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
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
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
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
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
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