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Grantee Publication

Regulating the Medical Loss Ratio: Implications for the Individual Market [1]

American Journal of Managed Care
Vol. 17, No. 3
March 2011
Abraham, J.M. and P. Karaca-Mandic
pp. 211-218

Objective: To provide state-level estimates of the size and structure of the US individual market for health insurance and to investigate the potential impact of new medical loss ratio (MLR) regulation in 2011, as indicated by the Patient Protection and Affordable Care Act (PPACA).

Grants: 
Analyzing the Impact of the Medical Loss Ratio Under Health Reform on the Individual Market for Coverage in Each State [2]
Grants: 
Analyzing the Impact of the Medical Loss Ratio Under Health Reform on the Individual Market for Coverage in Each State [3]
Topic: 
Access [4]
Topic: 
Insurance Coverage [5]
Topic: 
Legal and Regulatory Environment [6]

Data-Driven Management Strategies in Public Health Collaboratives [7]

Journal of Public Health Management and Practice
Vol. 17, No. 2
March/April 2011
Varda, D.
pp. 122-132

This HCFO grant, funded under the special topic solicitation in Public Health Systems Research, examined partnerships designed to leverage limited resources and fulfill common missions, and developed the PARTNER tool to allow public health partners to measure their multi-agency collaborations in order to strengthen them. 

View full article [8]... (subscription required)

Grants: 
Understanding and Assessing Partnership Connections in Public Health Departments [9]
Topic: 
Public Health Systems [10]

Local Public Health Capacities to Address the Needs of Culturally and Linguistically Diverse Populations [11]

Journal of Public Health Management and Practice
Vol. 17, No. 2
March/April 2011
Schur, C.L., et al.
pp. 177-186

This HCFO grant, funded under the special topic solicitation in Public Health Systems Research, examined the public health needs of culturally and linguistically diverse populations. The objective of this project was to develop policy recommendations for implementation of promising strategies to better serve diverse populations.

View full article [12]... (subscription required)

Grants: 
Local Public Health Capacities to Address the Needs of Culturally and Linguistically Diverse Populations [13]
Topic: 
Public Health Systems [10]

Following the Money: Factors Associated with the Cost of Treating High-Cost Medicare Beneficiaries [14]

Health Services Research
Vol. 46, No. 4
July 2011
Reschovsky, J.D., et al.
pp. 997-1021


Objective. To identify factors associated with the cost of treating high-cost Medicare beneficiaries.

Data Sources. A national sample of 1.6 million elderly, Medicare beneficiaries linked to 2004–2005 Community Tracking Study Physician Survey respondents and local market data from secondary sources.

Grants: 
Cost and Efficiency in Treating High-Cost Medicare Beneficiaries: The Role of Physician Practice and Health System Factors [15]

Nearly Half of Families in High-Deductible Health Plans Whose Members Have Chronic Conditions Face Substantial Financial Burden [16]

Health Affairs
Vol. 30, No. 2
February 2011
Galbraith, A.A., et al.
pp. 322-331

High-deductible health plans—typically with deductibles of at least $1,000 per individual and $2,000 per family—require greater enrollee cost sharing than traditional plans. But they also may provide more affordable premiums and may be the lowest-cost, or only, coverage option for many families with members who are chronically ill.

Grants: 
Study of the Effects of High-Deductible Health Plans on Families with Chronic Conditions [17]
Topic: 
Benefit Design [18]
Topic: 
Chronic Care [19]
Topic: 
Insurance Coverage [5]

Differences in the Cost of Health Care Provided by Group Practices in Minnesota [20]

Minnesota Medicine
February 2011
Kralewski, J.E., et al.

Grants: 
The Characteristics of Best Medical Practices [21]
Topic: 
Costs and Cost Containment [22]
Topic: 
Organization and Supply of Care [23]
Topic: 
Provider Payment and Behavior [24]
Topic: 
Quality of Care [25]

Association Between Prior Authorization for Medications and Health Service Use by Medicaid Patients with Bipolar Disorder [26]

Psychiatric Services
Vol. 62, Issue 2
February 2011
Lu, C.Y., et al.
pp. 186-193

Objective. This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder.

Grants: 
Effects of Prior Authorization of New Medications among Medicaid Beneficiaries with Bipolar Disorder [27]
Topic: 
Behavioral Health [28]
Topic: 
Benefit Design [18]
Topic: 
Chronic Care [19]
Topic: 
Medicaid and SCHIP [29]
Topic: 
Prescription Drugs [30]

Possible Geographic Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communities [31]

Archives of Surgery
Vol. 146, No. 1
January 2011
Hsia, R. and Shen, Y.
pp, 46-52

Objective. To study whether traditionally vulnerable populations have worse geographic access to trauma centers.

Design. A cross-sectional analysis using data from the American Hospital Association Annual Survey from 2005 linked with zip code-level data from the US Census. We used a multinomial logit model to examine the odds of having difficult as opposed to easy access to trauma centers for a given subgroup of vulnerable populations.

Grants: 
Effect of Decreased Emergency Department Access on Patient Outcomes [32]
Topic: 
Access [4]
Topic: 
Acute Care [33]
Topic: 
Organization and Supply of Care [23]
Topic: 
Quality of Care [25]

Policy Options to Improve Discharge Planning and Reduce Rehospitalization [34]

JAMA
Vol. 305, No. 3
January 19, 2011
Mor, V. and Besdine, R.W.
pp. 302-303

In this commentary piece for JAMA, Vincent Mor, Ph.D., outlines policy options to improve discharge planning and reduce hospitalization that stemmed from HCFO-funded work [35] on state Medicaid policy and nursing home hospitalization. Dr. Mor and his co-author outline several Afforadable Care Act provisions designed to reduce hospitalizations including CMS changes to hospital reimbursement rules, the creation of ACOs, and payment bundling.

Grants: 
Impact of State Medicaid Policy Changes on Nursing Home Hospitalization [35]
Topic: 
Coordination of Care [36]
Topic: 
Long-Term Care [37]
Topic: 
Medicaid and SCHIP [29]
Topic: 
Provider Payment and Behavior [24]
Topic: 
Vulnerable Populations [38]

Workplace Clinics: A Sign of Growing Employer Interest in Wellness [39]

Center for Studying Health System Change
Research Brief No. 17
December 2010
Tu, H.T., Boukus, E., and G.R. Cohen


Interest in workplace clinics has intensified in recent years, with employers moving well beyond traditional niches of occupational health and minor acute care to offering clinics that provide a full range of wellness and primary care services, according to a study by the Center for Studying Health System Change (HSC). Employers view workplace clinics as a tool to contain medical costs, boost productivity and enhance their reputations as employers of choice. 

Read the full brief here… [40]

Grants: 
Large Employers Use of Workplace Health Clinics [41]
Topic: 
Consumer Behavior [42]
Topic: 
Coordination of Care [36]
Topic: 
Costs and Cost Containment [22]
Topic: 
Organization and Supply of Care [23]
Topic: 
Preventive Care [43]
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Links:
[1] http://www.hcfo.org/publications/regulating-medical-loss-ratio-implications-individual-market
[2] http://www.hcfo.org/grants/analyzing-impact-medical-loss-ratio-under-health-reform-individual-market-coverage-each-state
[3] http://www.hcfo.org/grants/analyzing-impact-medical-loss-ratio-under-health-reform-individual-market-coverage-each-stat-0
[4] http://www.hcfo.org/topics/access
[5] http://www.hcfo.org/topics/insurance-coverage
[6] http://www.hcfo.org/topics/legal-and-regulatory-environment
[7] http://www.hcfo.org/publications/data-driven-management-strategies-public-health-collaboratives
[8] http://journals.lww.com/jphmp/Citation/2011/03000/Data_Driven_Management_Strategies_in_Public_Health.4.aspx
[9] http://www.hcfo.org/grants/understanding-and-assessing-partnership-connections-public-health-departments
[10] http://www.hcfo.org/topics/public-health-systems
[11] http://www.hcfo.org/publications/local-public-health-capacities-address-needs-culturally-and-linguistically-diverse-popu
[12] http://journals.lww.com/jphmp/Citation/2011/03000/Local_Public_Health_Capacities_to_Address_the.11.aspx
[13] http://www.hcfo.org/grants/local-public-health-capacities-address-needs-culturally-and-linguistically-diverse-population
[14] http://www.hcfo.org/publications/following-money-factors-associated-cost-treating-high-cost-medicare-benediciaries
[15] http://www.hcfo.org/grants/cost-and-efficiency-treating-high-cost-medicare-beneficiaries-role-physician-practice-and-hea
[16] http://www.hcfo.org/publications/nearly-half-families-high-deductible-health-plans-whose-members-have-chronic-conditions
[17] http://www.hcfo.org/grants/study-effects-high-deductible-health-plans-families-chronic-conditions
[18] http://www.hcfo.org/topics/benefit-design
[19] http://www.hcfo.org/topics/chronic-care
[20] http://www.hcfo.org/publications/differences-cost-health-care-provided-group-practices-minnesota
[21] http://www.hcfo.org/grants/characteristics-best-medical-practices-0
[22] http://www.hcfo.org/topics/costs-and-cost-containment
[23] http://www.hcfo.org/topics/organization-and-supply-care
[24] http://www.hcfo.org/topics/provider-payment-and-behavior
[25] http://www.hcfo.org/topics/quality-care
[26] http://www.hcfo.org/publications/association-between-prior-authorization-medications-and-health-service-use-medicaid-pat
[27] http://www.hcfo.org/grants/effects-prior-authorization-new-medications-among-medicaid-beneficiaries-bipolar-disorder
[28] http://www.hcfo.org/topics/behavioral-health
[29] http://www.hcfo.org/topics/medicaid-and-schip
[30] http://www.hcfo.org/topics/prescription-drugs
[31] http://www.hcfo.org/publications/possible-geographic-barriers-trauma-center-access-vulnerable-patients-united-states-ana
[32] http://www.hcfo.org/grants/effect-decreased-emergency-department-access-patient-outcomes
[33] http://www.hcfo.org/topics/acute-care
[34] http://www.hcfo.org/publications/policy-options-improve-discharge-planning-and-reduce-rehospitalization
[35] http://www.hcfo.org/grants/impact-state-medicaid-policy-changes-nursing-home-hospitalization
[36] http://www.hcfo.org/topics/coordination-care
[37] http://www.hcfo.org/topics/long-term-care
[38] http://www.hcfo.org/topics/vulnerable-populations
[39] http://www.hcfo.org/publications/workplace-clinics-sign-growing-employer-interest-wellness
[40] http://www.hschange.org/CONTENT/1166/
[41] http://www.hcfo.org/grants/large-employers-use-workplace-health-clinics
[42] http://www.hcfo.org/topics/consumer-behavior
[43] http://www.hcfo.org/topics/preventive-care
[44] http://www.hcfo.org/taxonomy/term/4
[45] http://www.hcfo.org/taxonomy/term/4?page=14
[46] http://www.hcfo.org/taxonomy/term/4?page=11
[47] http://www.hcfo.org/taxonomy/term/4?page=12
[48] http://www.hcfo.org/taxonomy/term/4?page=13
[49] http://www.hcfo.org/taxonomy/term/4?page=16
[50] http://www.hcfo.org/taxonomy/term/4?page=17
[51] http://www.hcfo.org/taxonomy/term/4?page=18
[52] http://www.hcfo.org/taxonomy/term/4?page=19
[53] http://www.hcfo.org/taxonomy/term/4?page=48