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A Weekly Health Policy Round Up From Health Affairs            

**October 25, 2020**

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THIS WEEK ON THE BLOG

STORIES OF COVID-19

Physician Heroism Is Not A Sustainable Solution For Health Care

By Joy E. Obayemi (10/22/20)

When a COVID-19 patient cannot access her opioid use disorder
medication, a medical student goes the extra mile. But the kindness and
lauded "heroism" of providers should not be the only glue for a very
broken health care system.Read More >>

Caring For The Caregivers

By Nekee Pandya (10/22/20)

Recounting her experience as a hospitalist in a Manhattan ICU during the
pandemic's height, Nekee Pandya argues that hospitals must start
prioritizing the well-being of providers in order to help them process
trauma, prevent burnout, and provide the best possible care for
patients.
Read More >>

Chronic Disease Care Is Essential Care

By Dania Palanker (10/22/20)

While the shift to telehealth enabled continued care for many people
during the height of the COVID-19 pandemic, it failed those of us who
still needed in-person services, particularly people with chronic
conditions. There is a level of care that is essential to people living
with chronic illness and chronic pain, and it must be treated as such.
Read More >>

The Fine Line Between Essential And Non-Essential Care

By Amy K. Rosen (10/22/20)

CMS's decision to postpone non-essential care during the height of the
COVID-19 pandemic was a necessary step, but it had considerable
repercussions for patients with non-COVID-19 illnesses. This is the
story of one patient who fell through the cracks. Read More >>

COVID-19

Spillover Effects Of The COVID-19 Pandemic Could Drive Long-Term Health
Consequences For Non-COVID-19 Patients

By Julius L. Chen and Rebecca K. McGeorge (10/23/20)

As the COVID-19 pandemic persists, missed health care could accumulate
and have detrimental long-term impacts on patients. It is crucial to not
only understand how these potential impacts might manifest, but to also
begin conducting longitudinal research that can inform policies and
initiatives to assist at-risk populations. Read More >>

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Applying Value Assessment To The Health Care Sector For COVID-19

By William V. Padula (10/21/20)

Investing in rapid diagnostics for COVID-19 testing, managing critical
care volume surges, or finding potential cures or vaccines are obvious
steps, but to what extent are these investments cost-effective? I
explore the role of value assessment in identifying ways to address the
COVID-19 pandemic and prepare for future crises. Read More >>

Opportunities To Improve Value In Health Following The COVID-19 Pandemic

By Kevin N. Griffith and Melinda B. Buntin (10/21/20)

What could possibly make the COVID-19 tragedy even worse? Failing to
take advantage of a learning opportunity. The pandemic presents a
natural experiment, where researchers could observe the consequences of
stalled routine/elective care for patients' short- and long-term
health outcomes. Read More >>

FOLLOWING THE ACA

Premiums Drop Slightly As 2021 Open Enrollment Period Draws Near

By Katie Keith (10/23/20)

Overall, premiums are expected to drop by 2 percent for a 27-year old
for a silver benchmark marketplace plan sold through HealthCare.gov.
This builds on a 4 percent decline for 2020 and a 2 percent decline for
2019. Read More >>

SOCIAL DETERMINANTS OF HEALTH

Connecting The Dots: Improving Child Care Workers' Conditions Leads To
Better Health, Economic Stability, And Greater Equity

By Debbie I. Chang (10/21/20)

Child care workers are a linchpin for broader health and economic
security, especially during the pandemic, says the leader of a
California foundation. Improving these workers' wages, job quality, and
work conditions leads to better health for children and economic
stability for the workers and the families they serve. We must invest in
child care and child care workers at a level commensurate with the value
of improved health outcomes for millions of families and the value of
our economic stability and recovery. Read More >>

SYSTEMS OF CARE

Prioritizing The Elimination Of Prior Authorizations For Inpatient
Psychiatric Care

By Jessica E. Becker, Robert Accordino, and Eric Hazen (10/23/20)

Improvements in reimbursements to clinicians, as well as increased
access to and reimbursement for psychosocial resources for these
patients, could help create a better safety net system for patients with
mental illness, diminish the problem of prior authorization, and do
right by some of our most needy, and most stigmatized, patients. Read
More >>

MEDICAID

As Trump Administration Seeks US Supreme Court Review, A Second Year Of
Results From Medicaid Work Experiments Emerges

By Sara Rosenbaum, Benjamin D. Sommers, and Nia Johnson (10/19/20)

Research published in the September issue of Health Affairs provides a
rare opportunity to observe the effects of insurance-reduction policies
after a court intervened to set aside approval of Arkansas' Medicaid
work experiment. In this blog post, we discuss the issues at hand and
the importance of rapid research and evaluation. Read More >>

HEALTH INFORMATION TECHNOLOGY

Rethinking CMS Coverage And Reimbursement For The Fourth Industrial (AKA
Digital) Revolution

By Robert Horne and Lucia Savage (10/23/20)

Policy makers should modernize the statutory and regulatory rules that
govern how products and services are made available to Medicare
beneficiaries. That means including coverage and reimbursement policies
based upon the functional outcome of the care-and viewing digital
components as integral to all modes of care, not as stand-alone
novelties. Read More >>

MEDICARE

The Medicare Shared Savings Program In 2019: Positive Results During
Major Transitions And On The Eve Of A Pandemic

By Jonathan Gonzalez-Smith, Robert S. Saunders, William K. Bleser, David
Muhlestein, and Mark B. McClellan (10/20/20)

The Medicare Shared Savings Program continued to show positive savings
in 2019, as the Centers for Medicare and Medicaid Services (CMS)
introduced a major program overhaul-Pathways to Success. CMS should
continue to modify program specifications as needed to ensure that
accountable care organizations are judged fairly for their performance,
particularly during the COVID-19 pandemic. Read More >>

LEGAL & REGULATORY ISSUES

The FDA's Evolving COVID-19 Emergency Use Authorizations: How The
Convalescent Plasma Authorization Can Inform Future Vaccine And
Therapeutic EUAs

By Herschel Nachlis (10/20/20)

The Food and Drug Administration's Emergency Use Authorizations (EUAs)
during the COVID-19 pandemic highlight opportunities for improvements to
the EUA process that can bolster the quality of regulatory decision
making, the public's trust in regulatory decisions, and the public's
confidence in the lifesaving medical products that regulators authorize
and approve.
Read More >>

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IN THE JOURNAL

CHILDREN'S HEALTH

Children And The Opioid Epidemic: Age-Stratified Exposures And Harms

By Kelby W. Brown, Kayla Carlisle, Sudha R. Raman, Peter Shrader, Megan
Jiao, Michael J. Smith, Lisa M. Einhorn, and Charlene A. Wong

Among adult patients admitted for opioid use disorder treatment,
one-third report having their first opioid exposure in childhood,
highlighting the importance of addressing early opioid exposures. In
this study Kelby Brown and coauthors characterized age-stratified opioid
exposures, opioid-related harms, and disparities for North Carolina
Medicaid-insured children. Read More >>

ENTRY POINT

How COVID-19 Threatens The Safety Net For US Children

By Jessica Bylander

School closures appear to slow the spread of the virus, but for many
children the health ramifications are far broader. Read More >>

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New podcast!

Alan Weil sits down with Health Affairs Senior Editor Jessica Bylander
to discuss how certain families must find other ways, when schools
close, to secure the health and social services they provide.

Listen here.

CHILDREN'S HEALTH

Children's Oral Health: Progress, Policy Development, And Priorities
For Continued Improvement

By James J. Crall and Marko Vujicic

James Crall and Marko Vujicic examine children's oral health. They
report declines during the past thirty years in dental carries-the
most common pediatric oral disease-with particular improvement among
poor and near-poor children and Mexican American children. Yet major
gaps in coverage and care remain, leading the authors to recommend a
range of payment, delivery system redesign, and education reforms. Read
More >>

Changing The Face Of Health Care Delivery: The Importance Of Youth
Participation

By Linda S. Sprague Martinez, Catalina Tang Yan, Astraea Augsberger,
Uchenna J. Ndulue, Emanuel Ayinde Libsch, Ja'Karri S. Pierre, Elmer
Freeman, and Katherine Gergen Barnett

Linda Sprague Martinez and coauthors partnered with twelve Black and
Latinx youth researchers, ages 13-18, to conduct a youth needs
assessment in six Boston neighborhoods. Although two-thirds of survey
respondents agree that mental health is important for young people's
well-being, only 29 percent think it is easy to get help.
Read More >>

Trends In Orphan Drug Spending And Out-Of-Pocket Spending Among US
Children, 2013-18

By Kao-Ping Chua and Rena M. Conti

In this national study of privately insured children, mean annual
out-of-pocket spending for orphan drugs increased from $486 in 2013 to
$866 in 2018 (78.2 percent). Findings demonstrate that pediatric orphan
drug spending is increasingly burdening payers and families and suggest
that payers should better protect families against the prices of orphan
drugs by improving benefit design. Read More >>

Pediatric Drug Policies Supporting Safe And Effective Use Of
Therapeutics In Children: A Systematic Analysis

By Mary Carmack, Thomas Hwang, and Florence T. Bourgeois

Under the Best Pharmaceuticals for Children Act of 2002 and the
Pediatric Research Equity Act of 2003, the Food and Drug Administration
(FDA) can request pediatric studies for new drug and biologic
indications. Concerns have been raised that delays and noncompliance
with study requests contribute to high rates of off-label and
potentially unsafe or ineffective medication use in children. Mary
Carmack and coauthors used publicly available FDA documents to analyze
all indications for new drugs and biologics approved by the FDA from
2002 through 2018. Read More >>

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NARRATIVE MATTERS

A Mother In Wonderland: Securing Services For My Blind Child

By Carla Keirns

A parent navigates complex education policy to secure services and
supports for her blind child.
Read More >>

Listen to the podcast.

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About Health Affairs

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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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