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Comparative Evaluation of Pennsylvania's HealthChoices Program and Fee-for-Service Program

May 2005

Pennsylvania Coalition of Medical Assistance Managed Care Organizations

In 2003, in a major policy shift, the Pennsylvania Department of Public Welfare (DPW) terminated the planned statewide expansion of the HealthChoices program, the state’s large-scale capitated mandatory managed care program for Medical Assistance recipients. In early March of 2005, Pennsylvania began phasing in its new ACCESS Plus program, an enhanced primary care case management program, in the counties without mandatory capitated managed care, including those previously scheduled for HealthChoices expansion. The Pennsylvania Coalition of Medical Assistance Managed Care Organizations (the Coalition) was formed by the seven physical health managed care organizations that contract with the Commonwealth of Pennsylvania to provide services to recipients enrolled in the HealthChoices program. Given the state’s recent policy reversal and the fact that, like most other states, Pennsylvania continues to seek out options for reducing expenditures and gaining efficiencies, the Coalition desired an independent assessment of the value of the HealthChoices Program to help inform the continuing debate about the future direction of the state’s Medical Assistance program. Toward this end, the Coalition commissioned The Lewin Group to conduct a comparative evaluation of Pennsylvania’s HealthChoices Program and Fee-for-Service Program, focusing on four areas that contribute to a health care program’s overall value: its cost-effectiveness, its impact on access, the quality of services provided, and the program’s focus on and approaches to serving individuals with special needs.

Client Area: Associations
Expertise Area: Medicaid and CHIP


Assessment of Medicaid Managed Care Expansion Options in Illinois

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


Impact of SEA 493 Provisions on Indiana's Aged and Disabled Waiver

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: Center on Aging and Disability, Medicaid and CHIP


Fee Reconciliation Process under the Texas Medicaid Disease Management Program

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


Electronic Applications Present Opportunities to Improve Enrollment into New York's Public Health Insurance Programs

November 2004

United Hospital Fund
Lewin contact: Lisa Chimento

As part of an effort to identify ways to expand and strengthen public health insurance coverage, the United Hospital Fund, with the support of the Altman Foundation, commissioned The Lewin Group to study the process for applying for public health insurance programs in New York City and determine how automation might improve that process. Results of the analysis show that an automated application process could speed up the current application processing time by over one week and help applicants access medical care sooner by decreasing the transition time between agencies, reducing errors, and limiting duplication of effort. Automation would also save enrollment organizations and their staff one hour or more every day by improving process efficiencies.

Client Area: Foundations
Expertise Area: Medicaid and CHIP


Assessment and Recommendations Regarding Out-of-Network Reimbursement, Usage Standards and Resolution Processes

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


Medicaid Managed Care Cost Savings - A Synthesis of Fourteen Studies

July 2004

America’s Health Insurance Plans (AHIP)

America’s Health Insurance Plans (AHIP) engaged The Lewin Group to synthesize existing research on the savings achieved when states have implemented Medicaid managed care programs. The Lewin Group reviewed 14 studies, which included federally required independent assessments and studies commissioned by the federal and state governments and private foundations. The studies are grouped into three categories: 1) state studies, which examine states’ cost savings in their overall Medicaid managed care programs; 2) targeted Medicaid managed care studies, which assess savings in Medicaid managed care programs targeted to specific populations; and 3) specific service studies, which analyze Medicaid managed care program savings for specific services.

Client Area: Associations
Expertise Area: Medicaid and CHIP


How Policy Changes Impact Enrollment: A Look at Three Counties

May 2004

California HealthCare Foundation
Lewin contact: Lisa Chimento

In the current economic climate, California’s counties struggle with the need to provide health coverage to low-income individuals and families in the face of sharp budget cuts. How can a county ensure that its most vulnerable residents gain access to the appropriate public health insurance program? Three California counties – Alameda, San Mateo, and Santa Clara – have gone beyond state requirements, not only in expanding eligibility for coverage, but also in creating a more seamless process for enrollment in county programs, Medi-Cal, and Healthy Families. The report, prepared by The Lewin Group, explores the policy, operational, and other considerations of implementing partnerships among county agencies, health plans, and other community stakeholders to change and improve the process for enrolling families into public health care programs.

Client Area: Foundations
Expertise Area: Medicaid and CHIP


Business Opportunities in the Medicare Modernization Act for Community Affiliated Health Plans

April 2004

Association for Community Affiliated Plans (ACAP)
Lewin contact: Lisa Chimento

The Medicare Modernization Act of 2003 (MMA) has important consequences for dual eligible beneficiaries as well as Medicaid managed care plans. ACAP commissioned this report to provide member health plans with a better understanding of the Act's implications for their current Medicaid business -- as well as a roadmap to explore the possibility of expanding into Medicare managed care.

Client Area: Associations
Expertise Area: Medicaid and CHIP, Medicare


Actuarial Assessment of Medicaid Managed Care Expansion Options

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

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