How To Win The Doctor Lottery [Narrative Matters]
Not every doctor-patient encounter is healing, and it can seem a game of chance. One patient explores what it takes to win. (Source: Health Affairs)
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Nakazawa, D. J. Tags: Personal Experience ( Narrative Matters ), Physicians Source Type: research
Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims [Web First]
The Affordable Care Act (ACA) reformed the individual health insurance market. Because insurers can no longer vary their offers of coverage based on applicants’ health status, the ACA established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. To assess the impact of these programs, we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments....
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Jacobs, P. D., Cohen, M. L., Keenan, P. Tags: Health Care Finance, Health Reform, Managed Competition, Insurance Market, Affordable Care Act Web First Source Type: research
The Volume Of TV Advertisements During The ACAs First Enrollment Period Was Associated With Increased Insurance Coverage [Web First]
The launch of the Affordable Care Act was accompanied by major insurance information campaigns by government, nonprofit, political, news media, and private-sector organizations, but it is not clear to what extent these efforts were associated with insurance gains. Using county-level data from the Census Bureau’s American Community Survey and broadcast television airings data from the Wesleyan Media Project, we examined the relationship between insurance advertisements and county-level health insurance changes between 2013 and 2014, adjusting for other media and county- and state-level characteristics. We found that c...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Karaca-Mandic, P., Wilcock, A., Baum, L., Barry, C. L., Fowler, E. F., Niederdeppe, J., Gollust, S. E. Tags: Health Reform, Insurance Coverage, Affordable Care Act Web First Source Type: research
Most Americans Have Good Health, Little Unmet Need, And Few Health Care Expenses [Spending On Health Care]
The distribution of health care expenditures remains highly concentrated, but most Americans use few health care resources and have low out-of-pocket spending. More than 93 percent of "low spenders" (those in the bottom half of the population) believe they have received all needed care in a timely manner. The low spending by the majority of the population has remained almost unchanged during the thirty-seven-year period examined. (Source: Health Affairs)
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Berk, M. L., Fang, Z. Tags: Access To Care, Health Spending, Insurance Market Spending On Health Care Source Type: research
States With Prescription Drug Monitoring Mandates Saw A Reduction In Opioids Prescribed To Medicaid Enrollees [Opioid Prescriptions]
Prescription drug monitoring programs are promising tools to use in addressing the prescription opioid epidemic, yet prescribers’ participation in these state-run programs remained low as of 2014. Statutory mandates for prescribers to register with their state’s program, use it, or both are believed to be effective tools to realize the programs’ full potential. Our analysis of aggregate Medicaid drug utilization data indicates that state mandates for prescriber registration or use adopted in 2011–14 were associated with a reduction of 9–10 percent in population-adjusted numbers of Schedul...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Wen, H., Schackman, B. R., Aden, B., Bao, Y. Tags: Medicaid, Mental Health/Substance Abuse, Pharmaceuticals Opioid Prescriptions Source Type: research
Medicaid Adult Dental Benefits Increase Use Of Dental Care, But Impact Of Expansion On Dental Services Use Was Mixed [Oral Health]
Dental coverage for adult enrollees is an optional benefit under Medicaid. Thirty-one states and the District of Columbia have expanded eligibility for Medicaid under the Affordable Care Act. Millions of low-income adults have gained health care coverage and, in states offering dental benefits, oral health coverage as well. Using data for 2010 and 2014 from the Behavioral Risk Factor Surveillance System, we examined the impact of Medicaid adult dental coverage and eligibility expansions on low-income adults’ use of dental care. We found that low-income adults in states that provided dental benefits beyond emergency-o...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Singhal, A., Damiano, P., Sabik, L. Tags: Managed Care - Medicaid, Medicaid, Oral Health Care Source Type: research
Prevalence, Disparities, And Determinants Of Primary Cesarean Births Among First-Time Mothers In Mexico [Global Health]
Mexico has the second-highest prevalence of cesarean deliveries in the Americas, behind Brazil. Having had a previous cesarean delivery is highly predictive of having subsequent cesarean deliveries, yet evidence on the drivers of primary (that is, first-time) cesarean deliveries is sparse. Using 2014 Mexican birth certificate data and performing population-level analyses of data on 600,124 first-time mothers giving birth after at least thirty-seven weeks of gestation, we examined the prevalence and determinants of primary cesarean deliveries. We found a very high prevalence of cesarean deliveries among these women—48...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Guendelman, S., Gemmill, A., Thornton, D., Walker, D., Harvey, M., Walsh, J., Perez-Cuevas, R. Tags: International Issues, Maternal And Child Health Global Health Source Type: research
Industry-Led Access-To-Medicines Initiatives In Low- And Middle-Income Countries: Strategies And Evidence [Global Health]
Global biopharmaceutical companies are increasingly establishing access-to-medicines (AtM) initiatives in low- and middle-income countries. We reviewed the initiatives of twenty-one research-based global biopharmaceutical companies to assess their strategies for improving access and the quality of evidence on the impact of their initiatives. The number of operating initiatives increased from 17 in 2000 to 102 in 2015. Of the 120 different AtM initiatives identified, 48 percent used a medicine donation strategy, and 44 percent used a price reduction strategy. While companies have frequently claimed that their init...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Rockers, P. C., Wirtz, V. J., Umeh, C. A., Swamy, P. M., Laing, R. O. Tags: Access To Care, International Issues, Pharmaceuticals Global Health Source Type: research
The Medicare Access And CHIP Reauthorization Act: Effects On Medicare Payment Policy And Spending [Effects Of MACRA]
In 2015, Congress repealed the Sustainable Growth Rate formula for Medicare physician payment, eliminating mandatory payment cuts when spending exceeded what was budgeted. In its place, Congress enacted the Medicare Access and CHIP Reauthorization Act (MACRA), which established a two-track performance-based payment system that encourages physicians to participate in alternative payment models. MACRA could have huge effects on health care delivery, but the nature of those effects is highly uncertain. Using the RAND Corporation’s Health Care Payment and Delivery Simulation Model, we estimated the effects of MACRA on Me...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Hussey, P. S., Liu, J. L., White, C. Tags: Health Reform, Medicare, Physicians, Health Spending Effects Of MACRA Source Type: research
Mystery Of The Chargemaster: Examining The Role Of Hospital List Prices In What Patients Actually Pay [Business Of Medicine]
Hospitals in the United States maintain chargemasters that contain the official list prices for all billable services. The prices vary widely across hospitals and are more than three times what hospitals are paid for treating a patient, on average. From this it is tempting to conclude that list prices are a strange, yet ultimately inconsequential, quirk of US health care. However, using both state and national data sets covering the period 2002–14, we found considerable evidence suggesting that list prices reflect hospitals’ strategic behavior and have meaningful effects on payments made by and on behalf of pat...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Batty, M., Ippolito, B. Tags: Hospitals, Health Spending, Consumer Issues Business Of Medicine Source Type: research
Evaluating The Role Of Payment Policy In Driving Vertical Integration In The Oncology Market [Business Of Medicine]
The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003–15, finding that the rate of hospital or health system ownership of practices doubled from about 30 percent to about 60 percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that drama...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Alpert, A., Hsi, H., Jacobson, M. Tags: Medicare, Business Of Health Business Of Medicine Source Type: research
Small Decline In Low-Value Back Imaging Associated With The 'Choosing Wisely Campaign, 2012-14 [Medical Imaging]
Choosing Wisely was launched by the American Board of Internal Medicine in April 2012 as a patient- and clinician-targeted campaign to reduce potentially unnecessary "low-value" medical services. The campaign’s impact on low- and high-value care beyond its first year is unknown; furthermore, it is unknown whether some patients such as members of consumer-directed health plans and people residing in different US regions have responded more than others. To evaluate the impact of Choosing Wisely, we used commercial insurance claims to track changes in the use of low-value imaging (x-ray, computed tomography, and ma...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Hong, A. S., Ross-Degnan, D., Zhang, F., Wharam, J. F. Tags: Insurance - Employer-Based System, Quality Of Care, Health Spending, Consumer Issues Medical Imaging Source Type: research
After Nearly A Decade Of Rapid Growth, Use And Complexity Of Imaging Declined, 2008-14 [Medical Imaging]
In this study we examined more recent data to determine whether the slowdown had continued. Our data sources were the nationwide Medicare Part B databases for the period 2001–14. We calculated utilization rates per 1,000 enrollees for all advanced imaging modalities. We also calculated professional component relative value unit (RVU) rates per 1,000 beneficiaries for all imaging modalities, as RVU values provide a measure of complexity of imaging services and may in some ways be a better reflection of the amount of work involved in imaging. We found that utilization rates and RVU rates grew substantially until 2008 a...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Levin, D. C., Parker, L., Palit, C. D., Rao, V. M. Tags: Medicare, Business Of Health, Research And Technology Medical Imaging Source Type: research
Electronic Health Record Logs Indicate That Physicians Split Time Evenly Between Seeing Patients And Desktop Medicine [Physician Practice]
This study used data captured by the access time stamp functionality of an electronic health record (EHR) to examine physician work effort. This is a potentially powerful, yet unobtrusive, way to study physicians’ use of time. We used data on physicians’ time allocation patterns captured by over thirty-one million EHR transactions in the period 2011–14 recorded by 471 primary care physicians, who collectively worked on 765,129 patients’ EHRs. Our results suggest that the physicians logged an average of 3.08 hours on office visits and 3.17 hours on desktop medicine each day. Desktop medicine consists...
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Tai-Seale, M., Olson, C. W., Li, J., Chan, A. S., Morikawa, C., Durbin, M., Wang, W., Luft, H. S. Tags: Physicians, Health Information Technology Physician Practice Source Type: research
Physicians In Medicare ACOs Offer Mixed Views Of Model For Health Care Cost And Quality [Accountable Care Organizations]
Physicians’ willingness to change how care is delivered is a key component of the ability of accountable care organizations (ACOs) to transform patient care. Yet physicians participating in Medicare ACOs are only moderately convinced that ACOs are an effective model for delivering cost-effective care. (Source: Health Affairs)
Source: Health Affairs - April 3, 2017 Category: Global & Universal Authors: Schur, C. L., Sutton, J. P. Tags: Health Reform, Physicians, Quality Of Care Accountable Care Organizations Source Type: research
