Publications & Insights

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: Aging and Disability

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

Comparing the Cost and Coverage Impacts of the House and Senate Leadership Health Reform Bills: Long Term Costs for Governments, Employers, Families and Providers

In our most recent report, prepared for The Peter G. Peterson Foundation, we compared the effects of two major proposals to reform the U.S. health care system. These include the Senate Leadership “Patient Protection and Affordable Care Act” under consideration in December, and the “Affordable Health Care for America Act” passed by the House of Representatives in November 2009. In this study we provide estimates of the program’s impact on coverage and spending for the federal government, state and local governments, private employers, consumers and providers. We estimated the impact of both bills on federal spending over a 20 year period from 2010 through 2029. The Congress uses 10-year forecasts for budgeting purposes, which is currently 2010 through 2019. To better understand the long-term budget implications of the bill, we present spending estimates for both the 2010 through 2019 budget window and the 2020 through 2029 period.

Expertise Area: Health Reform

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: Aging and Disability

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’s analyses have helped to inform AHRQ’s decisions regarding which nominated topics to select for extensive evidence reports and technology assessments produced through the EPCs. These reports are used for informing and developing coverage decisions, quality measures, educational materials and tools, guidelines, and research agendas. Some reports are used to inform Medicare coverage decisions or to inform recommendations of the U.S. Preventive Services Task Force. The Lewin Group has conducted more than one hundred 15–25 page analyses of the nature and quality of evidence related to clinical topics nominated to AHRQ. The Lewin Group also planned and coordinated four national conferences on Translating Research into Practice and Policy under this effort.

Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA

Facility Planning Support for a Community Hospital

The Lewin Group supported a community hospital’s master facility plan by projecting service line volumes, their resulting capacity needs, and the financial impact of environmental changes and growth initiatives.

The following core components of The Lewin Group’s prospective financial and demand model informed the master facility plan:

• Projected income statements, cash flow, and balance sheets
• Corresponding financial ratios relevant to future financing options
• Prospective volume and occupancy by service type

Client Area: Hospitals, Health Systems, and Providers

Hospital District Merger Assessment

The Lewin Group reviewed the strategic and financial position of two hospital districts and advised the system on the ramifications of a merger between the two entities.

The Lewin Group illustrated various merger scenarios and their financial impacts, based on the following key issues:

• Service or facility consolidation
• Payer mix changes
• Debt capacity
• Impact analysis of tax subsidy and other legislative agenda items

Client Area: Hospitals, Health Systems, and Providers

Implant System for Low Back Pain: Evidence Review and Strategy

For a major orthopedic implants company, The Lewin Group reviewed the scope and quality of available evidence on the use of a novel implant system for treating low back pain. Based on the findings of this review and analysis of emerging evidence from available and continuing clinical trials, The Lewin Group identified strategic considerations for pursuing Medicare and other public and private reimbursement.

We reviewed unpublished and published peer-reviewed and other substantive literature for this class of implants, including alternative pedicle screw-based and interspinous systems. In addition to journal articles, our literature review included technology assessments, guidelines, coverage policies, and regulations in the United States and abroad. The Lewin Group evaluated the strength of evidence for the implant system and how payers would interpret and use this evidence in coverage policies, and provided recommendations for the design of further research to strengthen the case for coverage.

Client Area: Pharma / Bio / Device
Expertise Area: Evidence-Based Medicine / HTA

Medicaid Pharmacy Cost and Utilization: Fee-for-Service vs. Managed Care

This Lewin Group report brought hard data to bear on the many policymaking efforts underway in the Medicaid pharmacy arena.

Our report, Comparison of Medicaid Pharmacy Costs and Usage between the Fee-for-Service and Capitated Setting, was funded by the Center for Health Care Strategies and prepared in collaboration with the Association for Community Affiliated Health Plans. The Lewin Group:

• Presented quantified data findings
• Described differences in drug spending and usage patterns between Medicaid fee-for-service and capitated managed care programs
• Provided state Medicaid agencies and health plans with approaches to assess their programs’ success
• Identified cost-saving opportunities for Medicaid programs and health plans to consider

Client Area: Associations
Expertise Area: Medicaid and CHIP

NHLBI Pediatric Cardiovascular Risk Reduction Initiative

The National Heart, Lung, and Blood Institute (NHLBI) contracted with The Lewin Group to assist in an ongoing initiative.

The Lewin Group is providing comprehensive technical expertise and logistical support for the planning and development of evidence-based clinical practice guidelines to address cardiovascular risk reduction in children seen in primary care settings. The Lewin Group has:

• Developed and conducted a systematic literature search
• Abstracted information from in-scope studies into detailed evidence tables
• Devised a grading system for assessing the quality and methodological rigor of studies
• Facilitated communication among national expert panel members

Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA

Payment Error Rate Measurement (PERM) Program

The Centers for Medicare & Medicaid Services (CMS) selected The Lewin Group as the statistical contractor for the FY2007 PERM program.

The Lewin Group gained expertise in the PERM program through our work with CMS and many state Medicaid and State Children’s Health Insurance Program (SCHIP) programs since 2001. We pilot-tested various methodologies to measure payment error, and also implemented the FY2006 PERM measurement in Medicaid fee-for-service (FFS) in 17 states. The Lewin Group:

• Reviewed each state’s eligibility sampling plan to achieve an approvable plan
• Collected and analyzed Medicaid and SCHIP fee-for-service and managed care payment data
• Sampled fee-for-service line items and managed care capitation payments on a quarterly basis
• Calculated each state’s Medicaid and SCHIP program error rates

Client Area: Federal Government
Expertise Area: Medicaid and CHIP, Program Integrity

Performance Measurement Development for Hawai'i Teen Pregnancy Prevention and Positive Youth Development Programs

The Lewin Group was hired to provide the Hawai’i Department of Human Services (DHS) with objective criteria for measuring the performance of its TANF-funded Teen Pregnancy Prevention (TPP) and Positive Youth Development (PYD) programs, and to assess the degree to which DHS’ TPP/PYD initiative is grounded in the literature on TPP and PYD. The Lewin Group:

• Conducted a literature review on predictors of teen pregnancy and the effectiveness of TPP and PYD programs
• Developed program performance measures and a quarterly report format for DHS to use with its contractors to report on performance
• Produced a report and briefing of findings, and trained providers in using the performance measures

Client Area: State and Local Governments
Expertise Area: Children, Youth, and Family Policy

Physician Supply and Demand: Projections to 2020

The Lewin Group projected physician supply and requirements for 18 specialties for the Health Resources and Services Administration (HRSA).

Regular assessment of future health workforce supply and demand is key to setting policies as the nation’s health care needs change. Accurate projections can help the United States achieve its goal of ensuring access to high-quality, cost-effective health care. The Lewin Group:

• Researched implications of changing demographics
• Analyzed impact of changing government policies
• Forecasted trends that may affect future adequacy of physician supply
• Simulated potential affect of new technologies on short- and long-term requirements for physicians

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Review of County-wide Indigent Health Care System

The Lewin Group assisted with the development of a strategic plan to strengthen the service delivery and financing systems for a County’s safety net patients.

The final plan was designed to achieve the following goals:

• Enhance access to care for uninsured and indigent populations
• Articulate the role(s) for policymakers, hospitals, medical schools, public clinics, foundations, public health entities, and others to implement the strategic plan
• Encourage or design an effective governance and oversight approach
• Incorporate best practices for service delivery and financing

Client Area: Hospitals, Health Systems, and Providers

Supporting Children’s Hospitals and Children’s Health: The Role of the Federal “CHGME” Program

The Children’s Hospitals Graduate Medical Education Program (CHGME) allows independent children’s teaching hospitals to continue and expand their services dedicated to children’s unique health care needs.

A report by The Lewin Group highlighted the benefits of the CHGME Program across the following key hospital missions:

• Graduate medical education and training
• Complex, high-quality clinical care for all children
• Cutting-edge pediatric research
• Community benefits and rural outreach

Client Area: Associations
Expertise Area: Health Professionals Workforce

The Colorado Works Program Evaluation

The Colorado Department of Human Services (DHS) hired The Lewin Group to perform an in-depth study of Colorado’s Temporary Assistance for Needy Families (TANF) program, Colorado Works.

The study provides administrators with information about program strategies and the approaches counties might find useful for improving program implementation, performance, and outcomes. The five-year study, which began January 2005, was designed in active consultation with DHS and an Advisory Committee that included representatives of the counties and Colorado’s advocacy community. The Lewin Group is:

• Creating annual evaluation reports to summarize findings from activities
• Performing TANF work participation analyses that examine trends in rates over time, characteristics associated with compliance, and the effect of strategies being pursued by counties on rates
• Conducting caseload modeling to estimate the effects of changes in the population, economy, and program on the TANF caseload
• Conducting a study of Colorado Works “leavers” to examine how clients fare after exiting TANF

Client Area: State and Local Governments
Expertise Area: Income Security

The Lewin Group Home and Community-Based Services (HCBS) Population Tool

The Lewin HCBS Population Tool provides estimates of the potential demand for HCBS in the United States for between 2000 and 2020.  The Lewin Group generated these estimates by combining national-level data on specific disabilities and conditions with state-level Census data on age, income, and broad measures of disability. The Tool allows the user to generate state-specific estimates of the number of potential HCBS users controlling for calendar year, age, and income (relative to poverty).  Specifically, the model provides counts of persons in the community with MR/DD and with functional limitations [Activities of Daily Living (ADLs) and/or Instrumental Activities of Daily Living (IADLs)]. The user can select from among four different definitions of functional disability in addition to MR/DD conditions and functional limitations.

Lewin has used this tool to provide estimates of potential demand for HCBS at county-level for states including Vermont, Maine, Louisiana and Pennsylvania. The estimates at County level can be broken down by small age groups and income levels. State governments can use the estimate for Medicaid program planning, cost allocation, rate setting and other planning purposes.

Please click here to link to the tool.

Client Area: State and Local Governments
Expertise Area: Aging and Disability

Wisdom at Work: Retaining Experienced Nurses®

With the United States facing a growing shortage of hospital nurses, the Robert Wood Johnson Foundation (RWJF) created Wisdom at Work: Retaining Experienced Nurses (WAW) to build an evidence base to identify strategies to help hospitals retain experienced nurses.

RWJF engaged The Lewin Group to provide evaluation and technical assistance services for this continuing initiative. WAW, launched in early 2007, provided grants to 13 hospitals and health systems nationwide to evaluate the impact and outcomes of existing strategies aimed at retaining experienced nurses in hospitals. As part of its evaluation, The Lewin Group built an evidence base of effective nurse retention strategies. The Lewin Group:

• Provided evaluation coordination and technical assistance support to the grantees
• Facilitated the activities of a technical expert panel of nurse leaders
• Conducted research to identify strategies organizations are using to address the issue of knowledge management
• Prepared case studies describing successful best practices used by employers to retain experienced workers and their skills and knowledge

Client Area: Foundations
Expertise Area: Health Professionals Workforce
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The Adequacy of Pharmacist Supply: 2004 to 2030

December 2008

The Lewin Group and Altarum Institute recently completed a study for the U.S. Department of Health and Human Services on the future adequacy of supply of pharmacists. A previous Health Resources and Services Administration (2000) report documented the current and growing shortfall of pharmacists. Since release of that report the U.S. Bureau of the Census revised upward its projections of population growth, the Federal Government enacted the Medicare Part D program which expands prescription drug coverage to more elderly; technology continued to advance, minimum credentials for entry into the workforce for new pharmacists changed from baccalaureate to doctorate degrees, the Nation’s educational capacity to train new pharmacists and pharmacy technicians continued to expand and enrollment in schools of pharmacy has been at an all time high, and the role of pharmacists in providing care to patients continued to evolve. The Lewin Group and Altarum revised HRSA's Pharmacist Supply and Requirements Model (PhSRM) to examine current and projected future adequacy of pharmacist supply in the United States taking into account trends in the latest supply and demand determinants.

The overall findings are that the supply of pharmacists is growing significantly faster than was previously projected, but the demand for pharmacists continues to grow rapidly due in large part to population growth and aging. There is currently a moderate shortfall of pharmacists. The overall conclusion of this study is that the Nation has responded to earlier predictions of a growing shortfall of pharmacists, and to market forces that have raised pharmacist earnings, by expanding supply and increasing the use of technology and technicians. Still, the increase in supply will only be sufficient to keep pace with a rising demand due to changing demographics. Supply would need to increase further than currently projected to meet the demand caused by growth in per capita consumption of pharmaceuticals. Improvements in productivity through further employment of pharmacy aides and technicians and the application of evolving technologies should continue to help the supply meet these increases in demand.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Key Features of Colorado Works in Comparison to Other State TANF Programs

April 2008

The enactment of the 1996 Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) provided states with considerable flexibility to design their own welfare programs.  The result was an increase in the variation between states’ welfare programs.  In an effort to understand how Colorado’s TANF program compares to other programs across the country, the Colorado Department of Human Services (CDHS) commissioned The Lewin Group and its partners—the University of Colorado’s Health Sciences Center (UCHSC), the Johns Hopkins University’s Institute for Policy Studies (JHU), and Capital Research Corporation (CRC)—to perform an in-depth study of Colorado’s TANF program (Colorado Works) on a variety of different dimensions.  This report examines how Colorado compares with other states on dimensions such as caseload changes, program expenditures, eligibility requirements and benefits, work requirements, financial incentives to work, sanctions, work participation rates, employment outcomes, and diversion policies.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

A Framework for Continuous Evaluation of Office of Refugee Resettlement Formula Programs Supporting Employability Services

March 2008

An extension of The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report outlines ways that the Office of Refugee Resettlement (ORR) can better plan for and institutionalize evaluation and accountability throughout the range of refugee resettlement programs. It presents a variety of options ORR might consider to enhance its existing performance management activities and proposes experimental and non-experimental evaluations of selected service strategies.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Houston Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Houston, Texas. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Houston, which settled a large, diverse, and frequently changing refugee population. Themes emerging from this case study include Houston’s emphasis on rapid employment, driven in part by the relatively low TANF benefits offered in the state, the necessity of understanding newly arriving refugees’ cultural experiences when providing services to a changing population, and the special challenges facing refugees from Somalia and Liberia, who arrived with very low educational attainment. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Miami Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Miami, Florida. The study focused on refugees, asylees, and related populations who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Miami, including primarily Cubans, Colombians, and Haitians. Themes emerging from this case study include the role of Miami’s extensive network of experienced service providers and community support for arrivals; the strong focus on employment in refugee services; the relatively high education level of refugees served in Miami; the importance of bi-lingual Spanish and English skills; and special challenges facing the Haitian population The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Sacramento Case Study

March 2008

One of three case studies from The Lewin Group’s evaluation of two federally-funded employability programs serving refugees resettled in the U.S., this report presents findings from interviews with service providers, focus groups with program participants, and analysis of administrative, programmatic, and survey data on refugees served in Sacramento, California. The study focused on refugees who entered the country between 2000 and 2004 and received RSS or TAG services at some point in Sacramento, including primarily refugees from countries in the former Soviet Union and Hmong arriving in 2004. Themes emerging from this case study include Sacramento’s strong emphasis on English language training as a component of employability services; the use of on-the-job training by several service providers as a tool for moving refugees into permanent employment; and the importance of the welfare system in understanding the context in which the refugee employability programs operate. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

The Evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) Programs: Synthesis of Findings from Three Sites

March 2008

This report summarizes findings from The Lewin Group’s evaluation of the Refugee Social Service (RSS) and Targeted Assistance Formula Grant (TAG) programs. The Office of Refugee Resettlement (ORR) administers these programs and sponsored an evaluation to assess how program services are delivered and how refugees who receive them fare over time. RSS and TAG services aim at helping refugees overcome barriers to employment and integration into the United States. The study focuses on refugees in three sites—Houston, Miami, and Sacramento—who entered the country between 2000 and 2004. It relies on administrative and programmatic data, a survey of refugees, and information collected through interviews with service providers and focus groups with program participants. The study documents differences across the sites with regard to which refugee groups they served, the approaches taken for delivering services, and the emphasis placed on ESL instruction versus rapid employment. The report also presents employment, income, and public assistance outcomes of service recipients.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development, Income Security

Understanding Program Participation: Findings from the Colorado Works Evaluation

December 2007

The Deficit Reduction Act of 2005 (DRA) reauthorized the TANF program and made policy changes that increased the effective work participation rates that states must meet to avoid a financial penalty. In Colorado, counties have been reassessing strategies to meet federal requirements while still providing services and benefits to clients that best help them to meet their immediate needs and overcome barriers to longer-term self-sufficiency. This report examines three related topics affecting participation and engagement in Colorado’s TANF program. They are: (1) Work participation activities and strategies; (2) Diversion policies among Colorado’s counties; and (3) Sanctioning practices in Colorado.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Entry-Level Employers in Colorado: Results from a Survey of 25 Employers

August 2007

The purpose of this study is to examine Colorado employers’ experiences with welfare recipients they have hired for low-skill, entry-level jobs. The research gathers information on the characteristics of employers and the low-skill workforce, employer hiring practices, staffing needs, overall employer satisfaction, and employer feedback on county Colorado Works offices and workforce centers operated under local Workforce Investment Boards.  The survey provides information about the extent to which the Colorado Works program and the clients are able to meet employer needs.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Employment Services and Employer Interaction in Colorado Works Programs

June 2006

This report describes employment services in local Colorado Works programs, particularly strategies that involve interaction with employers and industries, highlighting promising practices for other programs. It finds that the most common employment-specific activities in Colorado counties are (1) job readiness workshops that generally include some guided job search activity, and (2) work experience activities.  It also finds that counties generally tailor their employment services to local labor market trends, working with both public and nonprofit agencies as well as private sector business when possible.  Finally, several county programs are found to have developed large and formal networks of employers for such employment activities which may serve as a model for other counties.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Program Coordination and Collaboration in the Colorado Works Program

June 2006

This report examines the variety of cross-agency collaboration and coordination strategies used by county Colorado Works/TANF programs across the state. Based primarily upon information collected during site visits to 18 Colorado Works county programs, this report focuses on collaborative arrangements in two major areas: (1) partnerships with local Workforce Centers and other community organizations to obtain employment, education, and training services; and (2) collaboration with other public agencies and private organizations to obtain a wide array of support services.  The report finds that program coordination is extensive and that there is wide variation in the network of collaboration across Colorado counties.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Serving the Hard-To-Employ in Colorado

June 2006

This report examines strategies Colorado counties were using to serve the hard-to-employ TANF population in 2005, highlighting promising approaches that counties might choose to adopt and providing  the state with useful information that can help guide future policy choices. While there are a wide range of issues that affect welfare recipients’ ability to succeed in the job market, this report focuses on seven barriers: 1) Physical disabilities; 2) Limited education and learning disabilities; 3) Mental health; 4) Substance abuse; 5) Domestic violence; 6) Limited English skills; and 7) Homelessness.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development, Income Security

Multiple Work Supports and Services May Help Low-Wage Workers Climb the Economic Ladder

December 2004

Written for the Research Forum, an initiative of the National Center for Children in Poverty (NCCP) at the Mailman School of Public Health of Columbia University, this article provides a short introduction to the literature on employment retention and advancement strategies and describes a group of interventions being tested in a national evaluation.

Expertise Area: Employment, Training, and Workforce Development

Impacts of Washington State's WorkFirst Post-Employment Labor Exchange

June 2003

Washington State implemented its WorkFirst Post-Employment Labor Exchange (WPLEX) in 1998 to provide post-employment services through a centralized call center. Staff contact individuals to provide them with guidance on career advancement, tips on specific job opportunities in the customer's labor market, vouchers for certain support services, and referral to social services and education providers. Washington's Employment Security Department hired The Lewin Group and its subcontractor, Cornell University, to conduct an evaluation of WPLEX. This report presents an overview of the program, an in-depth examination of the program's implementation and costs, and analysis of the effectiveness of WPLEX in moving individuals from welfare to work.

Client Area: State and Local Governments
Expertise Area: Employment, Training, and Workforce Development

Evaluation Design for the Ticket to Work Program: Preliminary Process Evaluation

March 2003

This report presents findings from the preliminary process evaluation of the Ticket to Work program (TTW), a program established by the 1999 Ticket to Work and Work Incentives Improvement Act (Ticket Act), designed to increase access to, and the quality of, rehabilitation and employment services available to Social Security disability beneficiaries. TTW incorporates the cost-reimbursement payment system that SSA has used in the past to pay state vocational rehabilitation agencies (SVRAs) for rehabilitation services provided to beneficiaries, provided that the beneficiary obtains earnings of at least the substantial gainful activity (SGA) level for nine months. Added to this performance-based system are two new payment systems with substantially stronger performance incentives, that can be used by either SVRAs or other qualified organizations, called Employment Networks (ENs): the outcome and milestone-outcome payment systems. Under both new systems, beneficiaries must exit cash benefit status on the disability rolls by reason of increased earnings for 60 months for SVRAs and ENs to receive full payment. The outcome payment system potentially pays more, but requires cash benefits to be zero before any payments are made, while the milestone-outcome system provides early payments based on achievement of earnings targets, even if cash benefits are never reduced to zero. SVRAs and ENs must each choose one of the two new payment systems, but SVRAs can also elect to use cost reimbursement on a case-by-case basis. The report is based on in-person and phone interviews conducted with staff from: SSA; MAXIMUS, the contractor hired to be TTW's Program Manager (PM); and 27 ENs and the 13 SVRAs serving beneficiaries in the 13 states that participated in Phase 1 of the TTW rollout: Arizona, Colorado, Delaware, Florida, Illinois, Iowa, Massachusetts, New York, Oklahoma, Oregon, South Carolina, Vermont, and Wisconsin. We also reviewed numerous documents and conducted limited analyses of administrative data. The data for this report was collected and synthesized during the July through November 2002 period, and thus, with a few exceptions, represent the status of TTW as of that time.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Unemployment Insurance Non-Monetary Policies and Practices: How Do They Affect Program Participation? A Study of 8 States

January 2003

This report explores the relationship between non-monetary eligibility policies and practices and program outcomes, such as recipiency and benefit duration. Information is collected on state non-monetary eligibility legislation, policies, and practices for unemployment insurance (UI) programs in a sample of states to document across-state variation that may affect UI recipiency. Research indicates that much of the state-level variation is due to policies, practices, and processes that are not easility captured by administrative data. Thus many of the questions explored during site visits to eight states focus on how UI operates at the ground level and how variation in UI operations helps explain some of the variation in program outcomes across states.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Evaluation Design for the Ticket to Work Program: Preliminary Report on Evaluation Design

August 2002

The Ticket to Work program (TTW) was established by the 1999 Ticket to Work and Work Incentives Improvement Act (Ticket Act). The program will provide eligible Social Security Disability Insurance and Supplemental Security Income disability beneficiaries with a Ticket, which can be used to obtain vocational rehabilitation or employment services through an Employment Network. The program is intended to increase access to, and the quality of, rehabilitation and employment services available to disability beneficiaries. TTW is designed to provide beneficiaries with greater freedom and choice of service providers, create competition among providers to provide high quality services that are responsive to beneficiary needs, and give providers incentives to deliver services in the most efficient and appropriate manner to achieve desired outcomes. The Social Security Administration (SSA) contracted with The Lewin Group to design a comprehensive evaluation of TTW. The Lewin Group teamed with Cornell University, Westat, and a number of independent consultants to conduct the project. The evaluation design developed under this project specifies the methods to be used to compare the net outcomes of TTW to outcomes under the current system, including level of benefits received by beneficiaries, work participation, earnings, duration of benefit receipt, and departures from the disability rolls. The evaluation was also designed to assess the total and net costs of the program, characteristics of ENs and beneficiaries who do and do not participate, factors that affect return to work, employment outcomes for participants, and beneficiary satisfaction with the program.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Research on Employment Supports for People with Disabilities: The Role of Health Insurance in Successful Labor Force Entry and Retention

December 2001

This paper provides a summary of the health insurance issues affecting employment of people with disabilities, including a discussion of the current programs and policies that are available. It presents findings from focus groups conducted with individuals with disabilities who have achieved a reasonable measure of employment success. The focus groups provided information about the extent to which access to health care influenced employment decisions of participants, and about various strategies participants employed for securing access both to employment and needed health care.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Research on Employment Supports for People with Disabilities: The Role of Supports in Successful Labor Force Entry for Youth with Disabilities

September 2001

This report summarizes the findings from information collected during three sets of focus groups conducted for a study on employment supports for people with disabilities. The study was intended to increase the understanding of the role of various supports in helping people with disabilities find and maintain employment.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

How Well Have Rural and Small Metropolitan Labor Markets Absorbed Welfare Recipients?

April 2001

This report examines the impact of welfare reform on 12 rural and small metropolitan areas around the county. It identifies changes in wages and employment for the low-skill labor force over two periods - 1993 to 1996, and 1996 to 1998 - to determine the effect of the movement of welfare recipients to work.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Employing Welfare Recipients with Significant Barriers to Work: Lessons from the Disability Field

October 2000

This report reviews the disability literature in order to examine the disability community's efforts to help individuals with significant disabilities access and maintain employment; and identify how welfare agencies can learn from and build upon lessons from the disability community. The report highlights strategies for increasing employment among people with disabilities, reviews the use of cash and in-kind supports to increase employment, outlines what is known about transitional services for persons with disabilities, and summarizes the key lessons for the TANF community.

Client Area: Foundations
Expertise Area: Employment, Training, and Workforce Development

Success in the New Welfare Environment: An Assessment of Approaches in HUD's Employment and Training Initiatives

March 2000

Interest in work and self-sufficiency among welfare recipients was heightened among government officials, social service providers, academics, and the general public when Congress enacted the Personal Responsibility and Work Opportunity Reconciliation Act (PWRORA), which changed the focus of the welfare system from income support to work. One agency affected by welfare reform is the U.S. Department of Housing and Urban Development (HUD). The transformation of the welfare system presented HUD with an important opportunity to conduct a preliminary assessment of its programs. As a result, HUD contracted with ICF Consulting and the Lewin Group to review the employment and training components of 13 HUD programs. This study assessed HUD's efforts to help residents transition from welfare to work. The study focuses on the following questions: What are the specific service components of HUD employment and training programs? To what extent are the practices consistent with the research on the effectiveness of those service approaches? What is the nature of the linkages between the HUD programs and the programs being provided through the larger human services and employment and training systems in the community?

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Employment Retention and Advancement Project: Conference Proceedings November 18-19, 1999

February 2000

This report contains the proceedings of a meeting held November 18-19, 1999 on the Administration for Children and Families' (ACF) Employment Retention and Advancement grant program. Attending the meeting were representatives from the ACF, 12 of the 13 states that received grants for the Employment Retention and Advancement project, The Lewin Group, the Manpower Demonstration Research Corporation along with other staff from the Department of Health and Human Services, researchers, and members of the welfare community. The purpose of the meeting was to share information on each state's demonstration plans and to engage in working sessions that would help each state further define these plans.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Employment Retention and Advancement Project: Program Design Manual

December 1999

The Program Design Manual is the one of a series of products developed by The Lewin Group, under contract to the Administration for Children and Families, to assist states to design program strategies for promoting the employment retention and advancement of TANF recipients. The manual provides states with a step-by-step process for thinking through goals, target populations, and strategies they might include in their program plans. The manual also provides helpful guidance with regard to issues related to the evaluation of these programs. ACF has a major initiative underway to identify sites for an experimental evaluation of employment retention and advancement programs. States interested in participating in that evaluation will find the manual helpful in thinking through their plans. States who are not interested in the evaluation but are planning initiatives in this area should find the manual helpful in thinking through their design options as well.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Employment Retention and Advancement Project: Conference Proceedings June 3-4, 1999 Washington, D.C.

September 1999

This report contains the proceedings of a meeting held June 3-4, 1999 on the Administration for Children and Families' (ACF) Employment Retention and Advancement grant program. Attending the meeting were representatives from the ACF, the 13 states that received grants for the Employment Retention and Advancement project, and The Lewin Group, along with other staff from the Department of Health and Human Services, researchers, and members of the welfare community. The purpose of the meeting was to share information on each state's demonstration plans and to engage in working sessions that would help each state further define these plans.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Job Retention and Advancement Among Welfare Recipients: Challenges and Opportunities: Research Synthesis

January 1999

Interest in job retention and advancement among welfare recipients was heightened among government officials, social service providers, academics, and the general public when Congress enacted Public Law 104-193 on August 22, 1996. The Personal Responsibility and Work Opportunity Reconciliation Act changed the focus of the welfare system from income support to work. There has been considerable research to date on a number of welfare-related issues including the duration of welfare spells, characteristics that are associated with long spells, and the impacts of demonstration programs that attempt to help women avoid dependency. But despite numerous evaluations, there is limited information available on the effectiveness of programs and services designed to help welfare recipients retain and advance in jobs. To help build knowledge about how best to help welfare recipients sustain employment and advance in the labor market, the Administration for Children and Families (ACF) issued planning grants to 13 states. The Employment Retention and Advancement Project is designed to help states implement and refine their employment, retention, and advancement strategies. At the request of ACF, The Lewin Group compiled a summary of the research on the employment patterns of welfare recipients and services that have attempted to help recipients remain in jobs and advance in the labor market.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development

Proceedings from the ACF Job Retention and Advancement Project State Meeting: Washington, D.C. November 12-13, 1998

January 1999

This report contains the proceedings of a meeting held November 12-13, 1998 on the Administration for Children and Families' (ACF) Employment Retention and Advancement grant program. Attending the meeting were representatives of the ACF, the 13 states that received grants for the Employment Retention and Advancement project, and The Lewin Group, along with other staff from the Department of Health and Human Services, researchers, and members of the welfare community. The purpose of the meeting was to share information on each state's demonstration plans and the latest research regarding retention and advancement.

Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
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