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 »
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 »
With the 2020 US presidential election drawing near, debate about the options for universal coverage will ramp up. At the heart of this debate is the estimated 45% of US adults who are either uninsured or under-insured. They are at risk of experiencing financial hardship or going without needed care in a time when access to… Read More »
The rapid emergence of COVID-19 reminds us of the importance of the public health system. Local health departments (LHDs) play a central role in emergency preparedness and response. Effective epidemic response rests on the performance of the essential public health activities— assessment, policy development, and assurance—by LHDs. Evidence suggests that LHDs can improve population health… Read More »
Yesterday, the Centers for Medicare and Medicaid Services (CMS) unveiled new guidance about using telehealth during this public health emergency due to the coronavirus outbreak. This guidance will help increase access to telehealth services. In addition, this will help people receive care who may not be able to visit their providers in person. While the… Read More »
With the current focus on social risk factors (SRFs) affecting health care, it is not surprising that methods for comparing hospital performance might do well to account for such factors in their assessment. If up to 70 percent of health outcomes are driven by factors beyond medical care, and measures used to compare hospitals focus… Read More »
Patients are sometimes referred to as “frequent flyers” when they visit an emergency department multiple times for the same issue. Often this is because discharged patients miss necessary follow-up care. This results in further worsening health, and may contribute to the frequent flying. To address this cycle, patients may be referred to a community health… Read More »
Health care is on everyone’s mind. Here’s what presidential candidates say about healthcare: the 2020 edition. We are two weeks into the 2020 presidential primary season. On the Democratic side, muddled results in Iowa and very close results in New Hampshire have sprung some surprises. Currently at the top of the Democratic field are Pete… Read More »
The need for a comprehensive payment approach that supports the entire maternity care experience from prenatal, labor, and delivery, to postnatal care, is critical for both maternal and child health outcomes. Aligning payment to reward better birth outcomes is becoming more widespread. A handful of states are experimenting with bundled payments to advance value-based payment… Read More »
The current healthcare system is not built for individuals with serious illnesses. These individuals can benefit from palliative care, which focuses on quality of life and symptom relief. Alternative payment models that incorporate palliative care are in development. Yet, the challenges of expanding these models of care are substantial. Betsy recently died after a sixteen-year… Read More »
Over the past eight years, the US health care system has seen the widespread implementation of Accountable Care Organizations (ACOs) as a way to move from volume to value. What are ACOs? ACOs are groups of providers that are collectively accountable for the cost and quality of care for a defined patient population. Examples include… Read More »
Although telehealth has been in use for quite some time, uptake has been low. In particular, an inconsistent policy landscape presents a number of obstacles, such as site restrictions on where telehealth can be delivered, provider restrictions on who can deliver services, and reimbursement restrictions around payment for services. However, some recently developed policies aim… Read More »
It is impossible to bring up a discussion of school sports without mentioning the great bogeyman of sports-related injuries: concussions. The number of concussions has been on the decline in recent years. But a recent estimate suggests that there are still about 4 concussions per 10,000 athletic exposures in high schools. An athletic exposure is… Read More »
Many issues affect the delivery of care to patients who are most in need. Particularly, those who live in rural areas or those who need specialized care may not have access to the care they need. Patients whose care transitions across acute care and long-term/post-acute care (LTPAC) settings may have additional challenges in receiving coordinated… Read More »
VBID and alternative payment models comprise two approaches to reform with different incentives that influence underlying motives. The underlying principle of Value-Based Insurance Design (VBID) is to align patient out-of-pocket costs, or cost-sharing (deductibles, co-pays, etc.), with clinical value of services. Decreasing cost-sharing for high-value services and increasing cost-sharing for low-value services is the goal of… 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 »
In Part I, we touched on how healthcare stakeholders like clinical researchers, doctors, pharmacists, and other providers can and are implementing blockchain technology to facilitate the collaborative exchange of research and data. In this installment, we discuss the business case for blockchain in healthcare. Policies and implementation regarding exchanging patient medical data among providers vary… Read More »
Hepatitis C treatment has gone through a revolution in the last 5 years. Treatment durations have dropped from 48 to 12 weeks, and success rates have improved dramatically. However, treatment costs have sky-rocketed accordingly, and access to care has become a significant issue, particularly for lower socioeconomic individuals and groups. Eligible veterans should have access… Read More »
Tailoring the primary care medical home model improves the care experience for US Department of Veterans Affairs (VA) patients with homelessness experience, according to a recent study by Dr. Audrey Jones and colleagues in the journal Medical Care. Researchers from the VA’s Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center and Center for Health Equity Research… Read More »
“A book lying idle on the shelf is wasted ammunition.” – Henry Miller, The Books in My Life (1952) The Medical Care Blog is home to many strong opinions. In the last year, contributors have written provocatively about the political determinants of health, highlighted the per-mile cost of President Trump’s wall in numbers of children who… Read More »
Individuals experiencing homelessness are among the most medically, socially, economically, and politically vulnerable in our society. Because of this, patterns of service use by these individuals can often serve as indicators of the safety net capacity and overall wellness of the systems of care we have in place – like “canaries in the coal mine.”… Read More »
It’s a new season. The federal government re-opened this week after a record-breaking shut-down. Democrats gained control of the U.S. House of Representatives, feeling newly emboldened after the dispute about a border wall. A gaggle of 2020 presidential hopefuls has revealed themselves in recent weeks, lining up to be, arguably, the most liberal class of… Read More »
Primary care sensitive (PCS) emergency department (ED) use is a measure that highlights the connection between primary and emergency care. The right care, for the right person, in the right place, at the right time is a reasonable goal of a high-quality health system. In the US, however, many people go to the emergency department… Read More »
President Trump wants $5 billion right now for his border wall, and another $7 billion (or maybe $13 billion) later on to finish the project. What else could we do with that kind of money? Here’s an idea: with $12 billion we could cover ALL 3.9 million uninsured children in the US today, and still have a… Read More »
There are approximately 61 million women of reproductive age (15-44 years) in the United States, and at any given time, 70% of them are at risk of unintended pregnancy—that is, they are sexually active but do not want to become pregnant. About 72% of women who currently use contraception use non-permanent methods, such as the… Read More »
Going to the hospital is more than a drag. For patients, it can be a frightening experience, dangerous to one’s health, a burden on family and caregivers, and very expensive. Policies to reduce preventable return visits to the hospital are good for patients – and good for Medicare’s bottom line. Medicare’s Hospital Readmission Reduction Program… Read More »
Over a third of all Americans are at an increased risk for chronic conditions such as heart attack, stroke, cancer, and diabetes due to their lack of sleep. Key disorders, such as obstructive sleep apnea, which now afflicts 30 million adults in the United States, are some of the primary causes of the morbidity and… Read More »
Welcome to the Bang for the Buck series! In this series, we will look at the most recent cost and cost-effectiveness research on public health methods and technology and discuss their potential for policy and implementation within the current health care system. As the costs of treating diseases continue to rise faster than inflation, prevention… Read More »