Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Care Management of Patients With Complex Health Care Needs

Explores how patients' complexity of healthcare needs, vulnerability, and age affect the cost and quality of their health care. Examines the potential for care management to improve quality of care and reduce costs, elements of success, and challenges

Antipsychotic Drug Use: Managing Cardiometabolic and Cost Effects

Across the US, 30%, or approximately one third of people meet the criteria for at least one mental illness.1 Of those with severe mental illness (SMI), namely schizophrenia and bipolar disorder, the mortality rate is more than twofold compared to the general population.2 The cardiovascular risk factors that contribute to cardiovascular related deaths, including metabolic disease and type II diabetes, are not only modifiable, but staggeringly higher for those with SMI.3 Though antipsychotic drug prescription is the standard protocol for SMI treatment, such drug effects on cardiovascular risk factors and related deaths exacerbate the much higher mortality rate for the severely mentally ill population. Due to both the prevalence of SMI and the physical comorbidities that it entails, analysis of healthcare costs associated with this population are an essential part of general health and policy improvement for the U.S. Therefore, a breakdown of the healthcare costs of this population requires not only acknowledgment of the modes of treatment for mental illness specifically, but also the identification and cost-analysis of the commonly associated physical comorbidities. This is especially important considering SMI is almost always considered chronic, and many SMI patients qualify for either Medicare, Medicaid, or both. Certain gaps in coverage can lead to lack of preventive care, exacerbating the cost burden. From a clinician’s perspective, assessing relevant scientific studies and reviews to change the relationship between primary care and psychiatry is necessary to dampen the high mortality rate of the SMI population. From a policy-maker’s perspective, analyzing the cause and effect balance between managing costs of care directed at the SMI itself against the adjunct costs from physical comorbidity calls for a change in the structure of therapeutic care and how the SMI population accesses primary care. The Collaborative Care model is a health care model that unifies psychiatric, behavioral, and primary care to support the mental, behavioral, and physical health of patients. By supporting holistic healthcare, the high cost of care for the SMI population will be diminished. The model includes four parts: patient-centered care, populationbased care, measurement-based treatment to target, and evidence-based care. Swapping oral antipsychotics with injectable versions will be especially cost-effective by improving adherence rates, and thus, reducing institutionalization and other hospitalizations. By enforcing the Collaborative Care model through community health center interventions, clinicians and policy makers will be able to work together to effectively leverage the health of the SMI population while eroding the high health care expenditure that this population currently imposes on states

Quality of Health Care for Medicare Beneficiaries: A Chartbook

Provides the results of a review of recently published studies and reports about the quality of health care for elderly Medicare beneficiaries. Includes examples of deficiencies and disparities in care, and some promising quality improvement initiatives

Mental Disorders and Medical Comorbidity

Presents findings on factors behind the prevalence of patients with both mental and medical conditions; mortality, quality of care, and cost burdens; and evidence-based treatment approaches, including self-management support. Outlines policy implications

Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Driving Value in Medicaid Primary Care: The Role of Shared Support Networks for Physician Practices

Examines the challenges of transforming small primary care practices under healthcare reform and options for Medicaid to drive changes through practice supports to help implement and sustain new models of care or catalyze investments in new systems

Multimorbidity, Management of COPD and Health Outcomes among Medicaid Beneficiaries

Chronic Obstructive Pulmonary Disease (COPD) is characterized by persistent and progressive airflow limitation caused due to chronic inflammation in the lungs. Approximately 15 million adults in the United States (U.S.) are estimated to be diagnosed with COPD and an equal number may have undiagnosed COPD. Challenges to COPD management include high prevalence of inflammation-related multimorbidity among individuals with COPD. The association between multimorbidity, existing COPD management and role of novel therapies with anti-inflammatory properties (e.g. statins) in improving COPD-specific outcomes is not well researched. Therefore, the purpose of this study was to use real-world observational data to provide a comprehensive understanding of the relationship between multimorbidity and COPD management as well as assess the effectiveness and safety of statins in terms of COPD management. The specific aims of three studies were to: (1) examine the association between inflammation-related multimorbidity and COPD management in terms of COPD medication receipt, long-acting bronchodilators persistence and COPD-specific outcomes; (2) assess the effectiveness of novel statin therapy in improving COPD-specific outcomes; (3) evaluate the safety of statins and other commonly used medications (antidepressants and inhaled corticosteroids) in terms of new-onset diabetes. This study used a retrospective longitudinal dynamic cohort design using data extracted from multiple years (2005-2008) of Medicaid Analytic eXtract (MAX) files to identify Medicaid beneficiaries with newly diagnosed COPD (n = 19,060). Findings from the first study documented very high prevalence of inflammation-related multimorbidity and indicated that it was significantly associated with reduced COPD-medication utilization and decreased persistence on long-bronchodilators. Our study findings suggest that COPD medication management may be poor due to competing demands arising from the presence of inflammation-related multimorbidity. The results from the study on effectiveness of statins revealed that any statin use improved COPD-specific outcomes compared to no statin use. A closer examination of the data revealed that only those with long-term statin use had better outcomes as compared to those with no statin use. We also found that beneficiaries with inflammation-related multimorbidity and statin use had better COPD-specific outcomes compared to those with multimorbidity and no statin use. From the third study, we found that association between statin use and risk of new-onset diabetes was no longer significant in analyses that controlled for selection bias in unobserved characteristics. Collectively, these findings indicate poor COPD management among those with multimorbidity and emphasize the need for novel therapies to effectively manage COPD. In this context, the current study underscores the advantage of statins in improving COPD-specific clinical and economic outcomes. This study indicate the need of randomized clinical trials and long-term observational studies to establish the efficacy, effectiveness, and safety of novel therapeutic agents in management of COPD

Strategies for Reining In Medicare Spending Through Delivery System Reforms: Assessing the Evidence and Opportunities

Outlines promising measures to achieve savings in Medicare costs by reducing the need for hospitalization and readmission and by reducing disparities across physicians and geographic areas in care delivery, utilization, and expenditures

Developing Innovative Payment Approaches: Finding the Path to High Performance

Discusses issues in facilitating, under the 2010 health reform law, initiatives to identify, develop, implement, and monitor payment and delivery system reforms to improve quality and control costs while supporting the fiscal integrity of public programs