Check out what's in the new issue
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Health policy research, commentary, and analysis
John,
Thank you for subscribing to Health Affairs Today!
As we look to engage the Health Affairs Today community in more ways, we
are sending you a special email to highlight the latest research from
our new issue, released today.
The November issue of
**Health Affairs** includes articles covering a broad range of topics,
including hospital payment and services, trends related to the
Affordable Care Act Marketplaces, the effects of adult Medicaid dental
benefits, prescription drug development and usage, and more.
Read The Full Issue
Hospitals
To reduce inappropriate inpatient billing for very short hospital stays,
in 2013 the Centers for Medicare and Medicaid Services implemented the
Two-Midnight rule, stating that Medicare inpatient payment was
appropriate only if a hospital stay was expected to last through at
least two midnights.
While the shift from inpatient to observation stays after the rule's
adoption has been previously reported, Sabrina Poon and colleagues
analyze 2007-2018 data using additional methods and conclude that the
shift is directly associated with the adoption of the rule
, it
occurred quickly and remained steady in subsequent years, and the shift
to observation stays was most pronounced for patients with more chronic
conditions.
Marcelo Cerullo and coauthors find private equity acquisition of
hospitals is associated with a higher probability of adding profitable
hospital-based services
,
profitable technologies, and freestanding or satellite emergency
departments.
ACA & Medicaid
David Anderson and Kevin Griffith examine Affordable Care Act (ACA)
Marketplace offerings and find that two-thirds of Americans have more
insurer options in 2021 than they did in 2018
,
partially reversing a trend of insurer exits from 2016 to 2018.
Paul Jacobs and Steven Hill calculate Marketplace premiums from 2015 to
2019 among families with incomes between four and six times the federal
poverty level, who are ineligible for federal subsidies.
The share of income required to purchase gold, silver, and bronze plans
increased significantly during this period
. For
example, the premium for the lowest-cost bronze plan grew from 12.2
percent of median family income in 2015 to about 19 percent in 2018 and
2019 for people ages 55-64 in the study population.
The economic shock of the COVID-19 pandemic led to job losses and people
moving into the ACA Marketplaces. John Hsu and coauthors analyzed the
relationship between state policies and the number and risk profile of
these new enrollees. They found larger increases in Marketplace
enrollment in states that did not expand Medicaid, and higher-cost
enrollees joining a Marketplace in states with narrower enrollment
criteria
.
Dental coverage for adults is an optional Medicaid benefit. Examining
survey data in the context of variation in state policies, Brandy Lipton
and coauthors determine that adult Medicaid dental coverage is
associated with a one-fifth reduction in the prevalence of untreated
caries among children in low-income families
after
Medicaid-enrolled adults had access to dental coverage for at least one
year.
Read The Full Issue
Pharmaceuticals
Even with direct funding, it is difficult to generate investments for
development of low-volume drugs given low expected revenue from sales.
As a consequence, policy makers have adopted "pull" incentives, which
provide a separate payment stream. Modeling various drug development
scenarios, Kevin Outterson concludes that incentives "totaling several
billion dollars per drug globally are required to make antibacterial
research and development projects economically attractive to commercial
sponsors
."
Kelly Lenahan and coauthors examine commercial health plans'
prescription drug step therapy protocols that determine patient
eligibility for specialty drugs. Across the ten diseases studied, more
than half of the step therapy protocols are more stringent than the
treatment guidelines adopted by national clinical organizations
.
Further, "Different plans applied step therapy protocols with markedly
different frequencies and required patients to step through different
numbers of prior therapies."
In March 2016, the Centers for Disease Control and Prevention (CDC)
released the Guideline for Prescribing Opioids for Chronic Pain. Tarlise
Townsend and coauthors investigate data from 2014 to 2018 and find the
guideline is associated with lower frequency and intensity of opioid
dispensing, including a reduction in patients' rate of receiving at
least one opioid prescription by approximately 20 percentage points by
December 2018.
Sarah Loch and coauthors examine the association of neonatal opioid
withdrawal syndrome (NOWS) with infant entry into foster care. They find
"an increase of one NOWS diagnosis per ten births in a county [is]
associated with a 41 percent higher rate of infant foster care entry
."
Read The Full Issue
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and past issues
.
"Private equity-acquired hospitals [are] less likely to add or continue
services that have unreliable revenue streams or that may face
competition from nonprofit hospitals."
- Cerullo M, Yang KK, Roberts J, McDevitt RC, Offodile II AC. Private
equity acquisition and responsiveness to service-line profitability at
short-term acute care hospitals. Health Aff (Millwood).
2021;40(11):1697-1705.
Attend these Events
Join Health Affairs for a free virtual event
! On November 10, we
highlight Kevin Outterson's article "Estimating The Appropriate Size of
Global Pull Incentives For Antibacterial Medicines
" from
the November issue with a special Journal Club session
.
On November 12, join Health Affairs Editor-in-Chief Alan Weil as he
interviews Michelle McMurry-Heath, CEO of Biotechnology Innovation
Organization , for our
Policy Spotlight series.
On November 16, Deputy Editor Rob Lott highlights the Leading to Health
series and health system transformation with Maninder Kahlon
from the University of
Texas at Austin during a
Lunch and Learn session.
Visit The Full Events Schedule
Listen to this Podcast
[link removed]
A Health Podyssey features interviews with leading and up-and-coming
researchers in health services and health policy. Upcoming guests
include Ashish Jha and Sabrina Poon.
In the spirit of the November issue, listen to this September episode
where Leah Rand discusses pushing against the quality-adjusted life-year
criticism in drug pricing
.
See All Podcasts
New Considering Health Spending Newsletter
Last month,
**Health Affairs** launched a new monthly newsletter dedicated to our
Considering Health Spending series. Each month, our Senior Editor Laura
Tollen will collect the latest news and research and dig into our
archives to reflect on how much the United States spends on health care
and how we might improve the value of that spending.
Sign Up For Considering Health Spending
Read The Full November Issue
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, and Health Affairs Sunday
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