For the United Hospital Fund and The Commonwealth Fund, The Lewin Group estimated the cost and coverage impacts of a variety of options to achieve universal health insurance coverage in New York. The Lewin Group analyzed the expansion scenarios using its Health Benefits Simulation Model. The full report of the project, A Blueprint for Universal Health Insurance Coverage in New York, is available on The Commonwealth Fund's website.

The City and County of San Francisco’s Controller’s Office and the Department of Public Health commissioned The Lewin Group to conduct a local market assessment and benchmarking analysis. The market assessment analyzes the current healthcare environment in the city, makes projections of demand for healthcare services, and examines the Department of Public Health’s role in providing direct healthcare to San Franciscans. The benchmarking analysis compares San Francisco General Hospital with comparable Bay Area, California and national public healthcare delivery systems across measures designed to assess efficiency and effectiveness. The benchmarking analysis also identifies best practices contributing to the success of the benchmark safety net systems.

Osteoporosis is a disease that is characterized by low bone mass and a deterioration of bone structure that results in bone fragility and an increased risk of fracture. The disease affects 10 million older Americans and is associated with significant mortality and morbidity. An additional 34 million individuals have osteopenia (low bone mass) and are at increased risk of fracture at some time in their lives. Osteoporosis-related fractures represent a serious illness burden and are a major cause of disability among Medicare beneficiaries. Dual-energy X-ray absorptiometry (DXA) is the“gold standard” for diagnosing osteoporosis, using World Health Organization criteria. Amid recent changes in Medicare reimbursement methodology, providers had become concerned that payment for DXA and vertebral fracture assessment (VFA) was below operating costs. However, a systematic study of the cost to perform a DXA procedure had not been conducted. The American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, The Endocrine Society and the American College of Rheumatology commissioned The Lewin Group to survey office-based providers of DXA, in order to develop estimates of the costs associated with providing DXA services to Medicare beneficiaries. This study should assist policymakers and others to determine whether the current Medicare reimbursement for DXA approximates real world operating costs.

Osteoporosis is a disease that is characterized by low bone mass and a deterioration of bone structure that results in bone fragility and an increased risk of fracture. The disease affects 10 million older Americans and is associated with significant mortality and morbidity. An additional 34 million individuals have osteopenia (low bone mass) and are at increased risk of fracture at some time in their lives. Osteoporosis-related fractures represent a serious illness burden and are a major cause of disability among Medicare beneficiaries. Dual-energy X-ray absorptiometry (DXA) is the“gold standard” for diagnosing osteoporosis, using World Health Organization criteria. Amid recent changes in Medicare reimbursement methodology, providers had become concerned that payment for DXA and vertebral fracture assessment (VFA) was below operating costs. However, a systematic study of the cost to perform a DXA procedure had not been conducted. The American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, The Endocrine Society and the American College of Rheumatology commissioned The Lewin Group to survey office-based providers of DXA, in order to develop estimates of the costs associated with providing DXA services to Medicare beneficiaries. This study should assist policymakers and others to determine whether the current Medicare reimbursement for DXA approximates real world operating costs.

This report, prepared for the Advanced Medical Technology Association (AdvaMed), presents estimates of the economic contributions of the Medical Technology Industry (MTI) to each of the 50 states and the District of Columbia. This includes 2006 estimates for each state of MTI employment, payrolls, and sales/shipments and of the multiplier economic effects on these same measures.

The concept of personalized health care (PHC) has attracted considerable scientific, medical, commercial and policy interest for its potential to sharpen the focus of health care and improve its effectiveness and efficiency. As part of a broader vision of advancing and leveraging medical research to improve and transform health care in the US, the Secretary of the US Department of Health and Human Services (DHHS) has identified personalized health care as one of the Department’s top 10 priorities. The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to convene a PHC Expert Panel to provide input to the Office of the Secretary, DHHS, toward realizing the integration of PHC into clinical and public health practice. During the meeting the panel considered and discussed five main issues pertaining to the integration of PHC into clinical and public health practice: Demonstrating clinical validity and utility of PHC Demonstrating value/cost-effectiveness of PHC Identifying the role of PHC in reducing health disparities Educating and engaging providers and patients about PHC Using databases to build evidence and inform decisions in PHC This report summarizes key observations that emerged from the Expert Panel’s discussion of these five main issues.

For the National Council of Child Support Directors, The Lewin Group and its subcontractor, EcoNorthwest, explored the potential implications of changes to federal financing of child support enforcement programs contained in the Deficit Reduction Act of 2005 (DRA). The project involved two tasks: Data Analysis. Using child support administrative data and economic and demographic information from the Census Bureau and other sources, the project team explored the potential effects of the DRA provision on use of incentives for state match on state performance in two areas: support order establishment and collections made on current support due. Survey of IV-D Directors. The project team had conversations with 28 state CSE directors about a number of DRA provisions, including the treatment of incentives for match purposes, adoption of (or increase in) the pass-through of collections to current assistance cases, and the mandatory fee for non-assistance cases that generate $500 or more in collections per year. The directors described the extent to which they expect to make up the funding shortfalls and the potential implications of any loss in funding.

The Lewin Group was engaged by the Association of Community Affiliated Plans to study the role of Medicaid and Medicaid health plans in reforms to cover the uninsured. This paper discusses the experiences of two programs that provide and/or subsidize coverage directly: The Massachusetts-run Commonwealth Care Health Insurance Program, which links eligible residents with approved insurance plans and helps them pay for the plans, and the county-administered children’s health initiatives (CHIs) in California, which cover low-income children who are not eligible for Medicaid or SCHIP. This report, based on discussions with Medicaid health plans that participate in these programs, discusses the use of Medicaid health plans as vehicles for expansion efforts in state and county health coverage expansion reform initiatives. This paper presents case studies of their experiences and lessons learned for both health plans and for purchasers.

The Lewin Group was engaged by the Association of Community Affiliated Plans to study the role of Medicaid and Medicaid health plans in reforms to cover the uninsured. This paper discusses the experiences of two programs that provide and/or subsidize coverage directly: The Massachusetts-run Commonwealth Care Health Insurance Program, which links eligible residents with approved insurance plans and helps them pay for the plans, and the county-administered children’s health initiatives (CHIs) in California, which cover low-income children who are not eligible for Medicaid or SCHIP. This report, based on discussions with Medicaid health plans that participate in these programs, discusses the use of Medicaid health plans as vehicles for expansion efforts in state and county health coverage expansion reform initiatives. This paper presents case studies of their experiences and lessons learned for both health plans and for purchasers.

The National Women's Health Resource Center (NWHRC) has released a new report by The Lewin Group. The report, Prevalence and Treatment Patterns of Pelvic Health Disorders Among U.S. Women, examines four pelvic health conditions - menorrhagia, uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse - that commonly affect women and, in particular, Baby Boomer women born between 1946 and 1964. The report addresses five key issues regarding each of the respective disorders: What is the prevalence among women in the U.S., and how does prevalence differ by age and other demographic variables? How do these disorders affect women, and, in particular Baby Boomers in the US? To what extent is the magnitude and severity of these disorders properly recognized and understood by public health practitioners, researchers and policymakers? Does a treatment gap exist? Do current treatment patterns reflect the most effective and appropriate standards of practice? Some of the report’s key findings include: At least one-third of all women in the U.S. will be treated for one or more pelvic health disorders by the age of 60. The Baby Boomer generation is currently in the phase of life with the highest rate of onset for pelvic health disorders. Pelvic health disorders have a substantial impact on women’s health and quality of life. Women’s reluctance to consult their physicians about symptoms associated with pelvic health disordrs results in under- and/or misdiagnosis, further complicating the treatment and overall understanding of the impact of these disorders. Current patterns of care indicate that clinically recommended and effective treatments generally are employed for each disorder. However, some clinicians and researchers are concerned about the common use of hysterectomies for menorrhagia and uterine fibroids, as well as the rate of anterior repairs used to treat SUI.

The National Women's Health Resource Center (NWHRC) has released a new report by The Lewin Group. The report, Prevalence and Treatment Patterns of Pelvic Health Disorders Among U.S. Women, examines four pelvic health conditions - menorrhagia, uterine fibroids, stress urinary incontinence (SUI) and pelvic organ prolapse - that commonly affect women and, in particular, Baby Boomer women born between 1946 and 1964. The report addresses five key issues regarding each of the respective disorders: What is the prevalence among women in the U.S., and how does prevalence differ by age and other demographic variables? How do these disorders affect women, and, in particular Baby Boomers in the US? To what extent is the magnitude and severity of these disorders properly recognized and understood by public health practitioners, researchers and policymakers? Does a treatment gap exist? Do current treatment patterns reflect the most effective and appropriate standards of practice? Some of the report’s key findings include: At least one-third of all women in the U.S. will be treated for one or more pelvic health disorders by the age of 60. The Baby Boomer generation is currently in the phase of life with the highest rate of onset for pelvic health disorders. Pelvic health disorders have a substantial impact on women’s health and quality of life. Women’s reluctance to consult their physicians about symptoms associated with pelvic health disordrs results in under- and/or misdiagnosis, further complicating the treatment and overall understanding of the impact of these disorders. Current patterns of care indicate that clinically recommended and effective treatments generally are employed for each disorder. However, some clinicians and researchers are concerned about the common use of hysterectomies for menorrhagia and uterine fibroids, as well as the rate of anterior repairs used to treat SUI.

This report explores the prevalence and economic impact of various chronic diseases in the states of South Carolina, Iowa, and New Hampshire. The chronic diseases covered include cardiovascular disease, diabetes, cancer, depression, and asthma.

This report conveys the findings of the Independent Assessment of the access, quality, and cost-effectiveness of health care services delivered under New Mexico’s Behavioral Health Collaborative. This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs. The Lewin Group has reviewed the access- and quality-related state contractual requirements, ValueOptions’ proposal to the State of New Mexico, Managed Care Audit, ValueOptions’ provider network, selected reports, provider satisfaction survey, national performance standards and MHSIP performance, ValueOptions’ Quality Management Program, and various financial reports. Based on the comprehensive review of submitted reports and data related to consumer and provider satisfaction, the program is off to a strong start in some respects and a challenging start in others. ValueOptions and the Interagency Behavioral Health Purchasing Collaborative have implemented a behavioral health system that is designed to not only provide access to quality health services, but also integrate other non-medical health member needs. The State of New Mexico has set extensive and specific requirements for performance, which ValueOptions has already met or appears to be making significant progress towards. New Mexico’s behavioral health system meets CMS guidelines and requirements in terms of access, quality, and cost-effectiveness.

This report explores the history of the North Carolina Health Choice for Children program over the past decade. The report also summarizes the perspectives of several key stakeholders and experts about the about the issues that will be discussed at the federal and state levels during the SCHIP reauthorization process.

This report conveys the findings of the Independent Assessment of the access, quality, and cost-effectiveness of health care services delivered under New Mexico’s Behavioral Health Collaborative. This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs. The Lewin Group has reviewed the access- and quality-related state contractual requirements, ValueOptions’ proposal to the State of New Mexico, Managed Care Audit, ValueOptions’ provider network, selected reports, provider satisfaction survey, national performance standards and MHSIP performance, ValueOptions’ Quality Management Program, and various financial reports. Based on the comprehensive review of submitted reports and data related to consumer and provider satisfaction, the program is off to a strong start in some respects and a challenging start in others. ValueOptions and the Interagency Behavioral Health Purchasing Collaborative have implemented a behavioral health system that is designed to not only provide access to quality health services, but also integrate other non-medical health member needs. The State of New Mexico has set extensive and specific requirements for performance, which ValueOptions has already met or appears to be making significant progress towards. New Mexico’s behavioral health system meets CMS guidelines and requirements in terms of access, quality, and cost-effectiveness.

coverage in comparison to Part D formulary coverage. The Pharmaceutical Research and Manufacturers of America requested The Lewin Group to look at certain comparisons made of those formularies. This report presents the results of that examination.

This report conveys the findings of the Independent Assessment of the quality, access, and cost-effectiveness of health care services delivered under the New Mexico Medicaid Managed Care program, Salud! This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs. The Lewin Group has reviewed the quality- and access-related state contractual requirements, each Salud! health plan’s quality improvement program, member and provider survey activities, HEDIS® and CAHPS® performance, provider network, and member materials, and various financial reports. The State of New Mexico has created a favorable environment for quality, access, and cost-effectiveness to occur in each of the three MCOs. Thus, the program clearly meets CMS guidelines and requirements in terms of quality, access, and cost-effectiveness.

In 2004, the District of Columbia’s Child Support Services Division (CSSD) launched a demonstration to improve collaboration between the child support agency and the Temporary Assistance for Needy Families (TANF) agency and reduce the number of TANF clients who failed to attend scheduled child support intake appointments, the first step to establishing a child support order. To accomplish this goal, child support intake workers were co-located at the TANF office in the Anacostia neighborhood. CSSD contracted with The Lewin Group to develop the demonstration and conduct the evaluation. To measure the effect of the intervention, individuals applying for TANF or visiting the office for recertification were randomly assigned to a treatment or control group. Treatment group members received child support services at the TANF office, while control group members followed the standard procedure for child support intake, which involved an in-person interview at the CSSD headquarters. The impact study found that the demonstration produced a significant increase in paternities and orders established; impacts on child support payments began to emerge after 12 months.

The purpose of this study is to estimate the potential savings offered throught the new Medicare prescription drug benefit to Medicare beneficiaries living with chronic conditions. For this study, The Lewin Group examined drug spending data for Medicare beneficiaries who face a decision whether to enroll in the Medicare drug benefit. The study focuses primarily on beneficiaries with chronic conditions because these beneficiaries have higher average drug costs than beneficiaries without chronic conditions. The specific chronic conditions included in this study are: Alzheimer's, arthritis, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, mental disorder, osteoporosis, and Parkinson's.

The Lewin Group was asked by The Pharmaceutical Research and Manufacturers of America to compare the formulary status of drugs commonly used by the Medicare population on the Veterans Affairs National Formulary, the two highest enrollment Medicare Part D plans, and the plan with the highest enrollment in the Federal Employee Health Benefit Program. This report presents the findings of that comparison.

Lewin assessed the performance of Connecticut's HUSKY Program, a capitated Medicaid initiative operated through contracts with four health plans. The study was coordinated through the Connecticut Association of Health Plans. The study's purpose is to provide objective information about the HUSKY Program and to compare the policy alternatives of retaining HUSKY versus adopting a "managed fee-for-service" model of coverage. The study finds the HUSKY Program to be successful (above national Medicaid managed care norms) on several key fronts -- delivering large-scale cost savings to taxpayers, fostering access to physician and preventive care services (e.g., EPSDT), and achieving high rates of enrollee satisfaction. The study concludes with a broad set of policy recommendations to strengthen HUSKY going forward, including a sharp increase in underlying Medicaid physician/dentist fee schedules to address the core problem that many "front-line" practitioners are reluctant to serve the State's poverty population.

The Office of the Assistant Secretary for Planning and Evaluation commissioned The Lewin Group to determine how and to what extent cost-effectiveness (CE) considerations are incorporated in the approval and adoption of new health technologies and the implications of not incorporating such considerations. This report examines the use of CE and other cost-health tradeoff evidence by federal and nonfederal health stakeholders, paying particular attention to the scope of authority, range and/or circumstances of use, and responsibilities for regulating CE and other economic information by the Food and Drug Administration. The role of economic evidence in decision-making also is explored in case studies of four contemporary health technologies: nucleic acid testing, Relenza (zanamivir), drug-eluting stents, and implantable cardioverter-defibrillators.

For the United Hospital Fund and The Commonwealth Fund, The Lewin Group estimated the cost and coverage impacts of a variety of options to achieve universal health insurance coverage in New York. The Lewin Group analyzed the expansion scenarios using its Health Benefits Simulation Model. The full report of the project, A Blueprint for Universal Health Insurance Coverage in New York, is available on The Commonwealth Fund's website.

The “Healthy Americans Act” (HAA) establishes a centrally financed system of private health insurance for all Americans not covered by Medicare, that is at least as comprehensive as the coverage provided to members of Congress. Employers give the money they now spend for health insurance to the worker as wages. Participants would chose from a selection of private plans offered through regional purchasing pools called “Health Help Agencies” (HHA's) on the basis of price. The competitive incentives created under the bill would reduce health spending by about 4.5 percent over the next 10 years.

Over the past 20 years, a significant number of senior citizens, particularly among the “oldest old” – persons 85 and older - have been choosing to stay in their homes rather than move to nursing homes, according to a study by The Lewin Group. The full report on this latest research by The Lewin Group was released at a news conference by Lisa Alecxih, Vice President at The Lewin Group, on Tuesday, November 21. The report takes an in-depth look at trends among America's large and growing senior population.

The potential benefits of managed care have led many States to consider expansions in capitated Medicaid programs to the extent that they are consistent with state health care policy goals and specific market and political conditions. However, current Medicaid hospital reimbursement calculations only include fee-for-service Medicaid utilization, which places significant barriers to expanded use of capitated Medicaid managed care contracting in some states. States considering expanding Medicaid managed care must balance any potential benefits against the risk of losing substantial Federal Upper Payment Limit (UPL) funds that play an increasingly important role in supporting the public health care sector, including public safety net hospitals. This report explores Medicaid UPL issues and recommends a policy solution to preserve existing federal funds flow to support public safety net and other providers while also removing barriers to the expansion of Medicaid managed care. The recommended policy change would remove an unintended barrier to managed care expansion, which would in turn allow policy makers to evaluate more clearly the costs and benefits of their Medicaid contracting strategies and make policy choices according to what works best for their state.

This report, commissioned by the Pharmaceutical Care Management Association, describes the effect that selected legal or regulatory interventions could have on the economics of mail-service pharmacy, and provides estimates of the impact of these interventions on pharmacy costs for consumers and payers. These interventions include: Any willing pharmacy laws which mandate the inclusion of pharmacies from a plan's network as long as the pharmacy is willing to meet the standard network terms, conditions and pricing Uniform cost sharing requirements whereby consumers' out-of-pocket expenditures are required to be the same regardless of whether a prescription is filled at a mail or retail pharmacy Required 90-day prescriptions at retail laws mandating that plans cover 90-day prescriptions at retail pharmacies

This analysis, commissioned by the Pharmaceutical Research and Manufacturers of America, sheds new light on how the Medicare prescription drug program is working by assessing the characteristics of plans chosen by beneficiaries. To date, most studies of the Medicare Part D drug benefit have analyzed overall plan offerings and average characteristics without taking into account the enrollment choices of Medicare beneficiaries. This analysis provides a more complete picture by using beneficiary choice to weight plan characteristics, since beneficiaries have disproportionately chosen to enroll in some plans; 64% of enrollment in concentrated in plans offered by four plan sponsors. The Lewin study finds that, on average, beneficiaries have chosen plans with lower premiums, reduced or zero deductibles, and broader formularies.

This report was commissioned by Marin County to analyze the services provided at Marin General Hospital and the extent to which County residents and County government rely on the hospital to meet health care needs. The report's recommendations are designed to help assure that health services in Marin are accessible and effective for all consumers.

For MedCath, Inc., The Lewin Group prepared a report to determine how cardiac care services provided in MedCath heart hospitals compare on measures of patient severity, quality and community impact to cardiac services provided in peer community hospitals across the country that perform open-heart surgery. The Lewin Group has also conducted similar studies in 2002, 2003 and 2004. An executive summary of each study is posted on the MedCath website.

The Medicare drug benefit, which went into effect in January 2006, has resulted in an increase in the number of Medicare beneficiaries with comprehensive prescription drug coverage; nine out of ten Medicare beneficiaries now have comprehensive prescription drug coverage. The Lewin Group analyzed how drug coverage has changed for seniors since implementation of the new Medicare drug benefit and developed a set of factsheets indicating what additional coverage is available to seniors in all 50 states and the District of Columbia.

The Children’s Hospitals Graduate Medical Education (CHGME) Program provides independent children’s teaching hospitals with equitable federal GME funding, enabling them to continue and expand their services dedicated to children’s unique health care needs, as well as to sustain and strengthen their teaching programs. Like their adult counterparts, independent children’s teaching hospitals leverage GME program funding to provide significant value to the patients and communities they serve. This report highlights these benefits across the following key hospital missions: graduate medical education and training; complex, high quality clinical care for all children; cutting edge pediatric research; and community benefits and rural outreach.

The Office of the Health Insurance Commissioner (OHIC) commissioned The Lewin Group to assess the surplus levels of Rhode Island’s three health plans, Blue Cross Blue Shield of Rhode Island, United HealthCare of New England and Neighborhood Health Plan of Rhode Island, pursuant to requirements of the Rhode Island Health Care Reform Act of 2004. The legislature asked OHIC to provide recommendations for what appropriate insurance surplus reserve levels might be for health insurers in Rhode Island. Lewin conducted this study to assess whether Rhode Island's three health plans have surplus levels within appropriate ranges, given the special circumstances of the individual plans and the Rhode Island market. To assess the sufficiency of surplus of health plans in the state, Lewin conducted a series of analyses in which we applied existing models for assessing health plan solvency. We also performed a detailed analysis of the financial experience of the three key insurers in Rhode Island. Lewin drafted and presented oral testimony for use at public forums convened by the Rhode Island Insurance Commissioner. Finally, Lewin drafted a final report that summarized key findings, addresses substantive issues raised during the forums, and made recommendations for action related to health plan surplus. Please click on the links for the March 7, 2006 report, and the individual reports for Blue Cross Blue Shield of Rhode Island, United HealthCare of New England and Neighborhood Health Plan of Rhode Island.

The Boone County Hospital is operated under a lease agreement between the Board of Trustees and BJC Healthcare. The Trustees retained The Lewin Group to provide an independent assessment of the lease agreement and to identify and analyze options for consideration regarding the future of the agreement. The Lewin Group's assessment was based on two key questions: Does Boone Hospital Center need to be leased? and Is the current lease fair to the Trustees and the County?

This paper, prepared for the Health Evidence Network of the World Health Organization, synthesizes the evidence pertaining to what is known about the effectiveness of economic instruments to reduce consumption of foods high in saturated fats and other energy-dense foods for preventing and treating obesity. The review found no direct scientific evidence of a causal relationship between policy-related economic instruments and food consumption, including foods high in saturated fats. Indirect evidence suggests that such a causal relationship is plausible, though it remains to be demonstrated by rigorous studies in community settings. Modeling analyses suggest that a combination of increased prices (in the form of taxes) for such nutrients as fat, saturated fat and sugar and subsidies on fibres could reduce consumption of the taxed nutrients, as well as total energy intake. Studies of tax and price policies applied to tobacco and alcohol products may serve as models for lowering consumption of energy-dense foods, but critical differences among these types of interventions may limit their generalizability to food consumption. The paper also addressed considerations for future policy and research.

The purpose of this report is to provide an objective summary description of Florida's current CON program and review process. It addresses the following questions: What is Florida's CON program? Why was the CON program established? When is a CON review necessary? What is the CON review process and timeline? What are the perceived benefits and disadvatnages of Florida's CON program?

The Lewin Group developed an analysis of options to expand coverage to the uninsured in the state of Mississippi and estimated their impact on government spending, employers and households. The policy options included in the analysis were selected to cover the range of policy recommendations developed under the Mississippi State Planning Grant project. These policy options include expanding coverage under public programs, expanding private insurance coverage and universal coverage options.

The Lewin Group was hired by the Hawai’i Institute for Public Affairs (HIPA), an independent non-partisan organization, to perform a comprehensive evaluation of the costs and benefits of a single-payer system as outlined in HB 1617. The evaluation is intended to assist the Hawai’i Health Care Task Force in developing a comprehensive health care coverage plan for the citizens of Hawai’i.

In this study, The Lewin Group estimated the cost and coverage impacts of the Health Insurance Marketplace Modernization and Affordability Act (S. 1955) sponsored by Senator Enzi of Wyoming and adopted by the Health, Education, Labor and Pension Committee of the U.S. Senate. The bill would establish a new optional regulatory standard that insurers in the small group market could choose to follow instead of state regulations. This standard would permit carriers to set rates according to the National Association of Insurance Commissioner’s (NAIC) 1993 Small Group Rating Model legislation, which permits premiums to vary with health status and other factors. Carriers electing this option also would be exempt from state mandated benefits requirements.

The Lewin Group assisted the U.S. Department of Health and Human Services, Health Resources and Services Administration respond to a Congressional request to examine the adequacy of the critical care workforce. Using findings from the literature, original research, and projections from the Physician Supply Model and Physician Demand Model, this report examines the current and future supply of critical care physicians (intensivists); the major factors and trends affecting the demand for their services; and the likely inadequacy of their numbers through 2020.

National Medicaid expenditures have risen at an average of 8.2 percent annually since 1995, outpacing states' revenue growth and placing enormous pressure on states to implement effective cost containment programs. The Medicaid Health Plans of America and the Association of Community Affiliated Plans jointly engaged The Lewin Group to quantify the savings that can be realized through state Medicaid agencies entering into capitation contracting with Medicaid managed care organizations. The report found, among other key points, that up to $83 billion can be saved over ten years if the capitation model were immediately applied to all appropriately suited Medicaid funds.

The Pennsylvania Health care Association commissioned The Lewin Group to conduct a study that would help answer the following questions: What long-term care services will be needed and available over the next ten years? What is the current supply of long-term care services in the Commonwealth? What will the demand for long-term care services in the Commonwealth be over the next 10 years? Given the current supply of long-term care services and the estimated rate of growth in the demand for these services, what are the trade-offs between providing nursing home care versus providing home- and community-based services? This report is the second in a series of reports commissioned by the Pennsylvania Health Care Association. The first report provides information on the economic impact of nursing homes on the Commonwealth.

The California Endowment engaged The Lewin Group to provide cost estimates and coverage impacts of four proposals to expand health insurance coverage in California, focusing in particular on the effect that the approaches would have on children. This report provides detailed estimates of the program costs and number of children who would become covered under these proposals, including changes in both public and private coverage.