Publications

Comparative Evaluation of Pennsylvania's HealthChoices Program and Fee-for-Service Program

May 2005

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

Medication Therapy Management Services: A Critical Review: Executive Summary Report

May 2005

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

The Burden of Skin Diseases: 2005

April 2005

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

Low-Income Medicare Beneficiary Savings Still Available in the Medicare Drug Discount Card Program: A Nine State Assessment

March 2005

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

The Economic Impact of Nursing Homes in the Commonwealth of Pennsylvania: Final Report

March 2005

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

Hospitals Share Insights to Improve Financial Policies for Uninsured and Underinsured: A Report from the Patient-Friendly Billing Project

February 2005

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

The Health Care for All Californians Act: Cost and Economic Impacts Analysis

January 2005

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

Costs of Serving Homeless Individuals in Nine Cities: Chart Book

November 2004

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

The Medical Technology Industry at a Glance 2004

September 2004

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

Assessment of Beneficiary Savings in the Medicare Drug Discount Card Program

August 2004

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