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Policy Prescriptions

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33 papers 0 to 25 followers Articles under review for www.policyrx.org -- a health policy and health services research literature review for clinicians, healthcare executives, and policymakers. Attend our Annual Symposium -- register at www.policyrx.com.
By Cedric Dark MD, MPH, FACEP, FAAEM
https://www.readbyqxmd.com/read/27927839/does-medicare-advantage-reduce-racial-disparity-in-30-day-rehospitalization-for-medicare-beneficiaries
#1
Yue Li, Xi Cen, Xueya Cai, Dongliang Wang, Caroline Pinto Thirukumaran, Laurent G Glance
This study determined potential racial and ethnic disparities in risk for all-cause 30-day readmission among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries initially hospitalized for acute myocardial infarction, congestive heart failure, or pneumonia. Our analyses of New York State hospital administrative data between 2009 and 2012 found that overall 30-day readmission rate declined from 22.0% in 2009 to 20.7% in 2012 for TM beneficiaries, and from 20.2% in 2009 to 17.9% in 2012 for MA beneficiaries...
December 6, 2016: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/27367865/impact-of-aca-insurance-coverage-expansion-on-perforated-appendix-rates-among-young-adults
#2
John W Scott, John A Rose, Thomas C Tsai, Cheryl K Zogg, Mark G Shrime, Benjamin D Sommers, Ali Salim, Adil H Haider
BACKGROUND: The 2010 Dependent Coverage Provision (DCP) of the Affordable Care Act allowed young adults to remain on their parents' health insurance plans until age 26 years. Although the provision improved coverage and survey-reported access to care, little is known regarding its impact on timely access for acute conditions. This study aims to assess changes in insurance coverage and perforation rates among young adults with acute appendicitis-an established metric for population-level health care access-after the DCP...
September 2016: Medical Care
https://www.readbyqxmd.com/read/27922910/impact-of-medicare-s-nonpayment-program-on-hospital-acquired-conditions
#3
Caroline P Thirukumaran, Laurent G Glance, Helena Temkin-Greener, Meredith B Rosenthal, Yue Li
BACKGROUND: Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inpatient days financed by Medicare] influences its response to the Program. OBJECTIVE: To determine whether the Program was associated with changes in HAC incidence, and whether this association varies across hospitals with differential Medicare patient load...
December 5, 2016: Medical Care
https://www.readbyqxmd.com/read/27997244/effect-of-medicaid-expansion-on-workforce-participation-for-people-with-disabilities
#4
Jean P Hall, Adele Shartzer, Noelle K Kurth, Kathleen C Thomas
OBJECTIVES: To use data from the Health Reform Monitoring Survey (HRMS) to examine differences in employment among community-living, working-age adults (aged 18-64 years) with disabilities who live in Medicaid expansion states and nonexpansion states. METHODS: Analyses used difference-in-differences to compare trends in pooled, cross-sectional estimates of employment by state expansion status for 2740 HRMS respondents reporting a disability, adjusting for individual and state characteristics...
February 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27920320/low-income-working-families-with-employer-sponsored-insurance-turn-to-public-insurance-for-their-children
#5
Douglas Strane, Benjamin French, Jennifer Eder, Charlene A Wong, Kathleen G Noonan, David M Rubin
Many families rely on employer-sponsored health insurance for their children. However, the rise in the cost of such insurance has outpaced growth in family income, potentially making public insurance (Medicaid or the Children's Health Insurance Plan) an attractive alternative for affordable dependent coverage. Using data for 2008-13 from the Medical Expenditure Panel Survey, we quantified the coverage rates for children from low- or moderate-income households in which a parent was offered employer-sponsored insurance...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27702958/marketplace-plans-with-narrow-physician-networks-feature-lower-monthly-premiums-than-plans-with-larger-networks
#6
Daniel Polsky, Zuleyha Cidav, Ashley Swanson
The introduction of health insurance Marketplaces under the Affordable Care Act has been associated with growth of restricted provider networks. The value of this plan design strategy, including its association with lower premiums, is uncertain. We used data from all silver plans offered in the 2014 health insurance exchanges in the fifty states and the District of Columbia to estimate the association between the breadth of a provider network and plan premiums. We found that within a market, for plans of otherwise equivalent design and controlling for issuer-specific pricing strategy, a plan with an extra-small network had a monthly premium that was 6...
October 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27854531/health-and-social-conditions-of-the-poorest-versus-wealthiest-counties-in-the-united-states
#7
Olivia Egen, Kate Beatty, David J Blackley, Katie Brown, Randy Wykoff
OBJECTIVES: To more clearly articulate, and more graphically demonstrate, the impact of poverty on various health outcomes and social conditions by comparing the poorest counties to the richest counties in the United States and to other countries in the world. METHODS: We used 5-year averages for median household income to form the 3141 US counties into 50 new "states"-each representing 2% of the counties in the United States (62 or 63 counties each). We compared the poorest and wealthiest "states...
January 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27854535/gain-in-insurance-coverage-and-residual-uninsurance-under-the-affordable-care-act-texas-2013-2016
#8
Stephen Pickett, Elena Marks, Vivian Ho
OBJECTIVES: To examine the effects of the Affordable Care Act's (ACA's) Marketplace on Texas residents and determine which population subgroups benefited the most and which the least. METHODS: We analyzed insurance coverage rates among nonelderly Texas adults using the Health Reform Monitoring Survey-Texas from September 2013, just before the first open enrollment period in the Marketplace, through March 2016. RESULTS: Texas has experienced a roughly 6-percentage-point increase in insurance coverage (from 74...
January 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27631748/health-care-use-and-spending-for-medicaid-enrollees-in-federally-qualified-health-centers-versus-other-primary-care-settings
#9
Robert S Nocon, Sang Mee Lee, Ravi Sharma, Quyen Ngo-Metzger, Dana B Mukamel, Yue Gao, Laura M White, Leiyu Shi, Marshall H Chin, Neda Laiteerapong, Elbert S Huang
OBJECTIVES: To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non-health center settings in a context of significant growth. METHODS: Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score-matched comparison groups receiving primary care in other settings. RESULTS: We found that health center patients had lower use and spending than did non-health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care...
November 2016: American Journal of Public Health
https://www.readbyqxmd.com/read/27628267/health-benefits-in-2016-family-premiums-rose-modestly-and-offer-rates-remained-stable
#10
Gary Claxton, Matthew Rae, Michelle Long, Anthony Damico, Heidi Whitmore, Gregory Foster
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2016, average annual premiums (employer and worker contributions combined) were $6,435 for single coverage and $18,142 for family coverage. The family premium in 2016 was 3 percent higher than that in 2015. On average, workers contributed 18 percent of the premium for single coverage and 30 percent for family coverage. The share of firms offering health benefits (56 percent) and of workers covered by their employers' plans (62 percent) remained statistically unchanged from 2015...
October 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27503973/uncompensated-care-decreased-at-hospitals-in-medicaid-expansion-states-but-not-at-hospitals-in-nonexpansion-states
#11
David Dranove, Craig Garthwaite, Christopher Ody
One pillar of the Affordable Care Act (ACA) was its expected impact on the growing burden of uncompensated care costs for the uninsured at hospitals. However, little is known about how this burden changed as a result of the ACA's enactment. We examine how the Affordable Care Act (ACA)'s coverage expansions affected uncompensated care costs at a large, diverse sample of hospitals. We estimate that in states that expanded Medicaid under the ACA, uncompensated care costs decreased from 4.1 percentage points to 3...
August 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27579915/impact-of-a-value-based-formulary-on-medication-utilization-health-services-utilization-and-expenditures
#12
Kai Yeung, Anirban Basu, Ryan N Hansen, John B Watkins, Sean D Sullivan
BACKGROUND: Value-based benefit design has been suggested as an effective approach to managing the high cost of pharmaceuticals in health insurance markets. Premera Blue Cross, a large regional health plan, implemented a value-based formulary (VBF) for pharmaceuticals in 2010 that explicitly used cost-effectiveness analysis (CEA) to inform medication copayments. OBJECTIVE OF THE STUDY: The objective of the study was to determine the impact of the VBF. DESIGN: Interrupted time series of employer-sponsored plans from 2006 to 2013...
February 2017: Medical Care
https://www.readbyqxmd.com/read/27421814/where-do-freestanding-emergency-departments-choose-to-locate-a-national-inventory-and-geographic-analysis-in-three-states
#13
Jeremiah D Schuur, Olesya Baker, Jaclyn Freshman, Michael Wilson, David M Cutler
STUDY OBJECTIVE: We determine the number and location of freestanding emergency departments (EDs) across the United States and determine the population characteristics of areas where freestanding EDs are located. METHODS: We conducted a systematic inventory of US freestanding EDs. For the 3 states with the highest number of freestanding EDs, we linked demographic, insurance, and health services data, using the 5-digit ZIP code corresponding to the freestanding ED's location...
July 12, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26733698/house-calls-california-program-for-homebound-patients-reduces-monthly-spending-delivers-meaningful-care
#14
REVIEW
Glenn A Melnick, Lois Green, Jeremy Rich
In 2009 HealthCare Partners Affiliates Medical Group, based in Southern California, launched House Calls, an in-home program that provides, coordinates, and manages care primarily for recently discharged high-risk, frail, and psychosocially compromised patients. Its purpose is to reduce preventable emergency department visits and hospital readmissions. We present data over time from this well-established program to provide an example for other new programs that are being established across the United States to serve this population with complex needs...
January 2016: Health Affairs
https://www.readbyqxmd.com/read/27411572/national-health-expenditure-projections-2015-25-economy-prices-and-aging-expected-to-shape-spending-and-enrollment
#15
Sean P Keehan, John A Poisal, Gigi A Cuckler, Andrea M Sisko, Sheila D Smith, Andrew J Madison, Devin A Stone, Christian J Wolfe, Joseph M Lizonitz
Health spending growth in the United States for 2015-25 is projected to average 5.8 percent-1.3 percentage points faster than growth in the gross domestic product-and to represent 20.1 percent of the total economy by 2025. As the initial impacts associated with the Affordable Care Act's coverage expansions fade, growth in health spending is expected to be influenced by changes in economic growth, faster growth in medical prices, and population aging. Projected national health spending growth, though faster than observed in the recent history, is slower than in the two decades before the recent Great Recession, in part because of trends such as increasing cost sharing in private health insurance plans and various Medicare payment update provisions...
August 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27324440/patient-centered-medical-home-recognition-and-clinical-performance-in-u-s-community-health-centers
#16
Leiyu Shi, De-Chih Lee, Michelle Chung, Hailun Liang, Diana Lock, Alek Sripipatana
INTRODUCTION: America's community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical performance. METHODS: Data for this study came from the 2012 Uniform Data System (UDS) as well as a survey of HCs' PCMH recognition achievement. The dependent variables included all 16 measures of clinical performance collected through UDS...
June 20, 2016: Health Services Research
https://www.readbyqxmd.com/read/27503961/physicians-participation-in-acos-is-lower-in-places-with-vulnerable-populations-than-in-more-affluent-communities
#17
Laura C Yasaitis, William Pajerowski, Daniel Polsky, Rachel M Werner
Early evidence suggested that accountable care organizations (ACOs) could improve health care quality while constraining costs, and ACOs are expanding throughout the United States. However, if disadvantaged patients have unequal access to physicians who participate in ACOs, that expansion may exacerbate health care disparities. We examined the relationship between physicians' participation in both Medicare and commercial ACOs across the country and the sociodemographic characteristics of their likely patient populations...
August 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/26972843/firearm-legislation-and-firearm-mortality-in-the-usa-a-cross-sectional-state-level-study
#18
Bindu Kalesan, Matthew E Mobily, Olivia Keiser, Jeffrey A Fagan, Sandro Galea
BACKGROUND: In an effort to reduce firearm mortality rates in the USA, US states have enacted a range of firearm laws to either strengthen or deregulate the existing main federal gun control law, the Brady Law. We set out to determine the independent association of different firearm laws with overall firearm mortality, homicide firearm mortality, and suicide firearm mortality across all US states. We also projected the potential reduction of firearm mortality if the three most strongly associated firearm laws were enacted at the federal level...
April 30, 2016: Lancet
https://www.readbyqxmd.com/read/27503974/medicaid-expansion-in-2014-did-not-increase-emergency-department-use-but-did-change-insurance-payer-mix
#19
Jesse M Pines, Mark Zocchi, Ali Moghtaderi, Bernard Black, Steven A Farmer, Greg Hufstetler, Kevin Klauer, Randy Pilgrim
In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014)...
August 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27196646/access-and-quality-of-care-by-insurance-type-for-low-income-adults-before-the-affordable-care-act
#20
Kevin H Nguyen, Benjamin D Sommers
OBJECTIVES: To compare access to care and perceived health care quality by insurance type among low-income adults in 3 southern US states, before Medicaid expansion under the Affordable Care Act. METHODS: We conducted a telephone survey in 2013 of 2765 low-income US citizens, aged 19 to 64 years, in Arkansas, Kentucky, and Texas. We compared 11 measures of access and quality of care for respondents with Medicaid, private insurance, Medicare, and no insurance with adjustment for sociodemographics and health status...
August 2016: American Journal of Public Health
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