October 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
The Lewin Group assisted the state of Vermont in developing options to expand insurance coverage in the state under the recent State Planning Grant program funded through the Health Resources and Services Administration (HRSA). This report describes the activities conducted to research the characteristics of uninsured Vermonters and the current state of the insurance, employer, and health care provider marketplaces. Additionally, this report contains the findings of the research as well as a summary of the various options developed under the HRSA grant.
Client Area: State and Local Governments
Expertise Area: Health Reform
September 2001
New York State Department of Civil Service
In January 1998, the New York Department of Civil Service implemented an integrated workers' compensation/health plan prescription benefit called "ONECARD Rx," which allows New York State employees to pay for WC prescription drug needs. The Lewin Group performed an evaluation of the benefit to measure cost effectiveness, quality of care received under benefit, and the feasibility of transferring the benefit concept to other WC health benefits and other employers. The evaluation found that the benefit can reduce health plan costs, and that workers and employers would likely gain from widespread adoption of the benefit.
Client Area: State and Local Governments
August 2001
Vermont Agency of Human Services, Office of Vermont Health Access
Lewin contact: John Sheils
For the state of Vermont, The Lewin Group explored the expected costs and impacts of a single-payer program in which all state residents are covered under a single public program funded primarily with an employer payroll tax.
This report presents The Lewin Group's analysis of the financial impact of a single-payer program on various payers for health care including state, local, and federal governments. It includes estimates of the financial impact of the proposal on employers by industry and firm size, and of the impact of the plan on household health spending by age, income level, and other characteristics.
Client Area: State and Local Governments
Expertise Area: Health Reform
August 2001
Wisconsin Legislative Audit Bureau
Lewin contact: Lisa Alecxih
In its second report for the Wisconsin Legislative Audit Bureau regarding the Family Care program, the Lewin Group notes that since its first report in November 2000, the Department of Health and Family Services and the pilot counties made considerable progress in implementing Family Care. Based on information through June 2001, the pilot counties demonstrated different stages of program processes, capacity, and enrollment. In January 2002, the counties will implement a final program element, an independent enrollment broker, as proposed by the Department and approved by the federal government. The report points out a number of areas that need to be addressed as the pilots continue, including outreach, provider relations, care management, quality assurance, and cost.
Client Area: State and Local Governments
Expertise Area: Aging and Disability
June 2001
Massachusetts Division of Medical Assistance
This study analyzes Medicaid payments made to acute care hospitals, non-acute hospitals, and community health centers licensed by the Massachusetts Department of Public Health. The study was commissioned through legislation that was passed in October 2000.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
May 2001
North Carolina General Assembly
In most states it is common to hear that the Medicaid program offers a "Cadillac" benefit package to its beneficiaries. In many ways this observation is true: Medicaid offers benefits unavailable in private insurance. But it is also true that the catchy use of the "Cadillac" comparison masks important points about Medicaid. For one, federal Medicaid law mandates that states offer certain services that exceed the benefits available through private health insurance plans. States must provide those federally mandated benefits. For another, the poverty and disability status of many Medicaid beneficiaries necessitates including services that are not needed by a generally healthier and wealthier population in a private insurance plan.
The North Carolina Medicaid Benefit Study was commissioned by the North Carolina Legislature to look in-depth at North Carolina's Medicaid benefit package. The Legislature wanted an independent expert review to know whether the process by which benefits are added to the Medicaid benefit package makes sense. It wanted to know how well these benefits are managed by the state's Medicaid agency. And the Legislature also wanted to know how North Carolina's benefit package and approach stack up against other state Medicaid programs, and to private insurers in North Carolina.
We found that the Medicaid program is managed by dedicated, skilled and professional public servants in both the Executive and Legislative branches of government. No matter how skilled the managers are, however, a state Medicaid benefit package inevitably looks "messier" than a private insurance product. For example, in North Carolina, as in other states, Medicaid benefits are added (and generally not actively managed) when the provider that is paid for the benefit is another public agency, such as a school (for special education services) or an Area Mental Health Authority (for behavioral health benefits). These decisions, which expand Medicaid far beyond commercial insurance, are typically motivated by a desire to access federal Medicaid funds to legitimately subsidize otherwise state-only funded health services. Over time the cumulative effect of these decisions can blur the line regarding whether the benefit package is designed to put a package of needed services around Medicaid beneficiaries or whether it is designed to support public providers with revenue.
In our review, we found features in North Carolina's Medicaid benefit process that could be improved, and that some changes could save over $130 million a year. The full report includes dozens of recommendations to improve the integrity of the program, its service to program beneficiaries, and its emphasis on cost containment.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
May 2001
California Office of the Attorney General
This report, prepared for the California Office of the Attorney General, assesses the potential effects of the proposed transfer of control of St. Luke’s Hospital to Sutter Health on the availability and the accessibility of health care services.
Client Area: State and Local Governments
November 2000
Idaho State Legislature Office of Performance Evaluations
This study assesses the management, oversight, and administration of the Idaho Medicaid program in key areas including utilization management, fiscal and budgetary control, veterans' homes, and Medicaid automated systems. The report identifies cost-savings opportunities for the state.
Client Area: State and Local Governments
Expertise Area: Medicaid and CHIP
November 2000
Wisconsin Legislative Audit Bureau
Family Care is an innovative, system redesign experiment designed to improve Wisconsin?s long-term care (LTC) system. Family Care creates two new community organizations, a Resource Center (RC) to provide one-stop shopping for information and assistance in obtaining services, and a Care Management Organization (CMO) to help arrange and manage services. The program also introduces managed care principles to control escalating costs. If the program achieves its goals, the new long-term care system will provide elderly and adult individuals with physical or developmental disabilities with greater access to flexible services that promote independence and facilitate a higher quality of life.
The Wisconsin Legislative Audit Bureau contracted with The Lewin Group to evaluate the Family Care pilot program. This report completes the first stage of the project, which was a process evaluation. The second stage will be the development of an impact evaluation, which will assess the extent to which the pilot projects are meeting the stated goals of Family Care. The final stage of the evaluation will assess the benefits and costs of the program This report contains background information on the Family Care program as a whole, as well as evaluative information on the development of each pilot project. The report also contains a glossary of terms and a research methodology section that demonstrates the contacts made in the five pilot counties?Fond du Lac, La Crosse, Milwaukee, Portage and Richland?in order to assess the current status of the Family Care program.
Client Area: State and Local Governments
Expertise Area: Aging and Disability
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