Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model.

Social determinants of health can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the Accountable Health Communities (AHC) Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by the Centers for Medicare and Medicaid Services, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services.

Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities.

The Center for Medicare and Medicaid Innovation launched the Accountable Health Communities (AHC) Model in 2017 to assess whether identifying and addressing Medicare and Medicaid beneficiaries' health-related social needs reduced health care use and spending. We surveyed a subset of AHC Model beneficiaries with one or more health-related social needs and two or more emergency department visits in the prior twelve months to assess their use of community services and whether their needs were resolved. Survey findings indicated that navigation-connecting eligible patients with community services-did not significantly increase the rate of community service provider connections or the rate of needs resolution, relative to a randomized control group.

Effects of Global Budget Payments on Vulnerable Medicare Subpopulations in Maryland.

There is little evidence regarding population equity in alternative payment models (APMs). We aimed to determine whether one such APM, the Maryland All-Payer Model (MDAPM), had differential effects on subpopulations of vulnerable Medicare beneficiaries. We utilized Medicare fee-for-service claims for beneficiaries living in Maryland and 48 comparison hospital market areas between 2011 and 2018.

Patient-Centered Medical Home Activities Associated With Low Medicare Spending and Utilization.

Purpose: To identify components of the patient-centered medical home (PCMH) model of care that are associated with lower spending and utilization among Medicare beneficiaries.

Methods: Regression analyses of changes in outcomes for Medicare beneficiaries in practices that engaged in particular PCMH activities compared with beneficiaries in practices that did not. We analyzed claims for 302,719 Medicare fee-for-service beneficiaries linked to PCMH surveys completed by 394 practices in the Centers for Medicare & Medicaid Services' 8-state Multi-Payer Advanced Primary Care Practice demonstration.

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures.

Changes in Utilization and Expenditures for Medicare Beneficiaries in Patient-centered Medical Homes: Findings From the Multi-Payer Advanced Primary Care Practice Demonstration.

Background: Patient-centered medical homes are expected to reduce expenditures by increasing the use of primary care services, shifting care from inpatient to outpatient settings, and reducing avoidable utilization. Under the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare joined Medicaid and commercial payers in 8 states to support ongoing patient-centered medical home initiatives.

Objective: To evaluate the effects of the MAPCP Demonstration on health care utilization and expenditures for Medicare beneficiaries.

Reducing Inpatient Hospital and Emergency Room Utilization Among Nursing Home Residents.

Objective: To examine the association among nursing home residents between strength of relationship with a primary care provider (PCP) and inpatient hospital and emergency room (ER) utilization.

Method: Medicare administrative data for beneficiaries residing in a nursing home between July 2007 and June 2009 were used in multivariate analyses controlling for beneficiary, nursing home, and market characteristics to assess the association between two measures-percentage of months with a PCP visit and whether the patient maintained the same usual source of care after nursing home admission-and hospital admissions and ER visits for all causes and for ambulatory care sensitive conditions (ACSCs).

Results: Both measures of strength of patient-provider relationships were associated with fewer inpatient admissions and ER visits, except regularity of PCP visits and ACSC ER visits.

Primary care and specialty providers: an assessment of continuity of care, utilization, and expenditures.

Background: Little is known as to whether medical home principles, such as continuity of care (COC), would have the same effect on health service use for individuals whose primary (or predominant) provider is a specialist instead of a primary care provider (PCP).

Objective: To test associations between health service use and expenditures and (1) beneficiaries' predominant provider type (PCP or specialist) and (2) COC among beneficiaries who primarily see a PCP and those who primarily see a specialist.

Research Design: This is a cross-sectional analysis of Medicare fee-for-service claims data from July 2007 to June 2009.

Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening.

Background: Although state Medicaid programs cover cancer screening, Medicaid beneficiaries are less likely to be screened for cancer and are more likely to present with tumors of an advanced stage than are those with other insurance. The current study was performed to determine whether state Medicaid eligibility and reimbursement policies affect the receipt of breast, cervical, and colon cancer screening among Medicaid beneficiaries.

Methods: Cross-sectional regression analyses of 2007 Medicaid data from 46 states and the District of Columbia were performed to examine associations between state-specific Medicaid reimbursement/eligibility policies and receipt of cancer screening.

Cancer Treatment for Dual Eligibles: What Are the Costs and Who Pays?

This study quantifies treatment costs for melanoma and breast, cervical, colorectal, lung, and prostate cancer among patients with dual Medicare and Medicaid eligibility. The analyses use merged Medicare and Medicaid Analytic eXtract enrollment and claims data for dually eligible beneficiaries age>18 in Georgia, Illinois, Louisiana, and Maine in 2003 (n=892,001). We applied ordinary least squares regression analysis to estimate annual expenditures attributable to each cancer after controlling for beneficiaries' age, race/ethnicity, sex, and comorbid conditions, and state fixed effects.

Cancer Screening Among U.S. Medicaid Enrollees with Chronic Comorbidities or Residing in Long-Term Care Facilities.

Background: Ensuring appropriate cancer screenings among low-income persons with chronic conditions and persons residing in long-term care (LTC) facilities presents special challenges. This study examines the impact of having chronic diseases and of LTC residency status on cancer screening among adults enrolled in Medicaid, a joint state-federal government program providing health insurance for certain low-income individuals in the U.S.

What happens to children who lose public health insurance coverage?

Little is known about what happens to children who disenroll from public health-insurance programs. A telephone survey was conducted of children who recently had disenrolled from either Oregon's State Children's Health Insurance Program (SCHIP) or FHIAP (premium assistance) programs, both of which have identical eligibility requirements. Access for these disenrolled children was driven largely by health insurance coverage.

Premium subsidy programs: who enrolls, and how do they fare?

Little is known about who enrolls in state premium subsidy programs or enrollees' experiences. This study surveyed parents of children enrolled in two programs with identical income eligibility requirements: Oregon's State Children's Health Insurance Program (SCHIP) and its premium subsidy program (FHIAP). Parents choosing FHIAP were more likely to be employed, to speak English, to have prior experience with premiums and private health insurance, and to perceive insurance as protection against future health care needs.

State payment limitations on Medicare cost-sharing: impact on dually eligible beneficiaries.

The Balanced Budget Act (BBA) of 1997 allowed states to limit how much their Medicaid programs contributed toward the Medicare cost-sharing liability of dually eligible beneficiaries. Policymakers have grown concerned that such limitations may affect access to care for these beneficiaries. We used a quasi-experimental design to analyze changes in access from 1996 to 1998, using Medicare and Medicaid data from nine states.

Consequences of states' policies for SCHIP disenrollment.

Policymakers are concerned about disenrollment from the State Children's Health Insurance Program (SCHIP). We describe disenrollment in Florida, Kansas, New York, and Oregon and assess the links between disenrollment and States' SCHIP policies. We found that SCHIP is used on a long-term basis (at least 2 years) for a significant group of new enrollees and as temporary coverage (fewer than 12 months) for many others.

Children in the Oregon Health Plan: how have they fared?

This study examines the impact of the Oregon Health Plan (OHP) on children's access to care. A telephone survey was conducted in 1998 of two groups of children: OHP enrollees and food stamp recipients not enrolled in OHP. Much of OHP's impact has been realized by the simple extension of health insurance coverage to Oregon's low-income children.

Impact of the Oregon Health Plan on access and satisfaction of adults with low income.

Objective: To evaluate the effects of the Oregon Health Plan (OHP) on beneficiary access and satisfaction.

Data Sources: Telephone survey of nondisabled adults in 1998.

Study Design: Two groups of adults were surveyed: OHP enrollees and Food Stamp recipients not enrolled in OHP.

Covering Uninsured Adults Through Medicaid: Lessons from the Oregon Health Plan.

The Oregon Health Plan (OHP), Oregon's section 1115 Medicaid waiver program, expanded eligibility to all residents living below poverty. We use survey data, as well as OHP administrative data, to profile the expansion population and to provide lessons for other States considering such programs. OHP's eligibility expansion has proved a successful vehicle for covering large numbers of uninsured adults, although most beneficiaries enroll for only a brief period of time.