The June issue of
Health Affairs explores a wide range of topics, including children’s Medicaid coverage, competition in the biosimilars market, sites of care for people with Alzheimer’s disease, and more.
Medicaid Aditi Vasan and coauthors assess children’s Medicaid participation before and after enactment of the continuous coverage provisions of the Families First Coronavirus Response Act.
They find that although "both prior continuous eligibility states and new continuous coverage states experienced increases in children’s Medicaid participation during the COVID-19 pandemic, the increase was significantly greater in new continuous coverage states."
Ju-Chen Hu and coauthors examine the relationship between quantitative managed care network adequacy standards and access to specialty care among Medicaid-enrolled children, including those with special health
care needs, who often have difficulty obtaining specialty care.
The authors find no association between the adoption of new standards and measures of specialty care use or unmet health care need.
Through the Medicaid Drug Rebate Program, state Medicaid programs receive mandatory rebates when prices rise
faster than inflation.
Congress expanded that program in 2017 to include generic drugs.
Benjamin Rome and coauthors find that between 2017 and 2020, inflationary rebates "offset an estimated 2–12 percent of the $54 billion total Medicaid generic drug spending."
They find that after the introduction of biosimilars in 2019– 20, Herceptin accounted for 45.3 percent of Medicare trastuzumab claims, whereas Kanjinti (a biosimilar) accounted for 39.6 percent of claims.
Between 2019 and 2022 Herceptin’s average sales price fell 21 percent, and "biosimilars’ net prices generally declined as new biosimilars entered."
They find that among rural hospitals without oncology services in 2011, those that joined
the 340B Drug Pricing Program, which provides access to discounted drugs, were more likely than similar hospitals that did not join the program to begin providing oncology services by 2020.
To estimate whether nursing home residents with Alzheimer’s disease and related dementias or cognitive impairment (ADRD-CI) have access to necessary care, Dana Mukamel and coauthors explore the distribution of nursing home residents with ADRD-CIacross US nursing homes.
They determine that "the majority of nursing homes…had a census ranging from 31 percent to 80 percent of residents with ADRD-CI."
Fewer than 1 percent of patients with ADRD-CI are in nursing homes where more than 90 percent of residents have ADRD-CI, which is associated with the highest quality of care. Naoki Ikegami and Thomas Rice argue that despite Japan’s aging populationand increased spending on a public long-term care insurance program, the government’s fee schedule has effectively contained the country’s health care expenditures.
The fee schedule consists of revisions to pharmaceutical pricing and incentives to provide coordinated primary and long-term care.
Joag recounts the difficulties she encountered as she tried to connect her patients with behavioral health services in an uncoordinated health system.
She advocates for coordinated care for older Americans that better integrates behavioral health needs into long-term care plans.
Accountable Health Communities
The Center for Medicare and Medicaid Innovation’s Accountable Health Communities (AHC) Model, launched in 2017, connects eligible Medicare and Medicaid beneficiaries with community services to address health-related social needs.
After analyzing survey results, the authors find that although the AHC Model effectively engaged participants, with more than 75 percent of beneficiaries opting in to receive navigation, "the assistance-track intervention did not significantly increase the rate of community service provider connection or the rate of health-related social
needs resolution."
ICYMI two recent health policy briefs released last
cover the issue of US residential segregation, its impact on health, and policies to alleviate the problem:
Health Affairs is the leading peer-reviewedjournalat 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.
