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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Individuals Living in the Community with Chronic Conditions and Functional Limitations : A Closer Look

February 2010

On January 28, the Engelberg Center for Health Care Reform at Brookings hosted a forum to discuss strategies for improving care for older Americans across a range of institutional and community-based settings. Experts and key stakeholders examined the components of health care reform most likely to influence older Americans; discussed promising models for payment, delivery-system reforms, and coordination across a continuum of care; and identified how quality and efficiency can be improved.

During the forum, Richard Frank, Deputy Assistant Secretary for Office of Disability, Aging, and Long-Term Care Policy for the Assistant Secretary for Planning and Evaluation, officially released a chartbook prepared by The Lewin Group. The chartbook takes a closer look at the health spending for individuals with chronic conditions and functional impairments living in the community. The Lewin Group analysis indicates that the combination of chronic conditions and functional limitations is a critical indicator and an improved targeting criteria for individuals with high health spending who could benefit from better coordination and management.

Client Area: Federal Government
Expertise Area: Aging and Disability

Economic Analysis of Availability of Follow-on Protein Products

September 2009

Unlike most conventional drugs, biological products are usually large, complex molecules that are produced by living organisms. These commercially engineered biologics currently account for billions of dollars in health care spending. Starting early last century, Congress has regulated most biologics separately from small molecules under the Biologics Control Act, which was later incorporated into the Public Health Service (PHS) Act. Although some biologics are regulated under the Federal Food, Drug, and Cosmetic Act (FDCA) for historical reasons, and are, therefore, candidates for generic production through section 505(j), an Abbreviated New Drug Application (ANDA), or through 505(b)(2), using data from previously approved innovator biologics to make claims of safety and effectiveness, there is no abbreviated path for replica or closely similar follow-on products for biologics under the PHS Act. While this group of products is known by various names, this report uses the term “follow-on protein products” (FoPPs).

Due to the potential cost savings that FoPPs could provide in the US market, members of Congress have made various proposals for establishing a regulatory pathway for FoPPs. The purpose of this report is to provide an unbiased estimate of potential cost savings from the introduction of FoPPs under multiple scenarios for abbreviated regulatory pathways. Findings from this analysis may be useful in the context of ongoing policy deliberations. A better understanding of the potential impact of legislative provisions for the regulatory pathway on cost savings may inform policymakers as such a pathway is considered.

Client Area: Federal Government

Updated Cost and Coverage Impacts Analysis for the Healthy Americans Act (HAA) (S.391): The Wyden/Bennett Bill

March 2009

This report provides estimates of the cost and coverage impacts of the Healthy Americans Act as introduced on February 5, 2009 (S. 391). It provides estimates of cost effects for the federal government, state and local governments, private employers and families, assuming the program is fully implemented in 2011. It also provides estimates of the average cost impacts of the Act for families by income, age and current coverage status.

Client Area: Federal Government
Expertise Area: Health Reform

Opening a Buy-In to a Public Plan: Implications for Premiums, Coverage and Provider Reimbursement

February 2009

Presentation by John Sheils to Senate Republicans and Staff February 11, 2009.

Client Area: Federal Government
Expertise Area: Health Reform

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

Laboratory Medicine: A National Status Report

May 2008

This report, commissioned by the Centers for Disease Control and Prevention  provides a detailed overview of the key factors affecting the laboratory medicine sector. It is intended that the report serve as a point of reference for measuring and improving quality in the future as well as for policy guidance to professional organizations, government agencies, and others who provide, use, regulate, and pay for laboratory services.

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

Welfare Time Limits: An Update on State Policies, Implementation, and Effects on Families

April 2008

One of the most controversial features of the 1990s welfare reforms was the imposition of time limits on benefit receipt. The law prohibits states from using federal TANF funds to assist most families for more than 60 months. Under contract to the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services, Lewin and MDRC conducted a comprehensive review of what has been learned about time limits. The review, which updates a 2002 study, includes analysis of administrative data reported by states to ACF, visits to several states, and a literature review. Key findings include the following: time-limit policies vary dramatically from state to state; nationally, at least a quarter million TANF cases have been closed due to reaching a time limit since 1996, although about one-third of these closures have occurred in New York, which continues to provide assistance through a state and locally funded program; and many of the families whose TANF cases were closed due to time limits are struggling financially and report being worse off than they were while on welfare.

Client Area: Federal Government
Expertise Area: Income Security

Local Implementation of TANF in Five Sites: Changes Related to the Deficit Reduction Act

March 2008

This study follows up on a study conducted by the Lewin Group and its subcontractor, the Nelson A. Rockefeller Institute of Government, which assessed and reported on recent adaptations made by local offices in managing Temporary Assistance for Needy Families (TANF) programs.  The assessment sought to clarify recent changes implemented by local program managers in five study sites to improve performance, several years after the initial wave of change brought about by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA).  This study revisited the original five study sites to determine the nature of changes brought about by the Deficit Reduction Act (DRA) of 2005, which reauthorized the TANF program.

Client Area: Federal Government
Expertise Area: 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

HRSA Transplant Center Growth and Management Best Practices Evaluation : Final Report

September 2007

The U.S. Department of Health and Human Services (HHS) has devoted considerable effort to achieving increased organ donation and transplantation rates by developing public awareness campaigns and identifying and replicating organ procurement organization donor hospital, and transplant center best practices. Despite a trend toward increased numbers of organ donors and transplants, a disparity remains between the demand for and supply of donor organs. In order to address tihs unmet need, HHS’s Health Resources and Services Administration has implemented several initiatives which have assisted in increasing the supply of donor organs and the number of organs transplanted per donor. HRSA now seeks to identify and spread the best practices of transplant centers that are quickly adapting to the increased supply of donor organs in order to help transplant programs across the country effectively grow. This report, prepared by The Lewin Group,  presents observations of the best practices of selected high-performing transplant centers that have achieved high organ transplantation rates and efficiency in recovered organ use, while maintaining expected or higher than expected patient and graft survival outcomes.

Client Area: Federal Government

Personalized Health Care Expert Panel Meeting: Summary Report

September 2007

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; and Using databases to build evidence and inform decisions in PHC. The report summarizes key observations that emerged from the Expert Panel’s discussion of these five main issues.

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

Local Implementation of TANF in Five Sites

January 2007

The devolution of responsibility for the nation’s primary welfare program from the federal government to state and local agencies was one of the most important institutional changes in federal welfare policy during the 1990s.  The Personal Responsibility and Work Reconciliation Act (PRWORA) of 1996 created the Temporary Assistance for Needy Families (TANF) block grant, which gave states considerable latitude to allocate funds across program functions and move functions outside of traditional welfare agencies to other public agencies and private organizations.  This study, conducted by the Lewin Group and the Nelson A. Rockefeller Institute of Government, determined how local management of TANF programs has evolved to address changing needs and improve program results.  Rather than viewing TANF implementation as a single event followed by a stable administrative structure and a static array of services and requirements, the project viewed implementation in dynamic terms.  It sought to understand how local welfare offices in five areas modify their programs and adopt more effective approaches in response to changing circumstances.

Client Area: Federal Government
Expertise Area: Income Security

Cost-effectiveness Considerations in the Approval and Adoption of New Health Technologies: Final Report and Case Studies

January 2007

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.

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

Cost and Coverage Estimates for the "Healthy Americans Act"

December 2006

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.

Client Area: Federal Government
Expertise Area: Health Reform

Physician Supply and Demand: Projections to 2020

October 2006

This paper presents projections of physician supply and requirements for 18 physician specialties using the Physician Supply Model and the Physician Requirements Model developed for the Health Resources and Services Administration by The Lewin Group and the Altarum Institute. The paper describes the data, assumptions and methods used to project the future supply of and requirements for physician services; presents projections from these models under alternative scenarios; and discusses the implications of these projections for the future adequacy of physician supply.

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Ensuring a Qualified Long-Term Care Workforce: From Pre-Employment Screens to On-the-Job Monitoring

May 2006

In an effort to improve the quality of care provided in long-term care settings, as well as ensure a committed and qualified long-term care workforce, the Office of the Assistant Secretary for Planning and Evaluation, within the U.S. Department of Health and Human Services, contracted with The Lewin Group to study the efficacy of various approaches to pre-employment screening and on-the-job monitoring of nurse assistants to prevent resident abuse in nursing homes. The two primary methods used for pre-employment screening include checking nurse aide registries and conducting criminal background checks. Federal guidelines require each state to establish and maintain a registry of nurse aides that includes certification information and substantiated findings of abuse, neglect, or financial exploitation in nursing homes. Previous studies have examined rates of abuse in nursing facilities, direct service worker capacity issues, and compliance of states to maintain nurse aide registries. This study looks across all of these issues, by examining the process states go through to collect and maintain information in their registries, state and employer mandated background check procedures, reporting and investigating policies/practices when abuse allegations are made, and the impact of such processes on the direct service workforce, employers and state agencies

Client Area: Federal Government
Expertise Area: Aging and Disability

Report to Congress: The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians

May 2006

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.

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

A Study of Hospital Charge Setting Practices

December 2005

The Medicare Payment Advisory Commission has expressed concerns about the accuracy and fairness of the current Medicare hospital inpatient and outpatient prospective payment system. Payment rates for these systems are based, to varying degrees, on hospital charges. In order to better understand hospital charge setting practices and the nature of hospital mark-ups across service lines, MedPAC engaged The Lewin Group to conduct a nationwide study of hospital charge practices. This report reviews the charge practices of a purposive sample of hospitals and hospital systems around the U.S.

Client Area: Federal Government
Expertise Area: Medicare

Organ Transplantation Breakthrough Collaborative: Best Practices Evaluation: Final Report

September 2005

One of the Nation's most pressing public health issues is the widening gap between the supply and demand for organs and tissues. The "Organ Donation Breakthrough Collaborative," a component of Secretary Thompsons's Gift of Life Donation Initiative, was launched in 2003 to increase organ donation by helping the national community of organ procurement organizations (OPOs) and hospitals to quickly identify, learn, adapt, replicate, and celebrate "breakthrough" practices that are associated with higher donation rates. To help the transplant community maximize every donation opportunity, HRSA has sponsored a second collaborative focused on increasing the number or organs recovered and transplanted per donor. This report presents observations of the practices of selected OPOs, hospitals and transplant centers that appear to be associated with higher rates of organs recovered and transplanted per donor.

Client Area: Federal Government

The Hospital Built Environment: What Role Might Funders of Health Services Research Play?

August 2005

Several noteworthy reports that have been released in the past few years raise troubling concerns about the quality and safety of health care in the United States. Many factors may contribute to the shortfalls in quality, including the way care is delivered and the adequacy of the facility within which that care takes place. A body of evidence is developing about how attributes of the various environments in which health care is provided mediate health care quality. Consistent with the growing movement to apply clinical evidence-based approaches to improve patient outcomes, hospital administrators and researchers also are placing greater emphasis on "evidence-based design" to support and facilitate clinical advances in the field. This is a process for creating hospital environments that is informed by the best available evidence concerning how the physical environment can affect patient outcomes, patient safety and satisfaction, and hospital staff safety and satisfaction. However, the field is relatively new, evidence supporting this approach is not yet robust in many areas and existing research on evidence-based hospital design is not widely known among policymakers, regulators and other decision makers and opinion leaders. This environmental scan is intended to assess what is and is not known about the relationships between hospital design and construction—the built environment—and patient outcomes and satisfaction, and staff working conditions. It discusses the following issues: What is currently driving the market for hospital design and construction? To what extent are hospitals requesting evidence-based designs? What is the research base for the hospital built environment? What are major challenges in building the field of evidence-based hospital design? What are the major gaps in current research and relevant areas of future focus? What are appropriate roles for funders of health services research interested in furthering improvements within the built environment?

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

Health Information Technology Leadership Panel: Final Report

March 2005

In August 2004, The Lewin Group was retained by the National Coordinator for Health Information Technology, US Department of Health and Human Services, to convene a Health Information Technology Leadership Panel (HIT Leadership Panel) and report on its findings. The HIT Leadership Panel met in Washington, DC, on November 29, 2004, to examine the importance of investing in HIT, particularly regarding the respective major roles of government and the private sector in its widespread implementation. HIT Leadership Panel members were drawn from executives in widely recognized companies that purchase substantial levels of health care for their employees. Companies with little or no direct involvement in the health care or information technology (IT) industry sectors were selected with the intention of learning how IT has been successfully adopted and used by other sectors. On May 11, 2005, Health and Human Services Secretary Mike Leavitt issued the report of the HIT Leadership Panel findings at the Business Rountable's CEO Health Care Summit where Secretary Leavitt and Treasury Secretary John Snow discussed the burden of rising health care costs on the U.S. economy and global competitiveness and the role of health IT in managing these costs. Following the Roundtable meeting, Secretary held a press conference with FedEx Corporation CEO Frederick Smith and Pepsico CEO Steven Reinemund to release the report.

Client Area: Federal Government

The Interaction of Child Support and TANF

January 2005

Child support is an important income source for many low-income families, and the receipt of support may be most critical for women as they transition off welfare. In the post-welfare reform era emphasizing work and self-sufficiency, many policymakers now consider child support as a key income support. In the effort to support self-sufficiency, for example, it is important that custodial parents, primarily mothers, know the rules of child support, establish orders, begin to receive child support while on welfare and receive child support payments on a regular basis after leaving welfare. To examine the interaction of child support and welfare receipt, researchers from MDRC, The Lewin Group, and The University of Wisconsin-Madison analyzed several data sources to address questions concerning child support receipt of current and former welfare recipients. This report is the second and final in a series for this project. The first report, produced by The Lewin Group, provided an extensive literature review.

Client Area: Federal Government
Expertise Area: Income Security

Statutory Rape: A Guide to State Laws and Reporting Requirements

December 2004

This report was prepared for the Department of Health and Human Services, Office of Child Support Enforcement (OCSE) under contract with The Lewin Group. The study reviews the implementation of the performance-based incentive funding system through which the Federal government awards payments to state Child Support Enforcement programs. OCSE implemented the new incentive formula over the fiscal year 2000 to 2002 period. The statute provided a gradual phase-in, in part, so that state officials would havetime to perfect their measurement of performance and identify factors that affect performance. This final report explores state experiences in implementing the new system, including problems, successes, advantages and disadvantages. It also reports changes to the new system that were recommended by child support stakeholders.

Client Area: Federal Government
Expertise Area: Children, Youth, and Family Policy

Study of the Implementation of the Performance-Based Incentive System: Final Report

September 2004

This report was prepared for the Department of Health and Human Services, Office of Child Support Enforcement (OCSE) under contract with The Lewin Group. The study reviews the implementation of the performance-based incentive funding system through which the Federal government awards payments to state Child Support Enforcement programs. OCSE implemented the new incentive formula over the fiscal year 2000 to 2002 period. The statute provided a gradual phase-in, in part, so that state officials would havetime to perfect their measurement of performance and identify factors that affect performance. This final report explores state experiences in implementing the new system, including problems, successes, advantages and disadvantages. It also reports changes to the new system that were recommended by child support stakeholders.

Client Area: Federal Government
Expertise Area: Income Security

What is Behind HRSA's Projected Supply, Demand, and Shortage of Registered Nurses?

September 2004

This paper provides a brief overview of the Nursing Supply Model and the Nursing Demand Model; describes the data, methods, and assumptions used to project RN supply and demand; presents findings from the models; and discusses the limitations of these and other models and methods to forecast demand for health workers.

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Women's Health and Mortality Chartbook

August 2004

The Women's Health and Mortality Chartbook is a collection of current state data on critical issues of relevance to women's health. The report was prepared by The Lewin Group for the DHHS Office on Women's Health and the Centers for Disease Control and Prevention. It ranks each state, the District of Columbia, and Puerto Rico in 27 indicators, including major causes of death, health risk factors, preventive care, and health insurance coverage.

Client Area: Federal Government

Spending on Social Welfare Programs in Rich and Poor States

July 2004

This study was conducted for the Assistant Secretary for Planning and Evaluation, DHHS. It addresses how a state’s fiscal capacity affects its spending on social welfare, how states differ in their "packaging" of services for low-income populations, how economic conditions affect state spending on social welfare, and how the poorest states have adjusted to their relative economic austerity. The study also looks at factors in addition to fiscal capacity and federal grants that might influence state spending, including state needs for social welfare spending, as measured by poverty and unemployment rates and political and institutional factors, including state budget processes. .

Client Area: Federal Government
Expertise Area: Income Security

The Economic Impact of Chronic Fatigue Syndrome

June 2004

For the Centers for Disease Control and Prevention, Lewin and Scientific Research Associates, Inc. developed estimates of lost labor market and lost household productivity at the societal and individual levels including sensitivity analysis around the key factors affecting the estimates for Chronic Fatigue Syndrome (CFS). Study objective included identification of data and/or evidence gaps that hinder thorough and sophisticated economic impact analysis of CFS and to provide recommendations for future analysis of CFS.

Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness

The Relationship of Earnings and Income to Food Stamp Participation: A Longitudinal Analysis

November 2003

This study considers the role that the dynamics of household income plays in determining Food Stamp Program (FSP) participation. In particular, many nonparticipant households have had a short-term drop in income. Other nonparticipants, however, have had long-term low income and are often very disadvantaged. Many households may not participate because the same conditions that limit their incomes, such as low literacy levels or physical or mental disability, also limit their ability to participate in the FSP. Many poor nonparticipants are receiving other benefits, such as Supplemental Security Income or Medicaid, suggesting an avenue by which agencies can reach eligible nonparticipants. The two main objectives of this study are to (1) determine the extent to which nonparticipation can reasonably be attributed to temporary low income, and (2) assess why some households that appear to have long-term low income do not participate.

Client Area: Federal Government
Expertise Area: Income Security

Study of the Implementation of the Performance-Based Incentive System: Interim Report

October 2003

Since 1975, the federal government has paid incentives to state child support enforcement programs to encourage improvement in collections through efficient establishment and enforcement techniques. The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) required the Department of Health and Human Services (HHS) to develop a performance-based incentive funding system through which the federal government would award payments to state child support enforcement (CSE) programs. The 1998 Child Support Performance and Incentive Act (CSPIA) created the new structure to reward states that operated effective CSE programs. The federal Office of Child Support Enforcement (OCSE) implemented the new incentive formula over the Fiscal Year (FY) 2000 to 2002 period. Policymakers called for the gradual phase-in so that state officials would have time to perfect their measurement of performance and identify factors that affect the determination of incentives. CSPIA requires HHS to produce interim and final reports that detail the implementation of this new system and offer recommendations for its improvement. This interim Report to Congress describes the development of the new incentive system, components of the system, and initial program results.

Client Area: Federal Government
Expertise Area: Income Security

The Organ Donation Breakthrough Collaborative: Best Practices Final Report

September 2003

One of the Nation's most pressing public health issues is the widening gap between the supply and demand for organs and tissues. The "Organ Donation Breakthrough Collaborative" is the most recent component of Secretary Thompsons's Gift of Life Donation Initiative. The purpose of the Collaborative is to increase organ donation by helping the national community of organ procurement organizations (OPOs) and hospitals to quickly identify, learn, adapt, replicate, and celebrate "breakthrough" practices that are associated with higher donation rates. This report presents a set of overarching principles and best practices associated with higher rates of organ donation that were identified based on site visits, in-depth face-to-face discussions, and other data collection involving selected organ procurement organizations and hospitals across the country.

Client Area: Federal Government

State Demographic, Economic, and Programmatic Variables and Their Impact on the Performance-Based Child Support Incentive System

August 2003

In 1998, Congress enacted the Child Support Performance and Incentive Act (CSPIA), to revise the incentive structure to reward states for performance on a larger number of their establishment and enforcement practices. In addition to other studies of the new incentive system, CSPIA required a report on how various demographic and economic variables affect state performance.

Client Area: Federal Government
Expertise Area: Income Security

Impact of the Army Continuing Education System (ACES) on Soldier Retention and Performance: Data Analyses

June 2003

The Army Continuing Education System (ACES) provides a wide range of in-service educational opportunities for enhancing the Army’s human resource potential while benefiting the careers of soldiers both during and after their military service. Although there is widespread belief that participation in ACES programs results in positive outcomes for both soldiers and the Army, there has been little rigorous research addressing this question.

Client Area: Federal Government

Changing Demographics: Implications for Physicians, Nurses, and Other Health Workers

April 2003

This report, prepared by The Lewin Group for HRSA, analyzes the health workforce implications of a growing and aging population that is also becoming more racially and ethnically diversity. In addition to an extensive literature review, the report presents findings from The Physician Aggregate Requirements Model (PARM) quantifying the expected increase in percentage of physicians' time spent treating elderly and minority patients. These findings have implications for the types of work physicians will be providing in future years (e.g., relatively more cardiology and less pediatric work), and the increased importance of providing culturally competent care as minorities become a larger share of total patients. At the same time that the U.S. population is aging and demanding more healthcare services, the health workforce is aging with significant numbers of physicians and nurses nearing traditional retirement age. The aging population and other societal trends have implications for where patients will receive healthcare services--such as a greater reliance on professional nursing and less reliance on informal care provided by family members.

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Child Support and TANF Interaction: A Literature Review

April 2003

Welfare and child support programs have long been intertwined. Given the common populations served and the role that child support payments play in self-sufficiency and cost recovery, understanding the interaction between child support and welfare is important. The Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) funded a study to examine this interaction. This literature review is the first report from this important study. A future report will present findings from analyses of several datasets examining the extent of child support receipt among current and former welfare clients and the contribution of payments to self-sufficiency.

Client Area: Federal Government
Expertise Area: Income Security

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

National Family Caregiver Support Program Resource Guide

December 2002

Intended for the staff of State Units on Aging, Area Agencies on Aging, Indian Tribal Organizations, and service providers, this Resource Guide offers practical information to help implement the new National Family Caregiver Support Program (NFCSP). As a Resource Guide—not a handbook of program policies or prescribed procedures—it features examples and resources to stimulate members of the aging network to pursue approaches that afford caregivers flexibility and assistance in meeting caregiver service needs. The information is based on established research and early practice experience and covers: roles of the aging network, profile of family caregivers, systems development, program effectiveness, working with families and other caregivers, NFCSP service components, designing the NFCSP in the context of diverse caregiver populations, and nontraditional approaches.

Client Area: Federal Government
Expertise Area: Aging and Disability

Comparisons of Client Outcomes across Cities: Does Case Mix Matter?

October 2002

This analysis aims to compare the performance of the treatment systems located within cities in different geographic regions, an approach to performance measurement and outcomes monitoring that has not previously been done. Using the CSAT Target Cities multi-site data set, the goals of this analysis were to (1) identify and operationalize standardized performance measures that are applicable across treatment systems within cities; (2) illlustrate a type of performance measurement analysis that can be conducted at the treatment system level; (3) assess the relative performance of the treatment systems/cities using the identified performance measures; and (4) highlight the uses, benefits, constraints and data requirements for system-level performance measurement monitoring and comparisons.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

State Policies to Promote Marriage: Final Report

September 2002

The Assistant Secretary for Planning and Evaluation (ASPE) funded this project to learn about the status of policies to support and promote marriage at the state level. It includes policies that have been enacted, as well as those proposed. Also included are policies proposed or adopted prior to PRWORA and those suggested after the law's passage. This report inventories marriage policies in the 50 states and District of Columbia in the following ten areas: Campaigns, commissions and proclamations Divorce laws and procedures Marriage and relationship preparation and education State tax policies State cash assistance policies State Medicaid policies State vital statistics Marriage support and promotion Youth education and development Specialty programs

Client Area: Federal Government
Expertise Area: Children, Youth, and Family Policy

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

Guidelines for Donor Registry Development Conference: Final Report

August 2002

This report summarizes a national forum on donor registries convened by the Health Resources and Services Administration (HRSA), Office of Special Program (OSP), Division of Transplantation (DoT) as part of the Secretary of the Department of Health and Human Services' Gift of Life Donation Initiative. The goals of the conference, held on November 29th and 30th, 2001. were to develop guidelines for successful donor registries; recommend options for a federal role in facilitating effective donor registries; identify strategies to promote commitment and involvement among government entities, organ procurement agencies, and tissue and eye banks; and inform ongoing policy making regarding donation.

Client Area: Federal Government

Administrative and Judicial Processes for Establishing Child Support Orders

July 2002

While the federal government has mandated the use of a number of enforcement techniques, states and localities still have considerable flexibility in designing the processes by which they establish child support. States have discretion in terms of shaping and running their child support programs. In many states, courts play a key role in child support order establishment, as well as other aspects of the program. In others, executive-branch agencies establish orders administratively. Despite the widespread use of the terms "judicial" and administrative," no study has tried to define each process -- or a range of quasi-judicial processes. The 50 states and the District of Columbia each has its own order establishment process and its own set of "players." This study addressed the following questions: What key characteristics define administrative and judicial processes? Is it possible to classify state processes into four or five key categories or types? Are there similarities, as well as differences, between the processes? How do cases progress through each of the process types? Are there differences in the number of people or agenies involved? Do clients perceive the processes as fair and accessible? Do cases appear to move quickly through one process or another? In order to answer the study questions, the project team developed a taxonomy of judicial and administrative processes; reviewed processes in nine states; and conducted site visits in five states.

Client Area: Federal Government
Expertise Area: Income Security

Projected Supply, Demand and Shortages of Registered Nurses: 2000-2020

July 2002

The Lewin Group assisted the National Center for Health Workforce Analysis to prepare supply and demand projections of registered nurses for the period 2000 through 2020. This report consists of three sections. The first presents the National Center’s projections of RN supply and demand, both national and State-specific, for the years 2000 through 2020. The second identifies and discusses the driving forces and trends underlying the projected supply; the third does the same for the projected demand.

Client Area: Federal Government
Expertise Area: Health Professionals Workforce

Welfare Time Limits: State Policies, Implementation, and Effects on Families

July 2002

Few features of the 1990s welfare reforms have generated as much attention and controversy as time limits on benefit receipt. Time limits first emerged at the state level and subsequently became a central feature of federal welfare policy in the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), which imposed a 60-month time limit on federally funded assistance for most families. To inform discussions about the reauthorization of PRWORA, the U.S. Department of Health and Human Services contracted with the Manpower Demonstration Research Corporation (MDRC) to conduct a comprehensive review of what is known about time limits. As part of this project, The Lewin Group conducted a survey of all 50 state welfare agencies.

Client Area: Federal Government
Expertise Area: Income Security

Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: A Literature Review

June 2002

This literature review summarizes the major findings from books, published articles, research and evaluation studies, and government documents (including "Web" publications) published since 1980, which focus on the cost effectiveness and cost benefits of substance abuse treatment. Cost effectiveness and cost benefit studies play an important role in evaluating existing and alternative substance abuse approaches and in assessing new treatment methods. Evaluating the outcomes and costs of treatment is necessary in order to determine how to more efficiently allocate scarce resources. This document is intended to assist policymakers, researchers/evaluators, and treatment providers interested in this field to identify and acquire evidence-based information specific to their interests. This review also explores trends and areas where there are gaps in the literature.

Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness, Mental Health and Substance Abuse

Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: An Annotated Bibliography

June 2002

This bibliography lists books, published articles and research/evaluation studies, and government documents (including "Web" publications) published since 1980 that focus on the costs of substance abuse treatment, methods for estimating the costs of treatment, and studies of the cost effectiveness and cost benefits of substance abuse treatment. This document also identifies trends and areas where there are gaps in the literature. A companion document, Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: A Literature Review, synthesizes the major findings from the reports and studies focusing on the cost effectiveness and cost benefits of substance abuse treatment identified in this bibliography.

Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness, Mental Health and Substance Abuse

Home and Community-Based Services in Seven States

April 2002

As part of a CMS-funded study, case studies were conducted in Alabama, Indiana, Washington, Wisconsin, Maryland, Michigan, and Kentucky to assess the major features of the home and community-based services system for older people and younger adults with physical disabilities in each State. The case studies analyzed the financing of services; administrative systems; eligibility, assessment, and case management structures; the services provided, including consumer-directed home care and group residential care; cost-containment efforts; and quality assurance. The role that Medicaid plays in home and community-based services is a major focus of the study.

Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP

Indicators of Cultural Competence in Health Care Delivery Organizations: An Organizational Cultural Competence Assessment Profile

April 2002

"How do we know cultural competence when we see it?" is the central question that prompted the Health Resources and Services Administration (HRSA) to sponsor a project to develop indicators of cultural competence in health care delivery organizations. The Assessment Profile builds upon previous work in the field, such as the National Standards for Culturally and Linguistically Appropriate Services (CLAS) , and serves as a future building block that advances the conceptualization and practical understanding of how to assess cultural competence at the organizational level. The Assessment Profile is an analytic or organizing framework and set of specific indicators to be used as a tool for examining, demonstrating, and documenting cultural competence in organizations involved in the direct delivery of health care and services. At a general level, the Profile can help organizations frame and organize their perspectives and activities related to the assessment of cultural competence. More specifically, it can be used in routine performance monitoring, regular quality review and improvement activities, assessment of voluntary compliance with cultural competence standards or guidelines, and periodic evaluative studies.

Client Area: Federal Government

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

Analysis of National and State Actions Regarding Organ Donor Registries

November 2001

This report provides an analysis of national and state level activity related to organ and tissue donor registries. It describes national- and state-level initiatives related to organ donor registries, examines the relative roles of federal and state governments in such registries, and assesses the effect of these activities and policies on efforts to strengthen donor registries. The report was sponsored by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Special Programs, Division of Transplantation to better inform attendees of its conference, Guidelines for Donor Registry Development on November 29-30, 2001. The conference is part of the HHS Gift of Life Donation Initiative. The report updates an earlier Lewin report Analysis of State Actions Regarding Donor Registries.

Client Area: Federal Government

Factors Influencing Effective Dissemination of Prevention Research Findings by the Department of Health and Human Services

October 2001

On behalf of the Office of the Assistant Secretary for Planning and Evaluation, The Lewin Group analyzed factors influencing effective dissemination of prevention research findings. The objectives of the study included identifying the mechanisms by which DHHS translates research findings into clinical and public health practices and how these processes can be improved.

Client Area: Federal Government

Results from the SSA Medicare Part B Buy-in Demonstration: Final Report

October 2001

Over the past two years, the Social Security Administration conducted a demonstration to increase enrollment in the Medicare Part-B Buy-in program, using a variety of outreach methods. This is the final report that evaluates these efforts to increase participation. This report presents key findings that indicate that outreach letters significantly increased enrollment. In addition, it examines whether the outreach made a difference if interested beneficiaries were referred to Medicaid agencies or SSA became actively involved in the application process. Finally, it examines the effect of other means of outreach, such as public service announcements and grass roots information dissemination.

Client Area: Federal Government
Expertise Area: Medicare

Health Resources and Services Administration Study on Measuring Cultural Competence in Health Care Delivery Settings: A Review of the Literature

September 2001

This report details a comprehensive review of the cultural competence theoretical and methodological literature. It begins with a review of how cultural competence has been conceptualized. The identification and discussion of the areas in which cultural competence must be evidenced are presented as critical domains for measuring cultural competence. The report then presents and applies a measurement framework for the identification and review of specific performance indicators and measures of cultural competence that are garnered from the literature. The report identifies key challenges in measuring cultural competence and potential areas for further analysis are discussed. The conclusion section of this report highlights key themes raised throughout the report and presents considerations for next steps.

Client Area: Federal Government

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

Results from Three of the Initial Models of the SSA Medicare Part B Buy-in Demonstration

September 2001

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in the Medicare Part B Buy-In program. In March 1999, SSA implemented four models in 11 sites around the country and the state of Massachusetts that involve different levels of SSA involvement. This report describes the demonstration, documents the implementation of the four models, and presents findings of the impact of each model on enrollment.

Client Area: Federal Government
Expertise Area: Medicare

The Economic Costs of Drug Abuse in the United States: 1992-1998

September 2001

This report, developed for The Office of National Drug Control Policy, presents new estimates of the societal cost of drug abuse. The most recent previous estimates of drug abuse related costs are for 1995. In addition, the report provides annual estimates for 1992 through 1998 and projections for 1999 and 2000 that are consistently developed, so that trends in the overall societal cost and in component costs of drug abuse can be evaluated. In developing the report, p articular emphasis was placed on estimating the health-related consequences and costs of illicit drug abuse, including the costs of substance abuse treatment for comorbid health problems. Other major economic costs of drug abuse estimated include: premature mortality, victim loss from drug-related property and violent crime (and child abuse), social welfare services, criminal justice expenditures, workplace and household productivity impacts, and "crime career" costs.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Initial Results from the Peer Assistance, Decision Making, and Widow(er)s Models of the SSA Medicare Part B Buy-in Demonstration

August 2001

SSA was mandated to conduct a demonstration to test outreach and application methods for enrollment in the Medicare Part B Buy-in program. This report provides information on the implementation and early outcomes of three of the six models implemented during fiscal year 2000. This report describes the demonstration, documents its implementation, and presents descriptive analyses of individuals targeted for the program.

Client Area: Federal Government
Expertise Area: Medicare

Do Larger Residential Service Delivery Units Have Lower Costs?

July 2001

This analytic report presents the results of an analysis of the relationship between the size of providers and the cost of delivering treatment services. It was found that large providers tend to have lower costs per unit of service than small providers, although it appears that this may be partially due to delivery of lower intensity services, with uncertain implications for the outcomes of care.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Screening for Mental Illness in Nursing Facility Applicants: Understanding Federal Requirements

July 2001

Medicaid law and regulations require States to have a Preadmission Screening and Resident Review (PASRR) program to determine whether nursing facility applicants and residents require nursing facility services and specialized mental health care. This paper reviews the literature concerning PASRR and mental health services for persons in nursing facilities. It details the Federal laws and regulations concerning PASRR, reviews key policy issues from the literature, clarifies frequently asked questions regarding the process, and identifies additional policy questions to be studied.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

The Cost and Components of Substance Abuse Treatment

July 2001

This document introduces a new tool available to study the costs of substance abuse treatment: the Center for Substance Abuse Treatment (CSAT) Substance Abuse Treatment Cost Allocation and Analysis Template (SATCAAT). The particular purpose and strength of the SATCAAT is the development of cost estimates for defined components and units of service that combine (often in different proportions by different providers) to constitute substance abuse treatment. The SATCAAT should be considered an example of an important approach to studying the costs of substance abuse treatment. The method is described and actual data are presented from a sample of providers in order to demonstrate the output and potential use.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Automated Cost-of-Living Adjustments of Child Support Orders in Three States

April 2001

In recent years, federal and state governments have taken a number of actions to strengthen the nation's child support system. One chief policy concern is that child support awards, over time, may not keep pace with non-custodial parent earnings or the cost associated with raising a child. Given the cost and complexity of traditional review and adjustment procedures, a number of states are considering, or have implemented, one of the two new approaches authorized in the Personal Responsibilty and Work Opportunity Reconciliation Act (PRWORA) of 1996: Cost-of-living (COLA) adjustments that alter orders periodically without reviews, and An automated method to identify orders eligible for review and to apply the appropriate adjustment. This report focuses primarily on COLA adjustments and reviews the COLA policies in two states: Minnesota, and New York. The study reviewed the processes involved in passing COLA legislation, the stakeholders who were involved, the steps the states took to implement their COLA systems, the fiscal outcomes for both the parents and the states, and assessments of the pros and cons of a COLA system. In addition, the study examined a proposed automated method for reviewing and adjusting orders in Vermont.

Client Area: Federal Government
Expertise Area: Income Security

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

Evaluation of SSA's Disability Quality Assurance (QA) Processes and Development of QA Options That Will Support the Long-Term Management of the Disability Programs: Final Report

March 2001

This report provides findings from the project team's review of SSA's quality assurance system for disability determinations and options for improvement. The report finds that SSA's QA system reflects the end-of-line inspection type of system that was prominent in the health care industry and other industries when it was developed, and needs to be transformed to a more advanced, state-of-the-art quality management system. This will require a sustained effort over many years. Program leadership will play a critical role. Options are presented for improving leadership, developing a culture of quality, improving pre-effectuation reviews, improving measurement of quality in initial determinations, improving SSA's relationship with the state Disability Determination Services, continuously improving the disability determination process, and improving the quality of appellate decisions.

Client Area: Federal Government
Expertise Area: Income Security

Administering Generous Mental Health Benefits: Opinions of Employers

January 2001

This report synthesizes the experiences of seven large employers that offer generous mental health benefits to their employees. Representatives of these employers shared their views and experiences in a one-day focus group.

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Characteristics of Caregivers Based on the 1996 Panel of the Survey of Income and Program Participation

January 2001

This issue brief, supported by the Adminstration on Aging, examines caregivers providing regular assistance to individuals with a disability or long-term health problem of all ages in 1998. It is intended to provide the Aging Network with general socio-demographic information about its potential target populations as a background for designing and implementing caregiver support services around the National Family Caregiver Support Program.

Client Area: Federal Government
Expertise Area: Aging and Disability

Assessment of Approaches to Evaluating Telemedicine

December 2000

In the mid-1990s, the National Library of Medicine (NLM) requested that the Institute of Medicine (IOM) develop a broad framework for telemedicine evaluation. In 1996, based on the deliberations of a 15-member expert committee, the IOM released its report, Telemedicine: A Guide to Assessing Telecommunications in Health Care. The report presented a framework built upon five main evaluation elements: 1) quality of care and health outcomes, 2) access to care, 3) health care costs and cost-effectiveness, 4) patient perceptions, and 5) clinician perceptions. Since 1996, the field of telemedicine has continued to evolve and mature. Recently, the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with The Lewin Group to assess current approaches to evaluating telemedicine. In particular, ASPE requested that Lewin extend or otherwise update the 1996 IOM framework for telemedicine evaluation as it applies to telemedical consultations The objective of this report, Assessment of Approaches to Evaluating Telemedicine, is to identify areas in which telemedicine evaluation is likely to be most useful in informing future policy and program decisions. Lewin's effort entailed integrating findings from a literature review, gathering information on evaluations of telemedicine activities funded by HHS, and conducting interviews with representatives of telemedicine programs and other experts in the field.

Client Area: Federal Government

Case Study Reports on Home and Community-Based Services

December 2000

The Centers for Medicare and Medicaid Services contracted with The Lewin Group, and its subcontractors, the Urban Institute, the University of Minnesota, Mathematica Policy Research, Inc., and the MEDSTAT Group, to design and implement a study of the impact of Medicaid home and community based services programs on quality of life, quality of care, utilization and cost. The research project is studying the financing and delivery of services to older and younger people with disabilities in seven states and the Medicaid financing and delivery of services for individuals with mental retardation and developmental disabilities (MR/DD) in six states.

Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP

Updating Estimates of the Economic Costs of Alcohol Abuse in the United States: Estimates, Update Methods and Data

December 2000

The economic costs of alcohol abuse are estimated to have been $184.6 billion in 1998. This estimate has been developed by making a series of adjustments to the most recent comprehensive estimates that attempt to account for changes expected to affect the estimates. This new estimate represents a 25 percent increase (3.8 percent per year on average) from the $148 billion comprehensive estimate developed previously for 1992. The current update has developed new estimates for 20 major cost components and has applied various combinations of 18 different specific adjustment factors to account for 1992 to 1998 changes in, e.g.: incidence/prevalence of selected alcohol-specific consequences; population; general prices; and worker compensation (wage rates).

Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse

Assessing Core Capacity for Infectious Diseases Surveillance

November 2000

The Lewin Group worked with The Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services to develop an investment plan to improve the nation's core capacity for infectious diseases surveillance. This project came in light of recent challenges to disease surveillance including bioterrorism, emerging infections, the rapid pace of technological development, and changes in the health care delivery system. The Lewin Group conducted extensive research, including a literature review, interviews and site visits, and convened a panel of experts to assist in plan development. Drawing on the literature and the experience of the expert panelists, the report identified eight goals for infections disease surveillance. Lewin's research identified three types of gaps in performance that have resulted in poor performance across the eight goals: gaps in the core capacity of the key entities involved in conducting surveillance of infectious diseases; gaps i