Essential Benefits Set Work Group BACKGROUND PAPER August 25, 2009 Essential Benefit Set Work Group
Prepared by: ADDITIONAL
RESOURCES
September 23, 2009 Additional Resources

Individuals with Special Needs and Health Reform: Adequacy of Health Insurance
Coverage
Kaiser Commission on Medicaid and the Uninsured
Publication Number: 7967. 2009-09-09
http://www.kff.org/healthreform/7967.cfm
This issue brief examines the health care needs and health costs of individuals with
special health challenges, focusing on those with low-to-moderate incomes. It finds that
even under a benefit package more generous than most offered in the private insurance
market, individuals and families can face significant gaps in coverage and large out-ofpocket costs, especially if they have serious health conditions. The findings have
implications for the health reform debate as policymakers consider minimum standards
for coverage, required cost sharing amounts and limits on covered benefits in health
plans.

Promoting Better Health for Minnesotans With Disabilities:: Ending Exclusion
A state plan developed by the Minnesota Disability Health Project, August 2007
http://www.health.state.mn.us/injury/pub/DisabilityHealthPlan.pdf
Minnesota's state plan, funded by CDC, to promote health and prevent secondary
conditions. It was coordinated by MDH with participation by 20 agencies and
organizations that serve or advocate for people with disabilities. Chapters focus on access
to health care, mental health, abuse prevention, and employment, as well as infrastructure
changes needed to accomplish the strategies.

Chronic Conditions and Comorbid Psychological Disorders
Melek.S, Norris. D. Milliman. 7/1/2008
http://www.milliman.com/expertise/healthcare/publications/rr/pdfs/chronic-conditionsand-comorbid-RR07-01-08.pdf
This report by Milliman looks at controlling health care cost by focusing on effective
diagnosis of behavioral illnesses along with effective delivery of behavioral healthcare.
Quality of care has been a major concern among both employers and beneficiaries.
Unfortunately, the quality of behavioral healthcare delivered in the United States is
highly uneven, with many receiving inadequate treatment, if any treatment at all. Studies
continue to emerge that suggest that patients with depression have a higher burden of
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medical illness than people without depression. Some report 40% or more of high
utilizers of healthcare have depression, anxiety, or dysthymia. Yet most caremanagement programs continue to separate medical and behavioral healthcare. This
report studies the opportunity for payers in the area of medical-behavioral integration. It
analyzes the cost impact of comorbid depression and anxiety on commercially insured
patients with certain chronic medical conditions. It identifies potential opportunities for
reductions in healthcare and other employer costs, and improved clinical outcomes.

The Guide to Clinical Preventive Services, 2008
Recommendations of the U.S. Preventive Services Task Force. AHRQ.
http://www.ahrq.gov/Clinic/pocketgd.htm
The U.S. Preventive Services Task Force (USPSTF) recommendations on screening,
counseling, and preventive medication topics and includes clinical considerations for
each topic. This new guide is an authoritative source for making decisions about
preventive services. The U.S. Preventive Services Task Force is an independent panel of
experts in primary care and prevention that systematically reviews the evidence of
effectiveness and develops recommendations for clinical preventive services. Sponsored
since 1998 by the Agency for Healthcare Research and Quality (AHRQ), the Task Force
is the leading independent panel of private-sector experts in prevention and primary care.
The pocket guide covers all USPSTF recommendations from 2001 through 2006. More
recent recommendations are available through the A-Z Topic Index.
Recommendations are organized for quick reference and easy searching. One section
matches recommended preventive services to patients—men, women, pregnant women,
and children.

Assessing the Appropriateness of Care—Its Time Has Come
Robert H. Brook, MD, ScD . JAMA. 2009;302(9):997-998.
http://jama.ama-assn.org/cgi/content/extract/302/9/997
Health care reform in the United States is likely to fail without fundamental changes in
the practice of medicine. What can be done within a year to substantially increase the
likelihood that Americans receive appropriate, humane, affordable care? A starting point
is to draw on more than 2 decades of empirical research based on the RAND/University
of California Los Angeles (UCLA) Appropriateness Method (RUAM) to develop explicit
criteria for determining the appropriateness of care.1-2 Physicians and patients can use the
results from applying this method to make better informed decisions about expensive,
elective procedures or diagnostic tests, and the process of developing the criteria will
strengthen the clinical evidence base. Brook recommends the use of RAND Corp's
Appropriateness Method to determine whether any given medical procedure is necessary,
appropriate, equivocal, or inappropriate. He suggests the method should be used by
patients and physicians, and not by insurance companies.
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CONFERENCES – TIME SENSITIVE MATERIAL

Creating a Culture of Health - Helping People Stay Well
Presented by Life Science Alley Crossroads Series
https://www.lifesciencealley.org/programs_events/detail.aspx?id=355
Location: Travelers Offices (Downtown St. Paul)
Cost: $149 to $189
Date and Time: 9/25/2009
Registration: 7:30 am - 8:00 am
Program: 8:00 am - 11:30 am
Event Description
Obesity and chronic diseases heavily burden our healthcare system (20% of the
population, it is reported, generates 80% of the healthcare costs). How will your
products and services help materially raise the level of health and lower the cost
burden in the areas of preventive health and the management of chronic illnesses?
Our unique panel of experts with experience in retail, consumer brands, medical
devices and healthcare will shed a light on both the barriers to compliance as well as
the real triggers that can help people actualize a healthy lifestyle on their own.
Speakers: Brigid Bonner, Senior Vice President of E-Commerce, Schwan's Home
Service Division; Archelle Georgiou, MD, President, Georgiou Consulting, LLC;
Philip Hagen, M.D., Medical Director, Mayo Clinic; Julia Halberg, MD, MS, MPH,
Director, Global Health, General Mills, Inc.; Arna Ionescu, Leader of Connected
Health Domain, IDEO; Mindy Kurzer, Ph.D., Director - Healthy Foods, Healthy
Lives Institute, University of Minnesota - College of Food, Agricultural and Natural
Resource Sciences; Brent Magid, President & CEO, Frank N. Magid Associates;
James Meyer, Chief Operating Officer, Muve

The Synthesis Project: Cost Savings and Cost-effectiveness of Clinical Preventive Care
Held on 9/22/2009. Power point slides available from Mike Rieth / Cirdan Health.
In the United States, medical advances have reduced the prevalence of many acute
conditions and increased life expectancy. As a result, chronic disease has become the
dominant source of mortality and is driven by risk factors that are largely preventable.
Preventive care has the potential to control risk factors, thereby reducing the prevalence of
costly chronic conditions. With the percentage of gross domestic product spent on health
care tripling from 1960 to 2006, policy-makers are looking at preventive care as a way to
slow the rate of growth in health spending. A new report from Robert Wood Johnson
Foundation’s Synthesis Project provides policy-makers with a framework for evaluating
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cost-effectiveness studies and investigates the economic evidence for investing in
preventive care.
Report Authors: Joshua Cohen, Ph.D.; deputy director, Center for the Evaluation of
Value and Risk in Health, Institute for Clinical Research and Health Policy Studies at
Tufts Medical Center. Peter Neumann, Sc.D.; director, Center for the Evaluation of Value
and Risk in Health, Institute for Clinical Research and Health Policy Studies at Tufts
Medical Center.
Reactor Comments: Steven Teutsch, M.D., M.P.H.; chief science officer, Los Angeles
County Department of Public Health. Michael O'Grady, Ph.D.; senior fellow, Health
Policy and Evaluation Department, NORC (National Opinion Research Center).
To register for the Webinar, please email your name, organization and telephone number
to Erica Garland at [email protected] or call 202-745-5119. You will receive
confirmation and instructions for joining the call and Web presentation.
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