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Policy Prescriptions

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38 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/28207344/the-future-of-the-affordable-care-act-and-insurance-coverage
#1
Sherry Glied, Adlan Jackson
We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. We evaluate the impact of retaining dependent coverage and high-risk pool provisions and show, on the basis of the ACA experience, that these provisions would have little effect on coverage...
April 2017: American Journal of Public Health
https://www.readbyqxmd.com/read/27856648/in-new-survey-of-eleven-countries-us-adults-still-struggle-with-access-to-and-affordability-of-health-care
#2
Robin Osborn, David Squires, Michelle M Doty, Dana O Sarnak, Eric C Schneider
Surveys of patients' experiences with health care services can reveal how well a country's health system is meeting the needs of its population. Using data from a 2016 survey conducted in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-we found that US adults reported poor health and well-being and were the most likely to experience material hardship. The United States trailed other countries in making health care affordable and ranked poorly on providing timely access to medical care (except specialist care)...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27982667/accountable-care-organization-hospitals-differ-in-health-it-capabilities
#3
Daniel M Walker, Arthur M Mora, Ann Scheck McAlearney
OBJECTIVES: The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. STUDY DESIGN: A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement...
December 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/28069842/most-newly-insured-people-in-2014-were-long-term-uninsured
#4
Sandra L Decker, Brandy J Lipton
In 2014-after the implementation of most of the Affordable Care Act provisions, including Medicaid expansions in some states and subsidies to purchase Marketplace coverage in all states-adults who had been uninsured for more than three years represented a larger share of the newly insured, compared to adults who had been insured for shorter periods of time.
January 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/27920322/patients-who-choose-primary-care-physicians-based-on-low-office-visit-price-can-realize-broader-savings
#5
Ateev Mehrotra, Peter J Huckfeldt, Amelia M Haviland, Laura Gascue, Neeraj Sood
Price transparency initiatives encourage patients to save money by choosing physicians with a relatively low price per office visit. Given that the price of such visits represents a small fraction of total spending, the extent of the savings from choosing such physicians has not been clear. Using a national sample of commercial claims data, we compared the care received by patients of high- and low-price primary care physicians. The median price for an established patient's office visit was $60 among low-price physicians and $86 among high-price physicians (price was calculated as reimbursement plus out-of-pocket spending)...
December 1, 2016: Health Affairs
https://www.readbyqxmd.com/read/27927839/does-medicare-advantage-reduce-racial-disparity-in-30-day-rehospitalization-for-medicare-beneficiaries
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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...
April 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/26733698/house-calls-california-program-for-homebound-patients-reduces-monthly-spending-delivers-meaningful-care
#19
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
#20
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
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