June 2005
Pennsylvania Legislative Budget and Finance Committee
Lewin contact: Lisa Chimento
In the last few years, the public's focus on the financial activities of Blue Cross and Blue Shield plans has intensified. First, the Blues nationwide started seeing large increases in their earnings. Second, the economy softened at the same time that health care costs swelled. In Pennsylvania, as in other states nationwide, this increased the numbers of uninsured and made it harder for those having insurance to afford it. Some stakeholders argued that the Blues should give up portions of their surpluses to help make health coverage more affordable.
The Pennsylvania Legislative Budget and Finance Committee commissioned The Lewin Group, pursuant to House Resolution No. 865, to conduct a study of the regulation and disposition of reserves and surpluses of health insurers in Pennsylvania—specifically the four Blue Cross and Blue Shield plans in the state. The report is divided according to the two central topics: the issue of the Blues' reserves and surpluses, (including an analysis of measures already taken to regulate the Pennsylvania Blues' reserves and surpluses, and other states' laws and practices) and an assessment of the Blues' community benefit spending and activities, along similar dimensions.
Client Area: State and Local Governments
May 2005
Illinois Commission on Government Forecasting and Accountability
Lewin Group to perform an actuarial assessment of the cost-effectiveness and feasibility of various approaches to expanding the use of managed care in the State's Medicaid program. The report presents a series of recommendations for expanding capitated managed care in some areas of the state and managed fee-for-service, including Primary Care Case Management, disease management and complex care coordination, in other areas. The objective of the project was to explore and identify Medicaid managed care approaches that will both save money and strengthen the quality of coverage beneficiaries receive.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
May 2005
Indiana Family and Social Services Administration
The Indiana Division of Disabilities, Aging, and Rehabilitative Services and the Office of Medicaid Policy and Planning contracted with The Lewin Group to study the impact of Senate Enrolled Act (SEA) 493, which makes significant changes in the State’s long term care (LTC) programs for individuals of advanced age and persons with disabilities. The study focused on the impact of changes to the State’s Section 1915(c) Aged and Disabled Medicaid Home and Community-Based Services Waiver.
Client Area: State and Local Governments
Expertise Area: Aging and Disability, Medicaid and CHIP
January 2005
Texas Health and Human Services Commission
Lewin assisted Texas' Health and Human Services Commission (HHSC – the state's Medicaid agency) in designing the detailed mechanisms by which cost performance would be measured. The contractor's administrative fees are 80% at risk for cost performance, and 20% at risk for quality performance. Lewin evaluated vendors' price bids and then worked extensively with HHSC to develop and negotiate the measurement criteria with the selected contractor. Lewin has also developed appropriate algorithms for identifying patients in each targeted disease category, specifying situations where persons will be excluded from the program, and designing and negotiating all aspects of HHSC's financial relationship with its disease management contractor.
Client Area: State and Local Governments
Expertise Area: Chronic Disease / Cost of Illness, Medicaid and CHIP
September 2004
Texas Health and Human Services Commission
Lewin contact: Lisa Chimento
The Texas Health and Human Services Commission retained The Lewin Group to assist in developing appropriate out-of-network payment rates and related policies, in accordance with the requirements of HB 2292, 78th Legislature. In Texas, considerable time and energy, on behalf of state staff, health plans, providers and other stakeholders, have been focused on out-of-network usage and reimbursement in the STAR and STAR+PLUS programs for the past several years. Lewin's objective was to take what the state had already learned, understand the successes and shortcomings, and develop a solution to move the program forward in a positive direction.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
June 2004
Save Our ERs Coalition
Lewin contact: Terry West
In recent years, Harris County's emergency care system has become increasingly overburdened by growing emergancy department volume. The Lewin Group was commissioned by the Save Our ERs coalition to assist them in creating a framework for revisioning the organization and delivery of health care services in Harris County be developing and examining three conceptually distinct and credible options for reconfiguring care to safety net populations in Harris County, arrayed by degree of system reorganization and resources required.
Client Area: State and Local Governments
Expertise Area: Health Reform
March 2004
Maryland Health Care Commission
Over the past few years, the Maryland Health Care Commission (MHCC) has undertaken several public reporting initiatives to assist the general public in making informed health care decisions. The Maryland General Assembly authorized the MHCC to produce several state sponsored online health care reports, including the Maryland Hospital and Nursing Home Performance Evaluation Guides, in January 2002 and August 2001, respectively.
Since the Guides were released, feedback has been primarily anecdotal. In its
Client Area: State and Local Governments
January 2004
Texas Health and Human Services Commission
The Lewin Group developed a comprehensive set of cost estimates for potential expansion of Texas' Medicaid managed care programs. The study included a projection of potential savings as a result of implementing various managed care expansion options, as well as a geographic analysis of potential expansion regions. The study also took into account the potential effects managed care expansion would have on other programs and benefits, such as pharmacy. Throughout the project, the Lewin team gathered input from various stakeholder groups, including hospitals, physicians, managed care plans, the PCCM vendor and State staff responsible for administering the current program to understand the concerns these groups have about the structure of the current program and their ideas for improving it. HHSC has relied heavily on the report in shaping its managed care expansion plans.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
December 2003
New York State Insurance Department
The State of New York launched the Healthy New York program in January 2001 to give working families access to affordable health insurance coverage. The Lewin Study examines the impact of Healthy NY and analyzes the enrollment, premium costs, cost experience by the HMOs, surveys the enrollees and gathers input from participating employers and participating health plans.
Client Area: State and Local Governments
Expertise Area: Health Reform
November 2003
Center for Health Care Strategies
In a project jointly funded by the State of Arizona and the Center For Health Care Strategies (CHCS), The Lewin Group assessed whether it would be best for AHCCCS (Arizona's Medicaid program) to continue to purchase all prescription drugs through its capitated managed care program, or whether the State's interests would be better served by "carving out" prescription drugs and paying for AHCCCS medications on a fee-for-service basis. Through aggressively managing the volume and mix of drugs, Arizona has achieved the lowest per capita pharmacy costs of any Medicaid program. While drug-specific prices would be more favorable under a carve-out due to the Federal rebate program, Lewin's projections are that a carve-out would result in a net increase in overall pharmacy spending. Taking the responsibility for pharmacy costs out of the hands of at-risk health plans is expected to lead to diminished cost-effectiveness in managing the volume and mix of prescribed drugs.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
Showing 51 to 60 of 79 item(s)