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

Will Employers Want Aging Boomers?

Explores the status quo of older workers; why baby boomers are likely to work longer; and how changes in needed skills, the characteristics of older workers, and labor force growth will affect demand for older workers. Includes policy recommendations

Models for Change: Building Momentum for Juvenile Justice Reform

Models for Change: Building Momentum for Juvenile Justice Reform tells the story of how innovative state leaders from across the country are creating a new path toward fair, rational, effective and developmentally appropriate models for juvenile justice reform. Pennsylvania, Illinois, Louisiana and Washington are already moving to reform and reshape their juvenile justice systems. These states have demonstrated strong leadership in juvenile justice policy, value collaboration and engagement and, because of their efforts, have changed the political climate to make deeper systems reform possible. Models for Change, a new initiative from the John D. and Catherine T. MacArthur Foundation, is seeking to build on their efforts in the hope that these states develop new model policies, practices and procedures that will strengthen their reform work, and possibly represent changes that could be replicated in other states

The roles of adult siblings in the lives of people with severe intellectual and developmental disabilities

BACKGROUND: Siblings of people with intellectual and developmental disabilities (IDD) often assume key roles to support their brothers and sisters. For people with more significant support needs, siblings may undertake additional roles and responsibilities throughout their lives. The purpose of the present study was to identify and describe the roles of adult siblings who have a brother or sister with severe IDD. METHOD: Seventy‐nine adult siblings from 19 to 72 years of age completed an online survey with open‐ended questions about the roles they play in their relationships with their brother or sister. RESULTS: Thematic analysis resulted in identification of several roles including caregiver, friend (social partner), advocate, legal representative, sibling (teacher/role model), leisure planner and informal service coordinator. CONCLUSION: Siblings assume key roles in the lives of people with IDD and need support from family and professionals to perform these roles.Accepted manuscrip

Socioeconomic Status and Medical Care Expenditures in Medicare Managed Care

This study examined the effects of education, income, and wealth on medical care expenditures in two Medicare managed care plans. The study also sought to elucidate the pathways through which socioeconomic status (SES) affects expenditures, including preferences for health and medical care and ability to navigate the managed care system. We modeled the effect of SES on medical care expenditures using Generalized Linear Models, estimating separate models for each component of medical expenditures: inpatient, outpatient, physician, and other expenditures. We found that education, income, and wealth all affected medical care expenditures, although the effects of these variables differed across expenditure categories. Moreover, the effects of these SES variables were much smaller than the effects found in earlier studies of fee-for-service Medicare. The pathway variables also were associated with expenditures. Accounting for the pathways through which SES affects expenditures narrowed the effect of SES on expenditures; however, the change in the estimates was very small. Thus, although our measures of preferences and ability to navigate the system were associated with expenditures, they did not account for an appreciable share of the impact of SES on expenditures.

Panel on future challenges in modeling methodology

This panel paper presents the views of six researchers and practitioners of simulation modeling. Collectively we attempt to address a range of key future challenges to modeling methodology. It is hoped that the views of this paper, and the presentations made by the panelists at the 2004 Winter Simulation Conference will raise awareness and stimulate further discussion on the future of modeling methodology in areas such as modeling problems in business applications, human factors and geographically dispersed networks; rapid model development and maintenance; legacy modeling approaches; markup languages; virtual interactive process design and simulation; standards; and Grid computing

Development of a Case-Mix Funding System for Adults with Combined Vision and Hearing Loss

Background: Adults with vision and hearing loss, or dual sensory loss (DSL), present with a wide range of needs and abilities. This creates many challenges when attempting to set the most appropriate and equitable funding levels. Case-mix (CM) funding models represent one method for understanding client characteristics that correlate with resource intensity. Methods: A CM model was developed based on a derivation sample (n = 182) and tested with a replication sample (n = 135) of adults aged 18+ with known DSL who were living in the community. All items within the CM model came from a standardized, multidimensional assessment, the interRAI Community Health Assessment and the Deafblind Supplement. The main outcome was a summary of formal and informal service costs which included intervenor and interpreter support, in-home nursing, personal support and rehabilitation services. Informal costs were estimated based on a wage rate of half that for a professional service provider ($10/hour). Decision-tree analysis was used to create groups with homogeneous resource utilization. Results: The resulting CM model had 9 terminal nodes. The CM index (CMI) showed a 35-fold range for total costs. In both the derivation and replication sample, 4 groups (out of a total of 18 or 22.2%) had a coefficient of variation value that exceeded the overall level of variation. Explained variance in the derivation sample was 67.7% for total costs versus 28.2% in the replication sample. A strong correlation was observed between the CMI values in the two samples (r = 0.82; p = 0.006). Conclusions: The derived CM funding model for adults with DSL differentiates resource intensity across 9 main groups and in both datasets there is evidence that these CM groups appropriately identify clients based on need for formal and informal support

CareOregon: Transforming the Role of a Medicaid Health Plan From Payer to Partner

Details Triple Aim pilot programs designed to offer patient-centered medical homes and multidisciplinary case management in an effort to improve population health, enhance patients' experience, and slow cost growth

Promising Practices: Supporting Transition of Youth Served by the Foster Care System

A continuation of the 1997 study funded by the Annie E. Casey Foundation, this collaborative effort with the National Resource Center for Youth Services presents findings of a study of approximately 100 independent living and transitional living programs. It identifies "promising practices" linked with positive outcomes for youth leaving foster care-and presents information drawn from interviews with program staff and participating youth