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A Weekly Health Policy Round Up From Health Affairs            

**June 28, 2020**

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FAST TRACK AHEAD OF PRINT

COVID-19

Primary Care Practice Finances In The United States Amid The COVID-19
Pandemic

By Sanjay Basu, Russell S. Phillips, Robert Phillips, Lars E. Peterson,
and Bruce E. Landon

Sanjay Basu and coauthors estimate that as a result of the near
elimination of in-person visits during the first months of the COVID-19
pandemic, primary care practices will be expected to lose $67,774 in
gross revenue per full-time physician this year, reaching $15.1 billion
in losses at the national level.Read More >>

IN THE JOURNAL

PRIVATE HEALTH INSURANCE

Out-Of-Network Spending Mostly Declined In Privately Insured Populations
With A Few Notable Exceptions From 2008 To 2016

By Zirui Song, William Johnson, Kevin Kennedy, Jean Fuglesten Biniek,
and Jacob Wallace

While out-of-network or potential "surprise" billing has garnered
increasing attention, particularly in emergency department and inpatient
settings, few national studies have examined out-of-network care overall
or in other settings. Zirui Song and coauthors examined out-of-network
spending and use among two large nationwide populations with
employer-sponsored insurance. Read More >>

CONSIDERING HEALTH SPENDING

Paying For Value From Costly Medical Technologies: A Framework For
Applying Value-Based Payment Reforms

By Marianne Hamilton Lopez, Gregory W. Daniel, Nicholas C. Fiore, Aparna
Higgins, and Mark B. McClellan

Marianne Hamilton Lopez and coauthors propose a value-based payment
framework for medical products, including drugs, devices, and diagnostic
tools. Read More >>

This article appears in the series Considering Health Spending
.

MATERNAL HEALTH

Improving Birth Outcomes And Lowering Costs For Women On Medicaid:
Impacts Of 'Strong Start For Mothers And Newborns'

By Lisa Dubay, Ian Hill, Bowen Garrett, Fredric Blavin, Emily Johnston,
Embry Howell, Justin Morgan, Brigette Courtot, Sarah Benatar, and
Caitlin Cross-Barnet

The Strong Start initiative of the Center for Medicare and Medicaid
Innovation supported enhanced prenatal care models for women enrolled in
Medicaid. Lisa Dubay and coauthors report significant positive results
with respect to birth outcomes, cesarean rates, and costs of delivery in
birth centers. Read More >>

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GLOBAL HEALTH POLICY

Maternal Cash Transfers Led To Increases In Facility Deliveries And
Improved Quality Of Delivery Care In Nigeria

By Edward N. Okeke, Zachary Wagner, and Isa S. Abubakar

Edward Okeke and coauthors report the results of a randomized controlled
trial of conditional cash payments designed to increase receipt of
prenatal and birth care in health facilities in Nigeria, the most
populous nation in Africa. Women eligible for the payment saw a 41
percent increase in deliveries at a health facility and a 37 percent
increase in the presence of a skilled birth attendant, with associated
improvements in the quality of care received. Read More >>

COVID-19

Self-Isolation Compliance In The COVID-19 Era Influenced By
Compensation: Findings From A Recent Survey In Israel

By Moran Bodas and Kobi Peleg

Moran Bodas and Kobi Peleg report the results of a poll of a randomized
sample of Israeli adults to ascertain their willingness to
self-quarantine. The authors found that when survey respondents were
told that compensation for lost wages would be provided, 94 percent said
they would comply with a self-quarantine order. However, when lost-wage
compensation was not provided, the compliance rate dropped to less than
57 percent. Read More >>

The Potential Health Care Costs And Resource Use Associated With
COVID-19 In The United States

By Sarah M. Bartsch, Marie C. Ferguson, James A. McKinnell, Kelly J.
O'Shea, Patrick T. Wedlock, Sheryl S. Siegmund, and Bruce Y. Lee

Sarah Bartsch and coauthors estimate the burden that the COVID-19
pandemic will place on the US health care system. Noting that per
episode costs for COVID-19 are substantially higher than for influenza
or pertussis, the authors conclude that over the course of the pandemic,
"direct medical costs incurred during the course of the infection
[range] from $163.4 billion if 20 percent of the population gets
infected to $654.0 billion if 80 percent of the population gets
infected." Read More >>

END-OF-LIFE CARE

Trends In Residential Setting And Hospice Use At The End Of Life For
Medicare Decedents

By Melissa D. Aldridge, Katherine A. Ornstein, Karen McKendrick, Jaison
Moreno, Jennifer M. Reckrey, and Lihua Li

As more people live and die in the community despite complex health
needs and functional impairment, the need for hospice increases. Using
nationally representative data, Melissa Aldridge and coauthors found
that 9.8 percent of Medicare beneficiaries spend the end of their life
in community-based residential settings and that these people had
significantly higher rates of hospice use over the study period,
compared with those in private residences and nursing homes. Read More
>>

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HEALTH AFFAIRS EVENT

The July 2020 issue of Health Affairs contains a cluster of articles on
a recurring theme: the culture of health, and specifically, how factors
outside the health system-like food, income and work-play a
significant role in health and health equity.

On Wednesday, July 8, Health Affairs editor-in-chief Alan Weil will host
an online forum featuring a selection of authors who contributed to the
policy proposals and analysis in the issue, and leaders in state and
local governments who everyday are striving to find creative, effective,
and equitable ways to deliver services during these most extraordinary
and challenging times.

Date: Wednesday, July 8, 2020
Time: 2:00 p.m. - 3:15 p.m. (Eastern)
Place: Online details to come after you've registered

Speakers to include:

* Kimm R. Campbell, Assistant County Administrator, Broward County,
Florida

* Emilie Courtin, Assistant Professor, London School of Hygiene and
Tropical Medicine, on "The Health Effects Of Expanding The Earned Income
Tax Credit: Results From New York City."

* Julia Goodman, Assistant Professor, Oregon Health & Science University
and Portland State University, on "Among Low-Income Women In San
Francisco, Low Awareness Of Paid Parental Leave Benefits Inhibits
Take-Up"

* Erica Kenney, Assistant Professor, H. Chan School of Public Health,
Harvard University, on "Impact of the Healthy, Hunger-Free Kids Act on
Obesity Trend"

* Marc Nicole, President, National Association of State Budget Officers

* Mona N. Shah, Senior Program Officer, Robert Wood Johnson Foundation

Health Affairs thanks Romana Hasnain-Wynia of the Denver Health and
Hospital Authority for serving as adviser on the culture of health
articles in this issue. We thank the Robert Wood Johnson Foundation for
their financial support for these articles and online briefing.

RSVP TO ATTEND

THIS WEEK ON THE BLOG

COVID-19

How Medicaid Must Upgrade Its Information Technology For The Huge
Increase In Enrollment Arising From COVID-19

By Jack Meyer (6/26/20)

Many Medicaid information technology systems are the health care
equivalent of antiquated clunker cars. Such systems could prove to be a
major barrier to the large number of people becoming newly eligible for
Medicaid due to sharply rising COVID-19-related unemployment. Read
More >>

The Uses of Adversity: Leveraging The COVID-19 Response To Eliminate
Viral Hepatitis

By Ronald O. Valdiserri, Alexander Billioux, Boatemaa Ntiri-Reid, and
Lauren Canary (6/26/20)

The COVID-19 pandemic has highlighted the vital role that public health
plays in the well-being of all citizens, especially populations that
have long suffered health inequities. We can and must use the
opportunities afforded by the SARS-CoV-2 response to address other
pressing health needs of these same populations, including viral
hepatitis and HIV.
Read More >>

The COVID-19 Crisis: An Opportunity To Build A Fairer, Healthier Nation

By Nadia J. Siddiqui, Dennis P. Andrulis, Derek A. Chapman, Kimberly
Wilson, Beth Jacob, Gail C. Christopher, and Naima Wong Croal (6/25/20)

Creating conditions for all communities to thrive is central to
containing the immediate spread and adverse outcomes of COVID-19, and to
building a country better prepared to respond to future crises. The
Health Opportunity and Equity (HOPE) Initiative, funded by the Robert
Wood Johnson Foundation, provides an interactive data tool showing where
the US and states are doing well, and could do better, on reaching
health equity goals. Now focused on COVID-19 and health inequities, HOPE
uses data from The COVID Tracking Project for its analyses. Read More >>

Assessing Morbidity And Mortality Associated With The COVID-19 Pandemic

By Michael A. Stoto and Matthew K. Wynia (6/25/20)

There are widely varying estimates of deaths and illness associated with
the COVID-19 pandemic, and their accuracy has become a source of
vigorous debate. At a minimum, all states should follow guidance from
the Centers for Disease Control and Prevention and the National Center
for Health Statistics, using standard case definitions and reporting
standards, to help ensure comparisons among states and other population
groups are more meaningful.
Read More >>

How Orphan Drug Policy Could Impede Access To COVID-19 Treatments

By Kao-Ping Chua and Rena M. Conti (6/25/20)

Many drugs being evaluated to treat or prevent COVID-19 have orphan drug
designation. Orphan drug policy could unintentionally impede access to
orphan-designated COVID-19 drugs by facilitating high prices. We suggest
reforms to mitigate price-related barriers to accessing such drugs. Read
More >>

Behavioral Health: A Payer-Based Strategy For Improving Access And
Quality During COVID-19 And Beyond

By Katherine Hobbs Knutson and Rahul Rajkumar (6/24/20)

Access to behavioral health care is limited by several system-level
factors, and addressing these challenges requires new strategies. Blue
Cross and Blue Shield of North Carolina is in its second year of a
long-term strategy to drive improvements in behavioral health access,
quality, and efficiency. Read More >>

World Cities And National Policy In The Time Of COVID-19

By Victor G. Rodwin and Michael K. Gusmano (6/24/20)

The challenge we now face-not only in New York, but in other world
cities-is whether these vulnerable giants and their national
governments will make the investments needed to protect and promote
health in the future. Read More >>

Improving Prenatal Care And Delivery In The Wake Of COVID-19: Lessons
From The 'Strong Start' Evaluation

By Sarah Benatar, Lisa Dubay, and Ian Hill (6/23/20)

The "Strong Start for Mothers and Newborns" initiative-which supported
three evidence-based prenatal care models: Birth Centers, Group Prenatal
Care, and Maternity Care Homes-provides an approach that can help meet
the needs of mothers and infants during the COVID-19 pandemic. Read More
>>

Pricing Remdesivir: A Domestic Reference Price Approach

By Sean Dickson and Timothy A. Lash (6/23/20)

Domestic reference pricing for remdesivir would consider the US launch
prices of therapeutically similar drugs and adjust those prices for
inflation and the presumed increased clinical innovation of the COVID-19
treatment. Read More >>

The Case For Using Novel Value Elements When Assessing COVID-19 Vaccines
And Therapeutics

By Sachin Kamal-Bahl, Richard Willke, Justin T. Puckett, and Jalpa A.
Doshi (6/23/20)

The pricing of vaccines and therapeutics in the context of the COVID-19
pandemic will likely have a lasting impact on how desperately needed,
innovative treatments are valued. Stakeholders should use this
opportunity to rethink the traditional cost-per-QALY paradigm and set a
precedent for a holistic conception of value. Read More >>

Preparing For The Next COVID-19 Crisis: A Strategy To Save Safety-Net
Hospitals

By Peter P. Reese, Eugene Lin, and Meera N. Harhay (6/22/20)

The COVID-19 pandemic has taxed our health care system to a point that
many safety-net hospitals face budget shortfalls that could force them
to close. Without a comprehensive strategy to protect safety-net
hospitals, the people they employ and the patients they serve will bear
the brunt of COVID-19's next wave. Read More >>

The Double Pandemic Of Social Isolation And COVID-19: Cross-Sector
Policy Must Address Both

By Julianne Holt-Lunstad (6/22/20)

Similar to an economic recession that can have lasting effects even
after the economy begins to grow, social restrictions put in place
during the pandemic may have profound long-term consequences for social
isolation and its health sequelae, even after they are lifted.
Read More >>

FOLLOWING THE ACA

New Congressional Investigation Of Short-Term Plans

By Katie Keith (6/26/20)

A new House Energy and Commerce Committee report has been released after
a year-long investigation of short-term, limited duration insurance
(STLDI) and the practices used by insurers and brokers who market these
products. The report provides one of the only known comprehensive
examinations into the practices of STLDI insurers and brokers. Read More
>>

Feds Carve Out Workplace COVID-19 Testing From Guaranteed Coverage And
More

By Katie Keith (6/25/20)

On June 23, the Departments of Health and Human Services, Treasury, and
Labor jointly issued a second round of guidance to implement the
COVID-19-related coverage provisions in the Families First Coronavirus
Response (Families First) Act and the Coronavirus Aid, Relief, and
Economic Security (CARES) Act. Collectively, these two bills require
comprehensive private health insurance plans to cover COVID-19 testing
and related services without cost-sharing, although only for the
duration of the declared public health emergency. Of note, the Trump
administration confirms that employers and insurers are not required to
pay for COVID-19 tests that are not used for diagnostic purposes. Read
More >>

House Democrats Introduce New Coverage Bill

By Katie Keith (6/24/20)

On June 22, Democrats in the US House of Representatives introduced the
Patient Protection and Affordable Care Enhancement Act (HR 1425). The
bill is designed to strengthen and expand upon the Affordable Care Act,
shore up the Medicaid program, and lower prescription drug prices. Read
More >>

MEDICAID

Trump Administration Proposes Medicaid Reforms To Encourage Innovative
Contracting Models

By Rachel Sachs (6/22/20)

CMS's Medicaid best-price reporting proposal should-if
finalized-mitigate legal uncertainty for pharmaceutical companies
seeking to enter into innovative contracting arrangements with
commercial insurers. However, more will be needed to address broader
drug pricing concerns and encourage true value-based payment reforms.
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 .  

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.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

Health Affairs, 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814, United States

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