I am a health economist, trained to make sense of messy data. I generally work amidst a sea of numbers. But I’ve found that seeking out stories in health services research–those of doctors and patients–can help me anchor what’s truly important in research. These stories may also help researchers communicate the value of their work… Read More »
A special supplemental issue of Medical Care supports the growing recognition that patient economic outcomes matter in health care. Sponsored by the Assistant Secretary for Planning and Evaluation (ASPE) in the U.S. Department of Health and Human Services, the issue highlights studies that explore the relationship between economic outcomes, patient care, health outcomes and equity. Patient-centered… Read More »
Medicare for All is Not Happening… 10 years from now will we have Medicare Advantage for All? Grandmother and granddaughter in the same health plan? Others have written that the US should achieve universal health insurance coverage, better health outcomes, and lower costs via comprehensive programs such as “Medicare for All”, as proposed by Senator… Read More »
In this post, we examine how the COVID-19 pandemic affected frequencies of diagnoses and claims costs in the Affordable Care Act (ACA) marketplaces in 2020 and 2021. The ACA marketplaces are critical sources of coverage for millions of Americans and were increasingly so during the COVID-19 pandemic due to job losses and coverage disruptions. The… Read More »
As part of its partnership with the Patient-Centered Outcomes Research Institute (PCORI), Medical Care has published its first PCORI-sponsored article collection, which provides specific information about the costs that healthcare systems can expect to incur in promoting the uptake of specific evidence-based programs. In September’s special issue, five project teams that received Implementation Award funding from PCORI… Read More »
The United States Preventive Services Task Force has recommended lung cancer screening for at-risk groups since 2013, and updated again in 2021. This is a simple procedure involving a low dose of radiation used to take a CT image of the chest. If utilized by most eligible Americans, screening could reduce lung cancer mortality by… Read More »
California just took a significant step toward single payer health care. On Oct 7, Governor Gavin Newsom signed Senate Bill 770 (Unified Health Care Financing) into law. Introduced by Senator Scott Wiener (D-San Francisco), the law directs the Secretary of the California Health and Human Services Agency to research, develop and pursue a waiver framework… Read More »
This entry was one of the winners of our Summer 2023 student blog contest! Trends in Life Expectancy The recent decline in life expectancy in the United States is largely attributed to the well-known COVID-19 pandemic and opioid epidemic. However, these recent crises are not the sole drivers of the stagnation and subsequent drop in… Read More »
The ACA marketplaces continue to be an important source of health insurance for millions of Americans. Achieving health equity for these enrollees may require more than simply providing coverage. The number of individuals who selected a Affordable Care Act (ACA) marketplace plan increased from 8 million [PDF] in 2014 to 16 million [PDF] in 2023.… Read More »
Last month, the Centers for Medicare and Medicaid Services (CMS) Innovation Center announced its newest alternative payment model for primary care, Making Care Primary (MCP). MCP builds upon lessons learned from previous CMS primary care models: the Comprehensive Primary Care Initiative, the Comprehensive Primary Care Plus (CPC+) initiative, the Maryland Primary Care Program, and Primary… Read More »
Over the past 25 years, significant strides have been made in shifting services for people with dementia and Alzheimer’s disease to home and community settings. Home and community-based services (HCBS) enable people with various forms of dementia to receive care in a familiar setting while promoting their independence, well-being, and overall quality of life. As… Read More »
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 »
Medicare Advantage should be making news. It’s not because the Medicare trust fund continues to run on fumes, which it does. Nor is it because Medicare was taken “off the table” in recent debates about cutting the federal budget, which it was. Rather, it should be getting a lot of attention for new data about its… 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 »
It’s that time of year again–APHA’s Annual Meeting! This year we’ll be meeting in Boston Nov. 6-9 with a digital event Nov. 14-16. I’m looking forward to seeing colleagues this year and getting to catch up with so many interesting people. Of course, I’m also excited about the excellent Medical Care Section Program. Here’s a… Read More »
A recent JAMA article noted that only one-third of new drug approvals through the accelerated approval process by the FDA in the US or the conditional marketing authorization in the EU have shown therapeutic value. Many of these drugs are high cost, and this begs the question if we are spending our health care dollars appropriately. … 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 »
In 2026, Medicare will negotiate prescription drug prices with manufacturers. It is a dramatic reversal of a stranglehold placed on Medicare back in 2003. And it may be one of the most impactful policy changes to the government program since its creation. But there is a catch…we have to wait. President Biden signed the Inflation Reduction… Read More »
The Medical Care Blog is preparing for its full return later this month. Until then, we are continuing to highlight articles published by our contributors on timely topics. A federal bill is pending that would allow Medicare to begin negotiating drug prices for the very first time. Even though it would begin with only 10… Read More »
It is not too late to fix the US healthcare system. But every day spent in this folly, the problem gets worse. It is time to move this conversation forward. We are excited to share that in November 2021, the American Public Health Association (APHA) formally adopted a policy statement titled “Adopting a Single-Payer Health… Read More »
Reuter’s announced in January that diabetes deaths in the United States continue to surge well above pre-pandemic levels with over 100,000 Americans dying from diabetes in 2021. Given COVID-19’s relationship to diabetes, we may see this trend continue. Increasing deaths from diabetes is a clear call to action for new solutions. Historically, diabetes has been… Read More »
In a previous post, we shared highlights from an event about fixing health care featuring Dr. Michael Fine, a family medicine physician, former public health official, and the author of Health Care Revolt. The faculty of the Department of Public Health at California State University Los Angeles led the event as part of a department-wide book read.… Read More »
Like others working at the intersection of public health and medicine, my faith in primary care has long been unshakeable. Increasingly actualized as the Patient-Centered Medical Home (PCMH), primary care has experienced a decade plus of attention thanks to efforts at retooling and rebranding the field. But in the last week, a tiny crack formed… Read More »
Children with complex health needs (CCHN) are a unique pediatric patient population. They have chronic medical and/or behavioral conditions that need ongoing health care. They use a disproportionate share of hospital resources. And they face greater social challenges when compared to other children. In North Carolina (where we work) and across the country, CCHN fail… Read More »
The Alzheimer’s Association’s 2021 Alzheimer’s Disease Facts and Figures report [PDF] shares that currently, six million Americans are living with Alzheimer’s disease, a number that has increased 145% since the turn of the century. Around the world, there are 50 million people living with Alzheimer’s disease or related dementia. Only a quarter of would-be patients… Read More »
The COVID-19 pandemic has strained healthcare and public health. Many workers in these industries have felt growing frustration with leadership. They face a barrage of medical misinformation, ethical strains, and burnout. Now more than ever, authentic leadership is critical in supporting healthcare workers and advancing public health. This post will describe authentic leadership and examine… Read More »
Homelessness persists in the US, and across the world, despite decades of recognition and longstanding efforts to end the condition. There have been major successes in our understanding of what policies and programs work to prevent and end homelessness. However, the work must and will find new ways to adapt and improve if we are… Read More »
Nonprofit hospitals make up the majority of hospitals in the US. In exchange for their tax-exempt status, the federal government requires these hospitals to provide support in the form of community benefits. Tracking community benefit spending and its impact is important to ensure that such spending aligns with community needs. Community benefit activities can include… Read More »
The Medicare Part D program, which was launched in 2006, is in the middle of its second decade of providing prescription drug coverage to Medicare beneficiaries. The Part D program has improved beneficiaries’ access to prescription drugs but at increasing cost. Federal spending for Part D has more than doubled from $44.3 billion in 2006… Read More »
A growing trend in health care, accelerated by the COVID-19 pandemic, is the implementation of telemedicine. Telemedicine is the delivery of health-related information and services among patients and providers via telecommunication technologies. An example is the use of video technology by doctors to evaluate, diagnose, or treat a patient instead of having a face-to-face encounter. … 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 »
Health insurers often pay health plans to manage the care of their members. Good care can help prevent emergencies, such as avoidable trips to a hospital emergency department (ED). Medically complex patients, such as those with behavioral health problems or substance use disorders, tend to have a lot of ED visits. Social determinants of health… Read More »
For older adults in the United States, obtaining and paying for prescriptions can be a challenge. Although most Americans over age 65 are eligible for prescription drug coverage under the Medicare Part D, understanding and navigating the benefit can be difficult. The Center for Medicare and Medicaid Innovation (CMMI) recently launched a new payment model… Read More »
What accounts for large differences in life expectancy from one neighborhood to another? This post explains what our team has discovered so far using an “artificially intelligent” approach to understanding social risk at the local level. Where you live affects how long you live In 2018, when the National Center for Health Statistics released the… 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 »
How could alternative pediatric payment models help to address children’s broad health, social, and developmental needs? This post delves into funding and financing challenges and potential solutions. I recently collaborated on a report on alternative payment models for child health with colleagues from the Duke Margolis Center for Health Policy and Mental Health America. The… Read More »
The COVID-19 pandemic caused large reductions in in-person office visits, costing primary care practices billions and exposing many of the risks associated with the fee-for-service (FFS) payment system. Capitation arrangements, in which providers are paid a per-member per-month payment, may offer a more attractive, less risky arrangement in the post-COVID-19 world. Almost all US health… Read More »
Millions are losing sleep due to anxiety, fear, and the difficulty of maintaining a schedule during this pandemic. Research suggests that those who get insufficient sleep may be at risk for health conditions such as obesity and heart disease. Yet, too much sleep may increase the risk of other health conditions such as diabetes and… Read More »
In March, CMS and other Federal agencies announced temporary telehealth policy changes in response to the COVID-19 public health emergency. These changes promoted continued access to care while allowing for physical distancing. Virtual care encounters have increased since March. However, as the public health emergency has continued, there are questions about the future of virtual… Read More »
COVID-19 has exposed the cracks in the foundation of America’s rural community health system. These cracks include increased risk of facility closures, loss of services, low investment in public health, maldistribution of health professionals, and payment policies ill-suited to low-volume rural providers. As a result, short-term relief to stabilize rural health systems and long-term strategies… Read More »
What are the potential impacts of COVID-19 on health care utilization? How will changes in healthcare use impact quality measures? Researchers are asking many key questions to understand the impacts of COVID-19. It is clear that trends in healthcare use are changing. These changes will likely affect quality measure scores in the future. This is… Read More »
In this series on options for universal coverage, we explore elements of various reform proposals and evaluate their potential impact. Rather than examining complete proposals, we highlight specific policy elements that appear in one or more such proposals. The three we focus on in this series are: Eliminating Medicare Advantage (May 14, 2020) Expanding Medicare… Read More »
Climate change is a contributory factor to wildfires in California this year that have engulfed 1.4 million acres of land. Most recently, lightning strikes sparked new fires in Northern California, including the L.N.U. Lightning Complex (currently the third largest fire in California history). Wildfires contribute to poor health outcomes and disrupt care delivery. In addition, the… Read More »
Provider contracting may sound dull, but it can have big impact on patients. Contracting may not be the first thing you think of when choosing a provider or facility. It may also not be something you have a lot of control over. But because of surprise billing, provider contracting can have a big effect on… Read More »
Current healthcare reimbursements may create incentives for excess use of ventilators to treat COVID-19 patients. Recent research has shown that healthcare providers, including hospitals, have experienced substantial financial losses as a result of the COVID-19 pandemic. Alternative, less-invasive treatments for critically ill COVID-19 patients could potentially improve patient outcomes. But these approaches expose hospitals to… Read More »
A new study out this month in Medical Care by Yongkang Zhang and colleagues finds that people in struggling neighborhoods have considerably higher spending on potentially preventable health care. While overall health care spending was similar between the most deprived areas and average communities, the finding about spending on potentially preventable health care tells an… Read More »
In this series on options for universal coverage, we explore elements of various reform proposals and evaluate their potential impact. Rather than examining complete proposals, we highlight specific policy elements that appear in one or more such proposals. The three we focus on in this series are: Part 1 – Eliminating Medicare Advantage (May 14,… Read More »
We don’t always think of health insurers as communicators. However, when insurers set reimbursement rates, they provide information that directly influences service delivery. When payors reimburse for certain services, they are informing providers these services are valued and providing these services is encouraged. When payors do not reimburse for services, or reimburse at lower rates,… Read More »
With less than five weeks to go before welcoming a second child, the patient sat in my exam room in tears. By all accounts, this was a routine appointment at the end of a routine pregnancy. Except on this particular day, clutching family photos from their recent baby shower, the patient shared with me that… Read More »