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Articles 1 - 30 of 412

Full-Text Articles in Health Law and Policy

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon Jun 2019

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon

Commonwealth Medicine Publications

Targeted strategies and sustained efforts at member outreach and engagement are helping Accountable Care Organizations (ACOs) and their Community Partners (CPs) achieve their shared goals for delivering patient-centered care. The most successful organizations focus on activities designed to create a stronger connection with their members, building trust and a better understanding of individuals’ characteristics and care needs. Positive results of these efforts include successful person-centered care planning, improved compliance with care plans and prescriptions, and implementation of recommended lifestyle changes — changes that help support independent living, reduce medical costs and complications, and drive improvements in member satisfaction.


University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish Jun 2019

University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish

Commonwealth Medicine Publications

On behalf of the Minnesota Department of Health Services, Health Law & Policy experts from our Public and Private Health Solutions group completed a literature review of successful efforts to improve the health of previously incarcerated individuals. In addition, our experts conducted five focus groups to obtain recommendations from experienced professionals who work directly with previously incarcerated individuals regarding interventions likely to improve the health of this unique population.

This study came about at the direction of Minnesota Legislature. They were interested in developing a methodology for paying higher rates to health care providers who provide services to high cost and ...


Health Care's Market Bureaucracy, Allison K. Hoffman May 2019

Health Care's Market Bureaucracy, Allison K. Hoffman

Faculty Scholarship at Penn Law

The last several decades of health law and policy have been built on a foundation of economic theory. This theory supported the proliferation of market-based policies that promised maximum efficiency and minimal bureaucracy. Neither of these promises has been realized. A mounting body of empirical research discussed in this Article makes clear that leading market-based policies are not efficient — they fail to capture what people want. Even more, this Article describes how the struggle to bolster these policies — through constant regulatory, technocratic tinkering that aims to improve the market and the decision-making of consumers in it — has produced a massive ...


Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six, Robin E. Clark, Linda Weinreb, Julie M. Flahive, Robert W. Seifert May 2019

Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six, Robin E. Clark, Linda Weinreb, Julie M. Flahive, Robert W. Seifert

Commonwealth Medicine Publications

Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care ...


Will Ending Certain Drug Rebates Lower List Prices And Patient Out-Of-Pocket Costs?, Mckenzie Taylor, Stephanie Tran Apr 2019

Will Ending Certain Drug Rebates Lower List Prices And Patient Out-Of-Pocket Costs?, Mckenzie Taylor, Stephanie Tran

Commonwealth Medicine Publications

Earlier this year, the Department of Health and Human Services (HHS) proposed changes to the current pricing and contracting system for federal health care programs, Medicare Part D and Medicaid.This proposal aligns with the Trump Administration’s blueprint for lowering drug prices which we have written about previously.


The Expanding Role Of Pharmacists: A Positive Shift For Health Care, Ashley Chiara Mar 2019

The Expanding Role Of Pharmacists: A Positive Shift For Health Care, Ashley Chiara

Commonwealth Medicine Publications

When reflecting upon the impactful members of a patient’s healthcare team, much consideration is given to the patient’s nurses, primary care physician and specialists. However, with nearly nine in 10 Americans living within five miles of a community pharmacy, and four in five receiving prescription benefits through a pharmacy benefit manager (PBM), the role of the pharmacist in orchestrating a patient’s care on the front lines is often overlooked.


Payment Reform For Kids, Robert W. Seifert Feb 2019

Payment Reform For Kids, Robert W. Seifert

Commonwealth Medicine Publications

Comprehensive care for children – including greater attention to behavioral health, socio-emotional development, and strong family relationships – may hold the key to lifelong health and well-being. With this premise, a group in Connecticut has just published recommendations for improving pediatric primary care through payment reform.


Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price Jan 2019

Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price

Commonwealth Medicine Publications

Prohibiting gag clauses could help lower consumer out-of-pocket pharmacy costs - if Pharmacy Benefits Managers don't raise prices to make-up the difference. Mylissa Price closes our blog series on President Trump's Blueprint to Lower Drug Costs in this final entry.


Deciphering State Medicaid Programs, Rachel Gershon Jan 2019

Deciphering State Medicaid Programs, Rachel Gershon

Commonwealth Medicine Publications

State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.


An Analysis And Critique Of Mental Health Treatment In American State Prisons And Proposal For Improved Care, Shelby Hayne Jan 2019

An Analysis And Critique Of Mental Health Treatment In American State Prisons And Proposal For Improved Care, Shelby Hayne

Scripps Senior Theses

Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost-effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental ...


Rethinking Consumer Protection: Escaping Death By Regulation, Thomas L. Tacker Jan 2019

Rethinking Consumer Protection: Escaping Death By Regulation, Thomas L. Tacker

Publications

This book is designed to appeal to anyone who is at all interested in topics related to making life better and safer—for all us consumers. Our current approach to consumer protection is extremely flawed; sometimes costing lives rather than saving them. There are better ways to protect ourselves and the people we love.


Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler Jan 2019

Unlocking Access To Health Care: A Federalist Approach To Reforming Occupational Licensing, Gabriel Scheffler

Faculty Scholarship at Penn Law

Several features of the existing occupational licensing system impede access to health care without providing appreciable protections for patients. Licensing restrictions prevent health care providers from offering services to the full extent of their competency, obstruct the adoption of telehealth, and deter foreign-trained providers from practicing in the United States. Scholars and policymakers have proposed a number of reforms to this system over the years, but these proposals have had a limited impact for political and institutional reasons.

Still, there are grounds for optimism. In recent years, the federal government has taken a range of initial steps to reform licensing ...


The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah Jan 2019

The Shadows Of Life: Medicaid's Failure Of Health Care's Moral Test, Barak D. Richman, Kushal T. Kadakia, Shivani A. Shah

Faculty Scholarship

North Carolina Medicaid covers one-fifth of the state’s population and makes up approximately one-third of the budget. Yet the state has experienced increasing costs and worsening health outcomes over the past decade, while socioeconomic disparities persist among communities. In this article, the authors explore the factors that influence these trends and provide a series of policy lessons to inform the state’s current reform efforts following the recent approval of North Carolina’s Section 1115 waiver by the Centers for Medicare and Medicaid Services. The authors used health, social, and financial data from the state Department of Health and ...


Legitimacy & Litigation: The Right To Health Care, Colleen M. Flood Jan 2019

Legitimacy & Litigation: The Right To Health Care, Colleen M. Flood

Washington University Global Studies Law Review

Much ink has been spilt by scholars over how courts should adjudicate socioeconomic rights, frequently by scholars in countries that do not expressly include such rights in their constitution. Pedro Felipe de Oliveira Santos describes well the formalist approach that drives many jurists and scholars to argue for minimalism on the part of courts adjudicating socioeconomic rights. The separation of power(s) argument is that courts are not democratically elected–governments are–and so the latter should be responsible for the complex trade-offs involved in allocating public funds to social programs.


Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran Dec 2018

Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran

Commonwealth Medicine Publications

The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs calls for incentives to lower drug list prices, including removing rebates. Our clinical consultant Stephanie Tran continues our pharmacy blog series with an assessment of this potential change & its impacts.


New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri Dec 2018

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri

Commonwealth Medicine Publications

New Trump Administrations Section 1332 waiver guidance increases state ACA flexibility. Rachel Gershon & Catie Torri discuss what this could mean for health care policy.


Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor Nov 2018

Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor

Commonwealth Medicine Publications

Mckenzie Taylor continues our monthly conversation on the strategies presented in The Trump Administration Blueprint to Low Drug Prices and Reduce Out-of-Pocket Costs, discussing the ways new negotiations between payers and manufacturers are helping to reduce drug prices.


Why Retirement Systems Should Consider Vocational Review, Jody Simpson Nov 2018

Why Retirement Systems Should Consider Vocational Review, Jody Simpson

Commonwealth Medicine Publications

Whether the task is determining if a disability retirement applicant is prevented from performing their past public employment or whether they are able to adjust to other substantial work, administering disability benefit claims is a complex process that requires a sophisticated skill-set to ensure accurate and objective determinations. A critical component of that process is a comprehensive vocational assessment that determines a disability applicants vocational skills and abilities before a final recommendation is rendered.

Discover the value of vocational review and why it can be a critical part of the decision-making process.


Hospital Mergers And Public Accountability: Tennessee And Virginia Employ A Certificate Of Public Advantage, Erin C. Fuse Brown Nov 2018

Hospital Mergers And Public Accountability: Tennessee And Virginia Employ A Certificate Of Public Advantage, Erin C. Fuse Brown

Erin C. Fuse Brown

No abstract provided.


How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih Oct 2018

How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih

Commonwealth Medicine Publications

In this installment of our blog series on "President Trump's Blueprint to Lower Drug Prices and Reduce Out-Of-Pocket Costs," our pharmacy expert Youkavet Samih discusses how creating drug competition drives down prices for consumers.


Legalization Of Physician-Assisted Suicide For Increased Patient Autonomy, Morgan Mcenroe Oct 2018

Legalization Of Physician-Assisted Suicide For Increased Patient Autonomy, Morgan Mcenroe

Religion: Student Scholarship & Creative Works

This essay features an assessment of the various factors which play into the argument for legalization of physician-assisted suicide (PAS) in the United States for increased patient autonomy. Arguments for legalization of PAS as a means of end-of-life care remain separate from voluntary euthanasia. National legalization of PAS, for this fundamental principle of hospice care, is necessary to allow a choice to those in their final stages of life of how they wish to leave. If the values of PAS advocates are maximization of autonomy and minimization of suffering, then it follows that the chronically depressed, as well as patients ...


Hiring Workers With Disabilities Makes Sense Whether The Job Market Is Hot Or Cold, Kathleen A. Petkauskos Oct 2018

Hiring Workers With Disabilities Makes Sense Whether The Job Market Is Hot Or Cold, Kathleen A. Petkauskos

Commonwealth Medicine Publications

The U.S. Department of Labor released its latest report in September, and it was more of the same. Unemployment remained at 3.9 percent, where it has hovered for much of the year, but there was a shift for one key demographic.

After decades of struggle, workers with disabilities are beginning to move the needle, outpacing the employment gains of people without disabilities. In August 2018, the employment-to-population ratio for working-age people with disabilities jumped to 30.2 percent from 29.5 percent the year before. The labor force participation rate for working-age people with disabilities also increased, rising ...


Utilization Management Programs Are Critical For Effective Mltss Programs, Jessica Carpenter Oct 2018

Utilization Management Programs Are Critical For Effective Mltss Programs, Jessica Carpenter

Commonwealth Medicine Publications

When discussing an efficient managed long-term services and supports (LTSS) program, the importance of a utilization management program cannot be overlooked. It’s a way to not only ensure individuals receive the high-quality services they need, but also realize substantial cost savings for payers.


A View Of The Drug Pricing Blueprint, Bonnie C. Greenwood Sep 2018

A View Of The Drug Pricing Blueprint, Bonnie C. Greenwood

Commonwealth Medicine Publications

Drug spend is predicted to experience the fastest annual growth between 2017-2026 compared to other health care goods and services.Contributing factors include increasing unit prices of branded and generic medications, growth of the specialty drug market, and greater numbers of people with access to prescription drug coverage. A recent analysis estimates total drug expenditures in 2016 to be $480 billion when accounting for gross profits of intermediaries in the distribution chain, such as wholesalers, pharmacy benefit managers (PBMs), and pharmacies. Certainly, the complexity of the drug distribution and reimbursement system and lack of pricing transparency can be viewed both ...


Hospital Mergers And Public Accountability: Tennessee And Virginia Employ A Certificate Of Public Advantage, Erin C. Fuse Brown Sep 2018

Hospital Mergers And Public Accountability: Tennessee And Virginia Employ A Certificate Of Public Advantage, Erin C. Fuse Brown

Faculty Publications By Year

No abstract provided.


Case Files Key To Comprehensive Medical Board Reviews, Jody Simpson Aug 2018

Case Files Key To Comprehensive Medical Board Reviews, Jody Simpson

Commonwealth Medicine Publications

There are many obstacles public retirement systems must overcome to ensure clinically sound medical board recommendations. Complex medical records that describe various conditions and ailmentsmust be compiled and analyzed to make accurate recommendations. There are key elements to inform a successful medical board review, and chief among them is compiling robust, well-documented case files. If you begin the process with incomplete documentation, you run the risk of getting a partial clinical picture of the member. Not having a full clinical picture could make it difficult to achieve a fully-informed decision.


Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman Aug 2018

Bringing Data Into Focus To Optimize Benefits And Savings For Medicare-Medicaid Members, Jenifer Hartman

Commonwealth Medicine Publications

Dual eligible recipients represent a critical population for state Medicaid programs. To get a better understanding of this unique demographic, MassHealth partnered with UMass Medical School to design data analytics programs around the objective of protecting Medicaid as the payer of last resort.

Over the last three years, these programs achieved over $68 million in new savings by optimizing benefits for dual eligible members. The program also identified and recovered over $21 million in Medicare premium overpayments for Medicaid members with discrepancies in Medicare entitlement and premium charges.

Jenifer Hartman of the Center for Healthcare Financing presented UMass Medical School ...


Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter Aug 2018

Managed Long-Term Services And Supports Program Framework: Best Practices, Jessica Carpenter

Commonwealth Medicine Publications

Health plans and accountable care organizations are working with Medicaid programs to transition fee-for-services long-term services and supports (LTSS) to a managed care model known as managed LTSS. With more individuals with disabilities seeking to living in their own homes or in community settings, payers must take proactive steps to ensure individuals receive the right service and in the right setting. This white paper details the actions health plan decision makers should consider while developing a comprehensive managed LTSS program.


Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan Aug 2018

Sne-Ptn Attends Cms Transforming Clinical Practice Initiative National Expert Panel 2018, Jay Flanagan

Commonwealth Medicine Publications

Practice transformation networks from across the country are going public with their successful results on patients and clinical practices. UMass Medical School’s Southern New England Practice Transformation Network (SNE-PTN) was one of the networks sharing its positive outcomes.


The Role Of Health Care In Criminal Justice Reform, Julie White Jul 2018

The Role Of Health Care In Criminal Justice Reform, Julie White

Commonwealth Medicine Publications

Mass incarceration continues to be problem in United States with over 2.2 million people incarcerated, costing approximately $80 billion in taxes annually. As a result of the coalescence of social policy researchers, restorative justice policies, civil rights activists, and economists, there is recognition that incarceration is not a financially sustainable ‘solution’ to crime.