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Cambridge, MA, United States

Hoag S.D.,Mathematica Policy Research Inc.
Academic Pediatrics | Year: 2015

Objective We examine a new simplification policy, Express Lane Eligibility (ELE), introduced by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), to understand ELE's effects on enrollment, renewal, and administrative costs. Methods Beginning in January 2012 and lasting through June 2013, we conducted 2 rounds of phone interviews with 38 state administrators and staff in 8 states that implemented ELE in Medicaid, Children's Health Insurance Program (CHIP), or both; we also conducted case studies in these same states, resulting in 136 in-person interviews. We collected administrative data on enrollments and renewals processed through ELE methods from the 8 states. Results ELE was adopted in different ways; the method of adoption influenced how many children were served and administrative savings. Automatic ELE processes, which enable states to use eligibility findings from partner agencies to automatically enroll or renew children, serve the most children and generate, on average, $1 million annually in administrative savings. Given the size of renewal caseloads and the recurring nature of renewal, using ELE for renewals holds substantial promise for administrative savings and keeping children covered. Conclusions Automatic ELE processes are a best practice for using ELE. However, because Congress has not yet made ELE a permanent policy option, states are discouraged from adopting this more efficient method of eligibility determination and redeterminations. Making ELE permanent would support states that have already adopted the policy; in addition, ELE could support the transition of children to Medicaid or exchanges should CHIP not be funded after September 30, 2015. © 2015 Academic Pediatric Association.

Tucker J.M.,North Dakota State University | Welk G.J.,Iowa State University | Beyler N.K.,Mathematica Policy Research Inc.
American Journal of Preventive Medicine | Year: 2011

Background: To date, no study has objectively measured physical activity levels among U.S. adults according to the 2008 Physical Activity Guidelines for Americans (PAGA). Purpose: The purpose of this study was to assess self-reported and objectively measured physical activity among U.S. adults according to the PAGA. Methods: Using data from the NHANES 2005-2006, the PAGA were assessed using three physical activity calculations: moderate plus vigorous physical activity ≥150 minutes/week (MVPA); moderate plus two instances of vigorous physical activity ≥150 minutes/week (M2VPA); and time spent above 3 METs ≥500 MET-minutes/week (METPA). Self-reported physical activity included leisure, transportation, and household activities. Objective activity was measured using Actigraph accelerometers that were worn for 7 consecutive days. Analyses were conducted in 2009-2010. Results: U.S. adults reported 324.5±18.6 minutes/week (M±SE) of moderate physical activity and 73.6±3.9 minutes/week of vigorous physical activity, although accelerometry estimates were 45.1±4.6 minutes/week of moderate physical activity and 18.6±6.6 minutes/week of vigorous physical activity. The proportion of adults meeting the PAGA according to M2VPA was 62.0% for self-report and 9.6% for accelerometry. Conclusions: According to the NHANES 2005-2006, fewer than 10% of U.S. adults met the PAGA according to accelerometry. However, physical activity estimates vary substantially depending on whether self-reported or measured via accelerometer. © 2011 American Journal of Preventive Medicine.

Michalopoulos C.,MDRC | Wittenburg D.,Mathematica Policy Research Inc. | Israel D.A.R.,MDRC | Warren A.,MDRC
Medical Care | Year: 2012

Background: Under current law, most Social Security Disability Insurance (SSDI) beneficiaries are not eligible for Medicare until 29 months after the Social Security Administration determines the onset of their disability. During this waiting period, >1 in 5 lacks health insurance. This study investigated the effects of providing health care benefits on the health, employment, and other services of uninsured beneficiaries. Methods: New SSDI beneficiaries without health insurance were randomly assigned to receive health care benefits, health care benefits plus additional supports, or a control group. Results: Compared with a control group, those provided health care benefits used more health care, had fewer unmet medical needs, spent less out of pocket on health care, and reported improved health. In addition, those provided the additional supports were more likely to look for work, but the supports did not affect work or SSDI benefits at this very early period. Conclusions: The results provide rigorous evidence that health care benefits can increase health care use and health outcomes. Longer-term follow-up is needed to fully assess the program's effects on its ultimate benefits and costs, including its long-term effects on health, employment, and benefit receipt. © 2012 by Lippincott Williams & Wilkins.

Memtsoudis S.G.,New York Medical College | Besculides M.C.,Mathematica Policy Research Inc.
Best Practice and Research: Clinical Anaesthesiology | Year: 2011

The goal of comparative effectiveness research (CER) is to improve effectiveness, efficacy and efficiency in health care. While CER seems to present a major opportunity to introduce accountability into health care by identifying and promoting best practices in medicine, many issues surrounding CER remain poorly understood by clinicians and researchers, including what study designs are most appropriate for such research and what analytic tools are most helpful. The goal of this review is therefore to provide background and definitions of what constitutes CER and to discuss the various study designs and their strengths and weaknesses in achieving the stated goals of CER, while relating them to examples relevant to perioperative research. We provide a brief outline of the types of analytic methods particularly useful for CER and connect the reader to references for their practice. Finally, we assess the role of CER in perioperative research and provide some thoughts on future paths. © 2011 Elsevier Ltd. All rights reserved.

Brown J.D.,Mathematica Policy Research Inc. | Wissow L.S.,Johns Hopkins University
Administration and Policy in Mental Health and Mental Health Services Research | Year: 2012

Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training. © Springer Science+Business Media, LLC 2011.

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