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A Weekly Health Policy Round Up From Health Affairs            

**May 24, 2020**

IN THE JOURNAL

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FAST TRACK AHEAD OF PRINT

Disparities In Outcomes Among COVID-19 Patients In A Large Health Care
System In California

By Kristen M. J. Azar, Zijun Shen, Robert J. Romanelli, Stephen H.
Lockhart, Kelly Smits, Sarah Robinson, Stephanie Brown, and Alice R.
Pressman

As the COVID-19 pandemic spreads throughout the United States, there is
growing evidence that racial and ethnic minorities and socioeconomically
disadvantaged groups bear a disproportionate burden of illness and
death. Kristen Azar and coauthors analyzed the medical records of
COVID-19 patients at Sutter Health, a large integrated health network in
Northern California, to measure potential disparities. After analyzing
1,052 confirmed COVID-19 cases from January 1 to April 8, 2020, the
authors observed that, compared with non-Hispanic white patients,
African Americans had 2.7 times the odds of hospitalization, after
adjusting for age, gender, comorbidities, and income. Read More >>

MEDICARE

Home Health And Postacute Care Use In Medicare Advantage And Traditional
Medicare

By Laura Skopec, Peter J. Huckfeldt, Douglas Wissoker, Joshua Aarons,
Judith Dey, Iara Oliveira, and Stephen Zuckerman

Laura Skopec and coauthors compare patterns of postacute
care-including care provided by skilled nursing facilities, inpatient
rehabilitation facilities, and home health agencies-under Medicare
Advantage and traditional Medicare. Read More >>

SYSTEMS OF CARE

Provider Integrated Medicare Advantage Plans Are Associated With
Differences In Patterns Of Inpatient Care

By David J. Meyers, Vincent Mor, and Momotazur Rahman

Health systems have increasingly developed integrated Medicare Advantage
(MA) plans to align financial incentives and improve coordination of
care and services across payer and provider. However, little is known
about integrated MA plans' effects on patient outcomes and on care
processes. David Meyers and coauthors used 2015 MA hospitalization data
to assess whether these new models are associated with differences in
the processes that take place during hospitalizations and differences in
patient outcomes. Read More >>

QUALITY OF CARE

Assessing The Effectiveness Of Peer Comparisons As A Way To Improve
Health Care Quality

By Amol S. Navathe, Kevin G. Volpp, Amelia M. Bond, Kristin A. Linn,
Kristen L. Caldarella, Andrea B. Troxel, Jingsan Zhu, Lin Yang, Shireen
E. Matloubieh, Elizabeth E. Drye, Susannah M. Bernheim, Emily Oshima
Lee, Mark Mugiishi, Kimberly Takata Endo, Justin Yoshimoto, and Ezekiel
J. Emanuel

Amol Navathe and coauthors report on a cluster-randomized controlled
trial they conducted with Blue Cross Blue Shield of Hawaii to
investigate the effects of three types of feedback as mechanisms to
improve health care quality: feedback on the physician's own
performance, feedback that included comparison to peers, and peer
comparisons feedback combined with a financial incentive tied to
outcomes. Read More >>

Improving The Accuracy Of Hospital Quality Ratings By Focusing On The
Association Between Volume And Outcome

By Laurent G. Glance, Caroline P. Thirukumaran, Yue Li, Shan Gao, and
Andrew W. Dick

Laurent Glance and coauthors explore the complex topic of how to measure
quality in smaller hospitals, where low case volumes can yield wide
year-to-year fluctuations in outcomes. The authors demonstrate the
viability of various approaches to combining individual hospital results
with national performance of similar-size hospitals. Read More >>

PRIVATE HEALTH INSURANCE

Health Insurance Surcharges For Tobacco Use Declined Among Small
Employers In 2018

By Jaskaran Bains, Michael F. Pesko, Johanna Catherine Maclean, and
Benjamin Lê Cook

Using data for 2016-18 from the Kaiser Family Foundation/Health
Research and Educational Trust Employer Health Benefits Survey, Jaskaran
Bains and coauthors analyzed trends in small-employer tobacco surcharges
and cessation programs. Read More >>

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IN THE JOURNAL

NARRATIVE MATTERS: BEHAVIORAL HEALTH CARE

Held Against Our Wills: Reimagining Involuntary Commitment

By Abraham M. Nussbaum

Abraham Nussbaum argues that involuntary psychiatric treatment for
people with serious mental illness should focus on returning to health
instead of reducing danger. Read More >>

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BOOK REVIEWS

Consumerism Made Real

By Jeff Goldsmith

Jeff Goldsmith reviews Peter Ubel's Sick to Debt: How Smarter Markets
Lead to Better Care, "a timely and searching review of the evidence on
the effectiveness of consumer decision making in health care." Read More
>>

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An Immigration Raid's Long-Lasting Damage

By Yasmin Sokkar Harker

Yasmin Sokkar Harker reviews Separated: Family And Community In The
Aftermath Of An Immigration Raid, by William D. Lopez,  "a powerful
story of suffering." Read More >> 

THIS WEEK ON THE BLOG

COVID-19

Congress Should Redirect The Medicare Shared Savings Program To Address
The COVID-19 Emergency

By Tim Gronniger, Anna Loengard, Lynn Barr, and Louise Yinug (5/22/20)

The current pandemic is a risk that can only be properly assumed by the
federal government. Accountable care organization (ACO) participants
cannot realistically budget and prepare for such an event on their own,
but Congress should harness the ACO infrastructure to combat the
pandemic and its secondary effects. Read More >>

Protecting The Hidden Homeless During COVID-19 And Beyond

By David Velasquez, Henry Ashworth, and Amanda Stewart (5/22/20)

Because of their higher likelihood of baseline poor health and inability
to isolate themselves, Americans who live in and out of motels and sober
living facilities will be disproportionately affected by COVID-19. This
crisis requires us to design better systems that monitor and support
this often-forgotten population. Read More >>

Under The Radar: Affordable Senior Housing Communities Need Support To
Fight COVID-19

By Robyn I. Stone, Alisha Sanders, and Geralyn Magan (5/22/20)

Approximately two million older adults live in rental properties
assisted by the Department of Housing and Urban Development and other
federal sources. Federal, state, and local policy makers must recognize
that publicly subsidized senior housing communities are hotspots for
COVID-19 infection and spread. These policy makers must then use a
multipronged approach to mitigate outbreaks and do so in partnership
with one another. Read More >>

Independent Primary Care Practices Are Small Businesses, Too

By Donna R. Shelley, Ji Eun Chang, Alden Lai, Ann M. Nguyen, and Carolyn
A. Berry (5/21/20)

Missing from state and national discussions about the impact of COVID-19
on hospitals and small businesses is discussion of the impact on smaller
independent primary care practices and how to aid them. Despite recent
trends, independent primary care practices continue to play a major role
in US health care delivery-more than half of primary care visits occur
in these practice settings. Read More >>

After COVID-19: How To Rejuvenate Primary Care For The Future

By Thomas Bodenheimer and Brian Yoshio Laing (5/21/20)

Ending the hegemony of the face-to-face visit and rebalancing the
appointment template toward 50 percent distance visits are likely to
improve patient access while reducing work and burnout. Read More >>

Protecting Privacy In Digital Contact Tracing For COVID-19: Avoiding A
Regulatory Patchwork

By Carmel Shachar (5/19/20)

We should rethink our approach to the governance of digital contact
tracing data to create one regulatory regimen to oversee these programs
and maximize consumer protections, regardless of who is implementing the
apps. Read More >>

How COVID-19 Will Likely Affect Spending, And Why Many Other Analyses
May Be Wrong

By Richard Kronick (5/19/20)

Why is it that other analysts are estimating 5 million or more COVID-19
hospitalizations, and I am estimating "only" 1 million-1.6
million? The answer is that my estimate is grounded in data on the
number of hospitalizations that have occurred during the first wave of
infections, and the assumption that the number of hospitalizations in
each subsequent wave will be similar to (or smaller than) the number in
the first wave. Read More >>

States Lead The Way In Responding To COVID-19 And Advancing Innovative
Health Policy Solutions On Many Fronts

By Heather Howard and Sonia Pandit (5/18/20)

Even before the coronavirus pandemic, health care was a top policy
priority for states. Just as governors have been leading the charge to
combat the pandemic, state leaders are at the forefront of innovative
health policy development on a multitude of issues to protect consumers.
Read More >>

I've Been Calling For Greater Private Insurance Coverage Of COVID-19
Testing. I've Been Wrong.

By Sabrina Corlette (5/18/20)

The massive and continual testing and vaccination effort required to
extricate us from this crisis will be extraordinary. If we are ever to
fully return to our workplaces, schools, concert halls, sporting venues,
and other community experiences, widely accessible and free testing and
vaccination is our only option. Read More >>

Medical Product Procurement In A Time Of Federalism: The COVID-19
Challenge

By Anand Devaiah, Michael Wijaranakula, Chinmay Kommuru, and Rena M.
Conti (5/18/20)

Ensuring the adequate supply of medical products is critical to
ameliorating disparities in the spread of COVID-19 and associated
outcomes. Read More >>

FOLLOWING THE ACA

ACA Round-Up: NH 1332 Waiver, Risk Adjustment, And Quality Reporting

By Katie Keith (5/21/20)

The Centers for Medicare and Medicaid Services continues to issue new
guidance and materials on coronavirus effects on Affordable Care Act
implementation. This post summarizes New Hampshire's application for a
waiver under Section 1332, new materials on the risk adjustment program,
and additional coronavirus-related delays to ACA programs. Read More >>

CONSIDERING HEALTH SPENDING

It's Time To Talk About COVID-19 Prices

By Robert W. Dubois (5/20/20)

We need a national conversation about how we are to value and price
treatments for COVID-19 to ensure access today and innovation
tomorrow.Read More >>

Valuing And Pricing Remdesivir: Should Drug Makers Get Paid For Helping
Us Get Back To Work?

By Joshua T. Cohen, Peter J. Neumann, and Daniel A. Ollendorf (5/20/20)

If early results from trials of remdesivir among patients with advanced
COVID-19 withstand the scrutiny of peer review, what might be a
"reasonable" or "fair" price for such a treatment?
Read More >>

These posts appear in the series Considering Health Spending
.

COSTS & SPENDING

Single Payer Or Not: Matching Problems With Solutions

By Mark A. Zezza and David Sandman

There are opportunities for meaningful health care reform that can be
accomplished with or without a broad overhaul of the system. Read More
>>

PRIMARY CARE

Primary Care Is Hurting: Why Aren't Private Insurers Pitching In?

By Leemore Dafny and J. Michael McWilliams (5/21/20)

We propose a simple solution that would deliver funds where needed, and
promptly: Insurers could multiply their reimbursements for primary care
by a common factor, such as 1.5. This "primary care boost" should
extend through the end of 2020 and be retroactive to March 15, to
compensate providers who remained open in spite of lower revenues,
higher costs, and the risks to themselves and their families. Read More
>>

ORAL HEALTH CARE

Connecting Low-Income Children To Dental Care: An Innovative Partnership
In Washington State

By Vanetta Abdellatif and Kimberly Craven (5/21/20)

For more than 20 years, the Access to Baby and Child Dentistry (ABCD)
program, in Washington State, has connected Medicaid-enrolled children
under age six to dental care in their local communities. Washington is
"a national leader" in the percentage of these young children receiving
dental care. Arcora Foundation has been a long-time supporter of ABCD, a
public-private partnership, which continues to shift its focus and
dollars from treatment to prevention. Read More >>

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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 .  

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health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

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