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Quality of Care and Litigation in Tennessee Nursing Homes

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


The Economic Value of Professional Nursing

December 2008

American Nurses Association

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


Comparison of VA National Formulary and Formularies of the Highest Enrollment Plans in Medicare Part D and the Federal Employee Health Benefit Program

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


Increasing Use of the Capitated Model for Dual Eligibles: Cost Savings Estimates and Public Policy Opportunities

November 2008

Association for Community Affiliated Plans; Medicaid Health Plans of America

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


The Economic Costs of Diabetes in the U.S. in 2007

March 2008

American Diabetes Association

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


Programmatic Assessment of Carve-In and Carve-Out Arrangements for Medicaid Prescription Drugs

October 2007

Association of Community Affiliated Health Plans (ACAP)

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


State Impacts of the Medical Technology Industry

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


Assessing the Costs of Performing DXA Services in the Office-based Setting : Final Report

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


Anticipated Effects of the Deficit Reduction Act Provisions on Child Support Program Financing and Performance: Summary of Data Analysis and IV-D Director Calls

July 2007

National Council of Child Support Directors

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


The United States Rheumatology Workforce: Supply and Demand, 2005-2025

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

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