A Resource Guide for State Officials: Implementing and Financing Assertive Community Treatment Programs
The Lewin Group prepared a field-tested and practice-proven Resource Guide for decision makers in state governments. It provides practical, experience-based information about strategies for implementing ACT programs to assist individuals who have severe and persistent mental illness. Additionally, the Resource Guide presents a broad overview of ACT program concepts and issues, including:
- Factors that help or hurt program implementation, such as financing structures, consumer issues, and common concerns
- A Budget Simulation Model that provides a cost forecasting method to enable states to project costs based on specific population and program design scenarios
- A companion literature review offers detail regarding assertions about ACT model requirements, and about the evidence-base of research supporting the ACT program
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
Aging and Disability Resource Center for AoA
Since 2003, The Lewin Group has provided expert technical assistance (TA) to assist states and community-based organizations in the design and implementation of the Aging and Disability Resource Center grants awarded jointly by the Administration on Aging (AoA) and CMS’ Real Choice Systems Change Grants. Activities have included identifying TA needs and developing “user-driven” plans; maintaining grantee profiles; providing TA through a variety of remote and on-site mechanisms (topic-focused calls, national meetings, site visits); establishing a system for grantee feedback and exchange; designing a formative evaluation; integrating all activities into a single website; and developing an online TA Tracking Tool to assist in and streamline the TA activity. In addition, The Lewin Group also supports policy development initiatives undertaken by AoA, particularly new additions to the Older Americans Act of 2006.
Client Area: Federal Government
Expertise Area: Long-Term Care
Analysis of Cost Efficiency of Hospitals
For a state hospital association, The Lewin Group analyzed the cost efficiency of acute care and critical access hospitals and identified the extent of hospital cost shifting from public to private payers.
The purpose of the study was to educate health care stakeholders about the following issues:
- Financial health of the state’s hospitals
- The extent that public payers reimburse hospitals below cost for services provided to public employees, the elderly, and historically vulnerable populations
- Implications of these findings
Client Area: Associations
Case Study: Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP) Pilot Exercise
The Lewin Group evaluated a pilot exercise of federal-state communications protocols to mobilize volunteer health professionals in an emergency.
The study included development of a communications assessment checklist, on-site observers in four states and in the HHS Emergency Operations Center, an After-Action Report, and presentations at two national conferences.
- The exercise started with four emails to state coordinators and ended 36 hours later with almost 400 volunteers ready to deploy
- State spam filters trapped time-sensitive information
- We identified the need to train federal and state personnel in informatics skills, including competencies with software such as spreadsheets and health alerting systems
Client Area: Federal Government
Expertise Area: Emergency Preparedness and Response
CMS Comprehensive Error Rate Testing (CERT) Program
The Lewin Group helped CMS develop the program by which it determines the accuracy of Medicare payments made to providers. CERT is based on sampling Medicare claims as they enter the processing systems, reviewing them, and calculating an error rate. The Lewin Group serves as the statistical contractor for this program, developing the algorithms for sampling claims, and calculating the payment error rate. An overall payment error rate is reported. In addition, error rates for different components of Medicare and for different services are calculated. This rate satisfies the requirements of the Improper Payments Information Act of 2002, and is reported by CMS to OMB and Congress.
Client Area: Federal Government
Expertise Area: Medicare
Community Hospital Strategic Plan
The Lewin Group assisted a community hospital in developing a strategic plan to address service line growth opportunities, physician alignment concepts, financial performance, and organizational governance and leadership.
The plan entailed the following phases:
- Fact-based analysis of the service area market
- Implications of maintaining the status quo and key strategic alternatives
- Development of a strategic vision for the market and its facilities
- Objectives and action steps in support of these objectives
Client Area: Hospitals, Health Systems, and Providers
Cost Impact Analysis of the “Health Care For America” Proposal (Economic Policy Institute)
The Lewin Group developed detailed analyses of the Health Care for America Proposal. Under the proposal, employers would be required to provide coverage or pay a payroll tax to have their workers covered under a newly created national health insurance pool called Health Care for America (HCA). Modeled on Medicare, Health Care for America would offer a single Medicare-like fee-for-service option (public HCA plan) and a selection of Health Maintenance Organizations (HMOs) or other private managed care plans (private HCA plans).
In our report, we estimated the impact on costs and coverage for each major stakeholder. This included a detailed analysis of changes in spending for the federal government and state and local governments. These included the cost of subsidies, offsets to existing government safety-net programs, and changes in tax revenues resulting from these proposals. Estimates were provided assuming full implementation in 2007, and included estimates of health spending over a ten-year period, including a phase-in of coverage under the proposal.
Expertise Area: Health Reform
Delaware Children's Health Chartbook
For Nemours Health and Prevention Services (NHPS), The Lewin Group produced a Chartbook on Children’s Health in Delaware, a comprehensive resource covering a broad range of children’s health issues.
Lewin conducted an extensive review of the children’s health data available from a variety of sources, performed a comprehensive analysis of these data, and worked closely with NHPS to present the findings in a visually appealing, user-friendly, and easy-to-interpret Chartbook. The Lewin Group:
- Highlighted current issues in children’s health
- Noted differences between Delaware and other states
- Identified disparities among racial and ethnic groups
- Informed policymakers
- Set research and funding priorities
Client Area: Foundations
Expertise Area: Community Health Needs Assessment
Demographic and Service Need Projections for the Aging Population: 2020–2030 – A Projection Model for the Baby Boomers of San Mateo County
The Lewin Group developed a model for the Health Department in San Mateo County, California, that projects the socio-demographic characteristics, as well as the health, housing, and transportation service needs for its aging “baby boomer” population.
With 40 percent of the county’s baby boomers born in another country*, and uncertainty regarding migration patterns, future income, and disability rates, our micro simulation model allows the County to vary key assumptions as well as the information included in the output tables. The Lewin Group created core output reports providing information about:
- Socio-demographic characteristics, including vulnerable populations
- Housing cost burdens for renters and owners
- Disability status
- Health care provider and nursing home bed supply needs
*From The Lewin Group tabulations of the 2005 American Community Survey conducted by the U.S. Census Bureau.
Client Area: State and Local Governments
Expertise Area: Long-Term Care
Design of Community Hospital’s Medical Staff Development Plan
The Lewin Group designed a medical staff development and recruitment plan for a community hospital that quantified the supply of and demand for physicians, by specialty, in accordance with Stark II guidance.
The detailed medical staff development plan included the following steps:
- Conduct a community needs study to reflect current and future physician needs
- Prioritize a list of key specialties that were at risk, and potential solutions for ensuring access
- Analyze internal quantitative and qualitative medical staff needs
Client Area: Hospitals, Health Systems, and Providers
Expertise Area: Health Professionals Workforce
Development of a Community Hospital’s Managed Care Contracting Strategy
The Lewin Group assisted a community hospital in establishing an overall managed care strategy based on its patient volume, market share, rate structure, internal self-assessment, and market dynamics.
Topics addressed in the managed care contracting strategy included:
- Criteria for evaluating a specific managed care contract opportunity
- Issues to evaluate in previous and current contracts
- Contract renewals
- Negotiating strategies
Client Area: Hospitals, Health Systems, and Providers
Economic Costs of Diabetes in the U.S. in 2007
Diabetes mellitus is the fifth leading cause of death in the United States. Diabetes also contributes to higher rates of morbidity–people with diabetes are at higher risk for heart disease, blindness, kidney failure, extremity amputations, and other chronic conditions.
The American Diabetes Association (ADA) hired The Lewin Group to study the economic toll of diabetes. As an update to our 2003 study, The Lewin Group estimated the national economic burden of diabetes at $174 billion in 2007. This consists of approximately $116 billion in additional health care expenditures attributed to diabetes, and $58 billion in lost productivity from absenteeism, reduced productivity, permanent disability, and premature mortality. Highlights include:
- Diabetes cost calculator that provides prevalence and cost estimates
- Assessment of continued growth in diabetes prevalence
- Analysis of changing practices, technology, and cost to treat people with diabetes
- Improvements in data sources and methods to estimate economic and social burden
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
Evaluation of a Major Foundation Sponsored Safety Net Ambulatory Care Redesign Collaborative
The Lewin Group examined an Ambulatory Care Redesign Collaborative designed to improve primary care providers’ productivity, patient flow, and provider and patient satisfaction at five public safety net hospital systems.
The evaluation featured two primary objectives:
- Assess Collaborative’s effectiveness in improving access and quality of clinic-based ambulatory care services
- Identify factors for sustainability
Client Area: Foundations
Evaluation of Refugee Social Services and Targeted Assistance Programs
The Lewin Group, with its subcontractors, performed a study for DHHS Office of Refugee Resettlement (ORR). This comprehensive evaluation examined the effectiveness of ORR employability services through the Refugee Social Services and Targeted Assistance Formula Grant programs. The study involved an implementation study, an outcome study, and a plan for continuous evaluation. The Lewin Group:
- Fielded a survey of more than 900 refugees
- Collected program and state administrative data
- Conducted focus groups of refugees
- Conducted site visits to understand how services are delivered and document outcomes achieved over time
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
Evidence-Based Practice Centers Coordinating Center for AHRQ
The Lewin Group serves as the Evidence-based Practice Centers (EPC) Coordinating Center, part of the Effective Health Care Program of the Agency for Healthcare Research and Quality. Our responsibilities have included scientific and technical support for AHRQ and the 14 Evidence-based Practice Centers in the United States and Canada, including critical analyses of the nature and quality of the evidence base relevant to a variety of clinical topics nominated to AHRQ by outside organizations.
The Lewin Group