Gilbert Gimm

Ebola crisis of 2014: are current strategies enough to meet the long-run challenges ahead?

The outbreak of the Ebola virus disease (EVD) in 2014 mobilized international efforts to contain a global health crisis. The emergence of the deadly virus in the United States and Europe among health care workers intensified fears of a worldwide epidemic. Market incentives for pharmaceutical firms to allocate their research and development resources toward Ebola treatments were weak because the limited number of EVD cases were previously confined to rural areas of West Africa. We discuss 3 policy recommendations to address the long-term challenges of EVD in an interconnected world.

The financial performance of integrated health organizations.

EXECUTIVE SUMMARY This study examines the impact of integration strategies on the financial performance of hospitals, physicians, and health plans over time. Results from a study of 36 large integrated health organizations (IHOs) suggest that financial performance is adversely affected by the scale of investment in integration but not necessarily by the timing or sequencing of the investments made. The results also suggest that some integration strategies have more detrimental effects on financial performance than do others. Finally, the results show that centralized integrative structures appear more financially successful than are less centralized structures.

Impact of early intervention programs for working adults with potentially disabling conditions: Evidence from the national DMIE evaluation

This article examines results from a study using random assignment and data from Social Security Administration files and state-based surveys to assess whether the DMIE, as implemented in these states, had a significant impact on the number of applications submitted for federal disability benefit programs and changed participants’ employment outcomes. Among other findings, the study showed that the early intervention programs were effective in reducing applications to federal disability programs 12 months after enrollment in the two states (Minnesota and Texas) with the largest number of participants.

The CareFirst Patient-Centered Medical Home Program: Cost and Utilization Effects in Its First Three Years

BackgroundEnhanced primary care models have diffused slowly and shown uneven results. Because their structural features are costly and challenging for small practices to implement, they offer modest rewards for improved performance, and improvement takes time.ObjectiveTo test whether a patient-centered medical home (PCMH) model that significantly rewarded cost savings and accommodated small primary care practices was associated with lower spending, fewer hospital admissions, and fewer emergency room visits.DesignWe compared medical care expenditures and utilization among adults who participated in the PCMH program to adults who did not participate. We computed difference-in-difference estimates using two-part multivariate generalized linear models for expenditures and negative binomial models for utilization. Control variables included patient demographics, county, chronic condition indicators, and illness severity.ParticipantsA total of 1,433,297 adults aged 18–64 years, residing in Maryland, Virginia, and the District of Columbia, and insured by CareFirst for at least 3 consecutive months between 2010 and 2013.InterventionCareFirst implemented enhanced fee-for-service payments to the practices, offered a large retrospective bonus if annual cost and quality targets were exceeded, and provided information and care coordination support.MeasuresOutcomes were quarterly claims expenditures per member for all covered services, inpatient care, emergency care, and prescription drugs, and quarterly inpatient admissions and emergency room visits.ResultsBy the third intervention year, annual adjusted total claims payments were

Return to work: A critical aspect of care coordination for younger dual eligibles

109 per participating member (95 % CI: −

The Effects of State Policy Decisions on the Employment and Earnings of Medicaid Buy-In Participants in 2006

192, −

Falls, Depression, and Other Hospitalization Risk Factors for Adults in Residential Care Facilities:

27), or 2.8 % lower than before the program and compared to those who did not participate. Forty-two percent of the overall decline in spending was explained by lower inpatient care, emergency care, and prescription drug spending. Much of the reduction in inpatient and emergency spending was explained by lower utilization of services.ConclusionsA PCMH model that does not require practices to make infrastructure investments and that rewards cost savings can reduce spending and utilization.

Examining access to care for younger vs. older dual-eligible adults living in the community.

BACKGROUND Annual health care costs for dual eligibles now top

Early interventions to prevent disability for workers with mental health conditions: Impacts from the DMIE

300 billion. Many dual eligibles are under age 65 and their needs differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for coordinated care. OBJECTIVES To assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence among these subgroups of factors associated with return to work. METHODS Population estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS). RESULTS Although they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42% of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees (AOR = 19.8, 95% CI = 16.2-24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied with the quality of the care they receive. CONCLUSIONS Dual eligible workers with disabilities are an important target population for coordinated services because of their high lifetime program costs - many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on federal disability programs.

Resident Aggression and Abuse in Assisted Living.

This article examines the Medicaid Buy-In program, so named because workers with disabilities “buy into” Medicaid coverage with monthly premiums. In 2006, 97,491 individuals were enrolled in 32 state Buy-In programs. States have taken different pathways toward the program’s dual objectives: expanding Medicaid coverage to vulnerable populations and promoting employment of working-age adults with disabilities. Analyses indicate that (a) some states appear to have accomplished both objectives, whereas other states have emphasized one over the other, and that (b) certain program features (e.g., higher earned income limits) contribute to both larger percentages of Buy-In participants who are employed and higher earnings of employed participants. The authors’ findings have implications for Buy-In design and the study of federalism in health care.