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Sara Rosenbaum

Publications and source records attributed to Sara Rosenbaum.

At least 37 records · Page 2Linked to original sources
PubMed2002

Improving childhood asthma outcomes in the United States: a blueprint for policy action.

BACKGROUND/OBJECTIVE: Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area. DESIGN/METHODS: A nominal group process with nationally recognized experts and leaders (referred to as "the committee") in childhood asthma. RESULTS: The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended. CONCLUSIONS: Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. childhood asthma, health care policy, health care services.

Advisory Committees↗
PubMed2002

Evaluation of agreements between managed care organizations and providers of community-based mental illness and addiction disorder treatments.

OBJECTIVE: To analyze the scope, content, and nature of contracts between managed care organizations (MCOs) and community-based mental illness and addiction disorder treatment and prevention service providers, focusing on implications for managed care policy. STUDY DESIGN: Qualitative and quantitative document content analysis. METHODS: We reviewed and coded 107 provider contracts from 17 states. Data were aggregated on MCO and provider demographics, scope of services, contractual obligations, and financial reimbursement mechanisms. Results were compared with those from a similar study conducted in 1996 with a sample of 50 contracts to identify changes over time. RESULTS: The MCOs purchased relatively few services from providers, omitting many services integral to the proper management of mental illness and addiction disorders. Service duties were often ambiguously described, leading to potentially significant and unanticipated financial risk for providers. The MCOs exert strong control over treatment decision making. Capitation and other risk-based payment arrangements are increasingly common, although most continue to use fee-for-service reimbursement methods. Contracts are structured to remove provider bargaining power; they allow MCOs to unilaterally amend all provisions on notice and without negotiation and permit termination "at will." CONCLUSIONS: Managed care contracts favor the needs of the managed care industry and are constructed to (1) shift significant amounts of financial risk onto providers and (2) manage and restrain providers' choices over the use of benefits through close oversight, financial controls, and incentives. Because a signed contract is a precondition to access to patients and insurance revenues, health professionals must sign them and indicate a general inability to negotiate their terms.

Community Mental Health Services↗
PubMed2002

Public health emergencies and the public health/managed care challenge.

The relationship between insurance and public health is an enduring topic in public health policy and practice. Insurers share certain attributes with public health. But public health agencies operate in relation to the entire community that they are empowered by public law to serve and without regard to the insurance status of community residents; on the other hand, insurers (whether managed care or otherwise) are risk-bearing entities whose obligations are contractually defined and limited to enrolled members and sponsors. Public insurers such as Medicare and Medicaid operate under similar constraints. The fundamental characteristics that distinguish managed care-style insurance and public health become particularly evident during periods of public health emergency, when a public health agency's basic obligations to act with speed and flexibility may come face to face with the constraints on available financing that are inherent in the structure of insurance. Because more than 70% of all personal health care in the United States is financed through insurance, public health agencies effectively depend on insurers to finance necessary care and provide essential patient-level data to the public health system. Critical issues of state and federal policy arise in the context of the public health/insurance relations during public health emergencies. These issues focus on coverage and the power to make coverage decisions, as well as the power to define service networks and classify certain data as exempt from public reporting. The extent to which a formal regulatory approach may become necessary is significantly affected by the extent to which private entities themselves respond to the problem with active efforts to redesign their services and operations to include capabilities and accountability in the realm of public health emergency response.

Disasters↗
PubMed2002

State eligibility rules under separate state SCHIP programs--implications for children's access to health care.

This Policy Brief is the fourth in a series of reports issued by the George Washington University Center for Health Services Research and Policy that examine the design of separately-administered State Children's Health Insurance Programs (SCHIP) that is, programs that operate directly under the authority of the federal SCHIP statute rather than expansions of state Medicaid programs. These Policy Briefs also consider the implications of states' design choices for children's access to health care. The first three briefs in this series focused on three aspects of separate SCHIP programs: children's legal right to assistance under separate programs; benefit and coverage design choices under SCHIP plans; and the design and structure of freestanding managed care contracts negotiated by SCHIP agencies. This issue brief focuses on how financial eligibility for SCHIP actually is calculated, that is, the formulas that states have developed to count children's family income for purposes of measuring eligibility. This topic is of central importance to overall program administration because of the federal legal prohibition against assistance to targeted low-income children who are in fact Medicaid-eligible. This prohibition on duplication of assistance was a crucial assumption in the enactment of SCHIP. It is also key to the conservation of limited SCHIP funding for targeted low-income children who are ineligible for either Medicaid or any other form of health insurance, particularly as unemployment rises and the number of lower income children without health insurance may be poised to increase.

Child↗
PubMed2002

Behavioral health and managed care contracting under SCHIP.

This Policy Brief examines behavioral health managed care contracting under separately administered State Children's Health Insurance Programs (SCHIP), i.e., programs that operate under the direct authority of Title XXI of the Social Security Act rather than as expansions of Medicaid. Most separate SCHIP programs buy managed care style health insurance for some or most of their enrolled children. Because Title XXI provides states with far greater administrative flexibility than Medicaid with respect to coverage and benefit design, provision of services, and administration of managed care arrangements,studying separate SCHIP managed care products sheds important light on how states might approach insurance and managed care design generally in the area of behavioral health were Medicaid modified through section 1115 demonstration or federal statutory authority to permit greater latitude. To conduct this analysis, two nationwide databases maintained by the George Washington University Center for Health Services Research and Policy (CHSRP) were used: a database consisting of all Medicaid MCO-style managed care contracts in use in Calendar Year 2000; and a nationwide database consisting of contracts used by separate SCHIP programs for the same calendar year. As of the point of collection in 2000 there were 33 such separate programs; according to CMS' latest website information, that total has now reached 35. Both sets of contracts were analyzed and separated into their components by lawyers experienced in managed care contract analysis and interpretation. The data were entered into working tables that organize the contents of the contracts into a series of searchable domains.

Child↗
PubMedDate not supplied

Medicaid's role in ambulatory health care.

Medicaid plays an enormously important role in ambulatory care financing, both primary and specialized, for patients with routine health needs, as well as individuals with chronic illness and disability. Nearly all Medicaid beneficiaries receive the vast bulk of their health care in ambulatory settings. Medicaid plays a critical role for low-income persons, including children, pregnant women and families, and elderly and disabled Medicare beneficiaries. The Bush administration's proposal to subject federal Medicaid spending to annual aggregate limits could be expected to have especially severe effects on states' capacity to support ambulatory services and achieve innovations in community-based care.

Adult↗
PubMedDate not supplied

Health centers at 40: implications for future public policy.

As health centers celebrate their 40th anniversary, the larger American healthcare system faces challenges as daunting as any in its history. These include rising, unchecked costs of care, deteriorating access to care--especially among low-income, uninsured, and minority Americans--and unsettled quality of care for many. The authors argue that, as policymakers face the challenge of health system reform, the health centers program serves as a potential model for improving the cost-effectiveness and appropriateness of healthcare, setting the course for primary healthcare. At the same time, the program's very future depends on matters that extend into the broadest reaches of US health policy, in the areas of coverage, finance, workforce, quality improvement, and population health.

Community Health Centers↗