IHPP Publications
September 2023
To improve access to behavioral health services in NH, we must expand the roles and settings that can effectively screen, assess, and treat children and adolescents with mild to moderate mental health conditions. Doing so would allow specialty behavioral health providers, an already limited resource, to focus on patients with severe or complex clinical needs. Both the Collaborative Care (CoCM) and Child Psychiatric Access Program (Access Program) models of care have been shown to improve access to behavioral health care while optimizing use of the limited workforce of child and adolescent psychiatrists (CAPs).
Mental Health Care Access for NH Youth: A Comparison of Two Models
September 2023
A shortage of specialty providers and numerous barriers to care access have resulted in a lack of essential youth behavioral health care in New Hampshire. Over the past decade, there have been efforts across NH to address this through Behavioral Health Integration (BHI), from multi-year initiatives to practice-level training or self-funded quality improvement projects. Despite the best efforts of many, the resulting increase in service capacity has been extremely limited. In order to inform future work in BHI, this assessment compiles the experiences, thoughts, and beliefs of primary care professionals and payers pertaining to the current availability, delivery, and payment methodologies of behavioral health services in primary care.
The Current State of Behavioral Health in Primary Care for NH Youth
August 2023
The Collaborative for Advancing Rural Excellence and Equity (CARE2) is a federally funded five-year program with the UNH ECHO Hub in collaboration with our partners, MCD Global Health, to provide two Project ECHO series annually on the topics of aging and substance use to care teams in New Hampshire, Maine, Vermont, and North Country New York. The Annual Report Evaluation Highlights from CARE2 Project Year 1 was developed to serve as a quantitative and qualitative review of our program’s impact across Cohort 1 of both of our ECHO programs: Project ECHO: Aging, Community, & Equity and the Substance Use Disorder (SUD) ECHO.
Collaborative for Advancing Rural Excellence and Equity (CARE2) Annual Report: Evaluation Highlights
June 2023
Background/Aims Community mental health centres in the US often struggle to implement the evidenced-based metrics and measurement processes required for quality reporting initiatives. Through the co-design and facilitation of a learning collaborative, all 10 community mental health centres in New Hampshire agreed on the goal of demonstrating measurement alignment and improvement across three behavioural health metrics related to depression and suicide risk, aiming for a screening rate of at least 85% in a year.
Methods The learning system framework and Lean Six Sigma define, measure, analyse, improve and control methodologies were used to increase participation and improve quality reporting. Teams were asked to participate in both a group learning collaborative and individual centre facilitation sessions, working with a quality improvement specialist. Reported measures were compared with subsets of the population data and between centres. Outliers were identified for potential reporting inaccuracies and opportunities for improvement.
Results All 10 community mental health centres were able to accurately report screening results on all three measures. After 12 months, 70% of the teams were able to reach the group-determined goal of at least 85% of eligible patients being screened in one measure, 40% of the teams met the benchmark in two measures and 20% of the teams were able to meet the benchmark in all three measures.
Conclusions Early investment by community mental health centre leadership through the development of a shared aim and project outcomes is essential to support learning and achieve positive outcomes. Quality improvement specialists are vital for facilitation of shared learning and practice across organisations.
September 2023
Investing in Primary Care: Advancing Nursing Education Workforce
December 2022
In April of 2022, the Institute for Health Policy and Practice (IHPP), in collaboration with the Department of Health and Human Services (DHHS) and the NH Pediatric Improvement Partnership (NH PIP), published the first version of the Mental Health Care Access in Pediatrics (MCAP) report, New Hampshire Children and Teens Experiencing Mental Health Disorders: An Analysis of 2019 Healthcare Claims Data. This report builds on the work of that publication, providing an analysis that explores care patterns in 2020, at the beginning of the 2020 COVID-19 pandemic. This update also includes an additional section focused on the providers of mental health care based on medical and pharmaceutical claims data.
August 2022
The Chronic Pain Self-Management ECHO was formed to provide educational content and a networking opportunity for those in rural New Hampshire and New England who work with individuals with chronic pain. This opportunity was in collaboration with the NH Citizens Health Initiative at the UNH Institute for Health Policy and Practice and the UNH Extension team. Six sessions were offered from September 2021 to March 2022. This evaluation report highlights the program background, participation in the series, impact of the series on participants, and considers future opportunities for education, research, and training on the topic of chronic pain self-management. Additional findings will be forthcoming.
Chronic Pain Self-Management Project ECHO Series: Evaluation Highlights
April 2022
The NH Mental Health Care Access in Pediatrics (MCAP) program is a collaborative effort of the NH Department of Health and Human Services and the NH Pediatric Improvement Partnership housed at the UNH Institute for Health Policy and Practice. Funded by the Health Resources and Services Administration, the focus of MCAP is to promote behavioral health integration in pediatric primary care. MCAP provides 1) training to pediatric and family practice clinicians in assessing and treating common pediatric mental health conditions through an annual Project ECHO® learning series, 2) clinician-to-clinician teleconsultation services, and 3) an annually updated referral directory of pediatric mental/behavioral health services in New Hampshire. To inform its programming, MCAP funded this analysis of 2019 pediatric medical and pharmacy claims data from commercial and NH Medicaid payers. Specifically, MCAP sought to examine health care claims for NH’s pediatric population to provide a descriptive analysis of:
- The burden of pediatric mental health conditions as defined by the percentage of children under age 18 with mental health conditions,
- Mental health conditions and comorbidities with other mental health conditions, and
- Mental health medical and pharmaceutical service utilization to produce measures of treatment.
April 2022
The purpose of this handbook is to guide pediatric and family practice primary care clinics and/or quality improvement (QI) organizations to initiate a process to screen for and respond to Adverse Childhood Experiences (ACEs). This handbook is based on the experience of the New Hampshire Pediatric Improvement Partnership (NH PIP) in supporting five New Hampshire pediatric practices in developing and piloting workflows to address ACEs within their patient population. The handbook provides a short background on project need, followed by a description of the initial implementation plan and required modifications due to varied factors. Next, this handbook outlines the results and lessons learned from of the project’s process evaluation. Finally, the handbook concludes with an improved and updated description of this QI process for replication elsewhere.
Facilitating a Quality Improvement Approach to Childhood Adversity Screening in Primary Care: A Handbook, owned by the University of New Hampshire and authored by Felicity Bernard, Corina Chao, Holly Tutko, and Dee Watts, licensed under CC BY NC ND 2.0.
April 2022
The purpose of this document is to serve as a practical guide to implementing trauma-informed care practices in Pediatric primary care clinics. It is designed to provide structure to the processes that are recommended to successfully, detect, treat and provide referrals to families who have experienced trauma and to build capacity and competence for a busy primary care office.
A Guide to Trauma-Informed Pediatric Primary Care, owned by the University of New Hampshire and authored by Felicity Bernard, Corina Chao, Holly Tutko, and Dee Watts, licensed under CC BY NC ND 2.0.
March 2022
Improving Pediatric Mental Health in NH through Collaboration and Community
March 2022
Pediatric Trauma-Informed Care at Various Levels of Integration
February 2022
The mission of the University of Vermont Center on Rural Addiction (UVM CORA) is to expand addiction treatment capacity in rural counties by providing consultation, resources, training, and evidence-based technical assistance to healthcare practitioners and other staff. With the baseline needs assessment, UVM CORA aims to identify current and future addiction treatment needs and barriers in New Hampshire with direct input from practitioners, policymakers, and other stakeholders.
August 2021
This data brief focuses on practitioner and stakeholder baseline needs assessment survey responses related to the impacts of COVID-19 on substance use and treatment in New Hampshire.
UVM CORA NH BNA COVID-19 Impact on Substance Use and Treatment Data Brief
October 2020
Teleprecepting grants us the opportunity to continue to lead the next generation of providers in caring for patients across the care continuum. Regardless of whether telehealth is being used as an emergency stopgap or will become a tool for ongoing practice, we must not delay in leading the next generation of providers and incorporating students into the care continuum.
March 2020
Project Extension for Community Healthcare Outcomes (ECHO)is an evidence-based method using web-based teleconferencing to link specialist teams with community-based sites to help community providers improve their ability to manage complex conditions. It has been proven to improve health care outcomes for vulnerable populations with limited access to care because of socioeconomic factors or geography. The New Hampshire Project ECHO Planning for Implementation and Business Sustainability Project undertook a planning process to inform how to best develop Project ECHO at UNH to serve New Hampshire health and community care providers and ultimately improve access to effective, timely care. Also included is a business and sustainability plan for long-term success of the UNH Project ECHO Hub and an evaluation plan for measuring efficacy.
March 2020
In 10 Steps for Improving Diabetes Care in New Hampshire you will find an easy-to-follow stepwise format of practical, best-practice strategies that are feasible to implement in any primary care setting. These Strategies are applicable to planning for prediabetes, as well.
July 2020
The Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership to develop a set of recommendations to address identifying and responding to Adverse Childhood Experiences and Social Determinants of Health in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews. Themes from these were identified and the findings are summarized in this report.
December 2017
In the spring of 2016, the New Hampshire Pediatric Improvement Partnership conducted an online survey of NH pediatric and family practice clinicians to understand practice patterns, comfort level, and support needs relative to caring for pediatric patients with ADHD. Of the clinicians surveyed, 138 responded yielding a 13% response rate.
Attention Deficit Hyperactivity Disorder (ADHD): Survey Report
May 2017
This paper is an accompanying document to a webinar delivered on May 16, 2017, for the New Hampshire Citizen's Health Initiative. As integrated behavioral health efforts in New Hampshire gain traction, clinicians, administrators, payers, and policy makers are looking for additional efficiencies in delivering high quality healthcare. Telehealth and mobile health have the opportunity to help achieve this while delivering a robust, empowered patient experience. Combining technology-savvy consumers with New Hampshire's high rate of electronic health record technology adoption, a fairly robust telecommunications infrastructure, and a predominantly rural setting, there is strong foundation for telehealth and mobile health expansion in New Hampshire's integrated health continuum.
December 2016
In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative created the NH Behavioral Helath Integration Learning Collaborative, as part of its Accountable Care Learning Network (NHACLN). The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service revenues. As well, follow up work on prior developments of a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings.
2016
The All Payer Claims Database (APCD) Council has collected and compiled responses to key questions posed to regulators in APCD states since the March 1, 2016 decision by the Supreme Court of the United States (SCOTUS) in Gobeille v. Liberty Mutual, related to key regulatory enforcement issues to be considered by states.
Key Regulatory Issues Facing APCD States Post Gobeille v. Liberty Mutual
November 2013
This study explored the specific nature of the Patient-Centered Medical Home models implemented across the nine pilot sites as well as the process of change enacted at these sites. The nine practices participating in the pilot varied with respect to their size, ownership, and history. The pilot sites are located across the state of New Hampshire, and vary in terms of the number of providers and the patient population served.
February 2012
A look at what's being done in the Granite State to reduce health care costs while improving care for patients. Focused is the Medical Home Project initiative.
February 2011
In 2008, The New Hampshire Citizens Health Initiative, in partnership with groups from all parts of the New Hampshire healthcare system, launched the Multi-Stakeholder Medical Home Pilot. Video series on the nine pilot sites throughout the state that are participating in the 2-3 year study of PCMH.
Covering the Care: Pregnancy Tops the List of Highest Out-Of-Pocket Costs for NH’s Commercially Insured
February 2025
This data brief presents a retrospective analysis of available medical claims data from New Hampshire’s commercial insurance plans. This brief focuses on conditions with the highest average out-of-pocket costs paid by commercially insured members in 2022. It also examines how out-of-pocket costs for those conditions have changed over a seven-year period (2016-2022). The analysis is based on claims data from January 2016 – December 2022 and is analyzed at the overall population level and by member gender. It is part of a series of analytic briefs examining the rate of the most common health conditions and treatment costs for those respective conditions.
Covering the Care: Pharmaceutical Utilization and Per-Member-Per-Month Costs
January 2025
This data brief presents a retrospective descriptive analysis of pharmaceutical utilization and its associated costs by utilizing available pharmacy claims data from three of New Hampshire’s insurance payers: commercial, NH Medicaid, and NH Medicare. The brief identifies the top ten drug classes by number of prescriptions filled and their per-member-per-month costs. The analysis is based on the most recent calendar year of pharmacy claims data available (January – December 2022).
Covering the Care: Pharmaceutical Utilization and Per-Member-Per-Month Costs
Covering the Care: Most Costly Health Conditions – Metabolic Disorders, Hemophilia, Cancers, and Transplants Top the List
February 2025
This data brief presents a retrospective analysis of available medical claims data from New Hampshire’s commercial, Medicaid, and Medicare insurance programs. This brief focuses on the conditions that incur the highest medical costs, regardless of their prevalence among the population. Metabolic disorders, hemophilia, certain cancers, and transplants were identified across all three payers as some of the costliest conditions. Most of these conditions have low prevalence and could, in some instances, be considered rare. There is variability in the prevalence of these conditions by payer type and there is a variability in the costs paid by payer type, with commercial insurance consistently having the highest costs. The analysis uses administrative medical claims data from January to December 2022.
Assessment Tools for Evaluating Primary Care Services and Delivery from the Consumer and Provider Perspective
February 2024
Develop a synthesis of tools and recommendations for collecting data from patients and clinicians related to primary care services and care delivery. Create a report of recommended tools that have been used and validated, ideally with an appendix of the actual survey instruments when they are available and can be used either with permission or for a fee.
February 2024
As a part of the Endowment for Health’s comprehensive strategy to improve the health of the people in New Hampshire (NH), the foundation invests in the University of New Hampshire Institute for Health Policy and Practice Health (UNH IHPP) to research and inform statewide health law and policy. Specifically, funding in 2023 focused on the provision of primary care in NH, which IHPP addressed through two reports and a focus group. The reports included a landscape on existing best-practice literature in primary care and, a review of assessment tools for evaluating primary care services and delivery. This paper provides a summary and findings of the focus group.
September 2023
A shortage of specialty providers and numerous barriers to care access have resulted in a lack of essential youth behavioral health care in New Hampshire. Over the past decade, there have been efforts across NH to address this through Behavioral Health Integration (BHI), from multi-year initiatives to practice-level training or self-funded quality improvement projects. Despite the best efforts of many, the resulting increase in service capacity has been extremely limited. In order to inform future work in BHI, this assessment compiles the experiences, thoughts, and beliefs of primary care professionals and payers pertaining to the current availability, delivery, and payment methodologies of behavioral health services in primary care.
The Current State of Behavioral Health in Primary Care for NH Youth Report
September 2023
Investing in Primary Care: Advancing Nursing Education Workforce
September 2023
NH Children and Teens Experiencing Mental Health Disorders: An Analysis of 2019-2021 Health Care Claims Data
April 2023
COVID-19 Pharmacy Claims Recovery Analysis
January 2023
COVID-19 Claims Recovery Analysis
December 2022
In April of 2022, the Institute for Health Policy and Practice (IHPP), in collaboration with the Department of Health and Human Services (DHHS) and the NH Pediatric Improvement Partnership (NH PIP), published the first version of the Mental Health Care Access in Pediatrics (MCAP) report, New Hampshire Children and Teens Experiencing Mental Health Disorders: An Analysis of 2019 Healthcare Claims Data. This report builds on the work of that publication, providing an analysis that explores care patterns in 2020, at the beginning of the 2020 COVID-19 pandemic. This update also includes an additional section focused on the providers of mental health care based on medical and pharmaceutical claims data.
New Hampshire Child and Teen Mental Health: An Analysis and Comparison of 2019-2020 Healthcare Claims Data
April 2022
The NH Mental Health Care Access in Pediatrics (MCAP) program is a collaborative effort of the NH Department of Health and Human Services and the NH Pediatric Improvement Partnership housed at the UNH Institute for Health Policy and Practice. Funded by the Health Resources and Services Administration, the focus of MCAP is to promote behavioral health integration in pediatric primary care. MCAP provides: 1) training to pediatric and family practice clinicians in assessing and treating common pediatric mental health conditions through an annual Project ECHO® learning series, 2) clinician-to-clinician teleconsultation services, and 3) an annually updated referral directory of pediatric mental/behavioral health services in New Hampshire. To inform its programming, MCAP funded this analysis of 2019 pediatric medical and pharmacy claims data from commercial and NH Medicaid payers. Specifically, MCAP sought to examine health care claims for NH’s pediatric population to provide a descriptive analysis of:
- The burden of pediatric mental health conditions as defined by the percentage of children under age 18 with mental health conditions,
- Mental health conditions and comorbidities with other mental health conditions, and
- Mental health medical and pharmaceutical service utilization to produce measures of treatment.
August 2021
The Center for Health Analytics, with funding from the Children's Health Foundation, has published their oral health report which analyzes dental claims to understand patterns of oral health care services, in addition to use of fluoride and patterns of care during the COVID-19 pandemic.
March 2021
The Center for Health Analytics (CHA) at the Institute for Health Policy and Practice (IHPP) has released a new report, Cost and Utilization of Treatment for Diabetes in New Hampshire: Analysis of Medical and Pharmacy All-Payer Claims Data. By utilizing tables from IHPP's NH Claims Report Suite, CHA analyzed measures of cost and utilization for Commercial (NHCHIS), NH Medicaid and NH Medicare beneficiaries who are indicated to have diabetes and/or the related heart conditions of Congestive Heart Failure, Hypertension and Cardiovascular Disease. This report includes an overview of how diabetes and the selected heart conditions compare to the 20 most common conditions for each payer population as well as a comparison of costs and utilization of drugs classified as anti-diabetic agents to the top 10 drug classes by total scripts. The report also analyzes variations of costs for beneficiaries with diabetes or the selected heart conditions with and without co-morbidities. This project was funded by the Division of Public Health Services at NH Department of Health and Human Services.
June 2020
The Institute for Health Policy and Practice, leveraging the UNH Survey Center's Granite State Panel, conducted a survey of NH adults to understand some of the immediate impacts of COVID-19 since January 2020. The survey includes 1155 respondents, and was fielded from April 16-20, 2020.
2020
To better understand a broad range of issues related to the cost and utilization of health care services, IHPP maintains a suite of analytic reports based on NH medical, pharmacy and dental claims data. The NH Claims Report Suite contains measures of types of service, burden of specific diseases and conditions, and use of medications, with the ability to drill down by population and geographic characteristics. This work was funded with support from the Endowment for Health and the New Hampshire Children's Health Foundation. For more information about the data sources, please see the methods tabs within the report suite. To learn more about the commercial claims data, visit nhchis.org.
January 2019
A comprehensive analysis of oral health claims data prepared by the Institute for Health Policy and Practice in collaboration with the Center for Health Analytics. This project coincides with the release of the Oral Health Report Suite, an on-line tool that is based on NH Medicaid fee-for-service and commercial dental claims data.
March 2018
A brief highlighting the value of APCDs in informing health system change.
Informing Health System Change- Use of All-Payer Claims Databases
2017
A shortage of specialty providers and numerous barriers to care access have resulted in a lack of essential youth behavioral health care in New Hampshire. Over the past decade, there have been efforts across NH to address this through Behavioral Health Integration (BHI), from multi-year initiatives to practice-level training or self-funded quality improvement projects. Despite the best efforts of many, the resulting increase in service capacity has been extremely limited. In order to inform future work in BHI, this assessment compiles the experiences, thoughts, and beliefs of primary care professionals and payers pertaining to the current availability, delivery, and payment methodologies of behavioral health services in primary care.
National Oral Health Conference Poster
September 2015
This report was created by the APCD Council with assistance and support from the New York State Health Foundation (NYSHealth). The authors of this report would like to thank NYSHealth for its funding and content support. Thanks also are extended to the New York State Department of Health for its input, content, and organizational support during this project. Finally, we would like to thank the many New York stakeholders and the interviewees from states other than New York whose thoughtful comments created the backbone for this report.
Support for this work was provided by NYSHealth. The mission of NYSHealth is to expand health insurance coverage, increase access to high-quality health care services, and improve public and community health. The views presented here are those of the authors and not necessarily those of the New York State Health Foundation or its directors, officers, and staff.
New York's All-Payer Database: A New Lens for Consumer Transparency
February 2015
With support from the Gary and Mary West Health Policy Center, the APCD Council has developed a manual for states to develop all-payer claims databases. The manual is a first of its-kind resource that provides states with detailed guidance on common data standards, collection, aggregation and analysis involved with establishing these databases.
May 2015
This document provides model legislation for APCD program development, based on the review of existing state APCD legislation (15 states at the time of the writing), anaylsis of other key federal and state regulations and statutes related to data collection and release and state experience with the legislative process.
September 2014
The primary task for this report is to summarize the work to develop a set of recommendations about the type of information that can be included in supplemental data submissions from the health insurance payers for inclusion in the MCDB, beginning with collection of 2014 data in 2015, and a mechanism for that collection process.
May 2014
All-payer claims databases are being developed in states across the nation to fill gaps in information about the health care system. The value of such databases is becoming more apparent as these databases mature and are used more frequently to help states better understand their health care utilization and costs.
January 2014
Over the past 10 years, a growing number of states have established state-sponsored all-payer claims database (APCD) systems to fill critical information gaps for state agencies, to support health care and payment reform initiatives, and to address the need for transparency in health care at the state-level to support consumer, purchaser, and state agency reform efforts. States with APCDs are responding to a need for comprehensive, multipayer data that allows states and other stakeholders to understand the cost, quality, and utilization of health care for their citizens. The purpose of this paper is to assist states embarking on APCD initiatives by highlighting key considerations for building statewide APCDs and potential solutions based on experiences in early-adopting APCD states.
The Basics of All-Payer Claims Databases: A Primer for States
2012
This report presents a summary of the costs to states associated with the development of AllPayer Claims Databases (APCDs). The findings are based on information gathered from states that have implemented APCDs, including review of state vendor contract documents and telephone interviews with state contacts. Both current and expired contract documents were reviewed.
October 2011
In 2008, the emergence of All Payer Claims Databases (APCD) was not only promising in terms of the potential of APCDs to explain and bend the cost curve of rising health care costs, but also presented a potential problem if each of the 50 states did not require the use of national standards for collecting the data from the payers. The APCD Council was formed to respond to this problem. With a learning network of states, insurers, vendors, and other stakeholders who are advancing the knowledge and development of All-Payer Claims Databases (APCD)1 , the APCD Council has been involved in the advocacy for and development of standards for APCD data collection for three years. Our work has been supported to date by The Commonwealth Fund, Academy Health’s State Coverage Initiative, Agency for Healthcare Research and Quality, National Governor’s Association, and with direct funding from UNH and NAHDO.
June 2011
This fact sheet focuses on the potential contributions of APCDs to health reform. Given the breadth of health reform, and the multiple possible uses of APCD data, this fact sheet is not intended to be a comprehensive review, but should serve to highlight some key opportunities available to states that have APCDs.
January 2011
Standardization of Data Collection in All-Payer Claims Databases
May 2010
This brief provides an overview of statewide APCDs and covers the following topics:
- What are APCDs?
- In what states do APCDs currently exist and what states are exploring APCDs?
- Why develop APCDs? • Who are the stakeholders of APCD systems?
- What are the major concerns or challenges related to APCDs and how they have been addressed?
- How are states using APCD information?
- How are APCDs governed and funded?
2010
All-Payer Claims Databases (APCDs) are large-scale databases that systematically collect health care claims data from a variety of payer sources. States are seeking assistance and tools to promote and strengthen the health and health care delivery for their populations. In establishing APCDs, states have identified several important uses of APCD data.
All-Payer Claims Databases in Public Health and Medicaid: A Fact Sheet
May 2008-Present
The APCD Council is a learning collaborative of government, private, non-profit, and academic organizations focused on improving the development and deployment of state-based all payer claims databases(APCD). The Council's work focuses on shared learning amongst APCD stakeholders, early stage technical assistance to states and catalyzing states to achieve mutual goals.
Covering the Care: Pregnancy Tops the List of Highest Out-Of-Pocket Costs for NH’s Commercially Insured
February 2025
This data brief presents a retrospective analysis of available medical claims data from New Hampshire’s commercial insurance plans. This brief focuses on conditions with the highest average out-of-pocket costs paid by commercially insured members in 2022. It also examines how out-of-pocket costs for those conditions have changed over a seven-year period (2016-2022). The analysis is based on claims data from January 2016 – December 2022 and is analyzed at the overall population level and by member gender. It is part of a series of analytic briefs examining the rate of the most common health conditions and treatment costs for those respective conditions.
Covering the Care: Most Costly Health Conditions – Metabolic Disorders, Hemophilia, Cancers, and Transplants Top the List
February 2025
This data brief presents a retrospective analysis of available medical claims data from New Hampshire’s commercial, Medicaid, and Medicare insurance programs. This brief focuses on the conditions that incur the highest medical costs, regardless of their prevalence among the population. Metabolic disorders, hemophilia, certain cancers, and transplants were identified across all three payers as some of the costliest conditions. Most of these conditions have low prevalence and could, in some instances, be considered rare. There is variability in the prevalence of these conditions by payer type and there is a variability in the costs paid by payer type, with commercial insurance consistently having the highest costs. The analysis uses administrative medical claims data from January to December 2022.
Covering the Care: Pharmaceutical Utilization and Per-Member-Per-Month Costs
January 2025
This data brief presents a retrospective descriptive analysis of pharmaceutical utilization and its associated costs by utilizing available pharmacy claims data from three of New Hampshire’s insurance payers: commercial, NH Medicaid, and NH Medicare. The brief identifies the top ten drug classes by number of prescriptions filled and their per-member-per-month costs. The analysis is based on the most recent calendar year of pharmacy claims data available (January – December 2022).
Covering the Care: Pharmaceutical Utilization and Per-Member-Per-Month Costs
August 2024
This data brief presents an analysis of available claims data from New Hampshire’s commercial, Medicaid, and Medicare insured populations. Specifically, the study identifies the top ten most prevalent health conditions, the cost of treatment for those conditions, and the overall medical cost for those with one of the identified conditions. The analysis is based on the most recent calendar year of available claims data (January – December 2022).
February 2024
The Institute for Health Policy and Practice (IHPP) of the College of Health and Human Services at the University of New Hampshire (UNH) contracted with Sarah Mason Eck of Scientific Health to provide a review of existing New Hampshire (NH) assessments and reports surrounding practices in primary care.
The primary goals of this assignment were to:
1. Review and synthesize data from within existing state, regional, and national assessments and reports regarding primary care and capacity in NH with a particular focus on infrastructure, access (barriers and utilization), clinical quality measures, provider workforce, and payment systems.
2. Review the literature for evidence-based best practices in primary health care, with a focus on primary care delivery models, payment methods, and spending measurement.
The State of Primary Care and Primary Care Capacity in New Hampshire
February 2024
Develop a synthesis of tools and recommendations for collecting data from patients and clinicians related to primary care services and care delivery. Create a report of recommended tools that have been used and validated, ideally with an appendix of the actual survey instruments when they are available and can be used either with permission or for a fee.
February 2024
As a part of the Endowment for Health’s comprehensive strategy to improve the health of the people in New Hampshire (NH), the foundation invests in the University of New Hampshire Institute for Health Policy and Practice Health (UNH IHPP) to research and inform statewide health law and policy. Specifically, funding in 2023 focused on the provision of primary care in NH, which IHPP addressed through two reports and a focus group. The reports included a landscape on existing best-practice literature in primary care and, a review of assessment tools for evaluating primary care services and delivery. This paper provides a summary and findings of the focus group.
Primary Care in New Hampshire Focus Group Report
July 2023
The UNH Franklin Pierce School of Law, Institute for Health Policy and Practice in collaboration with New Futures released the 2023 updated Resource Guide for Consumers: How to Access Mental Health and Substance Use Disorder Benefits.
2023 Resource Guide: How to Access Mental Health and Substance Use Disorder Benefits
February 2023
NH DHHS and UNH IHPP jointly hosted a stakeholder webinar regarding the March 31, 2023 end of continuous coverage and the Medicaid transition (‘unwind’) in an effort to share the latest information and resources, as well as field questions from our community partners and beneficiaries.
December 2022
At long last, health care providers and suppliers seeking to use patient incentives for contingency management to support evidenced based treatment for substance use disorder patients have guidance on how to minimize risk of fraud and abuse. Advisory Opinion, Office of Inspector General (OIG), posted March 2, 2022. Read about the risks, compliance tips and details.
March 2022
At long last, health care providers and suppliers seeking to use patient incentives for contingency management to support evidenced based treatment for substance use disorder patients have guidance on how to minimize risk of fraud and abuse. Advisory Opinion, Office of Inspector General (OIG), posted March 2, 2022. Read about the risks, compliance tips and details.
Legal Update on Fraud and Abuse Opinion on Contingency Management Program UNH Law
January 2021
Description: The paper highlights the need for New Hampshire to determine where it should invest broadband resources to close the digital divide that exists in the State between those who have internet access and those who do not; and equally as important, what modality of broadband infrastructure should be invested in to ensure equitable access to telehealth across New Hampshire and optimize broadband in the Granite State for the next 20-30 years.
2021
Advance Child Tax Credits start July 2021 as part of the federal COVID-19 relief package. Find out what you need to know.
May 2020
As part of the Medicaid expansion adopted in New Hampshire, the New Hampshire Department of Health and Human Services received waiver approval from the Centers for Medicaid and Medicare Services to implement Work and Community Engagement Requirements (WACER). This project explores the impact of the implementation of WACER on operations and infrastructure of community organizations. As well as exploring the expectations of "effort" by providers and community organizations to engage beneficiaries in the requirements.
July 2019
On July 8th, 2019 NH Department of Health and Human Services Commissioner Meyers suspended the Granite Advantage Program's Work and Community Engagement Requirements until September 30th, 2019. Here you will find the following questions answered: what does this mean for Granite Advantage Beneficiaries? What does this mean for providers? Why was the work requirement suspended? And, the status of the federal case Philbrick v. Azar.
June 2019
American Society of Law, Medicine, & Ethics in this report details changes in Medicaid Expansion in NH, the Granite Advantage Program, and the procedural history of implementation of Medicaid Expansion and the Work and Community Engagement Requirement (WACER)
American Society of Law, Medicine & Ethics (ASLME) 2019 NH Medicaid Work Requirement
May 2019
A review of the recent merger/affiliation activity in the Northern New England region, as well as regulations and requirements in New Hampshire and nearby states.
April 2019
In this program Granite Advantage rules updates are discussed along with updates on key outreach and planned outreach activities. Following is provider, member, and stakeholder feedback, ending with online resources and a discussion on the digital outreach campaign.
The Institute for Health Policy and Practice has released a series of data and policy briefs that seek to inform current conversations happening across the state.
- Covering the Care: Health Insurance Coverage in New Hampshire, 2021 Update
- Covering the Care: Legal Update, December 2020
- Covering the Care: Health Insurance Coverage in New Hampshire, 2020 Update
- Covering the Care: Health Insurance Coverage in New Hampshire, 2019 Update
- Covering the Care: Health Insurance Coverage in New Hampshire
- Covering the Care: A Focus on the NH Marketplace
- Covering the Care: Cost Sharing Reductions in NH
- Covering the Care: Medicaid, Work, and Community Engagement
September 2019
Professor Lucy Hodder presented at ARMI/BioFab USA's 2018 Fall Summit on "Understanding the Regulatory and Reimbursement Implications for Development of Engineered Tissue and Organs." Learn about her presentation and the work of BioFab USA. Produced and Hosted by A. J. Kierstead.
Podcast Regulatory and Reimbursement Implications for Development of Engineered Tissue and Organs
July 2018
On June 29, 2018, the United States District Court in D.C. overturned Kentucky’s approved Medicaid work and community engagement requirements as inconsistent with Medicaid’s primary objective to provide medical assistance to those who can’t afford it. New Hampshire, as well as Arkansas and Indiana, have approved Section 1115 waivers requiring certain Medicaid populations to work as a condition of eligibility. While the Stewart decision does not directly overturn such waiver approvals, it raises questions about what would happen if these waivers were challenged on similar grounds.
June 2018
NH provides Long Term Services and Supports in the form of nursing home care to eligible persons with limited financial resources. This brief breaks down the funding and reimbursement of long term care in NH.
October 2017
Summary of New Hampshire and Federal Regulations by Subject Matter. Chart of New Hampshire State Agency Responsibilities Federal Laws and Regulation: An Index.
Key NH and Federal Statutes Regulating Health Care Delivery and Payment
September 2017
The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects. A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD) Treatment Confidentiality Boot Camp sessions providing technical assistance to assist each IDN partner with their SUD confidentiality project goals. The “boot camp” consisted of several guided meetings with assigned homework to follow, leading to the ultimate development of processes, plans, and draft forms and policies to implement Part 2 confidentiality. The process incorporated learning from the Citizens Health Initiative’s existing New Hampshire Behavioral Health Integration Learning Collaborative.
May 2017
This summary provides an overview of “New Hampshire Medicaid Today and Tomorrow: Focusing on Value,” a daylong symposium hosted by the Institute for Health Policy and Practice at the University of New Hampshire School of Law on May 31, 2017. The event brought together over 180 participants from across the state including state and federal government agencies, managed care organizations, policy makers, researchers and academics, industry experts, advocacy groups and consumers.
March 2017
Jointly developed by the Institute for Health Policy and Practice and the NH Health Law and Policy Programs, the documents below highlight the details of five state Medicaid programs - New Hampshire, Maine, Massachusetts, Rhode Island, and Vermont. These overview documents were developed to provide a summary of each state's population, current eligibility guidelines, the history of each state's program and more.
October 2016
The College of Health and Human Services and the Northern New England Association of Healthcare Executives hosted a special event at the University of New Hampshire, Shaping the Future: Leadership and Public Policy in Healthcare. This event held two panels; the first titled Talent Management for Bench Strength Development moderated by Mark Bonica. The Second Panel held was moderated by Lucy Hodder and was titled the Healthcare Organization's Role in Formulating Public Policy.
Podcast: Shaping the Future: Leadership and Public Policy in Health Care
January 2016
This article by Lucy Hodder highlights the then ongoing legal dispute of Gobeille v Liberty Mutual concerning the ERISA act and All-Payer Claims Data reporting.
June 2015
Law Professor Lucy Hodder talks of Supreme Court case King v. Burwell concerning whether if the Internal Revenue Service permissibly created a regulation that extended the tax credits the Affordable Care Act authorized to federal exchanges as well as those created by the states?
May 2015
This document provides model legislation for APCD program development, based on the review of existing state APCD legislation (15 states at the time of the writing), analysis of other key federal and state regulations and statutes related to data collection and release and state experience with the legislative process.
January 2015
Law Professor Lucy Hodder shines light on the new opportunity for New Hampshire lawyers to help their clients and colleagues by decreasing the barriers to accessing treatment and coverage. UNH Health Law and Policy Program in collaboration with New Futures has put together a guide answering common questions and offering free tips, read this article to learn more about it.
The Mental Health Parity and Addiction Equity Act: What Parity Means for New Hampshire Article
April 2019
UNH College of Health and Human Services held a half-day summit of learning, networking, and exploration regarding long term care research. Sessions focused on current trends in research and the practical application of solutions from both a direct care and systems-based perspective.
November 2018
While everyone’s natural process of aging is different, most individuals will need some form of assistance as they age. This might include medical attention, help with meals, or receiving assistance with daily activities – and often includes several different services, simultaneously. Trying to keep up with medical and social needs requires coordination and communication among systems of care. In the absence of integrated coordination, people can have inefficient, frustrating, and even unsafe experiences. Given this landscape, systematic support as people age is critically important.
Developing a Foundation for Integrated Care Coordination: Part 1
June 2018
NH health insurance coverage data showcase as of June 2018.
July 2016
The physician-patient relationship has always been centered around the physician, with the Center on Aging and Community Living's "Person-Centered Care" video the relationship is reversed. Learn more about the benefits of the physician-patient relationship getting reversed.
July 2017
The following video was created as part of a training for the Practice Transformation Network. The training focuses on person-centered care transitions in a medical neighborhood.
December 2015
Citizens in the U.S. are making organized efforts to demand a new approach to planning urban communities, one that results in more sustainable and livable communities. The profession of social work in the U.S. once had a primary role in organizing urban residents to advocate for healthier environments in their neighborhoods. Yet, recent research documents the diminishing emphasis on community organization as an intervention method in social work. This paper offers a descriptive case study of a successful community organizing effort to promote a more livable city in Portland, Maine (USA).
A Case Study in Organizing for Livable and Sustainable Communities
Winter 2015
This paper examines the lack of advocacy for senior issues in the Granite State and explores strategies that can be employed to grow grass-roots leadership among older adults. The New Hampshire Senior Leadership Series, a program that provides support and training in advocacy and leadership skills, is highlighted as a promising practice to address this need.
September 2015
In a collective impact approach, the work begins with a shared understanding of the key challenges and opportunities before us and a commitment to solving it together through agreed upon actions and strategies. The process starts with mapping the landscape. This significant work by the Center on Aging and Community Living (CACL) at the University of New Hampshire is a knowledge base from which we will create shared goals, identify existing and emerging strategies and set a course for creating the elder-friendly communities we all want to live in as we age.
Environmental Scan to Help Create Elder-Friendly Communities in NH
Winter 2014
In the fall of 2012, the Center on Aging and Community Living (CACL) at UNH, with funding from the New Hampshire Endowment for Health, convened a series of meetings with key stakeholders to consider the future of New Hampshire’s system of Long Term Services and Supports. This paper summarizes that work. In response to mounting concerns about the impact of an aging population on our state, the New Hampshire Center for Public Policy Studies (NHCPPS) produced two reports - New Hampshire’s Silver Tsunami: Aging and the Health Care System; and Aging and the Public Long Term Care System. These reports frame the issues that New Hampshire is facing as it confronts the challenge of meeting the needs of an increasingly older population.
Winter 2014
In the fall of 2012, the Center on Aging and Community Living (CACL) at UNH, with funding from the New Hampshire Endowment for Health, convened a series of meetings with key stakeholders to consider the future of New Hampshire’s system of Long Term Services and Supports. This paper summarizes that work. In response to mounting concerns about the impact of an aging population on our state, the New Hampshire Center for Public Policy Studies (NHCPPS) produced two reports - New Hampshire’s Silver Tsunami: Aging and the Health Care System; and Aging and the Public Long Term Care System. These reports frame the issues that New Hampshire is facing as it confronts the challenge of meeting the needs of an increasingly older population.
2014
The ten chapters of this manual include easy to follow, pragmatic steps to implement a comprehensive approach to hypertension care originally developed by CMC/DHK. This approach was successful in improving hypertension control for the greater Keene community, and was successfully replicated in the communities of Manchester and Nashua. The first seven steps are best implemented sequentially, whereas steps eight through ten can be undertaken anytime, as they involve patient and community engagement. However, considering that each medical practice and community is unique, the steps can be customized to accommodate the distinct degree of readiness or available resources.
IHPP Resources
Prove It! Let the Data Tell the Story
Prove It! Let the Data Tell the Story is a hands-on course focusing on the use of data and basic statistics commonly used in public health. NH community leaders expressed the need for training about using data to support their efforts to improve the health of their communities, and Prove It! was conceptualized by the Empowering Communities project to meet that need. Prove It! provides a basic understanding of why we use data and how to use data in community health assessment and monitoring, using the specific focus on writing grant applications as the example.
For more information on having Prove It! taught in your organization, send an email to IHPP.UNH@unh.edu.
IHPP Grand Round Series
During this session, members of IHPP shared a selection of our work related to Mental Health and Substance Use Disorder (SUD) policy and treatment.
Watch the recording from March 31, 2022 below:
