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Health Affairs

Katie Keith
The holiday season brought a potentially fatal blow to the Affordable Care Act, but enrollment remained steady, and the law remains in place.
January 14, 2019: Health Affairs
Anne B Martin, Micah Hartman, Benjamin Washington, Aaron Catlin
Total nominal US health care spending increased 3.9 percent to $3.5 trillion in 2017, slowing from growth of 4.8 percent in 2016. The rate of growth in 2017 was similar to the increases between 2008 and 2013, which preceded the faster growth experienced during 2014-15-a period that was marked by insurance coverage expansion and large increases in prescription drug spending. Slower growth in health care spending in 2017 was mainly attributable to the use and intensity of goods and services, particularly for hospital care, physician and clinical services, and retail prescription drugs...
December 6, 2018: Health Affairs
Lanhee J Chen
The 2020 presidential election will be consequential for the future of health reform, with the two major-party nominees taking very different views on the future of the Affordable Care Act (ACA), as well as the policies needed to lower health costs and continue to expand access to coverage. The Republican nominee will likely signal broad opposition to the ACA and a desire to replace it with a state innovation-based approach to reform, based on the Graham-Cassidy-Heller-Johnson legislation considered by the Senate in the fall of 2017...
November 16, 2018: Health Affairs
Katie Keith
October brought new guidance on state waivers, more litigation, and preparation for the next open enrollment period.
November 13, 2018: Health Affairs
Kyan Safavi, Simon C Mathews, David W Bates, E Ray Dorsey, Adam B Cohen
Digital health companies hold promise to address major health care challenges, though little has been published on their impact. We identified the twenty top-funded private US-based digital health companies to analyze their products and services, related peer-reviewed evidence, and the potential for impact on patients with high-burden conditions. Data analytics (including artificial intelligence and big data) was the most common company type. Companies producing biosensors had the greatest funding. Publications were concentrated among a small number of companies...
January 2019: Health Affairs
Amber Willink, Nicholas S Reed, Frank R Lin
The Over-the-Counter Hearing Aid Act of 2017 will soon allow people to purchase hearing aids without an audiologist or hearing aid dispenser acting as a go-between. Under this new arrangement there will be no guarantee that purchasers with hearing loss will have access to the hearing care services that are often needed to optimize hearing and communication with the devices. Using data for 2013 from the Medicare Current Beneficiary Survey, we examined existing barriers to accessing those services among older Medicare beneficiaries who owned and used hearing aids...
January 2019: Health Affairs
Bara L Vaida
In Maryland communities such as Annapolis, Health Enterprise Zones have spurred investment and experimentation in care delivery.
January 2019: Health Affairs
Inmaculada Hernandez, Chester B Good, David M Cutler, Walid F Gellad, Natasha Parekh, William H Shrank
It is unknown to what extent rising drug costs are due to inflation in the prices of existing drugs versus the entry of new products. We used pricing data from First Databank and pharmacy claims from UPMC Health Plan to quantify the contribution of new versus existing drugs to the changes in costs of oral and injectable drugs used in the outpatient setting in 2008-16. The costs of oral and injectable brand-name drugs increased annually by 9.2 percent and 15.1 percent, respectively, largely driven by existing drugs...
January 2019: Health Affairs
Jonathan D Mayer
A haunting experience with untreated pain leads one researcher to demand better education about and treatment for pain.
January 2019: Health Affairs
David Wamble, Michael Ciarametaro, Katherine Houghton, Mayank Ajmera, Robert W Dubois
The continued rise in health care spending has led to an intense debate among policy makers and other health care stakeholders on how to best manage increasing costs, leading to a focus on cost increases with little consideration of the associated change in outcomes. We identified the extent to which increased medical intervention spending on seven prevalent chronic conditions in the US over a twenty-year period has been a good investment. The results provide disease-level cost-effectiveness ratios for comparing changes in medical care spending to changes in health outcomes for patients diagnosed with one of the conditions...
January 2019: Health Affairs
Matthew J Niedzwiecki, Hemal K Kanzaria, Juan Carlos Montoy, Renee Y Hsia, Maria C Raven
Little is known about mortality risk among frequent emergency department (ED) users. Using California hospital data for 2005-13 linked to vital statistics data, we found that frequent ED use in the past year was predictive of mortality among the nonelderly in both the short and longer terms.
January 2019: Health Affairs
David D Kim, Joshua T Cohen, John B Wong, Babak Mohit, A Mark Fendrick, David M Kent, Peter J Neumann
Because an intervention's clinical benefit depends on who receives it, a key to improving the efficiency of lung cancer screening with low-dose computed tomography (LDCT) is to incentivize its use among the current or former smokers who are most likely to benefit from it. Despite its clinical advantages and cost-effectiveness, only 3.9 percent of the eligible population underwent LDCT screening in 2015. Using individual lung cancer mortality risk, we developed a policy simulation model to explore the potential impact of implementing risk-targeted incentive programs, compared to either implementing untargeted incentive programs or doing nothing...
January 2019: Health Affairs
Alan R Weil
No abstract text is available yet for this article.
January 2019: Health Affairs
Stephen Isaacs, Paul S Jellinek, Terry Fulmer
Motivated by the increasing number of older people-many with chronic illnesses-and the lack of support for them, the John A. Hartford Foundation (JAHF) made improving the care of older adults one of its two priorities in 1983 and its sole priority in 1994. To accomplish this, the foundation adopted a two-part strategy: first, create a field of professionals capable of caring for an aging population, and second, test models of care for older adults. The JAHF steadfastly pursued that strategy until 2013, when it adopted an approach focused on advancing age-friendly health systems...
January 2019: Health Affairs
Malaz Boustani, Catherine A Alder, Craig A Solid, David Reuben
The current US system of reimbursement for dementia care does not support the complex biospychosocial needs of families living with Alzheimer disease and related dementias. We propose an alternative payment system for dementia care that would provide insurance coverage for evidence-based, collaborative dementia care models. This payment model involves a per member per month payment for care management services that would target community-dwelling beneficiaries living with dementia and evidence-based education and support programs for unpaid caregivers...
January 2019: Health Affairs
Katherine Hempstead, Julie Phillips
There have been massive increases in the supply of prescription and nonprescription opioids, the prevalence of opioid use disorder, and rates of fatal and nonfatal unintentional poisonings or overdoses in the US. We examined the relationship between rates of unintentional overdoses and intentional overdoses (poisoning suicides), using data for the period 2005-16 from the Centers for Disease Control and Prevention. Contrary to expectations, we found no evidence of positive associations in their trends. While unintentional opioid overdoses have increased dramatically, rates of poisoning suicides have scarcely changed...
January 2019: Health Affairs
Hefei Wen, Tyrone F Borders, Janet R Cummings
Office-based visits involving a buprenorphine prescription increased significantly among primary care and specialist physicians from 2006 to 2014. The growing involvement of nonpsychiatry physicians in buprenorphine prescribing has the potential to provide better access to care for people with opioid use disorders.
January 2019: Health Affairs
Christopher Ody, Lucy Msall, Leemore S Dafny, David C Grabowski, David M Cutler
Medicare's Hospital Readmissions Reduction Program (HRRP) has been credited with lowering risk-adjusted readmission rates for targeted conditions at general acute care hospitals. However, these reductions appear to be illusory or overstated. This is because a concurrent change in electronic transaction standards allowed hospitals to document a larger number of diagnoses per claim, which had the effect of reducing risk-adjusted patient readmission rates. Prior studies of the HRRP relied upon control groups' having lower baseline readmission rates, which could falsely create the appearance that readmission rates are changing more in the treatment than in the control group...
January 2019: Health Affairs
Robin E Clark, Linda Weinreb, Julie M Flahive, Robert W Seifert
Homelessness during pregnancy poses significant health risks for mothers and infants. As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy. We linked data about emergency shelter enrollees with Massachusetts Medicaid claims for the period January 1, 2008-June 30, 2015 to compare health care use and pregnancy complications for 9,124 women who used emergency shelter with those for 8,757 similar women who did not...
January 2019: Health Affairs
Gerard F Anderson, Peter Hussey, Varduhi Petrosyan
A 2003 article titled "It's the Prices, Stupid," and coauthored by the three of us and the recently deceased Uwe Reinhardt found that the sizable differences in health spending between the US and other countries were explained mainly by health care prices. As a tribute to him, we used Organization for Economic Cooperation and Development (OECD) Health Statistics to update these analyses and review critiques of the original article. The conclusion that prices are the primary reason why the US spends more on health care than any other country remains valid, despite health policy reforms and health systems restructuring that have occurred in the US and other industrialized countries since the 2003 article's publication...
January 2019: Health Affairs
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