State Benefit Design Choices under SCHIP - Implications for Pediatric Health Care

This policy brief1 is the second in a series of reports focusing on the design of state SCHIP programs as they near full implementation. It examines the extent to which state agencies adopt conventional insurance norms or adhere to special principles of Medicaid coverage design for children in designing separately administered (or freestanding) SCHIP programs. The issue of coverage design is particularly relevant for children with low prevalence conditions and special health care needs. Increasingly, conventional insurance uses standardized coverage norms to limit coverage and treatment. These standardized norms take the form of across-the-board treatments and exclusions, limited definitions of medical necessity, and the use of irrebuttable, standardized treatment guidelines in determining when covered treatments will be available. All of these practices are impermissible under Medicaid, which uses exceptionally broad preventive standards to determine coverage of children; such standards favor coverage of children with low prevalence problems

Assessing the Effects of Medicaid Documentation Requirements on Health Centers and Their Patients: Results of a Second Wave Survey

This report represents a second wave follow-up to a first wave study whose purpose was to measure the effects of the Deficit Reduction Act\u27s citizenship documentation requirements on health centers and their patients. The earlier study, conducted six months after implementation, found that the law had a widespread impact, including delayed applications, interrupted enrollment, disruptions in care, and at least anecdotal evidence of a growth in the number of uninsured patients as a result of the denial or loss of Medicaid coverage. This second wave survey underscores the existence of serious, ongoing problems more than a year after implementation. Specifically, the second wave survey finds that: Three-quarters of all health centers continue to experience significant problems with citizenship documentation barriers for one or more patient groups; among health centers experiencing problems, the situation appears to be worsening rather than lessening on key measures. Documentation requirements appear to have particularly affected several specific patient categories, including pregnant women, children, patients new to the service area, and newborns. About one-third of health centers report a longer and more difficult application and enrollment process. Nearly one-half of health centers continue to report that Medicaid application and enrollment disruptions and delays continue to affect their ability to arrange for specialty care and many affected centers report increased costs associated with helping patients with application and enrollment problems. Although regulatory changes issued in 2007 were intended to address the problem, a significant number of health centers continue to report enrollment delays affecting newborns. Despite the fact that the DRA did not modify the State Children’s Health Insurance Program (SCHIP) when administered as a separate program, fully one-third of health centers located in states with separate SCHIP programs, and 45 percent of respondents in states with combination programs (Medicaid expansions plus a separate SCHIP expansion), reported that citizenship documentation requirements are being applied to SCHIP applicants as well. These findings suggest that changes implemented in the final rules have done little to ease burdens associated with the DRA’s citizenship documentation requirements, and that the law\u27s greatest impact is falling on low income children and pregnant women and the health care providers that serve them

How Care Is Managed: A Descriptive Study of Current and Future Trends in Care and Cost Management Practices Under Private Sector Employee Benefit Plans

In the fall of 2001, the United States Department of Health and Human Services\u27 Office of the Assistant Secretary for Planning and Evaluation (ASPE) asked the Center for Health Services Research and Policy in the School of Public Health and Health Services, The George Washington University Medical Center, to undertake a descriptive study of the current and future trends in cost and care management techniques used in the employment-based health insurance marketplace. The purpose of this study was to identify and report on (1) the cost and care management techniques currently in use in the private sector by health plans and employers, and (2) what, in the view of experts, were the likely future trends. The research team was asked to perform this descriptive study by interviewing experts in field. As part of the study, the Center was also asked to conduct a review of the literature concerning current cost and care management approaches used by managed care plans and employers in the private sector, with a focus on non-peer reviewed articles in trade journals and the popular press. Since the focus of this study was private sector purchasers, we were asked to exclude literature regarding cost and care management techniques used in the Medicaid and Medicare programs

Charting the Legal Environment of Health Information

Over the past several years, increased attention has been focused on the importance of health information to health care quality improvement. The level of focus on health information has increased with the advent of electronic medical records and electronic health information systems designed to facilitate the use of health care data. Although these systems are still in their relative infancy, they hold enormous promise for revolutionizing the availability and use of health information to improve clinical performance, empower employers and consumers to better understand health plan choices and facilitate health claims administration. Their potential has been a catalyst for change in a growing number of communities, with the emergence of private/public partnerships to develop regional health information systems

Community Health Centers in Indiana: State Investments and Returns

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state\u27s most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state\u27s investment in community-based health centers

Health Information Technology in the United States: On the Cusp of Change, 2009

In this report we use the data collected for ONCHIT to focus on EHR adoption in the inpatient setting. We report on several important policy issues. These include the rate of adoption of EHRs among U.S. hospitals generally and among safety-net hospitals, changes in both state and federal policy, and the potential of EHRs to change the quality measurement enterprise

Accountability in Medicaid Managed Care: Implications for Pediatric Health Care Quality

This study examines the structure and operation of Medicaid and State Children\u27s Health Insurance Program (SCHIP) health care access and quality monitoring systems for children enrolled in comprehensive managed care arrangements. As the single largest purchasers of pediatric health care in the U.S., Medicaid and SCHIP agencies play a potentially powerful role in pediatric health policy. How these agencies approach, design, and carry out health quality monitoring activities has the potential to have a major impact not only for poor and low-income children, but for the entire pediatric health system. Even when these systems are developed exclusively for publicly insured children, their influence can extend beyond the four corners of a specific contractual arrangement, since participating health professionals, health care institutions and businesses typically are not exclusive to these arrangements, and the devolutionary influence of one purchaser\u27s expectations thus can travel beyond the scope of the agreement

Emerging Privacy Issues in Health Information Technology

Health information technology (HIT) and electronic health records (EHRs) are topics that currently engender lively debate in our health care system. In our 2006 inaugural report, Health Information Technology in the United States: The Information Base for Progress, we examined the challenges related to accurately measuring HIT adoption in the United States and made recommendations both for improving existing, ongoing national surveys and for new surveys. This report expands on those efforts, reporting on new survey data among physicians generally and among those serving “vulnerable populations” and exploring methods of evaluating the effect of these technologies on the cost and quality of health care

Recent Federal Initiatives in Health Information Technology

Health information technology (HIT) has the potential to revolutionize the delivery of health care. In our two previous reports about HIT in the United States we detailed the challenges faced by policy-makers working toward the goal of increased adoption of electronic health records. Since that time the role of health information technology in promoting higher quality, more efficient health care has taken a central position in the current health care reform debate. There is broad bipartisan support to speed health information technology adoption, and the American Recovery and Reinvestment Act of 2009 (ARRA) has made promoting a national interoperable health information system a priority, authorizing significant resources to achieve this goal. This report builds on our previous work, initiated by the Office of the National Coordinator for Health Information Technology (ONCHIT) in 2007, to design and deploy standardized measures of electronic health record (EHR) adoption in a national hospital survey. This report, like its predecessors, is funded by the Robert Wood Johnson Foundation (RWJF) which has a longstanding commitment to understanding and improving the quality of American health care. This commitment includes a multitude of efforts designed to address all dimensions of the quality problem, including inequities in care. RWJF has supported this report in order to share the lessons of the ONCHIT work more broadly and review what is known about the state of EHR adoption and its implications for improving health care quality

State purchasing and enforcement quality care for children in Medicaid and SCHIP managed care

State Medicaid/Children\u27s Health Insurance Program (SCHIP) agencies play pivotal roles in ensuring that participating health plans provide quality care. In 2003, researchers interviewed SCHIP officials with oversight responsibilities in nine states and found that all agencies had formal monitoring procedures and that all of them regularly collected data that measured health plans\u27 compliance with quantifiable standards. Several states designed a graduated incentive and penalty system, which they believed favored compliance. Many agencies also stressed the need for collaboration with participating plans, because of underlying systemic barriers. None of the surveyed states considered their contractual agreements with health plans as all-encompassing on quality improvement, which underscores the importance of additional, noncontractual strategies to improve the quality of care. The survey found a disparity between state expectations for health plan performance and the realities of the delivery system, including the priorities of health plans and providers. The sample states were good monitors who enforced general contractual standards of pediatric quality of care; however, one shortcoming was found. Few of the surveyed states focused on oral disease or lead poisoning as part of their overall quality improvement efforts