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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