Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees [Web First]
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Bradford, A. C., Bradford, W. D. Tags: Medicaid, Pharmaceuticals Web First Source Type: research
Federal Funding Insulated State Budgets From Increased Spending Related To Medicaid Expansion [Web First]
As states weigh whether to expand Medicaid under the Affordable Care Act (ACA) and Medicaid reform remains a priority for some federal lawmakers, fiscal considerations loom large. As part of the ACA’s expansion of eligibility for Medicaid, the federal government paid for 100 percent of the costs for newly eligible Medicaid enrollees for the period 2014–16. In 2017 states will pay some of the costs for new enrollees, with each participating state’s share rising to 10 percent by 2020. States continue to pay their traditional Medicaid share (roughly 25–50 percent, depending on the state)...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Sommers, B. D., Gruber, J. Tags: Health Reform, Medicaid, State/Local Issues, Health Spending, Affordable Care Act Web First Source Type: research
Improving Allocation And Management Of The Health Workforce In Zambia [Global Health]
Building a health workforce in low-income countries requires a focused investment of time and resources, and ministries of health need tools to create staffing plans and prioritize spending on staff for overburdened health facilities. In Zambia a demand-based workload model was developed to calculate the number of health workers required to meet demands for essential health services and inform a rational and optimized strategy for deploying new public-sector staff members to the country’s health facilities. Between 2009 and 2011 Zambia applied this optimized deployment policy, allocating new health workers to areas w...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Walsh, F. J., Musonda, M., Mwila, J., Prust, M. L., Vosburg, K. B., Fink, G., Berman, P., Rockers, P. C. Tags: International Issues, Workforce Issues Global Health Source Type: research
Vast Majority Of Development Assistance For Health Funds Target Those Below Age Sixty [Global Health]
Development assistance for health targets younger more than older age groups, relative to their disease burden. This disparity increased between 1990 and 2013. There are several potential causes for the disparity increase. (Source: Health Affairs)
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Skirbekk, V., Ottersen, T., Hamavid, H., Sadat, N., Dieleman, J. L. Tags: Health Care Finance, International Issues, Health Spending, Demography, Elderly Global Health Source Type: research
Mongolias Public Spending On Noncommunicable Diseases Is Similar To The Spending Of Higher-Income Countries [Global Health]
Although there is increased recognition of the global challenge posed by noncommunicable diseases (NCDs), translating that awareness into resources for action requires better data than typically available in low- and middle-income countries. One middle-income country that does have good-quality information is Mongolia. Using detailed administrative data from Mongolia and supplementary survey-based information, we estimated public spending on four NCDs in Mongolia and reached four main conclusions. First, Mongolia’s public spending patterns on NCDs are similar to NCD spending observed in countries with much higher per...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Dugee, O., Munaa, E., Sakhiya, A., Mahal, A. Tags: Health Care Finance, International Issues, Health Spending Global Health Source Type: research
Rapid Growth In Mental Health Telemedicine Use Among Rural Medicare Beneficiaries, Wide Variation Across States [Telemedicine]
Congress and many state legislatures are considering expanding access to telemedicine. To inform this debate, we analyzed Medicare fee-for-service claims for the period 2004–14 to understand trends in and recent use of telemedicine for mental health care, also known as telemental health. The study population consisted of rural beneficiaries with a diagnosis of any mental illness or serious mental illness. The number of telemental health visits grew on average 45.1 percent annually, and by 2014 there were 5.3 and 11.8 telemental health visits per 100 rural beneficiaries with any mental illness or serious men...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Mehrotra, A., Huskamp, H. A., Souza, J., Uscher-Pines, L., Rose, S., Landon, B. E., Jena, A. B., Busch, A. B. Tags: Access To Care, Medicare, Mental Health/Substance Abuse, Rural Health Care Telemedicine Source Type: research
Modeling The Economic And Health Impact Of Increasing Childrens Physical Activity In The United States [Children's Health]
Increasing physical activity among children is a potentially important public health intervention. Quantifying the economic and health effects of the intervention would help decision makers understand its impact and priority. Using a computational simulation model that we developed to represent all US children ages 8–11 years, we estimated that maintaining the current physical activity levels (only 31.9 percent of children get twenty-five minutes of high-calorie-burning physical activity three times a week) would result each year in a net present value of $1.1 trillion in direct medical costs and $1.7&...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Lee, B. Y., Adam, A., Zenkov, E., Hertenstein, D., Ferguson, M. C., Wang, P. I., Wong, M. S., Wedlock, P., Nyathi, S., Gittelsohn, J., Falah-Fini, S., Bartsch, S. M., Cheskin, L. J., Brown, S. T. Tags: Health Promotion/Disease Prevention, Maternal And Child Health, Public Health, Health Spending Children ' s Health Source Type: research
Most Hospitals Received Annual Penalties For Excess Readmissions, But Some Fared Better Than Others [Hospital Payment]
The Hospital Readmissions Reduction Program (HRRP) initiated by the Affordable Care Act levies financial penalties against hospitals with excess thirty-day Medicare readmissions. We sought to understand the penalty burden over the program’s first five years, focusing on characteristics of hospitals that received penalties during all five years, how penalties changed over time, and the relationship between baseline and subsequent performance. More than half of participating hospitals were penalized by the Centers for Medicare and Medicaid Services in all five years of the program. From fiscal years 2013 to 2017, the g...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Thompson, M. P., Waters, T. M., Kaplan, C. M., Cao, Y., Bazzoli, G. J. Tags: Hospitals, Medicare Hospital Payment Source Type: research
Medical Group Structural Integration May Not Ensure That Care Is Integrated, From The Patients Perspective [Integrated Care]
Structural integration is increasing among medical groups, but whether these changes yield care that is more integrated remains unclear. We explored the relationships between structural integration characteristics of 144 medical groups and perceptions of integrated care among their patients. Patients’ perceptions were measured by a validated national survey of 3,067 Medicare beneficiaries with multiple chronic conditions across six domains that reflect knowledge and support of, and communication with, the patient. Medical groups’ structural characteristics were taken from the National Study of Physician Organiz...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Kerrissey, M. J., Clark, J. R., Friedberg, M. W., Jiang, W., Fryer, A. K., Frean, M., Shortell, S. M., Ramsay, P. P., Casalino, L. P., Singer, S. J. Tags: Business Of Health, Chronic Care Integrated Care Source Type: research
Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO [Integrated Care]
We examined the impact of patient participation in a Pioneer ACO and its care management program on rates of emergency department (ED) visits and hospitalizations and on Medicare spending. We used data for the period 2009–14, exploiting naturally staggered program entry to create concurrent controls to help isolate the program effects. The care management program (the ACO’s primary intervention) targeted beneficiaries with elevated but modifiable risks for future spending. ACO participation had a modest effect on spending, in line with previous estimates. Participation in the care management program was associa...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Hsu, J., Price, M., Vogeli, C., Brand, R., Chernew, M. E., Chaguturu, S. K., Weil, E., Ferris, T. G. Tags: Managed Care - Medicare, Medicare, Health Spending Integrated Care Source Type: research
Enrollment In A Health Plan With A Tiered Provider Network Decreased Medical Spending By 5 Percent [Physician Practice & Payment]
Employers and health plans are increasingly using tiered provider networks in their benefit designs to steer patients to higher quality and more efficient providers in an effort to increase value in the health care system. We evaluated the impact of a tiered-network health plan on total health care spending and on inpatient, outpatient, and outpatient radiology spending for nonelderly enrollees in a commercial health plan in 2008–12. The tiered network was associated with $43.36 lower total adjusted medical spending per member per quarter ($830.07 versus $873.43), which represented about a 5 percent decrease in ...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Sinaiko, A. D., Landrum, M. B., Chernew, M. E. Tags: Managed Care, Health Spending Physician Practice & amp; Payment Source Type: research
The Medicare Access And CHIP Reauthorization Act And The Corporate Transformation Of American Medicine [Physician Practice & Payment]
This article briefly summarizes the demographics of US physician practice, the potential advantages and disadvantages of physician employment by large corporations, and the evidence to date on the performance of large versus small physician practices and hospital-employed versus independent physicians. It describes the features of MACRA likely to lead physicians to seek corporate employment and the steps the Centers for Medicare and Medicaid Services has taken through MACRA to aid small independent physician practices. I conclude that MACRA’s net effect is likely to be accelerated corporate employment of physicians a...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Casalino, L. P. Tags: Hospitals, Medicare, Physicians Physician Practice & amp; Payment Source Type: research
High-Price And Low-Price Physician Practices Do Not Differ Significantly On Care Quality Or Efficiency [Physician Practice & Payment]
We examined the relationship between physician practice prices for outpatient services and practices’ quality and efficiency of care. Using commercial claims data, we classified practices as being high- or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36 percent higher prices. Patients of high-price practi...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Roberts, E. T., Mehrotra, A., McWilliams, J. M. Tags: Quality Of Care, Health Spending, Consumer Issues Physician Practice & amp; Payment Source Type: research
Passive Enrollment Of Dual-Eligible Beneficiaries Into Medicare And Medicaid Managed Care Has Not Met Expectations [Dual-Eligible Enrollment]
The Centers for Medicare and Medicaid Services Financial Alignment Initiative represents the largest effort to date to move beneficiaries who are eligible for both Medicare and Medicaid—known as dual eligibles—into a coordinated care model by the use of passive (automatic) enrollment. Thirteen states are testing integrated payment and delivery demonstration programs in which an estimated 1.3 million dual eligibles are qualified to participate. As of October 2016, passive enrollment had brought over 300,000 dual eligibles into nine capitated programs in eight states. However, program participation leve...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Grabowski, D. C., Joyce, N. R., McGuire, T. G., Frank, R. G. Tags: Managed Care - Medicaid, Managed Care - Medicare, Medicaid, Medicare, Elderly Dual-Eligible Enrollment Source Type: research
Low-Cost Behavioral Nudges Increase Medicaid Take-Up Among Eligible Residents Of Oregon [Medicaid Enrollment Process]
Efforts to reduce the ranks of the uninsured hinge on take-up of available programs and subsidies, but take-up of even free insurance is often less than complete. The evidence of the effectiveness of policies aiming to increase take-up is limited. We used a randomized controlled design to evaluate the impact of improved communication and behaviorally informed "nudges" designed to increase Medicaid take-up among eligible populations. Fielding randomized interventions in two different study populations in Oregon, we found that even very low-cost interventions substantially increased enrollment. Effects were larger in a popul...
Source: Health Affairs - May 1, 2017 Category: Global & Universal Authors: Wright, B. J., Garcia-Alexander, G., Weller, M. A., Baicker, K. Tags: Insurance Coverage, Medicaid Medicaid Enrollment Process Source Type: research
