Dear John,

The March issue of Health Affairs contains articles that cover a variety of topics, including nursing home ownership and staffing, Medicaid’s role in maternity care, physicians’ participation in Medicare Advantage (MA) networks, and more.

Nursing Homes

The Biden administration announced a series of reforms in 2022 aimed at improving transparency of nursing home ownership.

In an article that is part of our Age-Friendly Health series, Amanda Chen and coauthors assess data released by the Centers for Medicare and Medicaid Services (CMS) as part of its efforts to increase accountability.

Comparing the public data with information in proprietary databases, the authors find that “only a third of the [private equity (PE)] and fewer than a fifth of the [real estate investment trust] investments identified in the proprietary files were also present” in the CMS data.

In another Age-Friendly Health paper, John Bowblis and coauthors examine trends in the use of staffing agencies among freestanding nursing homes before and during the COVID-19 pandemic.

The percentage of nursing homes using any direct care agency staff rose from 22.5 percent in 2018–19 to 49.1 percent in 2022, and the share of hours worked by agency staff more than tripled during this period.

Medicaid

As states implement new options for postpartum Medicaid coverage, Sarah Gordon and coauthors explore lessons from the continuous enrollment provision of the Families First Coronavirus Response Act of 2020, which required states to provide continuous coverage to all Medicaid enrollees during the height of the pandemic.

Those provisions led to an increase (from 59.3 percent to 90.7 percent) in the rates of continuous coverage for one year postpartum, and they eliminated the large rates of disenrollment that historically have occurred in the third postpartum month.

Kate Strully and coauthors explore the association between Medicaid expansion under the Affordable Care Act and maternal health outcomes among American Indian/Alaska Native women.

Using 2010–19 data, the authors estimate that the expansions increased Medicaid coverage but had no effects on early initiation of prenatal care or infant birthweight.

Physicians

In an article that is part of our series on The Practice of Medicine, Ola Abdelhadi and coauthors report substantial increases in PE ownership of physician practices between 2012 and 2021, resulting in sixty Metropolitan Statistical Areas where PE firms control more than half of the market in at least one medical specialty.

Sara Schaefer and coauthors compare rates of elective versus emergency surgery among patients with three conditions where limited access to care may lead to the patient requiring emergency surgery.

The authors find that Medicare beneficiaries living in more severe primary care shortage areas had higher rates of emergency surgery and were more likely to have serious complications and readmissions.

Eran Politzer and coauthors analyze primary care physician services in MA plans. They find that the average primary care physician who is in an MA network had annual per patient costs that were $433 less than the average within the physician’s region, while providing similar quality of care.

Notably, the 19 percent of primary care physicians who did not participate in any MA networks had much higher costs and lower quality scores.

In Narrative Matters, Kara Ayik shares the story of her son’s rare disease diagnosis and says that she tells parents “not to perceive their doctors as infallible deities but to learn, do their own research, and be bold in standing up for their children.”

Equity

Jeah Jung and coauthors compare differences in quality of care by race and ethnicity for enrollees in MA compared with enrollees in traditional Medicare.

Examining three quality outcomes using data from the period 2016–19, the authors find no consistent pattern. Rather, quality-of-care gaps between MA and traditional Medicare “varied with the minority group and the quality measure in question.”

Yan Guo and coauthors track discontinuation of the use of pre-exposure prophylaxis (PrEP) among sexual and gender minority people. They find an annual PrEP discontinuation rate of 35–40 percent in the four-year national cohort study.

The authors conclude that housing instability, prior PrEP discontinuation, lack of health insurance, and younger age are all risk factors for
PrEP discontinuation.

Meals on Wheels, funded through a range of sources including the Older Americans Act of 1965, provides home-delivered meals to more than one million older Americans annually.

Sarah Walsh and coauthors explore associations between Meals on Wheels use and the likelihood that the recipient will remain living in the community or be hospitalized.

They conclude, “Meals on Wheels services could help some specific groups of beneficiaries maintain community residence, such as those who are Black, enrolled in Medicaid, or frail."

Medicare’s Mental Health Care Problem

Grace McCormack et al.

Suicide Rates Are High And Rising Among Older Adults In The US

Chloe Zilkha et al.

Will Religious Freedom Claims Trump Public Health? Braidwood And HIV Prevention

Devon R. Minnick et al.

Celebrating Women's History Month

This Women's History Month, we're elevating women who work to advance health equity and policy. 

In a October 2023 article, Chanelle Diaz and coauthors explore why dismantling immigrant imprisonment is critical to advancing health equity.