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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Projected Economic Impact of Eliminating California’s Medi-Cal Adult Day Health Care Program

May 2010

This study estimates the potential State revenue impacts associated with the proposed elimination of the Medi-Cal ADHC program. While the proposed elimination of the Medi-Cal ADHC program would save direct expenses on the program, policymakers should also consider the potential negative impacts of the elimination on cost-shifting to other more expensive care settings, loss of jobs among ADHC employees, reductions in family caregivers’ ability to work, loss of State tax revenue, forfeiting $164 million annually in federal Medicaid matching funds and economic impact on local businesses and other entities that would lose revenue from the elimination of adult day health care providers.

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

Analysis of the July 15 draft of The American Affordable Health Choices Act of 2009

July 2009

In this memorandum for The Heritage Foundation, originally published July 17, 2009 and revised July 23, 2009 , we present estimates of the impact of the Act on sources of insurance coverage and provider incomes. We present our results in the following sections:

• Insurance exchanges and the public plan;
• Medicare payment reforms;
• Coverage effects;
• Detailed physician impacts analysis; and
• Detailed hospital impacts analysis.

Client Area: Foundations
Expertise Area: Health Reform

Developmental and Economic Effects of Parenting Programs for Expectant Parents and Parents of Preschool-age Children

February 2009

This study, for the Partnership for America's Economic Success, explores the impacts of a range of parenting education programs and their short- and long-term gains for families and society.

Client Area: Foundations
Expertise Area: Children, Youth, and Family Policy

A Path to a High Performance U.S. Health System : Technical Documentation

February 2009

This document presents the approach used by The Lewin Group to estimate the impact of the Commonwealth Fund’s health reform proposal entitled “Path to a High-Performance Health Care System.” The report describe the provisions of the plan and explains how Lewin simulated the plan’s impact on coverage and costs for households, employers, the federal government and state and local governments. It also presents the methodology used to estimate the cost impacts of a series of system savings initiatives included in the proposal.

The primary analytic tool used in the analysis is The Lewin Group Health Benefits Simulation Model (HBSM). The model is designed to show the impact of major health reform plans on major stakeholder groups. It provides estimates of enrollment and costs under alternative health reform plans that reflect the impact of financial incentives created under the plan. Lewin supplemented the model with separate analysis of the various system savings proposals. For each initiative, the report provides a description of the proposal, a review of the available research and evidence on the options and Lewin's estimates of the program’s impact over five-, ten- and fifteen-year periods.

Client Area: Foundations
Expertise Area: Health Reform

An Analysis of Leading Congressional Health Care Bills, 2007 - 2008: Part I, Insurance Coverage

January 2009

The Commonwealth Fund commissioned The Lewin Group to estimate the cost and coverage impacts for each of the proposals examined in this report.

Client Area: Foundations
Expertise Area: Health Reform

Assessment of One-e-App: A Web-based Application and Enrollment Application for Public Health Insurance Programs

October 2008

The California HealthCare Foundation and The California Endowment engaged The Lewin Group to conduct an assessment of One-e-App, an electronic application and enrollment system that allows applicants to apply for multiple public programs through a single application process. The assessment focused on evaluating and demonstrating the benefits of One-e-App both qualitatively and quantitatively. This report presents a summary of the assessment’s background, Lewin’s approach to the analysis, key analytic findings, key implementation considerations, and policy and operational considerations promoting One-e-App’s optimal use.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Bending the Curve: Technical Documentation

June 2008

This document is a compilation of the technical documentation developed for the Commonwealth Fund analysis of options for reducing health spending growth entitled “Bending the Curve.” In this analysis, we provided cost analyses for 15 alternatives for reducing health care costs. We developed these analyses with the Lewin Group Health Benefits Simulation Model (HBSM) and the best available data. For each of the 15 options, we provide a narrative summary of the proposal, a review of the available research and evidence on the option and our estimates of the program’s impact over five- and ten-year periods.

Client Area: Foundations
Expertise Area: Health Reform

What Public Employee Health Plans Can Do To Improve Health Care Quality : Examples from the States

January 2008

In recent years, health system stakeholders have experimented with a wide range of efforts to stimulate quality improvement, often combined with efforts to contain costs.This report explores strategies that public and private purchasers are using to improve care quality, focusing specifically on the role that states play as employers providing health benefits for public employees and retirees. Examples of innovations used by state public employee health plans include: promoting provider adherence to clinical guidelines and best practices, publicly disseminating provider performance information, implementing performance-based incentives, developing coordinated care interventions, and taking part in multi-payer quality collaborations.

Client Area: Foundations

Estimates of the Cost and Coverage Impacts of Proposals to Expand Health Insurance Coverage in New York

December 2006

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

Client Area: Foundations
Expertise Area: Health Reform

Evaluation of the California HealthCare Foundation's Ambulatory Care Redesign Collaborative

July 2006

The California HealthCare Foundation commissioned The Lewin Group to conduct an evaluation of an Ambulatory Care Redesign Collaborative whose objectives included improving patient cycle time, provider productivity and provider and patient satisfaction levels at nine clinic sites affiliated with five public hospital and healthcare systems in California. This report presents the findings of Lewin's external evaluation of this initiative.

Client Area: Foundations

Understanding Florida's Certificate of Need (CON) Program

May 2006

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

Client Area: Foundations

Estimated Cost and Coverage Impacts of Four Proposals to Expand Health Insurance Coverage for Children in California

April 2006

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

Client Area: Foundations
Expertise Area: Health Reform

Strategic Planning for Safety-Net Services: Final Report

February 2006

In July of 2005, The Lewin Group was engaged to develop a strategic plan and unified approach to the coordination and delivery of health care services to the medically indigent population of Tulsa County and the surrounding metropolitan area. The final strategic planning for safety-net services report presented a “road-map” that would in the long-term lead to measurable improvements in health care outcomes for Tulsa residents.

Client Area: Foundations
Expertise Area: Community Health Needs Assessment

Electronic Applications Present Opportunities to Improve Enrollment into New York's Public Health Insurance Programs

November 2004

As part of an effort to identify ways to expand and strengthen public health insurance coverage, the United Hospital Fund, with the support of the Altman Foundation, commissioned The Lewin Group to study the process for applying for public health insurance programs in New York City and determine how automation might improve that process. Results of the analysis show that an automated application process could speed up the current application processing time by over one week and help applicants access medical care sooner by decreasing the transition time between agencies, reducing errors, and limiting duplication of effort. Automation would also save enrollment organizations and their staff one hour or more every day by improving process efficiencies.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Assessment of Health Care Safety Net Needs and Services in Central Louisiana

May 2004

In 2003, The Rapides Foundation contracted with The Lewin Group to conduct an intensive assessment of the programmatic and financial environment of primary and hospital services for the medically indigent and describe options for an affordable and more effective system of delivery.

Client Area: Foundations
Expertise Area: Health Reform

How Policy Changes Impact Enrollment: A Look at Three Counties

May 2004

In the current economic climate, California’s counties struggle with the need to provide health coverage to low-income individuals and families in the face of sharp budget cuts. How can a county ensure that its most vulnerable residents gain access to the appropriate public health insurance program? Three California counties – Alameda, San Mateo, and Santa Clara – have gone beyond state requirements, not only in expanding eligibility for coverage, but also in creating a more seamless process for enrollment in county programs, Medi-Cal, and Healthy Families. The report, prepared by The Lewin Group, explores the policy, operational, and other considerations of implementing partnerships among county agencies, health plans, and other community stakeholders to change and improve the process for enrolling families into public health care programs.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Covering America: Cost and Coverage Analysis of Ten Proposals to Expand Health Insurance Coverage

October 2003

The Covering America project, made possible by a grant from the Robert Wood Johnson Foundation and directed by the Economic & Social Research Institute (ESRI), promotes serious thinking and debate about comprehensive policies to extend health care coverage to uninsured Americans. In June 2001 the project published a set of 10 comprehensive health coverage proposals. The Robert Wood Johnson Foundation commissioned The Lewin Group to analyze the 10 proposals and prepare estimates of the number of people who would be covered by public and private health insurance and the costs of extending coverage. Appendices to the summary report provide a detailed explanation of the methodology used for the study, and detailed cost and coverage estimates for each proposal. Additional publications prepared for the Covering America project are posted on the ESRI website. Appendix A: The Health Benefits Simulation Model (HBSM): Uniform Methodology and Assumptions Appendix B: Reforming the Tax Treatment of Health Care to Achieve Universal Coverage, by Stuart M. Butler Appendix C: Assessing the Combination of Public Programs and Tax Credits, by Judith Feder, Larry Levitt, Ellen O'Brien, and Diane Rowland Appendix D: A Private/Public Partnership for National Health Insurance, by Jonathan Gruber Appendix E: Medicare Plus: Increasing Health Coverage by Expanding Medicare, by Jacob S. Hacker Appendix F: Expanding Health Insurance Coverage: A New Federal/State Approach, by John F. Holahan, Len M. Nichols, and Linda J. Blumberg Appendix G: A State-Based Proposal for Achieving Universal Coverage, by Richard Kronick and Thomas Rice Appendix H: An Adaptive Credit Plan for Covering the Uninsured, by Mark V. Pauly Appendix I: Near-Universal Coverage Through Health Plan Competition: An Insurance Exchange Approach, by Sara J. Singer, Alan M. Garber, and Alain C. Enthoven Appendix J: The Medical Security System: A Proposal to Ensure Health Insurance for all Americans, by Alan R. Weil Appendix K: A Plan for Achieving Universal Health Coverage: Combining the New with the Best of the Past, by Elliot K. Wicks, Jack A. Meyer, and Sharon Silow-Carroll

Client Area: Foundations
Expertise Area: Health Reform

Simplifying Medi-Cal Enrollment

June 2003

The Medi-Cal Policy Institute commissioned The Lewin Group to study various ways in which the process for families applying for Medi-Cal, California's Medicaid program, could be simplified. To apply for Medi-Cal, many applicants must provide documentation of their assets and income, which can serve as a barrier to successful completion of the application process. Through interviews with county eligibility workers, advocates, state staff and others, Lewin developed several alternatives for simplifying both the assets and income tests. For five of these options, Lewin developed estimates of medical costs and administrative savings associated with the implementation of these initiatives. The results of the analyses are summarized in an issue brief, as well as in two detailed reports addressing each of the assets and income options. A technical report on the cost modeling is also included.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

The California Working Disabled Program : Lessons Learned, Looking Ahead

April 2003

The California Working Disabled Medi-Cal Buy-In Program was implemented in April 2000 to enable disabled individuals to participate in the workforce without the threat of losing their Medi-Cal coverage. Although a relatively new program, policymakers and advocates have already begun considering programmatic and policy changes that would build on the existing program, expand eligibility, and broaden access to certain services. This study was initiated to better understand the factors affecting enrollment in CWD and to estimate the enrollment and cost impacts of select programmatic changes. This report shares findings from an enrollee survey, interviews with county eligibility workers, and modeling of data from the Census Bureau and the California Department of Health Services.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Patient Advocate Foundation Survey: Patient and Consumer Views of Brown Bagging and Mandatory Vendor Imposition

January 2003

For the Patient Advocate Foundation (PAF), The Lewin Group tabulated and reported the results of a PAF survey of patient and consumer attitudes regarding two practices being used by some health plans to manage chemotherapy costs, commonly known as "brown bagging" and "mandatory vendor imposition."

Client Area: Foundations

Financial Impact of the 2020 Vision Proposal

October 2002

The Lewin Group developed an analysis of the cost and coverage impacts of a proposal to expand insurance coverage developed by the Commonwealth Fund. Results from the analysis were featured in a recent article in Health Affairs by Karen Davis and Cathy Schoen of the Commonwealth Fund. The proposal includes an expansion of employer sponsored coverage through a "pay-or-play" program in which employers must either provide coverage to their workers or pay a tax covering their workers under a new public program. The proposal also expands upon the existing Medicaid/SCHIP programs, provides premium subsidies to middle-income people for the purchase of insurance, creates a Medicare buy-in for people over age 60 and permits people to obtain coverage from health plans offered through the Federal Employees Health Benefits Program (FEHBP).

Client Area: Foundations
Expertise Area: Health Reform

Financial Performance of Academic Health Center Hospitals, 1994 - 2000

September 2002

This report examines how competitive market dynamics between 1994 and 2000 have affected the financial stability of academic health center (AHC) hospitals and their ability to support their academic and social missions. It looks at the financial challenges facing AHC hospitals and demonstrates that fewer financial resources are currently available to subsidize mission-related activities than at any other time since 1994. Although the analysis focuses on AHC hospitals, the report considers other teaching hospitals as well as other types of hospitals.

Client Area: Foundations

Medicaid Budget Options

June 2002

Following successful children's outreach efforts, and now facing rising unemployment and health care costs, the demands on state Medicaid budgets are increasing at the same time that states have less funds available for their share of Medicaid. Governors and state legislatures have identified Medicaid as their leading "budget buster," and are looking for any means possible to control costs. The Bush Administration is permitting benefit cutbacks, while many Governors and members of Congress are seeking to increase federal Medicaid funding in the midst of an already strained federal budget. Are there effective methods to moderate the underlying health care costs for the Medicaid population? What policy tools are available to provide quality care to Medicaid beneficiaries at a price states and the federal government can afford? These questions are addressed in the paper, Medicare Budget Options, which was presented at the Ninth Princeton Conference, Can Health Care Spending Be Contained?, June 6-8, 2002.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Supports for Working Poor Families: A New Approach

December 2001

With welfare reform, millions of families with children have shifted from reliance on cash assistance from Aid to Families with Dependent Children (AFDC) to reliance on earnings. Increases in programs providing support to low-wage workers and their families have facilitated this shift from welfare to work. Key work support programs include the Earned Income Tax Credit, food stamps, medical insurance under the State Children's Health Insurance Program and Medicaid, and subsidized childcare. By "making work pay," these work support programs have helped families move from welfare to work and have improved family well-being. This paper presents innovative policy options for improving access to the Food Stamp Program (FSP). It presents background on the current programs and the rationale for why a new approach is needed; suggests principles to serve as a guide in designing a new approach; presents options for making the benefits available under the FSP readily accessible to eligible working families; and discusses where to go from here and lays out first steps.

Client Area: Foundations
Expertise Area: Income Security

Kansas School Health Center Initiative: Database Manual

August 2001

The manual serves as a guide to the Kansas School Health Inititative database, which was developed using Microsoft Access. The School Health Center database was designed to help track the students enrolled in school health centers and the encounters with those students. In addition, the database produces monthly reports that provide center staff with demographic, socioeconomic, and health characteristics of the population enrolled in and using the school health center.

Client Area: Foundations

Business Case Analysis for health-e-app: A Web-Based Enrollment Application for Public Health Insurance Programs

June 2001

The California HealthCare Foundation commissioned The Lewin Group to conduct a business case analysis of Health-e-App---an interactive, Web-based enrollment application designed to expedite and simplify the enrollment of children and pregnant women in California's Medi-Cal (Medicaid) and Healthy Families (SCHIP) programs. Modeled on the state's four-page joint Medi-Cal and Healthy Families mail-in paper application, Health-e-App offers unique features like real-time preliminary program eligibility determination and application tracking that allows community-based enrollment workers to inform inquiring clients of the application's status at different points. A pilot test of Health-e-App demonstrated that state-of-the-art technology can be applied to improve systems for enrolling low-income individuals in public health insurance programs and to enhance stakeholders' understanding of the entire application process.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Comparing Physician and Dentist Fees among Medicaid Programs

June 2001

The study provides details on fee-for-service Medicaid payment rates for 50 common medical services, including office visits, surgeries, and tests. The report contains payment rates for all 50 states and the District of Columbia.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

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

October 2000

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

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

Health Coverage 2000: Cost and Coverage Analysis of 8 Proposals to Expand Health Insurance Coverage

September 2000

In January of 2000, the Robert Wood Johnson Foundation (RWJF) sponsored the "Health Coverage 2000" conference at which eight major health care organizations and associations introduced proposals to expand health insurance coverage. Some of those proposals were introduced as the next steps toward universal health coverage and two of them would incrementally phase in universal insurance coverage by the middle of this decade. The incremental reform proposals included various expansions of Medicaid and the State Children's Health Insurance Programs (SCHIP), changes in tax subsidies for insurance including modifying the current tax exclusions and/or introducing tax credits for health insurance, and expansion of high-risk pools. Lewin was asked to estimate the cost and coverage impacts of the eight proposals. Assuming full implementation in 2001, Lewin estimated that the incremental reform proposals would cost between $15.4 billion and $59.1 billion and would reduce the number of uninsured by 7.3 million to about 19 million persons. Therefore, the incremental reform proposals would cover no more than about 40 percent of the uninsured. The universal coverage programs would cost between $324 billion and $454 billion per year. The incremental reform proposals specified no new revenue sources to cover the cost of the programs. However, the universal coverage proposals did include new revenues that would cover most if not all of the costs of the programs.

Client Area: Foundations
Expertise Area: Health Reform

Kansas School Health Center Initiative Performance Management System: Instruction Manual

September 2000

The purpose of this manual is to provide a performance management system and reporting tools for use by the Kansas School Health Center Initiative. The performance management system consists of five monitoring and measurement components: 1) Student Profiles; 2) Student Utilization Reports; 3) Health Risk Surveillance; 4) Client Satisfaction Monitoring; and 5) Annual Performance Measurement. Used together, the monitoring and measurement components enable program staff to demonstrate accountability to a variety of constituencies and to make evidence-based decisions about administrative, program and service improvements.

Client Area: Foundations

State Experiences with Access Issues under Children's Health Insurance Expansions

May 2000

This report explores six states' experiences with eligibility, outreach, and enrollment as they developed their State Child Health Insurance Program. It explores how the design and administration of state incremental insurance expansions affect access to health insurance coverage and, ultimately, access to all health care services. The study was intended to inform national policy discussion about these publicly financed expansions and to provide early feedback for states as they implement insurance programs for low-income families and individuals.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Managed Care Lock-In: Analysis of Impact on Medi-Cal

March 2000

Under the existing Medi-Cal managed care program, enrollees are free to disenroll from their existing health plan at any time – with the disenrollment becoming effective on the first of the upcoming or ensuing month. States have the option, under provisions of the Balanced Budget Act of 1997 (BBA), to restrict beneficiaries' latitude to voluntarily disenroll from their existing health plan. The Medi-Cal Policy Institute engaged The Lewin Group to evaluate the pros and cons of implementing this feature, known as "lock-in," in California. The report contains an overview of the BBA provisions; an overview of state experiences and perspectives; data analysis of a lock-in policy for Medi-Cal; and pros and cons, and policy considerations of a lock-in policy for Medi-Cal.

Client Area: Foundations
Expertise Area: Medicaid and CHIP

Care Management Programs for the Uninsured with a Conceptual Framework and Sample Tools to Guide Development

January 2000

This report is designed to help the executive leadership of safety-net organizations assess the benefits of, and determine whether or not to invest in, care management programs. It also provides a "road map" for the design and implementation of care management programs. The report explains the business environment that supports investments in care management programs for the indigent, chronically ill, uninsured population. Additionally, it draws on the experiences of safety-net providers to help decision-makers assess the value of these programs in their environment. Using results from expert interviews, case studies, site visits, and the successes and challenges of 24 safety-net providers, the how-to guide specifically describes how care management programs are developed and provides a sampling of tools designed by health centers, hospital networks, and health plans to enable others to build on these efforts.

Client Area: Foundations
Expertise Area: Health Reform

Evaluation of the First 18 Months of the Health Rights Hotline: A Pilot Independent Assistance Program of the Center for Health Care Rights

January 2000

This report is the final report of The Lewin Group's evaluation of the Health Rights Hotline, an independent, privately funded pilot program that provides assistance and information to all health care consumers in the Sacramento, California area. The Hotline is a project of the Center for Health Care Rights, a California-based consumer advocacy organization, and Legal Services of Northern California. The Hotline, and the independent evaluation prepared by The Lewin Group, were both funded by a consortium of California health foundations: The California Wellness Foundation, the Kaiser Family Foundation, and the Sierra Health Foundation. The foundations sponsored the Hotline as a way of testing one approach to helping patients navigate the health care system, and rationalizing the patchwork of resources available to assist consumers. In addition to providing services, the Hotline seeks to model philosophical, practical, and programmatic elements for consideration by other organizations elsewhere in California and the United States.

Client Area: Foundations
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