Costs

William Feldman and coauthors analyze how manufacturers limit generic competition through the use of patents and other exclusivities granted to inhalers approved by the Food and Drug Administration.

Of the sixty-two inhalers for asthma and chronic obstructive pulmonary disease that were approved during 1986–2020, only one contained an active ingredient with a new mechanism of action, and more than half of all patents were on the devices themselves, not the active ingredients.

In a companion Perspective, Scott Hemphill and Bhaven Sampat argue for updating the system for competition between brand-name and generic drugs, with a focus on challenging invalid or irrelevant patents.

In another Perspective, Robin Feldman suggests that we consider the social value of extending market protection for minor modifications of existing innovations.

Care provided by nurse practitioners (NPs) and physician assistants (PAs) can be billed to Medicare either directly or under the name of a supervising physician—a practice referred to as indirect billing. Using indirect billing obfuscates the amount of care delivered by these providers.

Sadiq Patel and coauthors determine that the number of indirectly billed visits by NPs and PAs in fee-for-service Medicare grew from 10.9 million in 2010 to 30.6 million in 2018.

Two decades after implementation of tax-favored health savings accounts
(HSAs), Sherry Glied and coauthors conclude that HSAs no longer serve their original purpose.

With the growth in cost sharing in traditional insurance, HSAs provide a tax benefit to higher-income people without increasing cost-conscious behavior.

Care Delivery

Using nationally representative data from 2011–17, Krista Harrison and coauthors determine that the proxies of hospice-enrolled people living with dementia are more likely to rate last-month-of-life care as excellent compared with the proxies of people living with dementia who did not enroll with hospice.

As the COVID-19 pandemic has revealed, nursing home residents are particularly vulnerable to harm.

Michael Wasserman and Tamara Konetzka argue that effective responses to pandemics or natural disasters are rooted not only in providers’ compliance with regulations but also in broader system preparedness, which arises from stronger nursing home administration, managerial accountability, and integration into community disaster planning.

In October 2015 the Centers for Medicare and Medicaid Services launched
the Comprehensive End-Stage Renal Disease Care Model, the first specialty-oriented accountable care organization (ACO) model designed to serve a specific Medicare subpopulation.

Darin Ullman and coauthors find that, relative to a fee-for-service Medicare comparison group and a traditional ACO group, beneficiaries participating in the model had reduced Medicare payments, hospitalizations, and likelihood of hospital re-admission after one year.

Buprenorphine is highly effective at preventing overdoses and treating opioid use disorder.

Mark Meiselbach and coauthors report that in 2019, 50 percent of Medicaid managed care enrollees in states with high overdose death rates had access to fewer than 1.9 buprenorphine prescribers per 100,000 population, with variation across states.

Juan Andino and coauthors assess trends in interstate telehealth uptake
by Medicare beneficiaries during 2017–20 in light of COVID-19-related
regulatory changes.

The volume of interstate telehealth use increased from about 17,000 services in the first quarter of 2020 to almost 100,000 services in the fourth, but this mode of care delivery remained a relatively small share of all outpatient and telehealth visits.

COVID-19

Riley Shearer and coauthors report that as of the end of 2021, people incarcerated in Minnesota state prisons had a COVID-19 vaccination completion rate of 70.9 percent compared with 64.0 percent of the general population and 33.7 percent among those experiencing homelessness.

Those experiencing homelessness or incarceration were less likely to have received booster shots than the general population.

Neil Sehgal and coauthors find that after factors such as age, access to health care, and chronic disease burden are controlled for, counties in which a majority of presidential votes cast were for the Republican presidential candidate in 2020 experienced 72.9 additional COVID-19 deaths per 100,000 people relative to majority Democratic counties.

The province of Ontario, Canada, closed its schools because of COVID-
19 on December 26, 2020.

Tiffany Fitzpatrick and coauthors find very low rates of additional cases subsequent to gradual reopening and conclude "that any increases in case growth after the reopening of schools may be manageable with appropriate mitigation policies."

In case you missed it, we launched Health Affairs Insider, a membership offering exclusive access to content beyond the journal.

Health Affairs Insider is a membership community that includes exclusive news from Health Affairs, entry to our growing portfolio of virtual events, and curated email newsletters on priority health policy topics.

Use discount code HAInsider10 for $10 off your Health Affairs Insider membership before June 15 to secure your access to Insider-only exclusive events.

This month, Health Affairs will host events featuring Admiral Rachel Levine, HHS Assistant Secretary for Health, Rabih Torbay, president and CEO of Project HOPE, Sadiq Patel of Harvard University, and Health Affairs' Don Metz.

Beginning this month, exclusive access to our virtual Lunch and Learn, Professional Development, and Journal Club events will be limited to Health Affairs Insider and Unlimited members only.

Theme issue briefings, which are held alongside the launch of a monthly issue on a dedicated topic, and Policy Spotlights will continue to be free for all to attend.

June events include a Journal Club on June 16 featuring Sadiq Patel from Harvard’s Blavatnik Institute for Health Care Policy on indirect billing.

On June 21, Health Affairs Executive Editor Don Metz will lead a Professional Development to discuss the journal’s manuscript submission and selection processes.

On June 24, Admiral Rachel L. Levine, Assistant Secretary for Health at the US Department of Health and Human Services, will join a free Policy Spotlight event.

Finally, there will be a free Professional Development event on June 28 featuring Rabih Torbay, president and CEO of Project HOPE.

To become an Insider and attend all virtual events, visit our membership page.

A Health Podyssey goes beyond the pages of Health Affairs to tell stories behind the research and share policy implications.

This month, upcoming guests will include Ateev Mehrotra, Krista Harrison, and Sherry Glied to discuss topics such as hospice care quality for older adults with dementia and the frequency of indirect billing to Medicare.

On a recent episode, Christine Ritchie from Massachusetts General Hospital and Harvard Medical School joins A Health Podyssey to discuss what a reimagined health system designed around the needs of older patients could look like and what it would take to get there.

About Health Affairs

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