementing Coordinated Care for Dual Eligibles: Conflicts and Opportunities"

HiMSS Annual Conference and Exhibition—Orlando, FL—February 23-27, 2014
Craig Schneider, Moderator: Empowering Consumers with Access to Healthcare Cost Information

National Child Health Policy Conference—Washington, DC—February 5, 2014
Henry Ireys, Moderator and Joseph Zickafoose, Speaker: Improving Quality of Care for Children: Early Lessons form the CHIPRA Quality Demonstrations

National Health Policy Conference—Washington, DC—February 3-4, 2014
Paul Ginsburg, Speaker: Price Transparency: What It Is and What It Isn't

National Association of Health Data Organizations—Denver, CO—December 11-12, 2013
Craig Schneider, Moderator: Privacy vs. Transparency: Innovations and Considerations for Public Reporting and The Role of Patient-Centered Care in Transforming the Health Delivery System

Marwood Group Annual Healthcare Conference—Washington, DC—December 3
James Verdier: "Dual Eligibles: Opportunities and Challenges"

The Center for Health Information & Decision Systems Annual Workshop on Health IT and Economics—Washington, DC—November 15-16, 2013
Eric Lammers: "Geographic Variation in Health IT and Health Care Outcomes: A Snapshot Before the Meaningful Use Incentive Program Began"

Commission on Long-Term Care Public HearingPopulations in Need of LTSS and Service Delivery Issues—Washington, DC—July 17, 2013
Randall Brown: "Care Coordination Programs for Improving Outcomes for High-Need Beneficiaries: What's the Evidence?"

World Congress Annual Leadership Summit on MedicaidUncovering Medicaid Solutions in a Time of Expansion—Arlington, VA—July 15-17, 2013
James Verdier, Moderator: State Medicaid Directors Perspective on Medicaid Expansion and the Future of State Medicaid Programs
James Verdier, Panelist: Examining the Implementation of Dual Eligibles Coordinated Care Demonstrations

Health Affairs BriefingHealth Information Technology Adoption and Use—Washington, DC—July 9, 2013
Catherine DesRoches: "Adoption of Electronic Health Records Grows Rapidly, But Fewer Than Half of US Hospitals Had at Least a Basic System in 2012"

AcademyHealth Annual Research Meeting—Baltimore, MD—June 22-25, 2013

Accountable Care Organization Summit—Washington, DC—June 12-14, 2013
James Verdier, Panelist: Integrating Care for Dual Eligibles

National Medicaid Congress—The Path to 2014 Implementation—Arlington, VAMay 29-31, 2013
James Verdier, Speaker: Dual Eligibles Mini Summit Welcome and Overview
James Verdier and Others: "New State Care Coordination Initiatives for Duals"
James Verdier, Maggie Colby, and Others: "Dual Eligible Care in a SNP vs. FFS: Findings from a Natural Arizona Experiment"

The Commonwealth Fund and the Institute for Healthcare Improvement—The Use and Relevance of Hospital Readmission Measures for Improvement—New York, NY—May 28, 2013
Craig Schneider, Invited Speaker

National Health Policy Forum—Getting the Price Right: Ensuring Access and Promoting Efficiency in Medicare Advantage—Washington, DC—May 17, 2013
Marsha Gold, Speaker

University of Michigan Retirement Research Center Research Workshop—Ann Arbor, MI—April 20, 2013
Yonatan Ben-Shalom: "Trends in Longitudinal Statistics for Young Social Security Disability Awardees"

American Society on Aging National Forum on Care Transitions—It Takes a Village—Chicago, IL—March 16, 2013
Randall Brown, Presenter

Health Information Management Systems Society Annual Conference—New Orleans, LAMarch 4-7, 2013
Craig Schneider and Others: "Using Technology to Improve Care Transitions: The IMPACT Project"

Integrated Care Resource Center Webinar—March 13, 2014
Jim Verdier and Others: "Medicare 101 and 201: Key Issues for State Programs for Medicare-Medicaid Enrollees"

Robert Wood Johnson Foundation—The State of Risk Adjustment and Potential Improvements—Webinar—July 25, 2013
Eric Schone and Randall Brown, Speakers

Health Resources and Services Administration TARGET Center—Engaging Hard-to-Reach Populations Series: Empowering the Patient—Webinar—May 15, 2013
Margaret Hargreaves, Speaker