Who Treats Medicaid Patients?

By | June 14, 2016

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?

Tell Me a Good Story: The Value of Stories in Health Services Research

By | April 19, 2024

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 »

Racial/Ethnic Concordance and Doctor Communication

By | March 14, 2024

Patient-provider racial/ethnic concordance (i.e., physician and patient identify as the same race/ethnicity) has emerged as one key suggestion for mitigating healthcare disparities. Past research has underlined its benefits, including improved infant mortality and more appropriate prescription regimens. However, the sum of the evidence remains unclear and many facets of the patient-provider relationship have yet to… Read More »

Social Determinants of Health Programs Improve Health Outcomes

By | February 1, 2024

The social determinants of health (SDOH), the conditions in which we are born, live, learn, work, play, worship, and age, have a significant impact on health outcomes. Research shows that a whopping 80-90% of health outcomes are dependent on SDOH factors, while medical care only accounts for about 10-20%. New clinical-community partnerships designed to address… Read More »

Category: All

Health Plans With Deductibles See Lower Lung Cancer Screening Rates

By | November 22, 2023

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 »

Beyond COVID and Opioids: Contextualizing Life Expectancy Decline in the United States

By | September 18, 2023

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 »

Healthy Intersections Podcast: June 2023

By | June 19, 2023

Welcome to the June 2023 episode of the Healthy Intersections podcast! This month, we sit down again with Carol Schmitt, Chief Scientist at RTI International, along with Juliet Sheridan, to talk about another of the RTI Rarity interactive state maps. This time, we are looking at North Carolina. We talk about historical redlining, climate change,… Read More »

Using data-driven quality measurement and analytics to build health equity

By | April 27, 2023

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 »

Telemedicine and Depression

By | March 23, 2023

 The rapid transition from in-person to care to telemedicine visits at the start of the COVID‑19 pandemic did not adversely affect the quality of care – and even improved some aspects of care – for patients with major depression in a major integrated health system, according to a new report. The study appears as part of… Read More »

Healthy Intersections Podcast: February 2023

By | February 10, 2023

This month’s podcast features a round-up of this month’s blog posts and a summary of three articles recently published in the journal Medical Care. Listen here or via your favorite podcast platform! Transcript Hello friends. Welcome to the Healthy Intersections Podcast for February 2023. This podcast is sponsored by the American Public Health Association’s Medical… Read More »

Long-acting reversible contraception in the era of abortion bans

It is more important than ever to expand access to a broad range of safe and effective contraceptives that includes long-acting reversible contraception (LARC) methods. We are living in a new era in the US. As of early November, 2022, abortions are banned from the point of conception in 12 states and severely restricted in… Read More »

APHA Calls for Single-Payer Health Reform

By | July 6, 2022

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 »

Diabetes Cure or Diabetes Management?

By | May 26, 2022

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 »

Is Something Going Wrong With the Patient Centered Medical Home?

By | January 27, 2022

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 »

How are CMMI health policy evaluations addressing non-parallel trends?

To help determine which health policy changes to the Medicare or Medicaid programs are desirable, the CMS Center for Medicare and Medicaid Innovation (CMMI) relies on formal evaluations, performed by outside contractors, of how smaller scale, typically voluntary, demonstrations and other initiatives impact outcomes of interest. However, determining causal impacts often relies on the key… Read More »

Category: All

“Carve In” Mental Health and Substance Use Treatment

By | December 21, 2021

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 »

APHA Annual Meeting 2021 Preview

By | October 23, 2021

The annual meeting of the American Public Health Association starts this weekend!  This year the meeting is being held in person in Denver with lots of virtual options as well. I know everyone is excited about getting back together and connecting as a community. I can’t wait to connect with friends and colleagues and meet… Read More »

COVID-19 and Health Workforce Equity

COVID-19 has uncovered and multiplied health workforce equity challenges across the US. In the early days of the pandemic, healthcare workers faced incredible personal risk from an unknown, highly contagious, deadly disease. Insufficient personal protective equipment (PPE) and reprimand and dismissal by employers for speaking out worsened this risk. As waves of COVID-19 swept across… Read More »

Multimorbidity and Psychosocial Aspects of Homelessness

By | September 13, 2021

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 »

Broken Trust and Cancer Prevention

The pandemic has familiarized us all with the phrase “medical mistrust,” often framing those who have it as being irrational or uninformed.  Oft ignored is the biomedical community’s long legacy of broken trust.  Addressing cancer-related inequities will require health professionals to make concerted efforts to repair that broken trust. Cancer and Broken Trust People of… Read More »

From Policy to Practice: Teamwork in a Public Health Crisis

During its recent mid-year meeting, the American Public Health Association’s Medical Care Section was honored to hear from two physician leaders serving at the heart of the fight against COVID-19. Hailing from opposite ends of the country, Drs. Atul Nakhasi (California) and Ayne Amjad (West Virginia) shared their insight about teamwork in a public health… Read More »

Racism and Rurality in COVID-19 Burden

The inequitable distribution of COVID-19’s terrible burden has been well documented. There are notable disparities by race and ethnicity. COVID-19 rates, including incidence and fatality rates, are higher among Black, Indigenous, and other Persons of Color (BIPOC). This is structural racism at its worst, in which BIPOC individuals are disproportionately represented among essential workers and… Read More »

Admitting Defeat in the Fight Against Obesity

By | March 26, 2021

As we are overcoming the COVID-19 pandemic, the obesity pandemic is worsening. The United States is the most obese country in the world. Is it time to admit defeat in this 30-year battle against obesity?  Only 1 in 122 mildly obese people with a primary care physician will achieve a normal weight, according to a… Read More »

Rewarding ACOs that Manage Complex Patients

By | March 22, 2021

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 »

The Complexity of COVID-19 Vaccine Distribution in Rural Areas

During the past year, the COVID-19 pandemic has highlighted health inequality created by social determinants of health (SDoH) in the United States. SDoH include all aspects of the living environment, social support, safety, well-being, and resource availability, directly or indirectly influencing physical health outcomes. Consideration of SDoH is critical for successful comprehensive COVID-19 vaccine rollout.… Read More »

Rural Telehealth in the COVID Era and Beyond

National Rural Health Day provides an opportunity to reflect on the quality of medical care in rural and medically underserved communities. This year has posed additional challenges to fragile healthcare systems and vulnerable populations. Faced with new barriers, rural communities are adapting and innovating through telehealth. COVID-19 caught the entire country off balance, highlighting structural… Read More »

Rebuilding the Foundation of Rural Community Health after COVID-19

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 »

Behavioral Health: Actuarial Value, Integration, & Innovation

Behavioral health — counseling, mental health care, and care for substance use issues — is one of the basic benefits associated with health insurance and healthcare delivery. The COVID-19 pandemic has reminded us of the gross inadequacy of current behavioral health to deliver high quality care to most Americans. The past 30 years of health… Read More »

After COVID-19, We Must Build Back Better

By | August 17, 2020

The COVID-19 pandemic has brought to light the gross underinvestment in public health, primary care, and the social determinants of health in the United States. Yet, this experience gives us a chance to rethink our health and social service systems, as these are often siloed. We see education, employment, healthcare, housing, and other social services… Read More »

#SexEdForAll: What We Need to Prevent Intimate Partner Violence

By | June 1, 2020

We just wrapped up #SexEdForAll month in May, yet most people still believe sex education is just about sex. But it’s so much more than that! That’s why I created the Sexuality Education Legislation and Policy: A State-by-State Comparison of Health Indicators story map, in conjunction with the Robert Graham Center for Policy Studies in… Read More »

Updated guidance on using telehealth during this public health emergency

By | April 15, 2020

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 »

Are Community Health Workers Worth It?

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 »

Much ado about rural health

By | February 5, 2020

As of late, rural health has been a hot topic and buzzword in the public health and health policy spheres. Health Affairs recently published an entire issue related to topics on rural health. The American Journal of Public Health recently issued a call for manuscripts for a special issue dedicated entirely to rural health. Rural… Read More »

ACO Implementation: Current evidence and a way forward

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 »

School Health Policy Series: Part 1 – Everything’s Coming up ACEs

By | November 14, 2019

This month, the website www.ACEsAware.org is set to launch. It will train healthcare workers to screen for Adverse Childhood Experiences (known as ACEs) in primary care clinics, but is that scope too narrow?  Should school workers be included too? The website is part of the work of Dr. Nadine Burke Harris in her new role… Read More »

Introducing a Special Series on School Health

By | December 2, 2019

This month, The Medical Care Blog is hosting a series of posts about the importance of school health. Following up on our 2016 series on the childhood roots of inequity (read the first in the series here), we are dedicating our Thursdays this month to posts that reflect on the health challenges that confront schools.… Read More »

Patient Portals: Part 1 – Who Is Using Portals, and For What?

By | December 2, 2019

Providers’ portal usage rates have been high for some time. While many patients have access to a portal, routine use is less common. In this three-part series, we will explore several questions: Who is using portals? What are the factors that prevent or facilitate the optimal use of portals to engage patients in their care?… Read More »

At 5 Years: Great Blog Posts That (Almost) Nobody Read

By | September 12, 2019

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 »

The State of Abortion in America in 2019

By | June 19, 2019

A 14-year-old girl came to my primary care clinic with abdominal pain, similar to abdominal pain she’s had intermittently for years. As with all women of reproductive age, I checked a urine pregnancy test, and it was positive. I returned to the patient’s room to talk with her about the result, and her first question… Read More »

Medication Overload: The drug epidemic that no one is talking about

The opioid crisis has captured America’s attention, becoming an official “national emergency” and prompting swift action from government agencies, patient advocates, and health care providers. This is as it should be. Over the past decade, opioid overdoses have led to millions of hospitalizations, more than 100,000 deaths, and caused great harm in communities all across… Read More »

Health Equity Through the Lenses of Intersectionality and Allostatic Load

By | February 20, 2019

Although the term health equity is widely used, a common understanding of this term is lacking. Viewing health equity through the lenses of allostatic load and intersectionality could help. This blog post considers three case scenarios, all of which are composites of actual cases that have occurred within the United States, to explore ideas of… Read More »

Hospitalizations of Individuals Experiencing Homelessness Driven by Behavioral Health Concerns

By | February 6, 2019

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 »

Can teamwork make the dream work?

By | January 17, 2019

In 2019, mental health and opioid use disorders remain major public health issues. The most recent estimates suggest that 40 million adults experience mental illness in the U.S. and nearly 8 million adults experience both mental and substance use disorders at the same time. Individuals with mental illness also face higher risks of co-occurring chronic health conditions and… Read More »

Instead of Building a Wall, Let’s Insure America’s Children

By | January 7, 2019

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 »

Engaging Communities & Patients in Research

Engaging patients and families in their care has been a longstanding goal for quality improvement. Engaging patients and communities in research is an emerging field of work and collaboration, and a recent Medical Care article discusses some similarities and differences between engaging patients and communities. Why do we engage communities and patients in research? To create… Read More »

APHA 2018 Preview

By | November 1, 2018

APHA 2018 starts November 10! Thousands of public health practitioners, students, scholars, and activists will descend on San Diego, CA on Saturday for our annual conference. As in previous years, your faithful co-editors will be there, live-tweeting about sessions! So be sure to follow @MedCareBloggers for real-time updates. The program is looking great, and we are excited about… Read More »