Improving state Medicaid policies with comparative effectiveness research: a key role for academic health centers.
ABSTRACT After the Patient Protection and Affordable Care Act is fully implemented, Medicaid will be the largest single health care payer in the United States. Each U.S. state controls the size and scope of the medicine benefit beyond the federally mandated minimum; however, regulations that require balanced budgets and prohibit deficit spending limit each state's control. In a recessionary environment with reduced revenue, state Medicaid programs operate under a fixed or shrinking budget. Thus, the state Medicaid experience of providing high-quality care under explicit financial limits can inform Medicare and private payers of measures that control per-capita costs without adversely affecting health outcomes. The academic medicine community must play an expanded role in filling evidence gaps in order to continuously improve health policy making among U.S. states. The Drug Effectiveness Review Project and the Medicaid Evidence-based Decisions Project are two multistate Medicaid collaborations that leverage academic health center researchers' comparative effectiveness research (CER) projects to answer policy-relevant research questions. The authors of this article highlight how academic medicine can support states' health policies through CER and how CER-driven benefit-design choices can help states meet their cost and quality needs.
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ABSTRACT: State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council's "The Road Ahead: Research Partnership to Transform Services," ( http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf ), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals with mental disorders. The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states, and to address significant state-defined health policy initiatives. Five projects involving eight states were selected through peer review for funding. Projects began in 2009 and were funded for 3 years. This report provides a brief description of the five projects, followed by an analysis of the impact, challenges, and lessons learned from these policy-partnered studies. We conclude by offering suggestions on ways to use state administrative data for informing state health policies, which is especially timely given national and state changes in the structure and financing of healthcare.Administration and Policy in Mental Health and Mental Health Services Research 01/2015; · 3.44 Impact Factor
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ABSTRACT: State Medicaid programs are playing an increasingly important role in the U.S. health care system and represent a major expenditure as well as a major source of revenue for state budgets. The size and complexity of these programs will only increase with the implementation of the Patient Protection and Affordable Care Act. Yet, many state Medicaid programs lack the resources and breadth of expertise to maximize the value of their programs not only for their beneficiaries but also for all those served by the health care system.Universities, especially those with medical schools and other health science programs, can serve as valuable partners in helping state Medicaid programs achieve higher levels of performance, including designing and implementing new approaches for monitoring the effectiveness and outcomes of health services and developing and sharing knowledge about program outcomes. In turn, universities can expand their role in public policy decision making while taking advantage of opportunities for additional research, training, and funding. As of 2013, approximately a dozen universities have developed formal agreements to provide faculty and care delivery resources to support their state Medicaid programs. These examples offer a road map for how others might approach developing similar, mutually beneficial partnerships.Academic medicine: journal of the Association of American Medical Colleges 09/2013; · 2.34 Impact Factor
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ABSTRACT: Approximately 25-30% of the Nepalese population live below poverty line. Majority of them reside in a geographically inaccessible place while most of the health centers are focused in the urbanized cities of Nepal. Hence, they are deprived of quality health care at that level and need urgent attention by the concerned authorities. The government has not increased its human resource for health in the last two decades, while population has doubled up but the number of doctors serving in public sectors has remained the same as it was in 1990s. We have got 19 medical colleges at the moment. If one district is allocated to each medical colleges, it could help improve district health system at local level in Nepal. This can be accomplished by posting postgraduate resiendts in the peripheral district hospital as a part of their training and later encouraging them to serve for certain years. This could be a perfect example of government envisioned public private partnership in the country. This is a concept that has already been started in many parts of the world that can be moulded further to improve health service at peripheral part of the country. It is also the social accountability of the medical colleges for the development of the nation. Keywords: district health care system; medical education; social accountability.JNMA; journal of the Nepal Medical Association 52(187):142-147. · 0.17 Impact Factor