Category Archives: Medicaid
Human Capital News Roundup: Oregon’s Medicaid system, ‘healthy’ fast food restaurants, primary care workforce innovation, and more.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni and grantees. Some recent examples:
RWJF Clinical Scholar Alan Teo, MD, MS, is the lead author of a study that finds the quality of a person’s social relationships influences the person's risk of major depression, regardless of how frequently their social interactions take place. “The magnitude of these results is similar to the well-established relationship between biological risk factors and cardiovascular disease,” Teo told Health Canal. “What that means is that if we can teach people how to improve the quality of their relationships, we may be able to prevent or reduce the devastating effects of clinical depression.”
RWJF recently announced the selection of 30 primary care practices as exemplary models of workforce innovation. The practices will serve as the basis for a new project: The Primary Care Team: Learning from Effective Ambulatory Practices (LEAP). Among them is CareSouth Carolina, the Hartsville Messenger reports. Learn more about the LEAP project and the practices selected for the program.
Low-income Oregonians who received access to Medicaid over the past two years used more health care services, and had higher rates of diabetes detection and management, lower rates of depression, and reduced financial strain than those without access to Medicaid, according to a study co-authored by RWJF Investigator Award in Health Policy Research recipient Amy N. Finkelstein, PhD, MPhil. The study found no significant effect, however, on the diagnosis or treatment rates of hypertension or high cholesterol levels. Among the outlets to report on the findings: Forbes, the New York Times, the Washington Post Wonk blog, Health Day, and the Boston Globe Health Stew blog. Read more about Finkelstein’s research on the Oregon Medicaid system.
What the Election Means for Health and Health Care… The Re-Election of President Obama Curtails the Likelihood of Major Medicaid Reductions
Frank J. Thompson, PhD, is a professor at the School of Public Affairs and Administrations and at the Center for State Health Policy at Rutgers, The State University of New Jersey. Thompson is a 2007 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research, studying Medicaid: Political Durability, Democratic Process and Health Care Reform. The RWJF Human Capital Blog asked scholars and fellows from a few of its programs to consider what the election results will mean for health and health care in the United States.
Human Capital Blog: What do you think the election will mean for the country’s health care system?
Thompson: It means that the country can go forward with implementing the Affordable Care Act (ACA). My research focuses on Medicaid—the federal grant program to the states that insures some 65 million low-income people. Under the ACA, Medicaid is slated to cover most people with incomes up to 133 percent of the poverty line as of 2014. In the recent election, the differences between the two parties on the ACA and Medicaid were stark. The Romney-Ryan ticket pledged not only to repeal the ACA but to convert Medicaid to a block grant and to cut funding for the program by more than 30 percent over ten years. The degree to which a Romney administration would have achieved these objectives remains an open question. But the reelection of President Obama curtails the likelihood of major Medicaid reductions over the next four years.
Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:
- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.
- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.
- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.
- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.
- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.
- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.
- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.
- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.
Around the country, print, broadcast and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows and grantees. Some recent examples:
RWJF/ U.S. Department of Veterans Affairs Clinical Scholar Charles D. Scales, Jr., MD, spoke to NPR about a kidney stone “epidemic.” Scales led a study that finds the prevalence of kidney stones has nearly doubled since the mid-1990s, likely due to dietary and lifestyle changes that have led to increasing rates of obesity, diabetes, and gout. Read more about his research.
RWJF Investigator Award in Health Policy Research recipient Matthew C. Nisbet, PhD, MS, also spoke to NPR about his research on how to frame the climate change debate to best persuade and move people to action. Nisbet conducted the research with fellow Investigator Edward W. Maibach, PhD, MPH. Read more about their research, and read a Q&A with Nisbet about framing public health issues.
Separately, the Christian Science Monitor spoke to Maibach, director of the Center for Climate Change Communication at George Mason University, about a poll the Center conducted last spring on global warming and how much of a priority the issue should be for the President and Congress.
“After 9/11, America’s about 10 million Arab and Muslim Americans, who were too often the victims of association with the perpetrators of the attacks, were—and continue to be—subjects of suspicion, discrimination, and abuse,” Clinical Scholars alumnus Aasim Padela, MD, MSc, writes on CNN’s Global Public Square blog. “As researchers who study the health of Arab and Muslim Americans, we regularly see the toll this climate of discrimination takes upon these communities… Healing our country after 9/11 must mean healing all Americans affected by that day, and the memory of 9/11 should not be used to discriminate against or marginalize any American. Ensuring that this is the case is the only way this country can continue to work to heal the gaping wound those attacks left on the social fabric of our entire country.” Read a post Padela wrote for the RWJF Human Capital Blog.
Last week, the Robert Wood Johnson Foundation (RWJF) and The Alliance for Health Reform sponsored a briefing to discuss oral health care in the United States, particularly for children and other vulnerable populations.
The discussion was co-moderated by David Krol, MD, MPH, FAAP, RWJF Human Capital Portfolio team director and senior program officer. “Oral health is an integral part of overall health,” he said. It faces the same challenges as overall health care, including “racial, ethnic, geographic disparities in disease and access to care, financing challenges, issues of determining and maintaining quality of care, and workforce controversies.” Krol said he would like to see “all conversations on health and health care… naturally include oral health.”
In 2009, preventable dental conditions accounted for more than 830,000 emergency department visits nationwide, Julie Stitzel, MA, of the Pew Center on the States’ Children’s Dental Campaign told the audience. Children were the patients for 50,000 of those visits. “There’s a real opportunity for states to save money because these visits, again, are totally preventable,” she said. “We know that getting treated in an emergency room is much more costly than the care delivered in a dental office, and states are bearing a significant share of these expenses through Medicaid and other public programs.”
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
Patrick H. Conway, M.D., M.Sc., is an alumnus of the Robert Wood Johnson (RWJ) Foundation Clinical Scholars program (2005 – 2007) and the new Chief Medical Officer for the Centers for Medicare & Medicaid Services.
I am writing to update the RWJ Clinical Scholars “Family,” the Foundation community and friends, on a new career development. For those whom I haven’t met, I was a RWJ Clinical Scholar at the University of Pennsylvania. I recently took on the role of Chief Medical Officer for the Centers for Medicare & Medicaid Services (CMS) and Director of the Office of Clinical Standards and Quality (OCSQ) for CMS. I report directly to Dr. Don Berwick, the Administrator, and have already learned a lot from him.
The Chief Medical Officer (CMO) portion of this role entails being the senior clinical advisor to the Administrator of CMS, representing the agency to a wide range of stakeholders, and shaping policy across the agency. I work closely with regional CMS CMOs across the country.
The Director of OCSQ role entails leading an office of hundreds of staff, thousands of contractors, and a budget exceeding $1.3 billion annually. Our office is responsible for all quality measures for CMS, including how the measures link to payment. We are responsible for programs such as value-based purchasing for hospitals and other providers, the hospital inpatient quality reporting program, and physician quality reporting system. We are working to align measures across programs, focus on outcomes when possible, improve patient safety, and incentivize coordinated care across settings. We lead quality improvement organizations (QIOs) in all 50 states and three territories and we plan to further develop these organizations into learning networks supporting improvement directly at the front lines of care.
The office is also responsible for all coverage decisions for CMS, including provider services, medical devices and biologics, and diagnostic testing. We believe these coverage decisions can better support quality of care and evidence development.
We are also responsible for all clinical standards, such as conditions of participation, for CMS. We are currently rewriting the hospital conditions of participation, which would be the first time that these have been updated in decades. These conditions guide the survey and certification work done across the country by Joint Commission and CMS surveyors.
Finally, the office contains the information systems group that supports collection of quality measurement data from hospitals, physicians, and other providers across the country.
Amy N. Finkelstein, Ph.D., M.Phil., is a 2003 Robert Wood Johnson Foundation Investigator Award in Health Policy Research recipient and a professor of economics at the Massachusetts Institute of Technology (MIT). Finkelstein gave the following interview to the Human Capital Blog as part of our ongoing Voices from the Field series. Read more about her research.
Human Capital Blog: How did you come up with the idea for this study?
Amy Finkelstein: In early 2008 I heard a story on the radio about how the state of Oregon was conducting a lottery for access to Medicaid. It was one of those once-in-a-lifetime moments in which I thought "I must drop everything and look into this right away!" and so that's what I did. This was, literally, the chance of a lifetime: the opportunity to bring the gold standard of medical and scientific research—a randomized controlled trial—to an important social science and policy question.
HCB: Why hasn’t this kind of randomized control trial study of Medicaid been done before?
Finkelstein: There have been two major impediments to doing a randomized control trial of the effects of being uninsured relative to having insurance. The first is ethical concerns regarding doing such a randomization for research purposes. In our case this wasn't an issue because the state of Oregon had decided that a lottery was the fairest way to allocate a limited number of Medicaid slots. It was doing it for policy, not research purposes. Fortunately however the state also saw the enormous potential to learn from this opportunity and generously collaborated with researchers at Harvard, MIT, Providence Health & Services, and the National Bureau of Economic Research to make this possible.
The second major impediment of course was funding. Here we were extremely fortunate to have such generous funders, including of course the Robert Wood Johnson Foundation!
HCB: What were some of the most surprising findings?
A newly released study from the U.S. Government Accountability Office (GAO) finds that children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) have a much harder time obtaining care from medical specialists than do children who are privately insured.
The GAO based its conclusions on its 2010 survey of physicians. Its key findings:
- “More than three-quarters of primary and specialty care physicians are enrolled as Medicaid and CHIP providers and serving children in those programs.”
- “A larger share of primary care physicians (83 percent) are participating in the programs—enrolled as a provider and serving Medicaid and CHIP children—than specialty physicians (71 percent).”