December 2012
Lewin contact: Grace Yang
Lewin senior researchers just published an article in the December 2012 issue of Health Affairs on the long-term health and economic implications of smoking cessation in the Military. The article, "Simulation Of Quitting Smoking In The Military Shows Higher Lifetime Medical Spending More Than Offset By Productivity Gains" is based on a Lewin study for the Department of Defense using Lewin's Health Promotion Microsimulation Model. The study found that cessation accompanied by weight gain would increase average life expectancy by 3.7 years, and that the average lifetime medical expenditures would increase slightly as a result of prolonged life. Avoidance of weight gain after quitting smoking would increase average life expectancy by four additional months and reduce mean extra spending. Overall, the average net lifetime health care cost increase of $1,700 or less per ex-smoker would be modest and, for employed people, more than offset by even one year’s worth of productivity gains. These results boost the case for smoking cessation programs in the military.
Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness
October 2011
Centers for Disease Control and Prevention
Excessive alcohol use is responsible for an average of 79,000 deaths and 2.3 million years of potential life lost in the United States each year, making it the third leading preventable cause of death in this country. In addition to premature mortality, excessive alcohol consumption affects us all through consequences such as additional health care costs, property damage from fire and motor vehicle crashes, increased crime and criminal justice system costs, and lost productivity. The most recent detailed study of the economic costs of excessive alcohol consumption was conducted in 1998, and produced an estimate for 1992. Since then, there have been significant advances in our scientific understanding of the health and social impacts of excessive drinking.
Given the huge public health impact of excessive alcohol consumption and the improvements in scientific understanding since the prior estimates the CDC Alcohol Team, with generous support from the Robert Wood Johnson Foundation, engaged The Lewin Group to develop updated estimates of the economic cost of excessive alcohol consumption in the U.S. The purpose of the study was develop a more current estimate of the economic cost of excessive alcohol consumption in the U.S. and also to estimate the cost of binge drinking, drinking by underage youth, and drinking during pregnancy. Estimates were developed for 2006, the most recent year for which cost and outcome data were generally available.
A companion article based on this study was also published in the American Journal of Preventive Medicine at http://www.ajpmonline.org/article/S0749-3797%2811%2900538-1/abstract
Client Area: Federal Government
Expertise Area: Chronic Disease / Cost of Illness
June 2011
Prepared for The American Association of Retired Persons (AARP), American Hospital Association, American Medical Association, American College of Cardiology, and LeadingAge
Lewin contact: John Sheils
The Lewin Group developed a case study for The American Association of Retired Persons (AARP), American Hospital Association, American Medical Association, American College of Cardiology, and LeadingAge, which analyzes the economic impacts of the “Commitment to American Prosperity Act” (CAP) being considered by Congress to limit the growth in Federal spending. The case study examines the impact that spending reductions would have on people who depend upon federal programs for income and healthcare. Because health care is such a large portion of federal spending, it also presents estimates of the impact that these cuts would have on health care provider revenues and the resulting effects on access to care for Medicare and Medicaid beneficiaries.
Client Area: Associations, Federal Government
Expertise Area: Health Reform
February 2010
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Lisa Alecxih
On January 28, the Engelberg Center for Health Care Reform at Brookings hosted a forum to discuss strategies for improving care for older Americans across a range of institutional and community-based settings. Experts and key stakeholders examined the components of health care reform most likely to influence older Americans; discussed promising models for payment, delivery-system reforms, and coordination across a continuum of care; and identified how quality and efficiency can be improved.
During the forum, Richard Frank, Deputy Assistant Secretary for Office of Disability, Aging, and Long-Term Care Policy for the Assistant Secretary for Planning and Evaluation, officially released a chartbook prepared by The Lewin Group. The chartbook takes a closer look at the health spending for individuals with chronic conditions and functional impairments living in the community. The Lewin Group analysis indicates that the combination of chronic conditions and functional limitations is a critical indicator and an improved targeting criteria for individuals with high health spending who could benefit from better coordination and management.
Client Area: Federal Government
Expertise Area: Aging and Disability
September 2009
DHHS, Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Lewin contact: Clifford Goodman
Unlike most conventional drugs, biological products are usually large, complex molecules that are produced by living organisms. These commercially engineered biologics currently account for billions of dollars in health care spending. Starting early last century, Congress has regulated most biologics separately from small molecules under the Biologics Control Act, which was later incorporated into the Public Health Service (PHS) Act. Although some biologics are regulated under the Federal Food, Drug, and Cosmetic Act (FDCA) for historical reasons, and are, therefore, candidates for generic production through section 505(j), an Abbreviated New Drug Application (ANDA), or through 505(b)(2), using data from previously approved innovator biologics to make claims of safety and effectiveness, there is no abbreviated path for replica or closely similar follow-on products for biologics under the PHS Act. While this group of products is known by various names, this report uses the term “follow-on protein products” (FoPPs).
Due to the potential cost savings that FoPPs could provide in the US market, members of Congress have made various proposals for establishing a regulatory pathway for FoPPs. The purpose of this report is to provide an unbiased estimate of potential cost savings from the introduction of FoPPs under multiple scenarios for abbreviated regulatory pathways. Findings from this analysis may be useful in the context of ongoing policy deliberations. A better understanding of the potential impact of legislative provisions for the regulatory pathway on cost savings may inform policymakers as such a pathway is considered.
Client Area: Federal Government
March 2009
Lewin contact: John Sheils
This report provides estimates of the cost and coverage impacts of the Healthy Americans Act as introduced on February 5, 2009 (S. 391). It provides estimates of cost effects for the federal government, state and local governments, private employers and families, assuming the program is fully implemented in 2011. It also provides estimates of the average cost impacts of the Act for families by income, age and current coverage status.
Client Area: Federal Government
Expertise Area: Health Reform
February 2009
Lewin contact: John Sheils
Presentation by John Sheils to Senate Republicans and Staff February 11, 2009.
Client Area: Federal Government
Expertise Area: Health Reform
December 2008
DHHS, Health Resources and Services Administration
The Lewin Group and Altarum Institute recently completed a study for the U.S. Department of Health and Human Services on the future adequacy of supply of pharmacists. A previous Health Resources and Services Administration (2000) report documented the current and growing shortfall of pharmacists. Since release of that report the U.S. Bureau of the Census revised upward its projections of population growth, the Federal Government enacted the Medicare Part D program which expands prescription drug coverage to more elderly; technology continued to advance, minimum credentials for entry into the workforce for new pharmacists changed from baccalaureate to doctorate degrees, the Nation’s educational capacity to train new pharmacists and pharmacy technicians continued to expand and enrollment in schools of pharmacy has been at an all time high, and the role of pharmacists in providing care to patients continued to evolve. The Lewin Group and Altarum revised HRSA's Pharmacist Supply and Requirements Model (PhSRM) to examine current and projected future adequacy of pharmacist supply in the United States taking into account trends in the latest supply and demand determinants.
The overall findings are that the supply of pharmacists is growing significantly faster than was previously projected, but the demand for pharmacists continues to grow rapidly due in large part to population growth and aging. There is currently a moderate shortfall of pharmacists. The overall conclusion of this study is that the Nation has responded to earlier predictions of a growing shortfall of pharmacists, and to market forces that have raised pharmacist earnings, by expanding supply and increasing the use of technology and technicians. Still, the increase in supply will only be sufficient to keep pace with a rising demand due to changing demographics. Supply would need to increase further than currently projected to meet the demand caused by growth in per capita consumption of pharmaceuticals. Improvements in productivity through further employment of pharmacy aides and technicians and the application of evolving technologies should continue to help the supply meet these increases in demand.
Client Area: Federal Government
Expertise Area: Employment, Training, and Workforce Development
May 2008
DHHS, Centers for Disease Control and Prevention (CDC)
Lewin contact: Clifford Goodman
This report, commissioned by the Centers for Disease Control and Prevention provides a detailed overview of the key factors affecting the laboratory medicine sector. It is intended that the report serve as a point of reference for measuring and improving quality in the future as well as for policy guidance to professional organizations, government agencies, and others who provide, use, regulate, and pay for laboratory services.
Client Area: Federal Government
Expertise Area: Evidence-Based Medicine / HTA
April 2008
DHHS, Administration for Children and Families
One of the most controversial features of the 1990s welfare reforms was the imposition of time limits on benefit receipt. The law prohibits states from using federal TANF funds to assist most families for more than 60 months. Under contract to the Administration for Children and Families (ACF) in the U.S. Department of Health and Human Services, Lewin and MDRC conducted a comprehensive review of what has been learned about time limits. The review, which updates a 2002 study, includes analysis of administrative data reported by states to ACF, visits to several states, and a literature review. Key findings include the following: time-limit policies vary dramatically from state to state; nationally, at least a quarter million TANF cases have been closed due to reaching a time limit since 1996, although about one-third of these closures have occurred in New York, which continues to provide assistance through a state and locally funded program; and many of the families whose TANF cases were closed due to time limits are struggling financially and report being worse off than they were while on welfare.
Client Area: Federal Government
Expertise Area: Income Security
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