December 2006
Lewin contact: John Sheils
The “Healthy Americans Act” (HAA) establishes a centrally financed system of private health insurance for all Americans not covered by Medicare, that is at least as comprehensive as the coverage provided to members of Congress. Employers give the money they now spend for health insurance to the worker as wages. Participants would chose from a selection of private plans offered through regional purchasing pools called “Health Help Agencies” (HHA's) on the basis of price. The competitive incentives created under the bill would reduce health spending by about 4.5 percent over the next 10 years.
Client Area: Federal Government
Expertise Area: Health Reform
October 2006
DHHS, Health Resources and Services Administration (HRSA)
This paper presents projections of physician supply and requirements for 18 physician specialties using the Physician Supply Model and the Physician Requirements Model developed for the Health Resources and Services Administration by The Lewin Group and the Altarum Institute. The paper describes the data, assumptions and methods used to project the future supply of and requirements for physician services; presents projections from these models under alternative scenarios; and discusses the implications of these projections for the future adequacy of physician supply.
Client Area: Federal Government
Expertise Area: Health Professionals Workforce
May 2006
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Lisa Alecxih
In an effort to improve the quality of care provided in long-term care settings, as well as ensure a committed and qualified long-term care workforce, the Office of the Assistant Secretary for Planning and Evaluation, within the U.S. Department of Health and Human Services, contracted with The Lewin Group to study the efficacy of various approaches to pre-employment screening and on-the-job monitoring of nurse assistants to prevent resident abuse in nursing homes. The two primary methods used for pre-employment screening include checking nurse aide registries and conducting criminal background checks. Federal guidelines require each state to establish and maintain a registry of nurse aides that includes certification information and substantiated findings of abuse, neglect, or financial exploitation in nursing homes. Previous studies have examined rates of abuse in nursing facilities, direct service worker capacity issues, and compliance of states to maintain nurse aide registries. This study looks across all of these issues, by examining the process states go through to collect and maintain information in their registries, state and employer mandated background check procedures, reporting and investigating policies/practices when abuse allegations are made, and the impact of such processes on the direct service workforce, employers and state agencies
Client Area: Federal Government
Expertise Area: Aging and Disability
May 2006
DHHS, Health Resources and Services Administration
The Lewin Group assisted the U.S. Department of Health and Human Services, Health Resources and Services Administration respond to a Congressional request to examine the adequacy of the critical care workforce. Using findings from the literature, original research, and projections from the Physician Supply Model and Physician Demand Model, this report examines the current and future supply of critical care physicians (intensivists); the major factors and trends affecting the demand for their services; and the likely inadequacy of their numbers through 2020.
Client Area: Federal Government
Expertise Area: Health Professionals Workforce
December 2005
Medicare Payment Advisory Commission (MedPAC)
The Medicare Payment Advisory Commission has expressed concerns about the accuracy and fairness of the current Medicare hospital inpatient and outpatient prospective payment system. Payment rates for these systems are based, to varying degrees, on hospital charges. In order to better understand hospital charge setting practices and the nature of hospital mark-ups across service lines, MedPAC engaged The Lewin Group to conduct a nationwide study of hospital charge practices. This report reviews the charge practices of a purposive sample of hospitals and hospital systems around the U.S.
Client Area: Federal Government
Expertise Area: Medicare
September 2005
DHHS, Health Resources and Services Administration (HRSA)
Lewin contact: Clifford Goodman
One of the Nation's most pressing public health issues is the widening gap between the supply and demand for organs and tissues. The "Organ Donation Breakthrough Collaborative," a component of Secretary Thompsons's Gift of Life Donation Initiative, was launched in 2003 to increase organ donation by helping the national community of organ procurement organizations (OPOs) and hospitals to quickly identify, learn, adapt, replicate, and celebrate "breakthrough" practices that are associated with higher donation rates.
To help the transplant community maximize every donation opportunity, HRSA has sponsored a second collaborative focused on increasing the number or organs recovered and transplanted per donor. This report presents observations of the practices of selected OPOs, hospitals and transplant centers that appear to be associated with higher rates of organs recovered and transplanted per donor.
Client Area: Federal Government
August 2005
DHHS, Agency for Healthcare Research and Quality (AHRQ)
Lewin contact: Clifford Goodman
Several noteworthy reports that have been released in the past few years raise troubling concerns about the quality and safety of health care in the United States. Many factors may contribute to the shortfalls in quality, including the way care is delivered and the adequacy of the facility within which that care takes place.
A body of evidence is developing about how attributes of the various environments in which health care is provided mediate health care quality. Consistent with the growing movement to apply clinical evidence-based approaches to improve patient outcomes, hospital administrators and researchers also are placing greater emphasis on "evidence-based design" to support and facilitate clinical advances in the field. This is a process for creating hospital environments that is informed by the best available evidence concerning how the physical environment can affect patient outcomes, patient safety and satisfaction, and hospital staff safety and satisfaction.
However, the field is relatively new, evidence supporting this approach is not yet robust in many areas and existing research on evidence-based hospital design is not widely known among policymakers, regulators and other decision makers and opinion leaders. This environmental scan is intended to assess what is and is not known about the relationships between hospital design and construction—the built environment—and patient outcomes and satisfaction, and staff working conditions. It discusses the following issues:
What is currently driving the market for hospital design and construction?
To what extent are hospitals requesting evidence-based designs?
What is the research base for the hospital built environment?
What are major challenges in building the field of evidence-based hospital design?
What are the major gaps in current research and relevant areas of future focus?
What are appropriate roles for funders of health services research interested in furthering improvements within the built environment?
Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA
March 2005
DHHS, Office of the National Coordinator for Health Information Technology
Lewin contact: Clifford Goodman
In August 2004, The Lewin Group was retained by the National Coordinator for Health Information Technology, US Department of Health and Human Services, to convene a Health Information Technology Leadership Panel (HIT Leadership Panel) and report on its findings. The HIT Leadership Panel met in Washington, DC, on November 29, 2004, to examine the importance of investing in HIT, particularly regarding the respective major roles of government and the private sector in its widespread implementation. HIT Leadership Panel members were drawn from executives in widely recognized companies that purchase substantial levels of health care for their employees. Companies with little or no direct involvement in the health care or information technology (IT) industry sectors were selected with the intention of learning how IT has been successfully adopted and used by other sectors. On May 11, 2005, Health and Human Services Secretary Mike Leavitt issued the report of the HIT Leadership Panel findings at the Business Rountable's CEO Health Care Summit where Secretary Leavitt and Treasury Secretary John Snow discussed the burden of rising health care costs on the U.S. economy and global competitiveness and the role of health IT in managing these costs. Following the Roundtable meeting, Secretary held a press conference with FedEx Corporation CEO Frederick Smith and Pepsico CEO Steven Reinemund to release the report.
Client Area: Federal Government
January 2005
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Child support is an important income source for many low-income families, and the receipt of support may be most critical for women as they transition off welfare. In the post-welfare reform era emphasizing work and self-sufficiency, many policymakers now consider child support as a key income support. In the effort to support self-sufficiency, for example, it is important that custodial parents, primarily mothers, know the rules of child support, establish orders, begin to receive child support while on welfare and receive child support payments on a regular basis after leaving welfare. To examine the interaction of child support and welfare receipt, researchers from MDRC, The Lewin Group, and The University of Wisconsin-Madison analyzed several data sources to address questions concerning child support receipt of current and former welfare recipients. This report is the second and final in a series for this project. The first report, produced by The Lewin Group, provided an extensive literature review.
Client Area: Federal Government
Expertise Area: Income Security
December 2004
DHHS, Office of Child Support Enforcement
This report was prepared for the Department of Health and Human Services, Office of Child Support Enforcement (OCSE) under contract with The Lewin Group. The study reviews the implementation of the performance-based incentive funding system through which the Federal government awards payments to state Child Support Enforcement programs. OCSE implemented the new incentive formula over the fiscal year 2000 to 2002 period. The statute provided a gradual phase-in, in part, so that state officials would havetime to perfect their measurement of performance and identify factors that affect performance. This final report explores state experiences in implementing the new system, including problems, successes, advantages and disadvantages. It also reports changes to the new system that were recommended by child support stakeholders.
Client Area: Federal Government
Expertise Area: Children, Youth, and Family Policy
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