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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 >>

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 >>

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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