FAST TRACK AHEAD OF PRINT

Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate
By Charles Courtemanche, Joseph Garuccio, Anh Le, Joshua Pinkston, and Aaron Yelowitz

To minimize the spread of COVID-19 during March and April, US state and local governments joined worldwide efforts to impose social distancing measures. They have included bans on large social gatherings, public school closures, the shuttering of entertainment-related businesses, and shelter-in-place orders. Charles Courtemanche and coauthors examined the impact of these four measures, separately and collectively, and found that these policies reduced the daily COVID-19 growth rate by 5.4 percentage points after 1–5 days, 6.8 percentage points after 6–10 days, 8.2 percentage points after 11–15 days, and 9.1 percentage points after 16–20 days. Read More >>

EYE ON HEALTH REFORM

Risk Corridors, COVID-19, And The ACA
By Katie Keith

Affordable Care Act (ACA) litigation and implementation continue even amid the coronavirus crisis. The Supreme Court has ruled that insurers should receive more than $12.2 billion in owed risk corridors payments. Other ACA litigation continues as well. The Department of Health and Human Services released final Marketplace enrollment data for 2020, interoperability standards, guidance on coronavirus, and more. Read More >>

MEDICARE

Switching Between Medicare Advantage And Traditional Medicare Before And After The Onset Of Functional Disability
By Claire K. Ankuda, Katherine A. Ornstein, Kenneth E. Covinsky, Evan Bollens-Lund, Diane E. Meier, and Amy S. Kelley

Medicare Advantage (MA) plans have increasing flexibility to provide nonmedical services to support older adults aging in place in the community. However, prior research has suggested that enrollees with functional disability were more likely than those without disability to leave MA plans. Claire Ankuda and coauthors used data from the National Health and Aging Trends Study linked to Medicare claims to measure and characterize switches in either direction between MA and traditional Medicare in the twelve months before and after onset of disability. Read More >>

CONSIDERING HEALTH SPENDING

Wide State-Level Variation In Commercial Health Care Prices Suggests Uneven Impact Of Price Regulation
By Michael E. Chernew, Andrew L. Hicks, and Shivani A. Shah

Michael Chernew and coauthors find that "prices charged for health care services in the commercial market are well above those paid by Medicare." Using IBM MarketScan data, they report overall commercial-to-Medicare payment ratios of 2.16 for outpatient facility services, 2.06 for inpatient hospital services, and 1.63 for professional services. These ratios varied significantly across states, implying that using Medicare payment rates as a benchmark would have differential effects in different markets. Read More >>

Physician Prices And The Cost And Quality Of Care For Commercially Insured Patients
By Mark A. Unruh, Yongkang Zhang, Hye-Young Jung, Manyao Zhang, Jing Li, Eloise O’Donnell, Fabrizio Toscano, and Lawrence P. Casalino

Using data from the Health Care Cost Institute, Mark Unruh and coauthors analyze the relationship between physician prices and the cost and quality of care for commercially insured patients. Read More >>

These articles appear in the series Considering Health Spending.

BEHAVIORAL HEALTH CARE

The Impact Of Medicare’s Mental Health Cost-Sharing Parity On Use Of Mental Health Care Services
By Benjamin Lê Cook, Michael Flores, Samuel H. Zuvekas, Joseph P. Newhouse, John Hsu, Rajan Sonik, Esther Lee, and Vicki Fung

The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010–14. Benjamin Lê Cook and coauthors assessed whether this reduction in mental health cost sharing was associated with changes in specialty and primary care outpatient mental health visits and psychotropic medication fills. Read More >>

PRIMARY CARE

Medicare’s Care Management Codes Might Not Support Primary Care As Expected
By Sumit D. Agarwal, Michael L. Barnett, Jeffrey Souza, and Bruce E. Landon

To compensate physicians and their practices for activities that occur outside of traditional face-to-face visits, the Centers for Medicare and Medicaid Services introduced two new payment codes to the Medicare Physician Fee Schedule for services related to transitional care management (TCM) and chronic care management (CCM). Rates of adoption of these codes have been low. To understand the patterns of adoption, Sumit D. Agarwal and coauthors compared characteristics of the practices that billed for these services to those of the practices that did not and determined the extent to which a practice other than the beneficiary’s usual primary care practice billed for the services. Read More >>

THIS WEEK ON THE BLOG

COVID-19

The Role Of Hospital Infection Control In Flattening The COVID-19 Curve: Lessons From South Korea
By Ron C. Li and Doo Ryeon Chung (5/15/20)

The role of hospitals in the fight against COVID-19 must be expanded from treating sick patients to also serving the public health mission of preventing future disease outbreaks. These efforts need to be coordinated at scale to not just flatten the curve but also to keep it flat. Read More >>

COVID-19 And State Medical Liability Immunity
By Benjamin J. McMichael, John R. Lowry, William H. Frist, and R. Lawrence Van Horn (5/14/20)

COVID-19 has created a health care environment that is unprecedented and ripe for litigation. To provide physicians with some protection in the face of this emergency, states have begun taking action to address medical liability. Read More >>

A Model For Avoiding Unequal Treatment During The COVID-19 Pandemic
By Somnath Saha and Mary Catherine Beach (5/14/20)

COVID-19 has imposed on hospitals and health systems the threat of having to ration scarce resources. As health systems grapple with how to ensure truly fair resource allocation, Oregon’s experience with health care prioritization offers lessons. Read More >>

How To Maintain Momentum On Other Public Health Initiatives Even As COVID-19 Rages: Lessons From Pakistan
By Hina Khalid and Erika G. Martin (5/13/20)

As low- and middle-income countries (LIMCs) respond to the COVID-19 pandemic, it is imperative to ensure that other public health priorities continue to receive necessary support to maintain progress. Ongoing investments in more general health system strengthening can help LIMCs be more prepared to respond to future public health crises. Read More >>

COVID-19 Testing: Lessons From The HIV Testing Experience
By Ronald O. Valdiserri, Gary R. West, and David R. Holtgrave (5/13/20)

Policy makers and legislators must embrace a broad vision that extends beyond diagnostic testing when developing and funding strategies in response to the COVID-19 pandemic. There is benefit in considering how the cumulative experience of implementing public health HIV testing programs might inform the direction of future programs to test for SARS-CoV-2, especially in terms of the systems and structures necessary to support widespread testing for prevention purposes. Read More >>

In The Fight Against COVID-19, It’s Not Too Late To Fix America's Public Health System
By Oxiris Barbot (5/12/20)

It shouldn’t take mass casualties for the federal government to commit to safeguarding the public’s health. The cost of inaction is so clear. When public health systems are willing but unable to address developing threats, families, communities, and the economy suffer unimaginable losses. Read More >>

The Importance Of Nursing Home Transparency And Oversight, Even In The Midst Of A Pandemic
By David G. Stevenson and Alice Bonner (5/12/20)

During the COVID-19 crisis, nursing home oversight agencies must emphasize transparency while ensuring that residents and staff are connected to the resources and social supports they desperately need. Read More >>

Flu Masks Failed In 1918, But We Need Them Now
By E. Thomas Ewing (5/12/20)

We need to learn the right lessons from the failure of flu masks in 1918. Masks can work if we wear them correctly, modify behavior appropriately, and apply all available tools to control the spread of infectious disease. Read More >>

Federal Funding For State And Local Contact Tracing Efforts Is An Urgent Priority, And A Bargain
By Joshua A. Salomon and Arthur L. Reingold (5/11/20)

The investment that will help us reopen the United States will cost less than 1 percent of COVID-19 relief funding to date. Read More >>

FOLLOWING THE ACA

Opening Briefs Filed In Texas Challenge To ACA
By Katie Keith (5/17/20)

Opening briefs in California v. Texas were due on May 6. This post summarizes the opening briefs from a California-led coalition of 21 attorneys general and governors and the US House of Representatives; provides the latest on the Trump administration’s position in the lawsuit; and describes what happens next. Read More >>

Wide Range Of Amici Support California, House In Texas Litigation
By Katie Keith (5/17/20)

Briefing continues in California v. Texas. Amicus briefs in support of the parties defending the Affordable Care Act (ACA), due May 13, were filed by every major health care stakeholder group. Amici warn of massive disruption if all or parts of the ACA are deemed invalid. Many also emphasize the importance of the ACA to the nation’s COVID-19 response.
Read More >>

Risk Corridors Litigation: The Gift That Keeps On Giving
By Katie Keith (5/15/20)

On April 27, the Supreme Court ruled 8-1 that insurers were entitled to more than $12 billion in unpaid risk corridors payments. One might think that such a resounding decision would close this chapter in Affordable Care Act litigation. But things are rarely so simple with the ACA. Read More >>

MEDICAID

Overlap Plans Could Become An Important Option To Promote Continuity Of Care And Contain Health Care Costs During A Recession
By Katherine Hempstead and Joanna Seirup (5/15/20)

As Medicaid enrollment grows during the COVD-19 pandemic, overlap plans (plans offering both Marketplace and Medicaid managed care coverage) may play an increasingly important role in advancing continuity of care and containing growth in premium costs in many counties across the country. Read More >>

Finding The Sweet Spot: When It Comes To Medicaid MCOs And Payment Reform, One Size Does Not Fit All
By Julianne McGarry and Suzanne F. Delbanco (5/11/20)

Model Medicaid managed care organization contracts from states that have begun to plot a journey toward payment reform provide an abundance of forward-thinking and creative program design. Read More >>

HEALTH EQUITY

Inequity: Society’s Most Important Pre-Existing Condition
By Bob Hughes (5/11/20)

COVID-19 just underscores the oppression that has been embedded in our systems for years, says the president and CEO of a large health foundation in the Midwest. Historic racism is front and center during this time when all of us have various needs. But amidst all of the tragedy and upheaval, we also can chart a unified course for a healthier, more equitable future, he says. Read More >>

MEDICARE

Adapting Medicare Advantage Bidding For COVID-19–Related Uncertainty On Claims: A Proposal
By Steven M. Lieberman (5/15/20)

Establishing temporary high-cost reinsurance and risk corridors—now available to stand-alone prescription drug plans but not Medicare Advantage (MA) plans—would significantly mitigate risk and limit disruption in the MA market until the impacts of COVID-19 become better understood. Read More >>

Medicare’s Reliance On Acute Hospitalization Rates Could Undercut The Impact Of Its Primary Care First Program
By Leah M. Marcotte, Amol S. Navathe, Jonathan Staloff, and Joshua M. Liao (5/13/20)

Given the potential for primary care reform to improve outcomes, it is critical that policy and practice leaders avoid unintended consequences of program participation, engagement, and success. Read More >>

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.

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