June 2010
Prepared for: Advamed
Lewin Contact: Cliff Goodman
This report presents updated estimates of the medical technology industry’s (MTI) economic contributions from the previous industry analysis, which was released in 2007. The industry encompasses the manufacturing of everyday medical devices, such as contact lenses and thermometers, to high-tech equipment, such as implantable pacemakers, neurostimulators and state-of-the-art imaging systems. Each of the 50 States and the District of Columbia are benefitted by MTI establishments; nearly all have seen this industry grow since the 2007 report.
Client Area: Associations, Pharma / Bio / Device
January 2010
Lewin Contact: Cliff Goodman
Comparative effectiveness research (CER) is reshaping the evaluation of health care technology in the United States, with implications for innovation, regulation, payment, access, quality, and costs. The interest in CER arises from a widely perceived shortfall in evidence to inform decisions by clinicians, patients, health care provider organizations, and payers. The evidence expectations inherent in CER offer distinct challenges to the laboratory sector, as well as opportunities for those that can demonstrate the value of laboratory tests in the CER paradigm.
This report explains the rationale for CER, what CER is, and its significance for laboratory medicine. It describes the types of evidence generated by CER and how it compares with the evidence usually generated for regulatory purposes. The report summarizes current federal activities in CER that are relevant to laboratory medicine. Further, it describes implications of CER for the laboratory testing sector.
Client Area: Associations
Expertise Area: Comparative Effectiveness Research
September 2009
The paper is located here. The other link provides you a link to the web page for the conference and other materials.
Lewin Contact: Cliff Goodman
Client Area: Associations
Expertise Area: Comparative Effectiveness Research
September 2009
American Clinical Laboratory Association; Advanced Medical Technology Association (AdvaMed)
Lewin contact: Clifford Goodman
The contributions of clinical laboratory screening and diagnostic tests to health care quality and outcomes are substantial. These contributions were described in an earlier report from The Lewin Group, The Value of Diagnostics Innovation, Adoption, and Diffusion in Health Care (2005). This report updates key elements of that study, providing a current overview of the important role of laboratory screening and diagnostic tests in our health care system, today’s means of assessing value, and four case studies documenting value of specific tests to patient care.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA
July 2009
Medicaid Health Plans of America (MHPA); Association for Community Affiliated Plans (ACAP)
For MHPA and ACAP, The Lewin Group assessed the financial impact and administrative burden that out-of-network claims pose in Medicaid managed care. The report examined Medicaid non-emergency out-of-network payment policies in Arizona, California, Florida, Georgia, Maryland, Nebraska, New Jersey, New York, Pennsylvania, Tennessee, Texas and Wisconsin.
Client Area: Associations
Expertise Area: Medicaid and CHIP
June 2009
Pharmaceutical Research and Manufacturers of America (PhRMA)
PhRMA commissioned an evaluation of the degree to which changes in rebates for Medicare/Medicaid dual eligibles would create "spillover" impacts on the Part D premiums charged to other Medicare beneficiaries. Ingenix Consulting staff conducted modeling of various scenarios and Lewin staff prepared the written report. Our analyses estimate that if dual eligibles' prescriptions are paid for at Medicaid prices, additional costs will be imposed on Part D participants who are not dual eligibles. These increased monthly costs per beneficiary are estimated to range from $8 - $16, which constitutes an increase of 25% - 50% in the Part D premiums paid by non-dual eligibles.
Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare
March 2009
America's Health Insurance Plans (AHIP)
Lewin contact: Joel Menges
In 2004, America’s Health Insurance Plans engaged The Lewin Group to synthesize existing research on the savings achieved when states have implemented Medicaid managed care programs. This report is an update of the 2004 report, and includes both studies from the previous report and studies that have been released since 2004. In all, The Lewin Group reviewed 24 studies. The studies reviewed were identified and selected by America’s Health Insurance Plans and Lewin and include federally required independent assessments, studies commissioned by the federal and state governments, private foundations, and researchers, and one health plan-funded study. Studies are grouped into three categories: state studies, which examine states’ cost savings in their overall Medicaid managed care programs; targeted Medicaid managed care studies, which assess savings in Medicaid managed care programs targeted to specific populations; and specific service studies, which analyze Medicaid managed care program savings for specific services.
Client Area: Associations
Expertise Area: Medicaid and CHIP
March 2009
AARP
Lewin contact: Lisa Alecxih
AARP commissioned The Lewin Group to conduct research to help inform policy discussions about quality of care and litigation in Tennessee nursing homes. Specifically, the study addresses the following overarching policy questions: What are the factors driving litigation in Tennessee? What are the nursing home litigation trends in the state? What positive or negative outcomes does litigation have for nursing home residents? What steps have nursing facility operators in Tennessee taken to reduce the frequency and cost of litigation, and what are the implications for nursing home quality? What are the potential impacts of tort restrictions, based on the experiences of other states?
Based on the findings, the report discusses considerations and potential strategies for ensuring delivery of quality services in Tennessee nursing homes.
Client Area: Associations
Expertise Area: Aging and Disability
December 2008
American Nurses Association
Lewin contact: Tim Dall
For the American Nurses Association, The Lewin Group synthesized findings from the literature on the relationship between registered nurse staffing levels and nursing-sensitive patient outcomes in acute care hospitals. Using hospital discharge data to estimate incidence and cost of these patient outcomes together with productivity measures, Lewin estimated the economic implications of changes in registered nurse staffing levels. The study is published in the January 2009 issue of Medical Care.
Client Area: Associations
Expertise Area: Health Professionals Workforce
December 2008
Pharmaceutical Research and Manufacturers Association (PhRMA)
For the Pharmaceutical Research and Manufacturers of America, The Lewin Group compared the formulary status of drugs commonly used by the Medicare population on the Veterans Affairs National Formulary (VA formulary), the two highest enrollment Medicare Part D plans, and the plan with highest enrollment in the Federal Employee Health Benefit Program (FEHBP). Lewin first completed this analysis in January 2007 using the 2007 versions of the VA formulary, Medicare Part D formularies, and FEHBP formulary. This report provides an update to the 2007 analysis.
Client Area: Associations
Expertise Area: Medicare
November 2008
Association for Community Affiliated Plans; Medicaid Health Plans of America
Lewin contact: Joel Menges
This study addresses two questions. First, what are the financial implications of enrolling the dual eligible population into the capitated/integrated MCO setting on a comprehensive scale? This report estimates the cost impacts of serving dual eligibles in the capitated setting in each state across a fifteen year timeframe, demonstrating the impacts on Medicaid and Medicare spending, state and federal spending, and overall taxpayer outlays across the two programs.
Second, what are the key program design features and public policy issues that need to be addressed to achieve substantially larger-scale use of the capitated model for the dual eligible population? The report describes the barriers that have prevented more widespread enrollment of dual eligibles into MCOs, and outlines the specific policy-making opportunities to overcome these barriers.
Client Area: Associations
Expertise Area: Medicaid and CHIP
March 2008
American Diabetes Association
Lewin contact: Tim Dall
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. The study appears in the March 2008 issue of the journal, Diabetes Care.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
October 2007
Association of Community Affiliated Health Plans (ACAP)
Lewin contact: Joel Menges
The Lewin Group was engaged to provide a discussion of the programmatic issues involved in the use of a "carve-in" versus a "carve-out" approach for pharmacy benefits within capitated Medicaid managed care programs. To address this issue, Lewin interviewed a variety of key stakeholders including Medical Directors and Pharmacy Directors from managed care organizations in both carve-in and carve-out states, as well as representatives who could provide insight into the state Medicaid agency, provider, and pharmacy perspectives.
Client Area: Associations
Expertise Area: Medicaid and CHIP
October 2007
American Association of Clinical Endocrinologists, International Society for Clinical Densitometry, The Endocrine Society, American College of Rheumatology
Osteoporosis is a disease that is characterized by low bone mass and a deterioration of bone structure that results in bone fragility and an increased risk of fracture. The disease affects 10 million older Americans and is associated with significant mortality and morbidity. An additional 34 million individuals have osteopenia (low bone mass) and are at increased risk of fracture at some time in their lives. Osteoporosis-related fractures represent a serious illness burden and are a major cause of disability among Medicare beneficiaries. Dual-energy X-ray absorptiometry (DXA) is the “gold standard” for diagnosing osteoporosis, using World Health Organization criteria. Amid recent changes in Medicare reimbursement methodology, providers had become concerned that payment for DXA and vertebral fracture assessment (VFA) was below operating costs. However, a systematic study of the cost to perform a DXA procedure had not been conducted. The American Association of Clinical Endocrinologists, the International Society for Clinical Densitometry, The Endocrine Society and the American College of Rheumatology commissioned The Lewin Group to survey office-based providers of DXA, in order to develop estimates of the costs associated with providing DXA services to Medicare beneficiaries. This study should assist policymakers and others to determine whether the current Medicare reimbursement for DXA approximates real world operating costs.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA, Medicare
October 2007
Advanced Medical Technology Association (AdvaMed)
This report, prepared for the Advanced Medical Technology Association (AdvaMed), presents estimates of the economic contributions of the Medical Technology Industry (MTI) to each of the 50 states and the District of Columbia. This includes 2006 estimates for each state of MTI employment, payrolls, and sales/shipments and of the multiplier economic effects on these same measures.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA
July 2007
National Council of Child Support Directors
Lewin contact: Karen Gardiner
For the National Council of Child Support Directors, The Lewin Group and its subcontractor, EcoNorthwest, explored the potential implications of changes to federal financing of child support enforcement programs contained in the Deficit Reduction Act of 2005 (DRA). The project involved two tasks the first being Data Analysis. Using child support administrative data and economic and demographic information from the Census Bureau and other sources, the project team explored the potential effects of the DRA provision on use of incentives for state match on state performance in two areas: support order establishment and collections made on current support due.The second task was a survey of IV-D Directors. The project team had conversations with 28 state CSE directors about a number of DRA provisions, including the treatment of incentives for match purposes, adoption of (or increase in) the pass-through of collections to current assistance cases, and the mandatory fee for non-assistance cases that generate $500 or more in collections per year. The directors described the extent to which they expect to make up the funding shortfalls and the potential implications of any loss in funding.
Client Area: Associations
Expertise Area: Income Security
July 2007
Association for Community Affiliated Plans (ACAP)
Lewin contact: Joel Menges
The Lewin Group was engaged by the Association of Community Affiliated Plans to study the role of Medicaid and Medicaid health plans in reforms to cover the uninsured. This paper discusses the experiences of two programs that provide and/or subsidize coverage directly: The Massachusetts-run Commonwealth Care Health Insurance Program, which links eligible residents with approved insurance plans and helps them pay for the plans, and the county-administered children’s health initiatives (CHIs) in California, which cover low-income children who are not eligible for Medicaid or SCHIP. This report, based on discussions with Medicaid health plans that participate in these programs, discusses the use of Medicaid health plans as vehicles for expansion efforts in state and county health coverage expansion reform initiatives. This paper presents case studies of their experiences and lessons learned for both health plans and for purchasers.
Client Area: Associations
Expertise Area: Health Reform, Medicaid and CHIP
March 2007
Pharmaceutical Research and Manufacturers of America (PhRMA)
A number of statements have been made about the comprehensiveness of VA formulary coverage in comparison to Part D formulary coverage. The Pharmaceutical Research and Manufacturers of America requested The Lewin Group to look at certain comparisons made of those formularies. This report presents the results of that examination
Client Area: Associations
Expertise Area: Medicare
March 2007
Pharmaceutical Research and Manufacturers of America (PhRMA)
This report explores the prevalence and economic impact of various chronic diseases in the states of South Carolina, Iowa, and New Hampshire. The chronic diseases covered include cardiovascular disease, diabetes, cancer, depression, and asthma.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
March 2007
American College of Rheumatology
Lewin contact: Paul Hogan
Lewin was engaged by the American College of Rheumatology to prepare projections of the supply of and the demand for rheumatologists. The results of the study were published in the March 2007 issue of the journal Arthritis & Rheumatism.
Client Area: Associations
Expertise Area: Health Professionals Workforce
February 2007
New Mexico Medical Review Association
Lewin contact: Joel Menges
This report conveys the findings of the Independent Assessment of the quality, access, and cost-effectiveness of health care services delivered under the New Mexico Medicaid Managed Care program, Salud! This report fulfills the requirement of the Centers for Medicare and Medicaid Services (CMS) that state Medicaid authorities arrange for an independent assessment of a state’s 1915(b) waiver programs.
The Lewin Group has reviewed the quality- and access-related state contractual requirements, each Salud! health plan’s quality improvement program, member and provider survey activities, HEDIS® and CAHPS® performance, provider network, and member materials, and various financial reports. The State of New Mexico has created a favorable environment for quality, access, and cost-effectiveness to occur in each of the three MCOs. Thus, the program clearly meets CMS guidelines and requirements in terms of quality, access, and cost-effectiveness.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2007
Connecticut Association of Health Plans
Lewin contact: Joel Menges
Lewin assessed the performance of Connecticut's HUSKY Program, a capitated Medicaid initiative operated through contracts with four health plans. The study was coordinated through the Connecticut Association of Health Plans. The study's purpose is to provide objective information about the HUSKY Program and to compare the policy alternatives of retaining HUSKY versus adopting a "managed fee-for-service" model of coverage.
The study finds the HUSKY Program to be successful (above national Medicaid managed care norms) on several key fronts -- delivering large-scale cost savings to taxpayers, fostering access to physician and preventive care services (e.g., EPSDT), and achieving high rates of enrollee satisfaction. The study concludes with a broad set of policy recommendations to strengthen HUSKY going forward, including a sharp increase in underlying Medicaid physician/dentist fee schedules to address the core problem that many "front-line" practitioners are reluctant to serve the State's poverty population.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2007
Pharmaceutical Research and Manufacturers of America (PhRMA)
The Lewin Group was asked by The Pharmaceutical Research and Manufacturers of America to compare the formulary status of drugs commonly used by the Medicare population on the Veterans Affairs National Formulary, the two highest enrollment Medicare Part D plans, and the plan with the highest enrollment in the Federal Employee Health Benefit Program. This report presents the findings of that comparison.
Client Area: Associations
Expertise Area: Medicare
November 2006
Medicaid Health Plans of America
Lewin contact: Joel Menges
The potential benefits of managed care have led many States to consider expansions in capitated Medicaid programs to the extent that they are consistent with state health care policy goals and specific market and political conditions. However, current Medicaid hospital reimbursement calculations only include fee-for-service Medicaid utilization, which places significant barriers to expanded use of capitated Medicaid managed care contracting in some states. States considering expanding Medicaid managed care must balance any potential benefits against the risk of losing substantial Federal Upper Payment Limit (UPL) funds that play an increasingly important role in supporting the public health care sector, including public safety net hospitals.
This report explores Medicaid UPL issues and recommends a policy solution to preserve existing federal funds flow to support public safety net and other providers while also removing barriers to the expansion of Medicaid managed care. The recommended policy change would remove an unintended barrier to managed care expansion, which would in turn allow policy makers to evaluate more clearly the costs and benefits of their Medicaid contracting strategies and make policy choices according to what works best for their state.
Client Area: Associations
Expertise Area: Medicaid and CHIP
September 2006
Pharmaceutical Research and Manufacturers of America (PhRMA)
Lewin contact: Lisa Chimento
This analysis, commissioned by the Pharmaceutical Research and Manufacturers of America, sheds new light on how the Medicare prescription drug program is working by assessing the characteristics of plans chosen by beneficiaries. To date, most studies of the Medicare Part D drug benefit have analyzed overall plan offerings and average characteristics without taking into account the enrollment choices of Medicare beneficiaries. This analysis provides a more complete picture by using beneficiary choice to weight plan characteristics, since beneficiaries have disproportionately chosen to enroll in some plans; 64% of enrollment in concentrated in plans offered by four plan sponsors. The Lewin study finds that, on average, beneficiaries have chosen plans with lower premiums, reduced or zero deductibles, and broader formularies.
Client Area: Associations
Expertise Area: Medicare
September 2006
Pharmaceutical Care Management Association
This report, commissioned by the Pharmaceutical Care Management Association, describes the effect that selected legal or regulatory interventions could have on the economics of mail-service pharmacy, and provides estimates of the impact of these interventions on pharmacy costs for consumers and payers. These interventions include:
Any willing pharmacy laws which mandate the inclusion of pharmacies from a plan's network as long as the pharmacy is willing to meet the standard network terms, conditions and pricing
Uniform cost sharing requirements whereby consumers' out-of-pocket expenditures are required to be the same regardless of whether a prescription is filled at a mail or retail pharmacy
Required 90-day prescriptions at retail laws mandating that plans cover 90-day prescriptions at retail pharmacies
Client Area: Associations
September 2006
National Association of Children's Hospitals
The Children’s Hospitals Graduate Medical Education (CHGME) Program provides independent children’s teaching hospitals with equitable federal GME funding, enabling them to continue and expand their services dedicated to children’s unique health care needs, as well as to sustain and strengthen their teaching programs. Like their adult counterparts, independent children’s teaching hospitals leverage GME program funding to provide significant value to the patients and communities they serve. This report highlights these benefits across the following key hospital missions: graduate medical education and training; complex, high quality clinical care for all children; cutting edge pediatric research; and community benefits and rural outreach.
Client Area: Associations
June 2006
Healthcare Leadership Council
Lewin contact: Lisa Chimento
The Medicare drug benefit, which went into effect in January 2006, has resulted in an increase in the number of Medicare beneficiaries with comprehensive prescription drug coverage; nine out of ten Medicare beneficiaries now have comprehensive prescription drug coverage. The Lewin Group analyzed how drug coverage has changed for seniors since implementation of the new Medicare drug benefit and developed a set of factsheets indicating what additional coverage is available to seniors in all 50 states and the District of Columbia.
Client Area: Associations
Expertise Area: Medicare
May 2006
Coalition to Protect Access to Affordable Health Insurance
Lewin contact: John Sheils
In this study, The Lewin Group estimated the cost and coverage impacts of the Health Insurance Marketplace Modernization and Affordability Act (S. 1955) sponsored by Senator Enzi of Wyoming and adopted by the Health, Education, Labor and Pension Committee of the U.S. Senate. The bill would establish a new optional regulatory standard that insurers in the small group market could choose to follow instead of state regulations. This standard would permit carriers to set rates according to the National Association of Insurance Commissioner’s (NAIC) 1993 Small Group Rating Model legislation, which permits premiums to vary with health status and other factors. Carriers electing this option also would be exempt from state mandated benefits requirements.
Client Area: Associations
Expertise Area: Health Reform
April 2006
Healthcare Leadership Council
Lewin contact: Lisa Chimento
This study, commissioned by the Healthcare Leadership Council, analyzes savings available to Medicare beneficiaries with common chronic conditions who enroll in a Prescription Drug Plan (PDP). The five chronic conditions studied are arthritis, diabetes, hypertension, osteoporosis and respiratory illness. 84 percent of Medicare beneficiaries report having at least one of these most common diagnoses. Lewin finds that, nationwide, beneficiaries can save 43 to 58 percent by enrolling in one of the 5 PDPs with the lowest costs.
The executive summary presents information at a national level by chronic condition. Available in separate files are state level findings for Alabama-Kentucky, Louisiana-North Dakota, and Ohio-Wyoming. Also available in separate files are the appendices which provide additional detailed data for Alabama-Kentucky, Louisiana-North Dakota, and Ohio-Wyoming.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness, Medicare
April 2006
The Medicaid Health Plans of America and the Association of Community Affiliated Plans
Lewin contact: Joel Menges
National Medicaid expenditures have risen at an average of 8.2 percent annually since 1995, outpacing states' revenue growth and placing enormous pressure on states to implement effective cost containment programs. The Medicaid Health Plans of America and the Association of Community Affiliated Plans jointly engaged The Lewin Group to quantify the savings that can be realized through state Medicaid agencies entering into capitation contracting with Medicaid managed care organizations. The report found, among other key points, that up to $83 billion can be saved over ten years if the capitation model were immediately applied to all appropriately suited Medicaid funds.
Client Area: Associations
Expertise Area: Medicaid and CHIP
April 2006
Pennsylvania Health Care Association
The Pennsylvania Health care Association commissioned The Lewin Group to conduct a study that would help answer the following questions:
What long-term care services will be needed and available over the next ten years?
What is the current supply of long-term care services in the Commonwealth?
What will the demand for long-term care services in the Commonwealth be over the next 10 years?
Given the current supply of long-term care services and the estimated rate of growth in the demand for these services, what are the trade-offs between providing nursing home care versus providing home- and community-based services?
This report is the second in a series of reports commissioned by the Pennsylvania Health Care Association. The first report provides information on the economic impact of nursing homes on the Commonwealth.
Client Area: Associations
Expertise Area: Aging and Disability
January 2006
Dietary Supplement Education Alliance
The Lewin Group was commissioned by the Dietary Supplement Education Alliance to (1) critically review the research literature for two dietary supplements for which an association has been shown between intake of the supplement and reduced risk of a disease that can lead to a loss of an older person's independence, and (2) develop estimates of potential health care savings that could result from daily use of the supplement. Supplement/disease combinations in this study are omega-3 fatty acids and coronary heart disease, and lutein/zeaxanthin and age-related macular degeneration.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA
January 2006
Louisiana Hospital Association
In an effort to develop a unified policy framework for redesigning Louisiana’s healthcare services in the wake of Hurricane’s Katrina and Rita, the Louisiana Hospital Association engaged The Lewin Group to conduct a series of interviews with healthcare, education, business and government leaders across the state to gather information regarding both short-term and long-term needs of the industry. The resulting report describes a series of proposed federal and state policy initiatives that would facilitate cost-effective redesign of Louisiana's healthcare delivery system.
Client Area: Associations
Expertise Area: Health Reform
January 2006
Association for Community Affiliated Plans; Medicaid Health Plans of America
Lewin contact: Lisa Chimento
The Association for Community Affiliated Plans and the Medicaid Health Plans of America retained The Lewin Group to conduct a study of the ways that states have implemented rules from the Balanced Budget Act of 1997 regarding actuarial soundness, in order to identify both best practices and continuing areas of concern. Lewin developed a survey to gather information from states and health plans on current rate-setting practices. This report presents the results of the survey.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2006
National Health Council
Lewin contact: Lisa Chimento
The purpose of this study is to estimate the potential savings offered throught the new Medicare prescription drug benefit to Medicare beneficiaries living with chronic conditions. For this study, The Lewin Group examined drug spending data for Medicare beneficiaries who face a decision whether to enroll in the Medicare drug benefit. The study focuses primarily on beneficiaries with chronic conditions because these beneficiaries have higher average drug costs than beneficiaries without chronic conditions. The specific chronic conditions included in this study are: Alzheimer's, arthritis, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, mental disorder, osteoporosis, and Parkinson's.
Client Area: Associations
Expertise Area: Medicare
August 2005
Pharmaceutical Care Management Association
Mail-service pharmacies—technologically advanced facilities operated primarily by pharmacy benefit managers (PBMs)—dispense millions of prescriptions each year with a high degree of accuracy and cost efficiency. This study seeks to quantify the savings associated with the mail-service pharmacy distribution channel being used to full potential.
Client Area: Associations
July 2005
Advanced Medical Technology Association (AdvaMed)
Lewin contact: Clifford Goodman
The Lewin Group was commissioned by The Advanced Medical Technology Association (AdvaMed) to examine certain key aspects of the US diagnostics industry. This document is intended to: a) educate and inform various audiences about diagnostics and the industry that develops them; b) describe the value of diagnostics through the health care continuum and the broader health system; c) describe the technology evolution in diagnostics and potential of these technologies to alter clinical practice; d) identify and describe the hurdles to product development and dissemination; e) identify changes necessary to overcome these challenges; and f) define actionable recommendations for enabling clinicians, patients, provider institutions, payers and other stakeholders to better realize the value and potential of diagnostics to improve health care delivery, individual health and the public’s health.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA
May 2005
Pennsylvania Coalition of Medical Assistance Managed Care Organizations
In 2003, in a major policy shift, the Pennsylvania Department of Public Welfare (DPW) terminated the planned statewide expansion of the HealthChoices program, the state’s large-scale capitated mandatory managed care program for Medical Assistance recipients. In early March of 2005, Pennsylvania began phasing in its new ACCESS Plus program, an enhanced primary care case management program, in the counties without mandatory capitated managed care, including those previously scheduled for HealthChoices expansion. The Pennsylvania Coalition of Medical Assistance Managed Care Organizations (the Coalition) was formed by the seven physical health managed care organizations that contract with the Commonwealth of Pennsylvania to provide services to recipients enrolled in the HealthChoices program. Given the state’s recent policy reversal and the fact that, like most other states, Pennsylvania continues to seek out options for reducing expenditures and gaining efficiencies, the Coalition desired an independent assessment of the value of the HealthChoices Program to help inform the continuing debate about the future direction of the state’s Medical Assistance program. Toward this end, the Coalition commissioned The Lewin Group to conduct a comparative evaluation of Pennsylvania’s HealthChoices Program and Fee-for-Service Program, focusing on four areas that contribute to a health care program’s overall value: its cost-effectiveness, its impact on access, the quality of services provided, and the program’s focus on and approaches to serving individuals with special needs.
Client Area: Associations
Expertise Area: Medicaid and CHIP
May 2005
American Pharmacists Association
The American Pharmacists Association (APhA) commissioned The Lewin Group to develop a report examining the range of Medication Therapy Management (MTM) programs and practices, and how they are currently being reimbursed. In the final rule implementing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), the Centers for Medicare and Medicaid Services (CMS) said that MTMS must "evolve and become a cornerstone of the Medicare Prescription Drug Benefit." The purpose of this report was to identify existing MTMS programs, standards of practice, and compensation models, and to develop a model for payers to consider in compensating pharmacists for MTMS. This report is intended to serve as a resource for pharmacists, health plans, and PDP sponsors charged with designing and implementing a Medicare MTM program.
Client Area: Associations
Expertise Area: Medicare
April 2005
Society for Investigative Dermatology; American Academy of Dermatology Association
Lewin contact: Clifford Goodman
Skin diseases have a broad and burdensome impact on the health and well-being of Americans, and account for substantial health care costs to the nation. Skin disease is one of the top 15 groups of medical conditions for which prevalence and health care spending grew the most between 1987 and 2000, exceeding spending rate increases for diabetes,cerebrovascular disease, and cancer. The purpose of this study, sponsored by the Society for Investigative Dermatology and the American Academy of Dermatology Association, was to estimate the prevalence, annual economic burden, and quality of life implications of a major group of skin diseases.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
March 2005
Pharmaceutical Research and Manufacturers of America (PhRMA)
On December 8, 2003, President Bush signed into law the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (MMA). The law modernizes Medicare so that,
beginning in January 2006, seniors and people with disabilities can have coverage for
prescription drugs that have become an important part of quality medical care. This new
benefit improves access to prescription drugs and provides important financial protections to
Medicare beneficiaries. The MMA specified that for the years 2004 and 2005, prior to implementation of the full prescription drug benefit, Medicare beneficiaries would have access to Medicare-approved discount cards, and beneficiaries meeting the low-income thresholds would have access to an additional $600 in annual cash assistance.
In 2002, The Lewin Group conducted a study commissioned by the Healthcare Leadership
Council that examined the potential savings to beneficiaries from using Medicare-approved
discount cards. The Pharmaceutical Research and Manufacturers of America (PhRMA),
engaged The Lewin Group to build upon this prior work to estimate the potential savings
forgone for low-income beneficiaries who do not sign up for Medicare-approved discount cards
in 2005 since these persons have the most to lose by not enrolling in the program.
Client Area: Associations
Expertise Area: Medicare
March 2005
Pennsylvania Health Care Association (PHCA)
Continued increases in longevity among the U.S. population, including those with chronic diseases or disabilities, are creating a demand for more LTC services of all types. Pennsylvania currently ranks second among the fifty states in the proportion of residents aged 65 and over. The Commonwealth’s fastest growing age group includes those aged 85 and over. Although occupancy levels in Pennsylvania nursing facilities have declined somewhat over the last few years, the rapidly growing aged 85 and over population necessitates a critical appraisal of the population's need for LTC services in the future and how these services should be coordinated. This appraisal has important implications for the Commonwealth's economy as well as the LTC community. With the current policy emphasis on HCBS LTC services, and the use of various provider taxes and intergovernmental transfers which may not be sustainable, there is a growing concern over the future financial viability of nursing homes. As such, various economic and healthcare delivery scenarios must be considered in future planning in order to assure an adequate supply of all types of LTC services to meet the complex needs of an aging population.
Given these concerns, PHCA commissioned The Lewin Group, Inc. to conduct a study that would address two basic questions:
What is the current economic impact of the nursing facility community on the Commonwealth?
What LTC services will be needed and available over the next ten years?
This report address the first of these two questions and contains information on the economic impact of nursing homes on the Commonwealth of Pennsylvania.
Client Area: Associations
Expertise Area: Aging and Disability
February 2005
Healthcare Financial Management Association (HFMA)
The Lewin Group helped the Healthcare Financial Management Association (HFMA) Patient Friendly Billing Project develop the report, Hospitals Share Insights to Improve Financial Policies for Uninsured and Underinsured Patients. The report explores key questions that hospital leaders may find useful to keep in mind when reviewing their financial assistance policies. It also provides tools and practical ideas to help hospitals and health systems revise their policies and procedures and implement those revisions quickly and effectively. Effective financial policies for uninsured and underinsured patients are an essential component of the community benefits hospitals provide.
Client Area: Associations
Expertise Area: Health Reform
January 2005
Health Care for All Education Fund
Lewin contact: John Sheils
In this study The Lewin Group estimated the impact of covering all California residents under a single health plan. The proposal analyzed is the "Health Care for All Californians Act: SB 921", introduced in February of 2003, with clarifications provided by the authors' staff through April 30, 2004. The program would cover a broad range of health services for all California residents, including an estimated 4.7 million Californians who are currently uninsured. Premium payments to insurers would be eliminated for employers and individuals, except for coverage of services not covered by the program. Instead, the system would be funded with current spending for government health programs and new taxes to replace the premiums eliminated under the program. Lewin estimated the amount of health spending in California under current law in 2006 for the various payers in California including employers, households, the federal government and state and local governments. Lewin then estimated health expenditures for each of these payer groups assuming the Act is implemented in 2006. The difference between estimated spending in 2006 under the Act and the estimated amounts spent in 2006 under current law, provide estimates of the impact of the program on spending for each payer group. Estimates of the cost impacts of the Act are provided for employers by firm size, industry, households, by age, income level and other demographic characteristics.
Client Area: Associations
Expertise Area: Health Reform
November 2004
Corporation for Supportive Housing
Lewin contact: Karen Linkins
This chart book presents estimates of the costs of serving homeless individuals in six alternative settings in nine cities. In addition to the estimates, this document includes: definitions for each of the six service settings for which estimates are presented; a description of how a single point estimate was calculated for each setting for each city; and a listing of the organizations that provided the estimates used. Settings include supportive housing, prison, jail, shelter, hospital, and mental hospital.
Client Area: Associations
September 2004
Advanced Medical Technology Association (AdvaMed)
Lewin contact: Clifford Goodman
The document, prepared for the Advanced Medical Technology Association (AdvaMed), presents data from a variety of government and private sources, and offers a comprehensive profile of the medical technology industry. Through numerous graphs and tables, the report provides the latest information on: the general composition of the U.S. medical technology industry; the international market for medical technology; trade and export statistics; economic activity of the sector and industry R&D spending. The report also includes recent statistical data on FDA and CMS’ regulatory oversight of the industry and highlights the contributions of the medical technology industry to the overall strength of the U.S. economy and to improved patient outcomes.
Client Area: Associations
August 2004
Healthcare Leadership Council
Lewin contact: Lisa Chimento
The Healthcare Leadership Council commissioned The Lewin Group to examine the savings available to Medicare beneficiaries who elect to participate in the Medicare-endorsed drug discount card program. The study analyzes the 150 drugs most frequently used by seniors and determines the range of savings available to seniors on those medications using their drug discount cards.
The study presents estimated average savings for beneficiaries who shop at retail pharmacies using the drug discount card, including the value of the $600 federal credit available to qualifying low-income beneficiaries. It also provides estimates of aggregate savings based on the number of beneficiaries projected to use the discount cards by the Centers for Medicare and Medicaid Services.
Client Area: Associations
Expertise Area: Medicare
July 2004
Future of Family Medicine Task Force Six
Lewin contact: John Sheils
The Lewin Group was retained by the Future of Family Medicine (FFM) Task Force Six to assist in developing a financial and reimbursement system for a New Model of Family Medicine (NMFM). Through a series of five task forces, the FFM project identified the core values of family medicine and developed a new model of practice. In this paper, The Lewin Group considers the financial implications of the NMFM. We conducted two types of analyses. First, we simulated the impact of the NMFM on a family physician practice's revenues and costs within the current fee-for-service reimbursement environment. Second, we evaluated alternative reimbursement mechanisms conducive to the NMFM.
Client Area: Associations
Expertise Area: Health Professionals Workforce
July 2004
America’s Health Insurance Plans (AHIP)
America’s Health Insurance Plans (AHIP) engaged The Lewin Group to synthesize existing research on the savings achieved when states have implemented Medicaid managed care programs. The Lewin Group reviewed 14 studies, which included federally required independent assessments and studies commissioned by the federal and state governments and private foundations. The studies are grouped into three categories: 1) state studies, which examine states’ cost savings in their overall Medicaid managed care programs; 2) targeted Medicaid managed care studies, which assess savings in Medicaid managed care programs targeted to specific populations; and 3) specific service studies, which analyze Medicaid managed care program savings for specific services.
Client Area: Associations
Expertise Area: Medicaid and CHIP
June 2004
Families USA
Lewin contact: Lisa Alecxih
On June 16th, 2004, Families USA released a report entitled "One in Three: Non-Elderly Americans without Health Insurance, 2002-2003." The report was based on an analysis of Census Bureau data conducted by The Lewin Group, and provides estimates of the number of people under age 65 who lacked insurance for at least one month over the two-year period of 2002-2003. The report provides national and state-level estimates, as well as a breakdown by selected population characteristics. Some of the highlights from the report include:
Approximately 81.8 million Americans -- one out of three people under 65 years of age -- were uninsured at some point of time during 2002-2003.
Almost two-thirds (65.3 percent) of this 81.8 million were uninsured for six months or more, and about half (50.6 percent) were uninsured for at least nine months.
States with the highest proportion of non-elderly individuals with insurance gaps during the 2002-2003 period include Texas (43.4%), New Mexico (42.4%), and California (37.1%). States with the lowest proportion of individuals with insurance gaps include Minnesota (22.4%), New Hampshire (23.0%), and Vermont (24.9%).
A significant proportion of the middle class experienced insurance gaps. For example, among people with incomes between 300 and 400 percent of the federal poverty level (between $55,980 and $74,640 in annual income for a family of four in 2003), more than one out of four were uninsured for all or part of the two year period.
Researchers Note: In March 2003, The Lewin Group completed a similar analysis for Families USA that provided estimates of lack of insurance over the period 2001-2002. That analysis relied on Census Bureau data from 1998-1999, the most recent data available at the time, projected forward based on known population and economic trends. More recently available Census Bureau data for 2001-2002 indicate that these earlier 2001-2002 uninsured estimates were conservative. Therefore, the new 2002-2003 estimates should not be directly compared to the previous estimates for 2001-2002.
Client Area: Associations
Expertise Area: Health Reform
June 2004
Alzheimer's Association
Lewin contact: Lisa Alecxih
To measure the cost benefit of potential Alzheimer research on Medicare and Medicaid spending and disease prevalence, the Alzheimer's Association commissioned The Lewin Group to conduct an analysis of potential savings the U.S. could realize with major breakthroughs in Alzheimer research. The report of this analysis, entitled Saving Lives, Saving Money: Dividends for Americans from Investing in Alzheimer Research, was released on June 23, 2004. The study assumes that by 2010, researchers will find a way to delay the onset of Alzheimer's disease just as scientists have been able to delay the onset of congestive heart failure, and a way to slow the progression of Alzheimer's just as they have slowed the progression of Parkinson's disease.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
June 2004
Georgians for a Common Sense Health Plan
Lewin contact: John Sheils
In this analysis, submitted to Georgians for a Common Sense Health Plan (GCSHP) in October 2003 and publicly released on June 21, 2004, The Lewin Group estimated the cost and coverage impacts of Georgia SecureCare, a proposed single payer health insurance program developed by GCSHP. The program would cover a broad range of services for all Georgia residents, including an estimated 1.1 million Georgians who are currently uninsured. SecureCare would replace public and private health insurance plans in the state, and would be financed by a consolidation of funding for current health care programs, a payroll tax to replace employer benefit plans and other dedicated revenues. The Lewin Group's analysis indicates that SecureCare would achieve universal coverage while reducing total health spending for Georgia by about $716 million annually.
Client Area: Associations
Expertise Area: Health Reform
May 2004
American Hospital Association
U.S. hospitals not only play a critical role in the health of Americans, they also contribute more than $1.3 trillion to the nation's economy, according to a TrendWatch report by The Lewin Group. Hospitals employ nearly five million people, rank second as a source of private sector jobs, and directly or indirectly support one of every nine jobs in the U.S., notes the report, which details the economic and societal contributions hospitals make to communities and states. According to the Lewin report, hospitals remain a stable source of employment even during times of economic stress, and support other businesses when they purchase the goods and services needed to provide care.
Client Area: Associations
April 2004
Association for Community Affiliated Plans (ACAP)
Lewin contact: Lisa Chimento
The Medicare Modernization Act of 2003 (MMA) has important consequences for dual eligible beneficiaries as well as Medicaid managed care plans. ACAP commissioned this report to provide member health plans with a better understanding of the Act's implications for their current Medicaid business -- as well as a roadmap to explore the possibility of expanding into Medicare managed care.
Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare
April 2004
American Hospital Association
An American Hospital Association (AHA) survey on hospital capacity constraints and ambulance diversions finds inpatient occupancy rates captured at midnight fail to reflect volume fluctuations by day and time of day and illustrates the difficulty of anticipating and responding to changes in demand -- which according to the survey can be extreme. The case studies done by The Lewin Group follow up on a 2002 national survey by Lewin (Emergency Department Overload: A Growing Crisis) that found nearly 80% of urban hospital EDs are at or over capacity, with more than half reporting diversions. The latest survey looked in depth at 28 hospitals in four communities -- Louisville, KY; Portland, OR; Harrisburg, PA; and El Paso, TX -- to see when and where capacity constraints occur within the hospital and how diversion situations develop across a community.
The study found capacity constraints and ambulance diversions continue to be concerns in these communities, with more than half of the hospitals in each community reporting their EDs at or over capacity. Though all of the communities experienced some level of ambulance diversion, diversion hours varied by community, as did the factors driving the diversions and hospital capacity constraints. Even within a hospital, the specific capacity issue leading to diversion differed across the three days studied.
Client Area: Associations
October 2003
Maryland Citizens' Health Initiative Education Fund
Lewin contact: John Sheils
In December of 2002, the Maryland Citizens' Health Initiative Education Fund Inc., released a plan to provide health insurance coverage to all Marylanders. The program requires all Maryland residents to obtain a minimum level of health insurance coverage for themselves and their children or pay a substantial tax penalty. To assist the low-income population, the program also provides subsidized coverage to adults living below 350 percent of the Federal Poverty Level (FPL), and children living below 400 percent of the FPL. In addition, the program requires that all insurers in the individual and small group market provide at least a minimum level of coverage with guaranteed issue, no pre-existing condition limitations, and with no variation in premiums by health status.
Client Area: Associations
Expertise Area: Health Reform
May 2003
Association of Community Affiliated Health Plans
A coalition of Medicaid Focused Health Plans contracted with The Lewin Group to analyze the impacts of allowing Medicaid managed care organizations (MCOs) to have access to the Medicaid drug rebate on a voluntary basis. Since its inception in 1991, the federal rebate program has applied only to Medicaid fee-for-service programs. Currently, Medicaid MCOs must enter into separate negotiations with drug manufacturers, either directly or through their contracting pharmacy benefits managers (PBMs), in order to obtain rebates. The proposal being explored would allow participating health plans to continue to pay for the ingredient costs of drugs as they do currently, but rebates would no longer be a negotiable item with the manufacturers or with the health plans’ pharmacy benefits managers (PBMs). Instead, Medicaid health plans would receive the same level of rebate available to state Medicaid fee-for-service programs. The report describes the potential trade-offs of the proposal and looks at its potential financial impact.
Client Area: Associations
Expertise Area: Medicaid and CHIP
March 2003
American Diabetes Association
Lewin contact: Tim Dall
For the American Diabetes Association, The Lewin Group conducted a study on the national cost of diabetes. We estimated that diabetes cost the nation approximately $132 billion in 2002, with direct medical expenditures totaling $91.2 billion and indirect expenditures (resulting from lost work days, restricted activity days, mortality and permanent disability) totaling $39.8 billion.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
February 2003
Oregon Association of Hospitals and Health Systems
The Oregon Association of Hospitals and Health Systems asked The Lewin Group to focus on four areas related to the Oregon Health Plan (OHP) Medicaid program and provider reimbursement. The areas were:
An analysis of Medicaid provider payments compared to actual provider costs
Comparisons to other states' Medicaid programs and to Medicare
The impact of proposed budget reductions
The effect of Medicaid payment rates on access to care.
This report describes Oregon's Medicaid reimbursement system and analyzes Oregon and national health expenditure data related to reimbursement issues. It presents discussions of the various findings and conclusions.
Client Area: Associations
Expertise Area: Medicaid and CHIP
February 2003
National Governors Association
Drawing upon our expertise in the effective management of Medicaid's prescription drug benefit, the Center for Best Practices at the National Governors Association commissioned an Issue Brief from The Lewin group entitled "Reducing Pharmacy Fraud, Abuse and Waste: Promising Practices of States." This Issue Brief identifies several tools states may utilize to prevent pharmacy fraud, abuse and waste. By utilizing these tools, states may save money without imposing reductions in the pharmacy benefit itself and without impairing access to prescription drugs by Medicaid beneficiaries.
Client Area: Associations
Expertise Area: Medicaid and CHIP
January 2003
American Health Care Association
This study updates an earlier report by The Lewin Group released in March 2002. This study update provides the impact of Medicare and Medicaid payment shortfalls on nursing facilities in 2003 and 2004.
Client Area: Associations
Expertise Area: Aging and Disability
October 2002
Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association (BCBSA) commissioned The Lewin Group to identify, discuss and analyze variables that "drive" physican healthcare costs. This study is one of several research efforts associated with BCBSA's national Healthcare Cost Campaign.
Client Area: Associations
October 2002
Blue Cross Blue Shield Association
The Blue Cross Blue Shield Association (BCBSA) commissioned The Lewin Group to identify, analyze and discuss variables that "drive" healthcare costs in outpatient settings. This study is one of several research efforts associated with BCBSA's national Healthcare Cost Campaign.
Client Area: Associations
September 2002
Advanced Medical Technology Association (AdvaMed)
Lewin contact: Clifford Goodman
The Lewin Group was commissioned by The Advanced Medical Technology Association (AdvaMed) to examine certain key aspects of the U.S. blood collection and distribution processes. In particular, this study examined the role of technological improvements in ensuring blood safety and the ability of the third-party reimbursement system to capture and account for increased costs of blood products and related services.
Client Area: Associations
Expertise Area: Evidence-Based Medicine / HTA
September 2002
Health Industry Group Purchasing Association
On behalf of the Health Industry Group Purchasing Association, The Lewin Group conducted a survey to determine the extent to which group purchasing organizations (GPOs) and health systems employ clinical review processes to inform technology decision-making. HIGPA's central question to Lewin was whether these clinical review processes support timely adoption and evidence-based, cost-effective use of health care technology.
Client Area: Associations
August 2002
American Health Care Association; Alliance for Quality Nursing Home Care
This study builds on an earlier analysis prepared by The Lewin Group that assessed the implications of the expiration of Medicare add-ons for nursing facility margins. It examines the magnitude and implications of reduced Medicare revenue on the industry's ability to generate and access capital in the future.
Client Area: Associations
Expertise Area: Medicare
July 2002
American College of Emergency Physicians (ACEP)
Lewin contact: Paul Hogan
This study, commissioned by the American College of Emergency Physicians, provides estimates of the total number of physicians practicing clinical emergency medicine during a specified period, describes certain characteristics of those individuals, and estimates the total number of full-time equivalents (FTEs), as well as the total number of individuals needed to staff those FTEs. The study appears in the July 2002 issue of the Annals of Emergency Medicine.
Client Area: Associations
Expertise Area: Health Professionals Workforce
February 2002
AARP Public Policy Institute
Lewin contact: Lisa Alecxih
For an AARP Public Policy Institute issue paper, Long-Term Care Insurance: An Assessment of States' Capacity to Review and Regulate Rates, The Lewin Group conducted a survey of state insurance departments' current practices relating to the regulation of long-term care insurance rates and assessed their ability to effectively regulate premiums for the long-term care insurance market. Several reports in the last decade question the adequacy of state regulatory efforts, citing insufficient regulatory efforts to protect consumers and chronic shortages of staff and resources. In addition, large increases in rates by some companies raise concerns about state efforts to ensure accurate pricing for long-term care insurance. Large rate increases, or a series of rate increases over time, could: (1) threaten consumers' ability to continue paying for coverage; and (2) erode confidence in the products being offered by the industry. The paper presents findings from the survey and ratings of states' current pricing review practices, as well as recommendations.
Client Area: Associations
Expertise Area: Aging and Disability
May 2001
American Gastroenterological Association
Lewin contact: Clifford Goodman
This study, conducted by The Lewin Group for the American Gastroenterological Association, analyzed major national and local databases to assess prevalence and cost of 17 digestive conditions: gastroesophageal reflux disease (GERD), gallbladder disease, irritable bowel syndrome (IBS), peptic ulcers, chronic liver disease and cirrhosis, chronic hepatitis C**, chronic diarrhea, diverticular disease, diseases of pancreas, Barrett's esophagus, ulcerative colitis, colorectal cancer, Crohn's disease, pancreatic cancer, liver cancer, foodborne illness and non-foodborne gastroenteritis. An article based on the study was published in the May 2002 issue (Volume 122 No 5) of the journal Gastroenterology.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
December 2000
American Obesity Association
This study estimated the direct costs of obesity to healthcare and found that the cost of all treatments for obese adults (defined as having a body mass index greater than 30) would be $238 billion in 1999, which includes $102 billion for 15 diseases that the project team specifically identified as associated co-morbidities. The study also found that approximately 75% of the direct costs were attributed to five diseases: Type II Diabetes, Heart Disease, Stroke, Hypertension, and Arthritis. The American Obesity Association sponsored the study, and the results were presented at the first annual Obesity Conference that took place in Washington, DC on September 15th, 1999.
The study presentation was revised September 13, 2000 to include slides on the cost of obesity in children
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness
May 2000
Maryland Citizens' Health Initiative Education Fund
Lewin contact: John Sheils
The purpose of this analysis was to explore the expected costs and impacts of two alternative universal health reform plans for Maryland. Both of these reform scenarios would greatly redistribute health care costs across families in various income groups by shifting from today's premium based system to a tax based system where individual payments for health coverage increase in proportion to income. In this report, we present our analyses of the financial impact of these health reform models on various payers for health care including state, local, and federal governments.
Client Area: Associations
Expertise Area: Health Reform
May 2000
Alliance for Quality Nursing Home Care, American Health Care Association
A new Lewin study shows that Medicare's funding of skilled nursing care has been significantly reduced by nearly twice as much as Congress intended. Currently, CBO budget figures show Medicare spending for SNF services from 1998 to 2002 will be $12.2 billion less than originally projected when the Balance Budget Act (BBA) was enacted in 1997; and $15.8 billion less when extended to 2004. Due to BBA payment reductions, the current low inflation rate, provider concerns about fraud and abuse, etc., Medicare SNF spending actually decreased from $13.6 billion in 1998 to $12.3 billion in 1999. These funding reductions have forced approximately 1600 SNFs that participate in Medicare into bankruptcy, and have markedly diminished the industry's ability to attract capital financing.
Client Area: Associations
Expertise Area: Medicare
February 2000
American Hospital Association
In May of 1999, The Lewin Group prepared a report for the American Hospital Association (AHA) showing the impact of the Balanced Budget Act of 1997 (BBA) Medicare provisions on America's hospitals and health systems. The BBA reduced payments for most hospital-based services, e.g. inpatient acute care, outpatient care, home health care, skilled nursing care, medical education, indigent care, and many other services.
Client Area: Associations
Expertise Area: Medicare
October 1999
National Coalition on Health Care
In this report we analyzed several proposals to modify the current tax treatment of health benefits and expenditures. The current tax code will provide about $125.6 billion in tax subsidies for the purchase of health insurance and health services in 2000. While the current tax treatment of health benefits has encouraged employers to offer coverage, it has been criticized as inequitable and a major contributor to health care cost inflation. We examined various tax credit proposals and modifications to the current tax-exemption for health care and estimated the impacts of these proposals on health insurance coverage levels and costs to governments, employers and families.
Client Area: Associations
Expertise Area: Health Reform
August 1999
American Association of Retired Persons
AARP's Public Policy Institute published a Lewin Group report on the potential impacts of jointly raising the Normal Age of Retirement (NAR) and Medicare Eligibilty Age (MEA) from age 65 to 67. Under this proposed policy, a significant portion of peopled aged 65 to 66 would lose their Social Security benefits and Medicare coverage. Some portion of these individuals, however, could potentially retain both their Social Security benefits and Medicare eligiblity by meeting the qualifications for the Social Security Disability Insurance (DI) program. Using data from the Survey of Income and Program Participation and Medicare Current Beneficiary Survey, we estimate that 11.7 percent of the population aged 65 to 66 would have retained their benefits under DI if the NAR and MEA were increased in 1993 to age 67. We also estimated that 11.4 percent of the population aged 65 to 66 would have retained their Medicare coverage under this policy change.
Client Area: Associations
Expertise Area: Medicare
May 1999
National Association for Home Care
Lewin contact: Lisa Alecxih
The Medicare Home Health Interim Payment System (IPS) raises concerns for beneficiaries and providers. A temporary plan proposed until HCFA develops a home care PPS, the IPS may cause the number of home health agencies (HHAs) exceeding the Medicare cost limits to more than double and the published cost limits to decrease 21% on average overall. HHAs may operate without knowing the per-beneficiary limits for up to 6 months of the initial IPS cost reporting period. Strategies developed by HHAs to cope with this reduction may include increasing the proportion of low-end users with fewer visits and restraining costs per visit and number of visits per beneficiary. Some of these strategies could have considerable consequences for high-use home health clients.
Client Area: Associations
Expertise Area: Medicare
May 1999
American Hospital Association
The Balanced Budget Act (BBA) of 1997 is projected to cut $71 billion in Medicare payments to hospitals, which may cause 7 out of 10 hospitals to have negative total Medicare margins by the year 2002. For all hospitals, total Medicare margins are projected to be around negative 4.4 percent, and margins for outpatient, hospital-based home health, and PPS-exempt services will all be negative under the BBA. The BBA reduced payments for most hospital services, including inpatient acute care, outpatient care, home health care, skilled-nursing care, medical education, and indigent care.
The study included hospital specific analyses for inpatient PPS and PPS-exempt hospital services, hospital-based home health services, and outpatient hospital services. The findings report Medicare payments and margins for these services, as well as total Medicare payments and margins.
Client Area: Associations
Expertise Area: Medicare
February 1999
Pharmaceutical Research and Manufacturers of America (PhRMA)
Lewin contact: Lisa Alecxih
Elderly patients paid for more than half (52%) the cost of their prescriptions out of their own pockets, according to a recent study for the Pharmaceutical Research and Manufacturers of America. This is not surprising since Medicare does not, for the most part, cover outpatient prescribed medications.
The study reviewed third party coverage options for pharmacy coverage (total average per beneficiary spending of $571 per person) as based on 1995 data. It showed that employers were the second largest source of payment (26%) through supplemental insurance. Beneficiaries with employer supplemental insurance drug coverage spent 31% out-of-pocket, while those with Medigap spent 60%, and those with Medicare HMO coverage spent 37% out-of-pocket. Additionally, only about 36% of beneficiaries with less than $10,000 in income had drug coverage, compared to 71% among those with $50,000 or more in income.
The study also showed that Medicare beneficiaries at the extreme ends of the income spectrum (that is, those poor enough to qualify for full dual Medicare/ Medicaid coverage or those with full coverage from employer-provided supplemental health plans) had the most extensive coverage. Those at greatest risk were the middle group: beneficiaries with individually purchased Medigap coverage have no or limited drug benefits.
Client Area: Associations
Expertise Area: Medicare
February 1999
National Coalition on Health Care
Lewin contact: John Sheils
The Health Care Financing Administration (HCFA) should promote "best practice" methods and educate providers. This study outlines ways in which the government can improve the quality of health care in Medicare programs. The cause for concern is due to the large gaps between the care that people should receive and the care they do receive. Medicare reforms must affect the whole system, and should not be tacked on as an afterthought.
Client Area: Associations
Expertise Area: Medicare
March 1998
National Association for Home Care
Lewin contact: Lisa Alecxih
The Medicare Home Health Interim Payment System (IPS) raises concerns for beneficiaries and providers. A temporary plan proposed until HCFA develops a home care PPS, the IPS may cause the number of home health agencies (HHAs) exceeding the Medicare cost limits to more than double and the published cost limits to decrease 21% on average overall. HHAs may operate without knowing the per-beneficiary limits for up to 6 months of the initial IPS cost reporting period. Strategies developed by HHAs to cope with this reduction may include increasing the proportion of low-end users with fewer visits and restraining costs per visit and number of visits per beneficiary. Some of these strategies could have considerable consequences for high-use home health clients.
Client Area: Associations
Expertise Area: Aging and Disability, Medicare
December 1997
American Association of Retired Persons
Lewin contact: Lisa Alecxih
This study found that Medicare beneficiaries spend on average two out of every ten dollars in income on out-of-pocket health expenses, excluding the costs of home health and nursing home care. In addition, the report found that older Medicare beneficiaries living below the poverty line spend on average more than one-third of their yearly income on out-of-pocket health care costs. A first-time look at the magnitude of out-of-pocket spending for the nearly 60 percent of poor Medicare beneficiaries who do not receive Medicaid, the study provides the first comparison of out-of-pocket costs paid by beneficiaries enrolled in HMOs versus those in traditional fee-for-service programs.
Client Area: Associations
Expertise Area: Medicare
April 1997
American Dietetic Association
Analysis of data from a Northwestern HMO shows that the use of dietition services under Medicare Part B as specified in the Medical Nutrition Therapy Act of 1995 can reduce inpatient and physician service use for patients with diabetes and/or cardiovascular disease. Utilization savings appeared within the first calendar quarter and increased over time. Authors found also that the program could produce net savings to Medicare over the period analyzed (1998 to 2000) if coverage is limited to those with diseases demonstrated to show savings.
Client Area: Associations
Expertise Area: Chronic Disease / Cost of Illness, Medicare
October 1996
American Hospital Association
Employer health coverage has continued to erode throughout this decade despite the success employers have had in controlling health care costs. Employers responded to the rapid growth in health care costs early in this decade by shifting workers to managed care plans that control costs through price competition and aggressive cost control. However, employers also adopted policies that have led to reductions in the number of covered individuals. For example, some large employers with generous benefits have outsourced many production and service jobs to outside contractors where health insurance is less common and benefits are less comprehensive. Some employers also have discontinued their retiree coverage programs which will ultimately reduce coverage among early retirees. To control costs, employers have also increased employee cost sharing under their health plans and have discontinued coverage for certain specialized services. For example, deductibles and copayments have increased under traditional indemnity plans, partly as an incentive for individuals to shift to managed care alternatives. Coverage for expensive specialty services such as infertility treatments has also declined despite a recent increase in the number of states requiring insurers to cover these services. In addition, employers have increased premium contribution requirements for family coverage, which may be partly responsible for the recent decline in employer coverage among dependents. Some of the reduction in employer coverage will be curtailed by the recently enacted "Health Insurance Portability and Accountability Act of 1996" which requires portability of employer coverage across jobs. However, the impact of this legislation is likely to be negligible since 45 states had already enacted similar legislation by 1995. Thus gaps in employer coverage are likely to continue to be the primary reason for becoming uninsured well into the future.
Client Area: Associations
Expertise Area: Health Reform
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