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Dear Health Committee Chairs:

These are excerpts from the August 2007 email update on state health policy resources available on the Internet. 

Looking Ahead 

The Fall Forum will be held November 26, 2007 - December 1, 2007, in Phoenix, Arizona.  Health-related sessions will be announced as they are developed.

Call for Proposals

State Health Access Reform Evaluation (SHARE)

On August 6^th, the Robert Wood Johnson Foundation, through the new State Health Access Reform Evaluation (SHARE) National Program, issued a call for proposals to support research and evaluation of state reform initiatives that focus on health care access. This solicitation supports the Foundation's activities to increase health care coverage and to evaluate reform efforts in a systematic way.  The State Health Access Data Assistance Center (SHADAC) in Minnesota is managing the solicitation in its role as the National Program Office for the SHARE initiative.    Larger-scale grants of up to $600,000 and smaller-scale grants under $200,000 will be awarded.  Larger-scale projects should be structured to run between 12 and 24 months, while smaller-scale projects should run between 12 and 18 months.  All applicants will be required to submit a brief proposal. These applications will be reviewed by SHARE staff and select applicants will be invited to submit a final grant application.  Brief proposals are due by Friday, September 14, 2007.

The call for proposals can be found at the SHARE website:  http://www.statereformevaluation.org/. 

For more information please direct questions to Deputy Director, Elizabeth Lukanen at elukanen@umn.edu or by phone at 612.626.1537.

After more than 10 years with the Health Chairs Project, Kala Ladenheim is leaving NCSL.  She sent us this note.

Dear Health Chairs,

Effective September 1^st, I will be leaving NCSL to return home to Maine, where I will be president/CEO of the Maine Center for Public Health.  I am delighted to be returning to Maine and excited about the new opportunities the job offers.  But leaving NCSL is hard.  NCSL has been an extraordinary place to work, and I’m pleased to believe that the colleagues I am leaving constitute one of the smartest and most vibrant units in a great organization.  Working with the Health Chairs has been the highlight of a great job.  Your knowledge, commitment, political and policy skills have been a source of inspiration and a challenge to excel.

Forum Director Donna Folkemer (Donna.Folkemer@ncsl.org) will continue to lead the Health Chairs Project, with close support from Sarah Steverman (Sarah.Steverman@ncsl.org), who many of you met at Chairs activities over the last year.  In addition, Kelly Wilkicki (mailto:Kelly.Wilkiki@ncsl.org) has taken the Health Chairs Bulletin in hand and will be editing it for the next year. 

With this move I become part of the NCSL alumni association.   I hope to continue to hear from many of you; email is cheap and easy and you are my community.  Maine is gorgeous at least 6 months of the year (and to my taste, all 12)  and I hope to see some of you up here!  My email in Maine after September 10  will be kladenheim@mcph.org. 

Resources Online

Kaiser Family Foundation’s statehealthfacts.org website recently updated its data pertaining to Medicaid & SCHIP, Health Status, HIV/AIDS, and Demographics & the Economy.  To access these resources and see what else has been added please visit  http://www.statehealthfacts.org/whatsnew.jsp.

Access

According to a Government Accountability Office (GAO) report released late June, the new proof of citizenship requirements have indeed reduced the number of Medicaid recipients, but that most of those removed were eligible but could not obtain proper documentation.  The GAO report also found that the new rules are expected to cost more than the savings they generate due to higher than expected administrative costs and lower than expected savings from ineligible noncitizens not receiving benefits.  A separate analysis by the House Committee on Oversight and Government Reform reported that in six states $8.3 million was spent to identify eight undocumented, and therefore ineligible, immigrants for a savings of $11,048.  To read a summary of the GAO report and House Committee analysis please visit  http://oversight.house.gov/documents/20070724110341.pdf.  The GAO report in its entirety can be found at http://www.gao.gov/new.items/d07889.pdf 

In an article published in Health Affairs, Benjamin Sommers discusses how poor retention of Medicaid and SCHIP recipients contributes to the 2/3 of uninsured children eligible but not enrolled.  This departs from most discussions regarding eligible but not enrolled children as a product of poor program outreach.  Results of this study reveal that 42 percent of uninsured but eligible children in 2006 had been enrolled in Medicaid or SCHIP in 2005.  This report includes state-by-state figures for legislators to determine if their decreased enrollment is more of a result of poor up-take or poor retention.  To view the report please visit http://content.healthaffairs.org/cgi/content/full/hlthaff.26.5.w560v1/DC1    

 

Costs

The Centers for Medicare and Medicaid Services (CMS) released a study of pay-for-performance incentives and their affect on overall costs.  The report compared 10 physician groups with doctors in the same locale on their adherence to quality criteria.  The report concluded that all 10 groups improved patient care during the first year, but only two groups reached the level for bonus payments.  These two groups were paid $7.3 million, and are estimated to have saved Medicare $95 million.  A critique of the report states that the selected physician groups were all large organizations with experience utilizing electronic health records.  The fact that only 2 of the selected groups could reach the reward level of care speaks to the difficulty of improving quality even for well established physician groups.  To view the report please visit  http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=2274&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

Providers and Workforce

The American Medical Association reports that more than 35 million people reside in underserved areas, and 16,000 physicians are needed to assuage this physician shortage which disproportionately affects rural areas and inner cities.  According to a GAO report, the number of physicians training with J-1 visas declined by approximately forty percent over the past ten years. J-1 waivers exist to allow foreign physicians to work in underserved areas for 3-5 years while seeking permanent residency.  Since 9/11 the federal government has implemented stricter rules for those seeking J-1 waivers, and as a result, only 61 have been approved since 2001.  To view the GAO report, please visit  http://www.gao.gov/new.items/d06773t.pdf

 

The Robert Graham Center and the American Academy of Family Physicians (AAFP) released graduate medical education (GME) payment tables for each teaching hospital years 2001-2005.  To find out rates for hospitals in your jurisdiction and see how they compare to other hospitals, please visit http://www.graham-center.org/PreBuilt/gme2001-2005.pdf

Oral Health

The National Academy for State Health Policy (NASHP) held a seminar on the potential utilization of Medicaid to improve access to oral health care. One of the most promising practices shared was the allowance of physicians and nurses to apply fluoride varnishes to at risk patients in their practices and receive Medicaid reimbursement for this activity.  To view the presentation and associated questions please visit http://www.talkpoint.com/viewer/presentation.asp

 

Quality and Chronic Conditions

A report from the National Council on Patient Information and Education determined that millions of Americans with chronic conditions do not take their medications properly.  Lack of adherence is believed to cost the nation up to $177 billion in medical bills and lost productivity per year, and is linked with approximately 40% of nursing home admissions.  The Agency for Healthcare Research and Quality is planning an outreach campaign to increase prescription drug adherence.  To view the report please visit http://www.talkaboutrx.org/documents/enhancing_prescription_medicine_adherence.pdf

Long Term Care

A GAO report titled “Nursing Home Reform:  Continued Attention Is Needed to Improve Quality of Care in Small but Significant Share of Homes” analyzes the quality of nursing home care and the enforcement of oversight since the passage of the Omnibus Budget Reconciliation Act of 1987 (OMBA 87).   To view the report, please visit http://www.gao.gov/new.items/d07794t.pdf

Percentage of Nursing Homes Cited for Actual Harm or Immediate Jeopardy, by State, Fiscal Years 2000-2006

Fiscal year
State		# of homes 2006		2000		2001		2002		2003		2004		2005		2006
Alabama		231		35.5		23.0		12.7		18.1		15.6		23.1		24.2
Alaska		15		28.6		26.7		26.7		0.0		0.0		0.0		26.7
Arizona		135		24.2		12.6		7.3		6.6		9.4		9.9		24.8
Arkansas		245		38.1		27.7		22.3		24.7		19.5		15.9		14.5
California		1,304		24.1		10.9		5.1		3.7		6.1		8.0		14.1
Colorado		215		20.4		26.4		32.7		20.9		25.9		40.4		44.8
Connecticut		245		41.9		51.6		45.8		43.1		54.4		44.2		50.8
Delaware		44		47.5		14.6		10.8		5.3		15.0		35.7		36.8
District of Columbia		20		17.7		28.6		30.0		41.2		40.0		30.0		25.0
Florida		688		22.8		20.2		14.9		10.2		7.8		4.2		9.1
Georgia		371		19.5		21.0		23.7		24.6		16.6		18.0		15.9
Hawaii		48		23.8		14.3		21.2		12.1		22.9		2.8		2.1
Idaho		80		51.4		29.7		39.2		31.9		27.3		38.4		47.8
Illinois		816		28.4		19.2		15.3		18.3		15.1		15.7		21.7
Indiana		526		45.0		29.4		23.2		19.7		24.1		28.3		33.4
Iowa		466		14.7		12.0		8.0		9.1		11.8		11.2		11.7
Kansas		361		37.9		30.7		32.9		26.5		30.3		34.9		38.3
Kentucky		298		26.8		29.1		23.2		26.1		14.6		7.7		11.4
Louisiana		307		21.8		29.9		21.7		16.2		12.0		15.4		15.8
Maine		114		11.1		13.9		6.6		11.1		12.8		7.0		9.8
Maryland		235		22.4		16.5		26.1		15.4		17.8		7.6		7.6
Massachusetts		456		29.1		24.4		24.6		25.9		16.7		22.6		20.9
Michigan		429		42.8		24.5		29.7		26.9		22.9		22.9		29.7
Minnesota		404		30.4		17.3		22.3		18.3		14.3		14.4		18.8
Mississippi		207		33.0		19.8		18.7		16.0		18.9		18.1		9.4
Missouri		526		19.8		13.0		15.6		12.5		11.7		15.4		15.6
Montana		97		33.3		29.7		12.0		20.0		18.0		17.9		16.7
Nebraska		229		19.2		21.1		20.1		14.8		15.3		14.4		25.7
Nevada		47		34.8		14.6		11.9		9.1		17.5		19.6		21.3
New Hampshire		83		37.8		31.1		29.4		24.1		25.6		26.3		22.9
New Jersey		363		25.5		27.8		18.8		10.5		13.5		18.2		15.5
New Mexico		75		23.7		16.9		14.9		21.3		24.3		29.4		25.0
New York		658		33.8		37.1		34.2		15.2		11.0		14.0		18.5
North Carolina		424		43.6		35.8		25.6		29.0		21.1		18.5		17.2
North Dakota		83		25.9		28.7		17.9		12.4		13.6		17.7		21.7
Ohio		980		26.6		27.3		25.4		19.1		11.4		13.8		14.6
Oklahoma		359		19.3		21.3		22.0		26.3		13.9		23.2		20.1
Oregon		142		45.5		32.6		23.7		20.3		15.9		19.8		18.6
Pennsylvania		724		30.3		19.2		13.5		17.2		19.5		15.2		13.6
Rhode Island		90		14.3		12.9		5.6		6.7		9.3		9.5		4.5
South Carolina		178		26.4		17.2		19.8		29.6		32.7		24.8		17.1
South Dakota		111		27.1		26.7		26.8		32.1		21.6		12.8		21.7
Tennessee		332		28.2		20.2		20.7		21.8		22.9		17.3		12.5
Texas		1,175		29.7		30.5		22.4		18.0		12.0		16.2		18.3
Utah		93		19.5		14.1		25.6		19.0		11.1		8.4		17.9
Vermont		41		22.5		18.2		15.0		10.0		19.5		23.7		13.5
Virginia		281		19.2		14.3		11.6		13.7		10.2		15.5		15.8
Washington		247		46.9		38.3		37.0		30.9		28.1		27.2		24.1
West Virginia		132		12.1		17.7		20.4		12.7		9.8		15.0		9.7
Wisconsin		403		15.8		15.6		11.2		10.9		13.1		18.2		23.0
Wyoming		39		52.8		32.4		25.0		22.9		17.1		11.8		16.2
Nation		16,172		28.4		23.3		20.2		17.8		15.7		16.8		18.9

Disabilities

The Aging and Disability Center (ADRC) released an issue brief exploring means for ADRCs to aid veterans via collaboration with Veterans Affairs (VA) branches.  ADRCs are ideal partner because they routinely work with physically, cognitively, or psychiatrically disabled individuals.  The VA estimates that in 2006 approximately one in five male over age 18 was a veteran, and the total amount of veterans was about 24 million.  To view this issue brief please visit http://www.hcbs.org/files/118/5851/Veterans_ADRC_issue_brief%5b1%5d.pdf

 

Mental Health

Health Management Associates released an analysis of 16 integrated physical and behavioral health services programs functioning at both state and local levels.  These publicly funded initiatives are grounded in the fact that mental health and substance use disorders (SUD) rarely occur independently of each other, and more frequently they are occurring in tandem with medical illnesses.  The findings suggest that effective integration can improve the quality of care and reduce costs for the treatment of physical health conditions.  The report can be viewed at http://www.oregon.gov/DHS/ph/hsp/docs/rwjfreport.pdf

Public Health

The Federal Interagency Forum on Child and Family Statistics, a group of federal agencies that analyze and disseminate data regarding children and families, released a report stating that the percent of high school students having sexual intercourse decreased since 1991, and the percent of those sexually active students using condoms rose during that same time period.  Although the number of students having intercourse has dropped since 1991, the Forum states that these numbers have stalled since 2001.  The CDC analyzed data from its Youth Risk Behavior Survey, and confirmed that the percent of students who ever had sex has not changed from 2001 to 2005.  The report can be viewed at http://www.childstats.gov/pdf/ac2007/ac_07.pdf

The Federal Interagency Forum on Child and Family Statistics also released its annual report called “America’s Children:  Key National Indicators of Well-Being, 2007.”  Findings include:  Increased percentage of children living with at least one working parent, increased birthrate for unmarried women, and increased percentage of children with low birth weights.  This study can be viewed at  http://www.childstats.gov/pdf/ac2007/ac_07.pdf

Annie E. Casey Foundation complied its annual Kids Count report which measures each state in terms of 10 indicators such as infant mortality and teen birth rate.  Overall the highest ranking state is Minnesota and the lowest is Mississippi.  To see how your state compares, please visit http://www.kidscount.org/sld/profile.jsp

State by State

The Patient Safety Authority of Pennsylvania released its 2007 June Patient Safety Advisory that found wrong-site surgeries are caught either before or after the start of an operation every other day in Pennsylvania.  PA is not alone or significantly different from other states in facing this problem, but they have created some unique aids to reduce the number of mistakes.  In many cases the patient or family member corrects the information so PA generated a consumer tip sheet to help patients.  They also promoted a “time out” step before surgery begins to double check the patient information, procedures and sites for the operation.  To view their entire report visit http://www.psa.state.pa.us/psa/lib/psa/advisories/v4n2_june_2007/jun_2007_advisory_v4_n2.pdf

Counter Conventional Wisdom

A study published in the Journal of the American Medical Association by Harvard Medical School researcher Grace Lee stated that underinsured children have less access to vaccines than the uninsured.  The problem is most prominent when considering newer vaccines such as one for meningitis.  The study pointed to health insurance plans not staying abreast of new vaccines, funding shortages, and lack of information regarding public demand which has led to decreased availability in private physicians offices and public health clinics.  To view the story please visit http://jama.ama-assn.org/cgi/content/abstract/298/6/638

Several months worth of past Chairs e-bulletins are archived at: http://www.ncsl.org/programs/health/forum/chairs/ebull/index.htm.

Have any questions you'd like answered?  A topic for which you’d like us to gather resources?  Do you have a report of your own you'd like to share with your peers?  Drop us a line.

Kala Ladenheim, Ph. D. Program Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-3557 fx: 202-737-1069
Kala.Ladenheim@ncsl.org

Donna Folkemer, Group Director
Forum for State Health Policy Leadership
National Conference of State Legislatures
ph: 202-624-8171 fx: 202-737-1069
Donna.Folkemer@ncsl.org   

 Health Chairs Project