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 >>

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 >>

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 >>

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.

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 >>

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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