The disproportionate impact of COVID-19 on underserved communities underscored the need for systemic change and renewed efforts to reduce health disparities in people with social risks. This post describes a partnership between Inovalon and Humana to develop a new health equity composite quality measure to identify disadvantaged populations with the largest care disparities and determine… Read More »
It isn’t what supporters of single-payer health care might prefer. But a Medicaid-for-all program, based on the already expansive safety-net program, might open new doors to universal coverage. And rising familiarity with the program is creating a window of opportunity. My realization began with several conversations First, it was a friend going through a divorce… Read More »
Better care coordination may improve access to primary care for people who are dually eligible for Medicare and Medicaid. Recent evaluations of the Financial Alignment Initiative (FAI)–an initiative incentivizing the financial alignment of Medicare and Medicaid–suggests care coordination could improve access to primary care services for some dually eligible beneficiaries. Care coordination alone, however, may… Read More »
The Medicaid Outcomes Distributed Research Network (MODRN) was started by AcademyHealth and is a collaborative research network of state Medicaid agencies and university partners. The goal of the network is to allow analysis and learning about Medicaid by facilitating comparison across states and aggregate data with a shorter lag time than other available sources. This… Read More »
More than 150,000 avoidable deaths occur each year due to mental, emotional, and behavioral health problems. This includes nearly 50,000 suicide deaths and 100,000 overdose deaths. People with chronic persistent mental illness suffer a 20-year shorter life expectancy. This country urgently needs to address how we pay for mental health services. Medicaid is a major… Read More »
Long-term services and supports (LTSS) for older adults and persons with disabilities have become a policy priority. The American Rescue Plan and the proposed American Jobs Act aim to increase LTSS spending through the Medicaid program, particularly for Home- and Community-Based Services (HCBS). These measures would address the need for wider service availability, while presenting… Read More »
Over 30% of Black, Latinx, and Indigenous populations in the US are enrolled in Medicaid programs; more than half of all Medicaid enrollees are people of color. As such, Medicaid policies disproportionately affect populations of color. As more institutions reckon with historical and current injustices due to centuries of racism and racist policies, understanding how… Read More »
Low-income households across the US are more likely to be uninsured or under-insured. Medicaid Expansion paves a path for low-income Americans to obtain access to care. Working-aged underinsured individuals tend to get later medical care and too little care–resulting in poorer health outcomes. Even insured individuals may delay necessary care because of cost. A 2018… Read More »
Over the past two decades, research has helped identify ways to reduce complications among people with diabetes and laid the foundation for primary prevention. However, prevention and treatments are still unequally applied, and social, economic, and age-related disparities persist. The June 2020 supplement issue of Medical Care argues for and presents the results of natural… Read More »
We announced last week that The Medical Care Blog has reached its 5-year milestone. As part of the editorial team, I’m excited to pause briefly and reflect on some great blog posts about healthcare that I think deserve to have been more widely read. Contributions from our authors have helped us reach more than 80,000… Read More »
Chlamydia and gonorrhea are among the most common sexually transmitted infections (STIs) in the United States, and research shows that 50% of sexually active individuals will contract an STI by 25 years old. Though chlamydia and gonorrhea are often asymptomatic in women, screening is important in order to prevent complications, such as pelvic inflammatory disease… Read More »
In a recent letter to state Medicaid directors, officials at the Centers for Medicare and Medicaid Services (CMS) encouraged states to implement work requirements in Medicaid, writing that “a growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes.” In response, 10 Republican-led states have… Read More »
[Editors’ note: This post was originally published on Feb. 7, 2018.] Now more than ever, we need a sensible, unified, national response to the opioid epidemic; a response that recognizes the gravity of the situation and the reality that opioid use disorder (OUD) is a chronic – and treatable – condition. While there are many… Read More »
Medication is an essential aspect of tertiary prevention, as it often addresses symptoms, may restore function, and minimizes adverse consequences associated with chronic conditions. Medication adherence is most often studied in the context of Medicare Part D. In a newly published Medical Care article, Drs. Roebuck, Kaestner, and Dougherty, instead measure the associations between medication… Read More »
One hundred and sixty-one Americans died of an opioid overdose each day in 2016, and early 2017 data suggest this trend is continuing. The medical and public health community knows from decades of research that providing individuals suffering from opioid use disorder with specific medications can save lives. Our public policies governing opioid use disorder,… Read More »
The Affordable Care Act (ACA) had a roller-coaster of a year. It began with threats of almost certain repeal, followed by effort after unsuccessful effort to dismantle it. Then in the last days of 2017, there was the successful repeal of the individual mandate penalty. This was brazen politics, suspenseful and often agonizing. It… Read More »
Over the last few decades, cigarette smoking has become a health burden concentrated primarily among low-income individuals in the U.S. In our recently published research study, Medicaid coverage expansions and cigarette smoking cessation among low-income adults, we sought to determine the relationship between recent expansions of Medicaid coverage and smoking cessation for low-income adults. Demographics… Read More »
Enrollment in Medicaid has been shown to enhance access to health care for our nation’s most vulnerable citizens. Yet despite these benefits, a substantial number of beneficiaries lose coverage at the time of renewal. An article by Xu Ji and colleagues, published in this month’s issue of Medical Care, demonstrates how critical maintaining continuous Medicaid coverage… Read More »
Opiate overdose is now the leading cause of accidental death in the United States, killing more than 50,000 people in 2015. About 20,000 of those deaths were attributed to the use of prescription opiate medications. As a physician, I want to alleviate my patients’ pain, but I have also taken an oath to do my… Read More »
Recently, I sat down to talk with Arlene Ash, PhD about risk adjustment. Dr. Ash is Professor and Chief of the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences at the University of Massachusetts Medical School. As a methods expert on risk adjustment in health services research, she has pioneered tools… Read More »
Emergency departments (EDs) nationwide are busy places. In some locales they are overcrowded. In places like Los Angeles and other dense, urban areas with high poverty, they are over-capacity to such an extent that they can grind to a halt for all but the highest priority cases. In years past, it was not unheard of for… Read More »
Smoking cessation is not innovative or trendy or even particularly exciting, but as a primary care doctor, in most cases helping a patient quit smoking is the best thing that I can do to help that patient over their lifetime. Without question. And for that reason, I always make it a priority to talk about it… Read More »
Republican Congressional leaders are currently debating how to repeal the Affordable Care Act (ACA) as part of the budget reconciliation process. Much of the debate over the ACA has focused on the individual mandate (and here) and the affordability (here and here) of coverage in the state-based marketplaces. The House version of the legislation, however,… Read More »
In a recent Medical Care article, Guy and colleagues analyzed health insurance expansions among parents from 1999 through 2012 to assess the impacts of four different types of public and private expansions. They primarily examined changes in parents’ health insurance coverage, but they also analyzed whether expanding coverage for parents could “spill over” and raise coverage… Read More »
With the mania of the presidential election in full tilt and the election just days away, it’s hard to have a rational public discussion about health care. Supporters of the two presidential candidates have drawn a deep and divisive line (or rather a tectonic fissure) in the sand about health care reform. This is due, in great part, to the bombastic, and ultimately… Read More »
Expanding health insurance coverage may improve health care access [PDF] and reduce financial stress [PDF]. Ideally, having health insurance and the resultant access to care should improve health outcomes and well-being, although the evidence is complicated and mixed. One thing is sure: expanded insurance coverage typically leads to more utilization – a concern for policymakers and administrators because… Read More »
Dual eligibility for Medicare and Medicaid is expected to improve access to care for low-income individuals who qualify for both programs, relative to eligibility for either program alone. Medicaid coverage of Medicare deductibles and co-payments can reduce the financial burdens that these cost sharing requirements may pose for low-income Medicare beneficiaries. These dual eligible beneficiaries… Read More »
In 2013, there were 10.7 million people enrolled [PDF] in both Medicare and Medicaid. Dual eligibility depends on age, income, and disability. Dually enrolled beneficiaries are also responsible for a large share of program costs overall; 31% of Medicare fee-for-services spending for 18% of beneficiaries [PDF] who are dually enrolled. Given the additional health challenges [PDF] faced by dual eligibles, this… Read More »
In a new Medical Care article published ahead of print, Cheryl R. Clark, MD, ScD, and colleagues, of Brigham and Women’s Hospital and Harvard, provide pre-ACA implementation estimates of income-based disparities in delayed or forgone care due to cost by race/ethnicity, by state-level Medicaid expansion status. Reforms can be unevenly implemented even if they address the primary causes of… Read More »
Who treats Medicaid patients? And is the quality of care provided by these individuals the same as you might expect from a clinician who takes only private insurance? An article in the April 2016 issue of Medical Care sought to answer these questions.
Although more than 92% of physicians reported seeing at least one Medicaid patient in 2011, the median proportion of Medicaid patients, for both PCPs and specialists, was less than 6%. This suggests that a small group of providers is responsible for seeing the majority of patients with Medicaid coverage…
As a current medical student, this research struck a nerve, particularly because of the emphasis on IMGs and medical school ranking. … What is more important to me is to understand what I, as a future primary care provider, can do. How do I ensure that people with Medicaid coverage get timely and appropriate referrals to specialty care? How can I expand my provider network to better equip them with the tools they need to ensure their long-term, lasting health?
Support for patient-centered medical homes (PCMH) has been growing in recent years. A typical PCMH model includes a primary care physician supported by a multidisciplinary team, coordinated care, measurements of quality and safety, and enhanced access to same-day appointments. Preliminary program evaluations have shown that PCMHs can improve access and quality, but to date, there… Read More »
Emergency department (ED) use has been increasing in the US for several decades, and some estimate that about half of all outpatient ED visits are potentially avoidable (also referred to as primary-care sensitive, or PCS). ED visits are expensive and may signify issues with access to, and quality of, care. Thus, reducing ED use is… Read More »