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, 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 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 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, given the extent of taxpayer contribution to its development.

Medicare And Medicaid

According to Peter Lyu and coauthors, the 2017 introduction of regional spending 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. 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 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, whereas home care workforce growth has slowed, since 2013. Thus, the ratio of workers to recipients fell 11.6 percent between 2013 and 2019.

Equity

Andrew Anderson and colleagues estimate the financial cost of disparities in preventable heart failure hospitalizations 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 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 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.

About Health Affairs

Health Affairs is the leading peer-reviewed journal 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, Health Affairs Today, and Health Affairs Sunday Update.

Project HOPE 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

Privacy Policy

To unsubscribe from this email, click here.