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Health Policy
The SPHERE Institute conducts research and provides technical
assistance on a variety of health policy issues, including health insurance
coverage for indigent populations, the provision and financing of health care
services, the role of safety net providers in delivering care, and ways to
assess and improve the quality of care. Our health policy research
encompasses a wide range of analytical and evaluative approaches, from the
examination of large claims data for government health insurance programs to
the collection of information through employee surveys on preferences for
employer-provided health care benefits.
Current and Recent Projects
Utilization of Medi-Cal Services by Current and Former
Foster Care Children
This project is designed to (1) describe patterns of Medi-Cal utilization and
expenditures by foster care children; (2) determine the extent to which former
foster care youths aged 18 through 20 years use Medi-Cal pursuant to the
recently enacted extension of eligibility to this group; (3) determine whether
the Californias appropriation of funds specifically for public health nurses to
assist foster care children, effective in January 2000, had an independent
impact on Medi-Cal utilization by these children; and (4) examine the effects
of the Kinship Guardianship Assistance Payment Program on the Medi-Cal
utilization of foster care children.
Cost Effectiveness of Three HRSA Special Programs of
National Significance (SPNS)
Over the next three years, SPHERE will be assessing the comparative
effectiveness and costs of three Ryan White CARE Act Special Programs of
National Significance (SPNS) Initiatives. The three initiatives share a goal of
engaging marginalized HIV-positive populations into primary healthcare by
employing common peer-based outreach methods. This common framework will be
examined and used to construct a cost-effectiveness analysis of HIV outreach
that will (a) assist SPNS in determining the cost implications of various
models of HIV care for purposes of replication and long-term sustainability,
and (b) enable the provision of valid and reliable information to Congress,
federal administrators, and local decision-makers on the affordability of
HIV-related programs. SPHERE is working closely with the cross-site evaluation
centers and individual grantees to develop tools and methods to provide a
parsimonious, transparent evaluation of the initiatives as a whole, in a
structure that is also flexible enough to be tailored to individual outreach
programs. We will assess not only the direct impacts of the interventions on
their participants, but also the broader epidemiological implications of HIV
outreach. Furthermore, our models will include an effectiveness measure of
life-years gained, an endpoint that is commonly used in reporting
cost-effectiveness of interventions for other chronic diseases, but has not
been widely used in the current literature on cost-effectiveness of behavioral
interventions for HIV management. Our analysis will therefore uniquely allow
comparison of the cost-effectiveness of strategies for managing HIV versus
other diseases.
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Funded by:
U.S. Department of Health and Human Services, Health Resources and Services Administration
Access for El Dorado County (ACCEL) Evaluation
The SPHERE Institute is currently serving as El Dorado County's evaluator for
their Health Information Technology (HIT) grant, funded by AHRQ. The ACCEL
project has two main aims: 1) to provide a medical home and improve health care
services for low-income residents of El Dorado County, and 2) to use
information technology to provide better coordinated care to those who live in
this large, rural, mountainous region, isolated from one another and served by
relatively few providers. The IT structure will support the work of community
health workers as well as connect providers throughout the system. SPHERE's
evaluation of this project, expected to last three years, will determine
whether the ACCEL IT was successfully implemented and its role in improving
health outcomes for ACCEL patients. The evaluation will use both qualitative
data (collected through surveys and focus groups) and quantitative data.
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Client:
El Dorado County Safety Net Provider Network
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Funded by:
U.S Department for Health and Human Services, Agency for Healthcare Research and Quality (AHRQ)
Medi-Cal Expenditures: Historical Growth and Long Term
Forecasts
In 2005, SPHERE completed a long-term forecast of California's Medicaid
program, Medi-Cal. This collaboration with the Public Policy Institute of
California (PPIC) and the California Department of Health Services (DHS) linked
a decade's worth of Medi-Cal eligibility and paid-claims data to address three
questions related to the fiscal challenges Medi-Cal may pose in the future for
California policymakers: First, how much are Medi-Cal costs likely to grow over
the next decade in the absence of policy changes? Second, how will this growth
compare to revenue growth? And third, what factors are driving Medi-Cal costs?
To answer these questions the paper forecasts the expected costs of the
Medi-Cal program through 2015, as well as examines the forces underlying recent
growth in Medi-Cal expenditures.
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Funded by: Public Policy Institute of California in subcontract
from the California Department of Health Services
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Utilization of Medi-Cal Services by Current and Former Foster Care Children