March 2001
Social Security Administration
This report provides findings from the project team's review of SSA's quality assurance system for disability determinations and options for improvement. The report finds that SSA's QA system reflects the end-of-line inspection type of system that was prominent in the health care industry and other industries when it was developed, and needs to be transformed to a more advanced, state-of-the-art quality management system. This will require a sustained effort over many years. Program leadership will play a critical role. Options are presented for improving leadership, developing a culture of quality, improving pre-effectuation reviews, improving measurement of quality in initial determinations, improving SSA's relationship with the state Disability Determination Services, continuously improving the disability determination process, and improving the quality of appellate decisions.
Client Area: Federal Government
Expertise Area: Income Security
January 2001
DHHS, Administration on Aging
Lewin contact: Lisa Alecxih
This issue brief, supported by the Adminstration on Aging, examines caregivers providing regular assistance to individuals with a disability or long-term health problem of all ages in 1998. It is intended to provide the Aging Network with general socio-demographic information about its potential target populations as a background for designing and implementing caregiver support services around the National Family Caregiver Support Program.
Client Area: Federal Government
Expertise Area: Aging and Disability
January 2001
DHHS, Center for Mental Health Services
This report synthesizes the experiences of seven large employers that offer generous mental health benefits to their employees. Representatives of these employers shared their views and experiences in a one-day focus group.
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
December 2000
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
In the mid-1990s, the National Library of Medicine (NLM) requested that the Institute of Medicine (IOM) develop a broad framework for telemedicine evaluation. In 1996, based on the deliberations of a 15-member expert committee, the IOM released its report, Telemedicine: A Guide to Assessing Telecommunications in Health Care. The report presented a framework built upon five main evaluation elements: 1) quality of care and health outcomes, 2) access to care, 3) health care costs and cost-effectiveness, 4) patient perceptions, and 5) clinician perceptions.
Since 1996, the field of telemedicine has continued to evolve and mature. Recently, the DHHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with The Lewin Group to assess current approaches to evaluating telemedicine. In particular, ASPE requested that Lewin extend or otherwise update the 1996 IOM framework for telemedicine evaluation as it applies to telemedical consultations
The objective of this report, Assessment of Approaches to Evaluating Telemedicine, is to identify areas in which telemedicine evaluation is likely to be most useful in informing future policy and program decisions. Lewin's effort entailed integrating findings from a literature review, gathering information on evaluations of telemedicine activities funded by HHS, and conducting interviews with representatives of telemedicine programs and other experts in the field.
Client Area: Federal Government
December 2000
DHHS, Centers for Medicare and Medicaid Services (CMS)
Lewin contact: Lisa Alecxih
The Centers for Medicare and Medicaid Services contracted with The Lewin Group, and its subcontractors, the Urban Institute, the University of Minnesota, Mathematica Policy Research, Inc., and the MEDSTAT Group, to design and implement a study of the impact of Medicaid home and community based services programs on quality of life, quality of care, utilization and cost. The research project is studying the financing and delivery of services to older and younger people with disabilities in seven states and the Medicaid financing and delivery of services for individuals with mental retardation and developmental disabilities (MR/DD) in six states.
Client Area: Federal Government
Expertise Area: Aging and Disability, Medicaid and CHIP
December 2000
National Institute on Alcohol Abuse and Alcoholism
The economic costs of alcohol abuse are estimated to have been $184.6 billion in 1998. This estimate has been developed by making a series of adjustments to the most recent comprehensive estimates that attempt to account for changes expected to affect the estimates. This new estimate represents a 25 percent increase (3.8 percent per year on average) from the $148 billion comprehensive estimate developed previously for 1992. The current update has developed new estimates for 20 major cost components and has applied various combinations of 18 different specific adjustment factors to account for 1992 to 1998 changes in, e.g.: incidence/prevalence of selected alcohol-specific consequences; population; general prices; and worker compensation (wage rates).
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
November 2000
DHHS, Agency for Healthcare Research and Quality (AHRQ)
The purpose of this project was to provide advice and recommendations to the Agency for Healthcare Research and Quality (AHRQ) about the design of a Web-based database of clinical performance measures that can be appropriately and functionally integrated with an enhanced National Guideline Clearinghouse.
Under contract to AHRQ, The Lewin Group performed a systematic evaluation of the features that a measures clearinghouse should embody and explored alternative approaches to CONQUEST's design and management. This report describes The Lewin Group project team's answers to AHRQ's questions, specifically:
What is the appropriate content of a redesigned CONQUEST database? What information technologies are needed to assure that CONQUEST efficiently meets the needs of its intended users? Can any processes, technology, or content be shared between NGC and CONQUEST without significantly impairing the usefulness and stability of either database? What is the optimal approach to managing the database, including acquiring, assessing, linking, and publishing measures to the Web, and maintaining them over time?
Client Area: Federal Government
November 2000
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
The Lewin Group worked with The Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services to develop an investment plan to improve the nation's core capacity for infectious diseases surveillance. This project came in light of recent challenges to disease surveillance including bioterrorism, emerging infections, the rapid pace of technological development, and changes in the health care delivery system. The Lewin Group conducted extensive research, including a literature review, interviews and site visits, and convened a panel of experts to assist in plan development. Drawing on the literature and the experience of the expert panelists, the report identified eight goals for infections disease surveillance. Lewin's research identified three types of gaps in performance that have resulted in poor performance across the eight goals: gaps in the core capacity of the key entities involved in conducting surveillance of infectious diseases; gaps in the flow of data and information among the entities involved in surveillance of infectious diseases; and gaps in the structures that support surveillance.
Client Area: Federal Government
September 2000
DHHS, Center for Substance Abuse Treatment
In this analysis, we estimated the relationship between treatment intensity and post-treatment societal costs associated with substance abuse treatment clients. We focused on the impact of length of stay and individual and group counseling sessions on crime-related costs (including criminal justice), health care costs, welfare payments, and client earnings. Societal benefits were measured by the estimated reductions in post-treatment costs and welfare payments or estimated increases in earnings and taxes with each additional day of treatment or hour of counseling. The additional benefits from increasing length of stay or counseling were compared with the additional cost of providing such care. The purpose of the analysis was to identify the value to society of varying the length of stay or hours of counseling for clients who received substance abuse treatment.
Client Area: Federal Government
Expertise Area: Mental Health and Substance Abuse
June 2000
US Department of Defense
The overseas cost of living allowance is a biweekly payment provided to approximately 280,000 members of the Uniformed Services stationed at one of 600 locations outside of the continental United States. Its purpose is to compensate members for differences in the cost of living between the continental United States (CONUS) and the their assigned location outside of the continental United States (OCONUS). This paper summarizes a review of the current system conducted by The Lewin Group. The review extended from the conceptual or theoretical premises of the current system to technical improvements in the methods of implementing the system.
Client Area: Federal Government
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