Health Care Utilization among Children Enrolled in Medicaid and CHIP via Express Lane Eligibility.

Objective: To assess health care utilization among children enrolled in Medicaid and CHIP via Express Lane Eligibility (ELE).

Data Sources/study Setting: Enrollment, claims, and encounter data for children enrolled in Medicaid or CHIP in Alabama, Iowa, Louisiana, and New Jersey during 2009-2012.

Study Design: We compared health care utilization among children enrolled via ELE and nondisabled children who enrolled through standard pathways in each state.

Adapting school-based substance use prevention curriculum through cultural grounding: a review and exemplar of adaptation processes for rural schools.

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin' it REAL substance use prevention curriculum for a rural adolescent population.

Value for the money spent? Exploring the relationship between expenditures, insurance adequacy, and access to care for publicly insured children.

This study examines the relationship between total state Medicaid spending per child and measures of insurance adequacy and access to care for publicly insured children. Using the 2007 National Survey of Children's Health, seven measures of insurance adequacy and health care access were examined for publicly insured children (n = 19,715). Aggregate state-level measures were constructed, adjusting for differences in demographic, health status, and household characteristics.

Patient mix in outpatient surgery settings and implications for Medicare payment policy.

In 2008, Medicare implemented a new payment policy for ambulatory surgical centers (ASCs), which aligns the ASC payment system with that used for hospital outpatient departments and reimburses ASCs approximately 65% of what hospitals receive for the same outpatient surgery. The authors assess patient selection across ASCs and hospital outpatient departments for four common surgeries (colonoscopy, hernia repair, knee arthroscopy, cataract repair), using data on procedures performed in Florida from 2004 to 2008. The authors construct measures of patient illness severity and cost risk and find that ASCs benefit from positive selection.

Out-of-pocket drug costs and drug utilization patterns of postmenopausal Medicare beneficiaries with osteoporosis.

Background: The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap.

Objectives: The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis.

Treatment approach and HbA1c control among US adults with type 2 diabetes: NHANES 1999-2004.

Objective: To examine the distribution of diabetic medications among adults with type 2 diabetes, and the association between glucose control and treatment approach in the US population.

Methods: Interview and prescription medication data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were used to determine the treatment approach for US adults with type 2 diabetes. Mean glycosylated hemoglobin (HbA1c) and the proportion of adults meeting recommended guidelines for glucose control were estimated for each treatment approach.