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Dear John,

The May issue of Health Affairs covers a broad range of topics: how
markets affect prices and utilization, how government payment policies
affect health system behavior, the implications of inequities in
preventable heart failure admissions in the US South, and more.

Read The Issue
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Markets and Payment

US cardiologists are increasingly employed by hospitals as a result of
hospital-physician integration.

Analyzing Medicare claims data, Brady Post and coauthors find that
although patients of hospital-integrated and independent cardiologists
had similar rates of relatively low-cost stress tests
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patients of integrated cardiologists had notably higher rates of cardiac
catheterization and coronary angioplasty, both of which are
high-intensity, hospital-based interventions.

Anthony LoSasso and colleagues use data from the 2021 Hospital Price
Transparency initiative
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to determine that "in states in which the market share of the dominant
health insurer exceeded 71 percent...[that] payer, on average, paid 14.7
percent less to hospitals than market-leading insurers in more
competitive insurance markets."

Under the 340B Drug Pricing Program, eligible hospitals receive
substantial discounts on drug purchases, creating opportunities for them
to earn higher profits from higher-cost discounted drugs than from
lower-cost undiscounted drugs.

By analyzing the administration of two high-volume biologics
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versus that of their biosimilar competitors, Amelia Bond and coauthors
estimate that 340B program eligibility is associated with a 66 percent
reduction in biosimilar use relative to the mean.

The 340B program is also associated with "more hospital-based
administrations of and revenues from biologic medications overall."

Frazer Tessema and colleagues determine that government funding for the
discovery and development of the first HIV pre-exposure prophylaxis
medication included $143 million in (inflation-adjusted) direct funding
from the National Institutes of Health and an additional $314 million in
"potentially related awards," leading to questions about whether high
prices for the drug were justified
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given the extent of taxpayer contribution to its development.

Read More
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Medicare And Medicaid

According to Peter Lyu and coauthors, the 2017 introduction of regional
spending
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into the Medicare Shared Savings Program (MSSP) benchmarks
"fundamentally altered participation incentives."

The result: "We found that [accountable care organization-] and
practice-level participation in the MSSP increasingly shifted to
providers with lower spending in their region after the introduction of
regionalized benchmarking that rewarded such selection."

David Velasquez and coauthors find that between 2013 and 2020,
full-benefit dual-eligible enrollment in integrated care programs (ICPs)
increased nearly fivefold, although it remained much lower than
enrollment in nonintegrated plans
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The authors also find that "compared with the non-ICP fee-for-service
Medicare program, within a given state, nearly all ICPs...had higher
odds of enrolling Black and Hispanic versus White beneficiaries and
lower odds of enrolling rural versus urban beneficiaries."

Analyzing data from sixteen states, Taryn Quinlan and coauthors find
that Medicaid coverage of postpartum long-acting reversible
contraception
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increases its use overall, with increases among Black mothers that are
3.7 percentage points greater than those among White mothers.

Amanda Kreider and Rachel Werner find that growth in Medicaid home and
community-based services participation has accelerated
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whereas home care workforce growth has slowed, since 2013. Thus, the
ratio of workers to recipients fell 11.6 percent between 2013 and 2019.

Read More
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Equity

Andrew Anderson and colleagues estimate the financial cost of
disparities in preventable heart failure hospitalizations
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among Medicare beneficiaries in the US South.

They calculate that the adjusted heart failure admission rate for Black,
American Indian/Alaska Native, and Hispanic beneficiaries was 1.73,
1.50, and 1.15 times the rate of White beneficiaries, respectively,
corresponding with annual excess costs of approximately $61 million, $1
million, and $8 million.

Arline Geronimus and colleagues find that the shift in the past two
decades to later-age childbearing
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increases the relative odds that White and Black women give birth to
very-low-birthweight infants by 10 percent and 19 percent, respectively,
net of socioeconomic factors.

The rise in maternal age distribution at first birth, they conclude,
"accounted for the growing Black-White inequity in infant mortality,
despite technological advances that lowered infant mortality rates
overall."

Drawing on the Department of Agriculture's definition of food deserts,
Caitlin Radford and coauthors analyze census tracts in Massachusetts in
March 2021
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and find "COVID-19 testing deserts" in 35.3 percent of segregated
Hispanic tracts, 51.3 percent of segregated Black tracts, 53.3 percent
of mixed minority tracts, and 24.1 percent of integrated tracts compared
with only 5.6 percent of segregated White tracts.

Order The Issue
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Join Health Affairs Unlimited to access our current and past issues
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This month, our events will cover topics like public health preparedness
and the Medicare shared savings program:

* Journal Club: Benchmarking Changes And Selective Participation In The
Medicare Shared Savings Program
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May 10, 2023

* Policy Spotlight: One-on-One Discussion with HHS Assistant Secretary
for Preparedness and Response Dawn O'Connell
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May 17, 2023

* Lunch And Learn: A Seat For All: Advancing Racial Equity In Scholarly
Publishing Of Health Policy And Health Services Research
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May 23, 2023

View Full Event Schedule
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Two new health policy briefs released last week cover the issue of US
residential segregation, its impact on health, and policies to alleviate
the problem:

* Residential Segregation And Health: History, Harms, And Next Steps
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by Justin Steil et al.

* Public Policies To Address Residential Segregation And Improve Health
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by Michael Lens et al.

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Is telemedicine here to stay
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hospitals tracking your data
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will the latest SCOTUS ruling
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affect your access to care?

Our podcasts explore questions like these every week and uncover the
latest findings and insights in health policy research.

In May, we'll host authors from the new journal issue to discuss topics
like hospital-physician integration, dual-eligible Medicare, and more.

Check out our podcasts, and subscribe on Spotify
<[link removed]>, Apple
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or wherever you prefer to listen.

Listen
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mailto:[email protected]

About Health Affairs

Health Affairs is the leading peer-reviewed journal
<[link removed]> at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org <healthaffairs.org>, Health Affairs Today
<[link removed]>, and Health Affairs Sunday
Update <[link removed]>.  

Project HOPE <[link removed]> is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 1220 19th Street, NW, Suite 800, Washington, DC 20036, United States

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