Dear John,

The July issue of Health Affairs covers topics ranging from Medicare payment models to physician revenue to the effects of an accelerated drug approval program.

It also contains two sets of projections from the US government:

• Jacqueline Fiore and colleagues at the Centers for Medicare and Medicaid Services provide ten-year projections of national health expenditures.
• Jessica Hale and colleagues at the Congressional Budget Office provide ten-year projections of sources of health insurance coverage.

Medicare

Shriram Parashuram and coauthors estimate that the Next Generation Accountable Care Organization model reduced per beneficiary spending on Medicare Parts A and B by about 2 percent, although those savings were more than offset by shared savings and other incentive payments.

Medicare Advantage (MA) plans have a financial incentive to identify as many diagnoses as possible among their enrollees.

Paul Jacobs examines in-home health risk assessments and chart reviews and finds that encounter-based risk scores for MA enrollees were 7.4 percent higher in 2021 when diagnoses from these sources were included.

In a Policy Insight, Robert Berenson and Kevin Hayes argue that the Medicare Physician Fee Schedule and Alternative Payment Models (APMs) are “intrinsically linked,” warranting efforts to fix the flaws in the fee-for-service payment system.

“Value,” they conclude, “must be sought in both the fee schedule and APMs.”

COVID-19

More than 200,000 nursing home residents and staff died during the COVID-19 pandemic.

Tamara Konetzka and coauthors describe lessons learned from how the pandemic affected nursing homes.

They summarize policy responses that worked, the roles of community prevalence and planning, the structural characteristics of facilities, and shorter-term solutions to improve nursing home outcomes in the future.

Melissa Barber and coauthors analyze how COVID-19 affected exports of active pharmaceutical ingredients (APIs) from India.

Overall, volume dropped dramatically with small changes in prices, with the exception of “sharp price increases for APIs for some repurposed medicines, particularly those with significant social media attention (hydroxychloroquine and ivermectin).”

Peter Smulowitz and coauthors explore the extent and causes of emergency department (ED) and hospital overcrowding during the pandemic.

Analyzing Medicare data, they find widespread reductions in overall ED visits between 2019 and 2022, suggesting that overcrowding was primarily due to constraints in hospital capacity, likely as a result of staffing shortages and the limited ability to discharge patients.

Yuping Tsai and coauthors examine data on a Health Resources and Services Administration program that reimbursed providers for COVID-19 vaccines administered to uninsured adults.

They find that it accounted for nearly thirty-nine million doses, or 5.7 percent of all doses administered to US adults.

Ravi Parikh and coauthors examine commercial claims data and find that “the COVID-19 pandemic was associated with a substantial decline in physician gross revenue in 2020 compared with 2018–19, ranging from −1.8 percent to −18.2 percent across specialties.”

Revenue began to return to baseline for some, but not all, specialties in 2021.

Access

Percutaneous coronary intervention (PCI) is a common procedure that opens blocked arteries and restores blood flow to the heart.

Renee Hsia and Yu-Chu Shen study the adoption of PCI services by US hospitals between 2000 and 2020 and find that “hospitals serving Black, racially segregated communities were 48 percent less likely to adopt PCI services [than] hospitals serving non-Black, racially segregated communities.”

Mark Meiselbach and coauthors explore overlap in carriers and networks in Medicaid and the Marketplaces.

They find that “on average, 52.1 percent of Medicaid managed care enrollees were enrolled by a carrier that also had a plan on the Marketplace in the same county.”

The Food and Drug Administration’s breakthrough therapy designation (BTD) program is one of several programs designed to expedite the development and approval of critical new drugs.

Analyzing drug approval data, Kathleen Miller and colleagues estimate that “the BTD program lowers late-stage clinical development time by 30 percent.”

In the context of high levels of reliance on managed care plans to administer Medicaid, Lauren Peterson and coauthors explore the conditions states place on those plans with respect to substance use disorder (SUD) treatment benefits.

Although states typically mandate coverage for these benefits, “notable numbers of state programs also allow managed care plans discretion to impose prior authorization requirements, as well as drug testing, fail-first, and psychosocial therapy requirements for SUD treatment medications.”

Sungchul Park and Rishi Wadhera find that higher-income adults are significantly more likely than lower-income adults to use high-value health care services, whereas the patterns are less clear for low-value services.

Join us on Wednesday, July 10, for a Lunch & Learn event discussing health and health care policy decisions that are expected in the closing days of the Supreme Court’s 2023-2024 term.

This event is exclusive to our Health Affairs Insiders.

Become an Insider today to stay up-to-date on what health care experts are thinking and talking about.

The July issue of Health Affairs includes two sets of projections from the US government.

Health Affairs This Week did deep dives on each projection; revisit those episodes to learn more:

• Diving into the New CMS National Health Expenditures Projections w/ Michael Chernew
• Breaking Down the CBO's Insurance Coverage Projections w/ Sabrina Corlette

The Future Of FDA Advisory Committees: Protecting Public Health And Preserving Public Trust

Reshma Ramachandran et al.

Estimating Overpayments To MA Plans: MedPAC Critics Get It Wrong

Steven M. Lieberman et al.

Moyle Review ‘Improvidently Granted,’ But Justices’ Positions On EMTALA, Emergency Abortions On Display

Sara Rosenbaum