Publications

Formulary of Highest Enrollment Part D Plan Includes More Unique Chemical Compounds than VA National Formulary

March 2007

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

The Prevalence and Cost of Select Chronic Diseases

March 2007

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

Independent Assessment of New Mexico's Medicaid Managed Care - Salud!

February 2007

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

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

January 2007

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

Assessment of HUSKY, Connecticut's Medicaid Managed Care Program

January 2007

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

Medicaid Upper Payment Limit Policies: Overcoming a Barrier to Managed Care Expansion

November 2006

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

Mail-Service Pharmacy Savings and the Cost of Proposed Limitations in Medicare and the Commercial Sector

September 2006

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

Beneficiary Choices in Medicare Part D and Plan Features in 2006

September 2006

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

Supporting Children's Hospitals and Children's Health: The Role of the Federal "CHGME" Program

September 2006

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

Medicare Part D Factsheets

June 2006

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