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A Weekly Health Policy Round Up From Health Affairs
November 24, 2019
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SUBSTANCE ABUSE
The Opioid Epidemic: A Needed Focus On Adolescents And Young Adults
By Julie Uchitel, Scott E. Hadland, Sudha R. Raman, Mark B. McClellan, and Charlene A. Wong (11/21/19)
From new payment models to specific care delivery strategies, the spectrum of reforms described here to reduce the harms from opioids to Generation Z can support them in their
adolescence and young adulthood, with benefits to be realized over a lifetime. Read More >>
RURAL HEALTH CARE
Right-Sizing Evidence-Based Programs To Improve Rural Health Care
By Elizabeth Ruen (11/21/19)
Billings Clinic, an integrated health system in Montana, adapted the Alameda Model of emergency psychiatric care for its use. The staff believed that this evidence-based model from an urban area in California could be
"right-sized" to serve a smaller population in a rural and frontier region. The author reports some promising early results at Billings Clinic's psychiatric stabilization unit. The Leona M. and Harry B. Helmsley Charitable Trust played an important role in those successes.
Read More >>
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LEGAL AND REGULATORY ISSUES
United States v. Gilead: Can a Lawsuit Yield Better Access To PrEP?
By Christopher J. Morten and Amy Kapczynski (11/18/19)
This lawsuit comes after a wave of pressure, beginning in Spring 2019, from a coalition of activists, HIV care providers, and civil society groups
organized by the PrEP4All Collaboration, urging HHS and its constituent agency, the CDC, to assert government-owned “patents for PrEP” against Gilead. Read More >>
HOSPITALS
A Look Inside The Hospital Transparency Final Rule
By Billy Wynne, Josh LaRosa, and Taylor Cowey (11/18/19)
CMS finalized a controversial set of requirements for the disclosure of hospital pricing data to degrees heretofore not seen. While the original proposal faced substantial backlash from stakeholders, CMS’ final decision is nearly identical to what the agency originally proposed. Read More >>
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PAYMENT
Private Equity And Powerful Physician Groups Raise Another Distraction
By Hunter Kellett, Alexandra Spratt, and Mark E. Miller (11/19/19)
Congress can help close a damaging loophole in the
health care system by bringing everyone to the negotiating table. Read More >>
PHARMACEUTICALS & MEDICAL TECHNOLOGY
Toward Continuous Evidence-Based Treatment For Opioid Use Disorder: Lessons from North Carolina
By Aaron McKethan, Hilary Campbell, Andrew Olson, Susan Kansagra, Elyse Powell, and Emma Sandoe (11/19/19)
We aim to draw attention, both within and beyond North Carolina, to learning that can increase the rate at which people with OUD receive appropriate, ongoing, evidence-based treatment. These findings are relevant for North Carolina and, we believe, instructive for state and federal policy making as we explore ways to make further progress related to the opioid epidemic. Read More
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PALLIATIVE CARE
States Take Up Palliative Care: NASHP’s Work With The John A.
Hartford Foundation
By Trish Riley and Kitty Purington (11/20/19)
States can play a critical role in educating the public and providers about the value of palliative care services and their place in a comprehensive system of care for people with serious illness and/or chronic conditions. Following a recent National Academy for State Health Policy meeting, the authors discuss ways to promote access to and quality of palliative services and how to address common roadblocks to implementing them in the states.
Read More >>
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HEALTH AFFAIRS EVENTS–Rural Health
Wednesday, December 4, 9:00 am – 1:00 pm Eastern
National Press Club – 529 14th Street NW, Washington DC (Metro Center)
Registration Now Open
The December 2019 issue of Health Affairs explores various dimensions of health and health care in rural America. Authors examine the health needs of people living in rural areas, investigate inequities in the availability, accessibility, and financing of care, and identify policies, financing mechanisms, and practices that can improve the health and well-being
of rural Americans. Join us for a forum during which authors will present their work and participate in a robust discussion:
- David Anderson, Research Associate, Health Policy Evidence Hub, Margolis Center for Health Policy, Duke University, on “Rural-Urban Differences In Individual Market Health Plan Affordability After Subsidy Payment Cuts”
- Abigail Barker, Research Assistant Professor, Washington University in St. Louis, and Center for Rural Health Policy Analysis at the Rural Policy Research Institute, University of Iowa, on “Effect Of Population Size On Rural Health Insurance Premiums In The Federal Employees Health Benefits Program”
- Michael Lawrence Barnett, Assistant Professor of Health Policy and Management, Harvard T. H. Chan School of Public Health, on “Adoption of Buprenorphine Waivers by Advanced Practice Providers Highest in Rural Areas with Expanded Scope of Practice”
- Kevin Bennett, Associate Professor, Director of the Research Center for Transforming Healthcare, and Director of the South Carolina Center for Rural & Primary Healthcare, University of
South Carolina School of Medicine, on “What is Rural, Anyway?”
- Hayley Germack, Assistant Professor, Acute & Tertiary Care, University of Pittsburgh School of Nursing, on “When Rural Hospitals Close, the Physician Workforce Goes”
- Carrie Henning-Smith, Assistant Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, on “Rural Counties With Majority Black Or Indigenous Populations Suffer Highest Rates Of Premature Death”
- Kenton Johnston, Assistant Professor, Health Management and Policy,
College for Public Health and Social Justice, St. Louis University, on “Why Do Rural Medicare Beneficiaries Have Higher Rates of Preventable Hospitalization and Mortality?”
- James Kirby, Senior Researcher, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, on “Rural Residents With Mental Health Needs Have Fewer Care Visits Than Urban Counterparts”
- Katy Backes Kozhimannil, Associate Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, on “Rural-Urban Differences In Severe Maternal Morbidity And Mortality In The US, 2007-15”
- Leighton Ku, Professor, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, on “Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care”
- Claire O'Hanlon, Advanced Fellow in Health Services Research, Veterans Affairs Center for the Study of Healthcare Innovation, Implementation & Policy and Adjunct Policy Researcher, RAND Corporation, on “Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation”
- Scott G. Phillips, Editor in Chief, Rural Health Quarterly, Texas Tech University Health Sciences Center, on “Higher US Rural Mortality Rates Linked To Socioeconomic Status, Physician
Shortages, And Lack Of Health Insurance”
- Janice Probst, Distinguished Professor Emerita, Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, on “Structural Urbanism Contributes To Poorer Health Outcomes For Rural America” and “Declines In Pediatric Mortality Fall Short For Rural Children”
- Scott Shipman, Director of Clinical Innovations; Director of Primary Care Initiatives, Association of American Medical Colleges, on “The Decline In Rural Medical Students: A Growing Gap In Geographic Diversity Threatens The Rural Physician Workforce”
- Sirin Yaemsiri, Senior Statistician, U.S. Government Accountability Office, on “Healthy People 2020: Rural Areas Lag In Achieving Targets For Major Causes Of Death”
Get event-specific emails delivered directly to your inbox.
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AHEAD OF PRINT
Declines In Pediatric Mortality Fall Short For Rural US Children
By Janice Probst, Whitney Zahnd, and Charity Breneman
While pediatric death rates have declined nationally, disparities remain for some groups of children. Janice Probst and coauthors analyzed mortality data from the Centers for Disease Control and Prevention, finding that rural youth ages 0–19 were more likely than urban youth to die during childhood throughout the period from 1999 through 2017. In addition, while the death rate for rural children dropped 19 percent between 1999 and 2017, from 77.6 per 100,000 children
to 62.9 per 100,000, the decline among urban children was significantly greater—a decrease of 24 percent, from 66.4 per 100,000 to 50.2 per 100,000. Among rural children, non-Hispanic black infants and American Indian/Alaska Native children were particularly at risk. Read More >>
This study will also appear in the journal’s December issue, Rural Health.
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HEALTH INFORMATION TECHNOLOGY
Are Patients Electronically Accessing Their Medical Records? Evidence From National Hospital Data
By Sunny C. Lin, Courtney R. Lyles, Urmimala Sarkar, and Julia
Adler-Milstein
Substantial policy effort has been directed at improving patients’ ability to access and use electronic health records. Using nationwide data from 2,410 hospitals for the period 2014–16, Sunny Lin and coauthors examined associations between patient- and hospital-level characteristics and access to and use of electronic health record data among discharged patients. Read More >>
Listen to author Sunny Lin interviewed about this article on WTOP-FM
HOSPITALS
Did Hospital Readmissions Fall Because Per Capita Admission Rates Fell?
By J. Michael McWilliams, Michael L. Barnett, Eric T. Roberts, Pasha Hamed, and Ateev Mehrotra
In general, readmission rates should fall as admission rates fall because the probability of an admission occurring soon after another is lower when there are fewer admissions per patient. J. Michael McWilliams and coauthors examined this relationship by conducting a simulation in which we removed random samples of admissions from Medicare claims data and recalculated readmission rates. Read More >>
MEDICAID
Medicaid Expansion Associated With Reductions In Preventable Hospitalizations
By Hefei Wen, Kenton J. Johnston, Lindsay Allen, and Teresa M. Waters
To examine the impact of Medicaid expansion under the ACA, Hefei Wen and coauthors reviewed inpatient databases for the years 2009–15. The authors found that the Medicaid expansion states saw greater reductions, compared to non-expansion states, of the number of patients hospitalized for conditions that could have been treated by ambulatory care interventions. Read More >>
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PHARMACEUTICALS & MEDICAL TECHNOLOGY
Little Consistency In Evidence Cited By Commercial Plans For Specialty Drug Coverage
By James D. Chambers, Ari D. Panzer, Elle F. Pope, Jennifer S. Graff, and Peter J. Neumann
Researchers have reported wide variation in how commercial health insurance plans cover specialty drugs, which suggests that a patient’s health plan can determine their access to these treatments. James Chambers and coauthors used information from the Tufts Medical Center Specialty Drug Evidence and Coverage Database to examine the evidence that plans reported reviewing in specialty drug coverage
policies. Read More >>
Biosimilar Filgrastim Uptake And Costs Among Commercially Insured, Medicare Advantage
By Pinar Karaca-Mandic, Jessica Chang, Ronald Go, Stephen Schondelmeyer, Daniel Weisdorf, and Molly Moore Jeffery
Pinar Karaca-Mandic and coauthors report on the uptake and costs of the first biosimilar in the US market, filgrastim-sndz (Zarxio). Following rapid uptake, by March 2018 filgrastim-sndz accounted for 47 percent of filgrastim administrations among the commercially insured and 42 percent among Medicare Advantage beneficiaries. Read More >>
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Medicaid And Private Insurance Coverage For Low-Income Asian Americans, Native Hawaiians, And Pacific Islanders, 2010–16
By John J. Park, Benjamin D. Sommers,
Sarah Humble, Arnold M. Epstein, Graham A. Colditz, and Howard K. Koh
John Park and coauthors take a close look at the effects of the ACA on Medicaid and private insurance coverage for low-income Asian Americans, Native Hawaiians, and Pacific Islanders. The authors report large gains in coverage in the period 2010–16 in both Medicaid expansion and nonexpansion states. Read More >>
ACCESS TO CARE
A Consumer-Centric Approach To Network Adequacy: Access To Four Specialties In California’s Marketplace
By Simon F. Haeder, David Weimer, and Dana B. Mukamel
Simon Haeder and coauthors incorporate more accurate practicing physician data and measures of patients’ travel distance into traditional approaches for measuring health plan network adequacy. Focusing on four
physician specialties in California, they show that “Marketplace plan networks are consistently narrower than their commercial plan counterparts.” Read More >>
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Association Of Medicare’s Annual Wellness Visit With Cancer Screening, Referrals, Utilization, And Spending
By Ishani Ganguli, Jeffrey Souza, J. Michael
McWilliams, and Ateev Mehrotra
Medicare’s annual wellness visit was introduced in 2011 to promote evidence-based preventive care and identify risk factors and undiagnosed conditions in aging adults. Use of the visit has risen steadily since then, yet its benefits remain unclear. Using national Medicare data for 2008–15, Ishani Ganguli and coauthors examined claims from fee-for-service Medicare beneficiaries attributed to practices that did or did not adopt the visit. The authors performed difference-in-differences analysis to compare differential changes in appropriate and low-value cancer screening, functional and neuropsychiatric care, emergency department visits, hospitalizations, and total spending. 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.
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