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In a push to encourage “personal responsibility,” the Centers for Medicare and Medicaid Services (CMS) has approved work requirements as a condition for receiving Medicaid benefits in four states - Kentucky, Indiana, Arkansas, and most recently New Hampshire, with applications from other states pending. In a new JAMA Viewpoint, Harald Schmidt and Allison Hoffman review the implications and ethics of Medicaid work requirements and other personal responsibility policies. They propose safeguards CMS should consider to minimize risk and protect beneficiaries’ health.
August 17, 2018
The opioid epidemic carries with it another epidemic, this one of infants born with neonatal abstinence syndrome (NAS), stemming from in utero exposure to opioids. NAS is characterized by withdrawal symptoms such as tremors, irritability, poor feeding, respiratory distress, and seizures. In a recent day-long course at Penn sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), health professionals came together to learn how to screen for, diagnose, and treat pregnant women with opioid use disorder (OUD) and their infants with NAS.
August 13, 2018
There has been considerable consumer and policymaker concern about the rising prices of some prescription drugs, from the thousands-percent increases in the price of generics like Turing Pharmaceuticals’ Daraprim to the average 8.8% increase by Pfizer for a large sample of its brand name drugs. Attributing price increases to a toxic mix of corporate welfare in the form of government-enforced protection for products and unmitigated greed by the stockholders of brand name drug firms (including many of us) misses an important question whose answer has been little studied. What is the cause of each price increase?
August 10, 2018
In a recent Scattergood Foundation report, LDI Senior Fellow Dominic Sisti and I tackle the curious case of the “institutions for mental diseases” (IMD) exclusion in Medicaid. For non-elderly adults, the national IMD exclusion prevents Medicaid from paying for inpatient care in institutions with more than 16 beds that primarily provide care for persons with “mental diseases” other than dementia or intellectual disabilities. In the wake of the opioid epidemic, mass incarceration, and shortages of behavioral health care capacity, the IMD exclusion has come under renewed scrutiny.
August 10, 2018
The Centers for Medicare and Medicaid Services has rolled out a number of bundled payment programs in the hopes that they will help to control costs and improve coordination and quality of care. A focus of these programs is the care delivered by skilled nursing facilities (SNFs) – a post-acute care setting that currently accounts for a significant portion of cost variation and spending in Medicare. In a new paper published in Health Affairs, we conducted semi-structured interviews of administrators and executives in 22 hospitals and health systems across 10 markets to understand how hospitals are thinking about SNF care for lower extremity joint replacement patients.
August 9, 2018
As the country faces an unprecedented opioid epidemic, there’s an active national conversation about how inappropriate prescribing contributes to chronic opioid use, misuse, and addiction. Evidence is rapidly evolving to inform the policy debate, especially regarding best practices for prescribing in acutely painful conditions, like an injury or surgery, but the evidence is less clear on the best policy solutions. Two new publications by LDI Fellows highlight issues around opioid ‘overprescribing’ and efforts to curb it.
August 8, 2018
In a recent study in Health Affairs, we compare the scope of primary care physician participation in the Marketplace with employer-sponsored insurance (ESI) and Medicaid. We assessed the in-network rate, which measures the share of physicians that accepted at least one insurance plan, and the appointment availability rate, which measures the rate of in-network offices that successfully scheduled new patient appointments with simulated patients. Across our ten-state sample, we found a clear pattern of access across insurance types: in-network rates and appointment availability rates for Marketplace plans fell between employer-sponsored insurance and Medicaid.
August 6, 2018
In a study in Health Affairs, LDI Senior Fellow Joshua Liao and colleagues report on what physicians think about Medicare’s new payment program, the Merit-based Incentive Payment System (MIPS). The authors found that in the first year, few physicians reported being familiar with the new payment policy designed to shift compensation from volume to value, and when informed, nearly 60 percent believed it would reduce or have no effect on the value of care.
August 2, 2018
In two new papers, "The Economics of Patient-Centered Care" in the Journal of Health Economics and “The Impact of Patient-Centered Medical Homes on Medication Adherence” forthcoming in Health Economics, LDI Senior Fellow Guy David and coauthors untangle the complexities of patient-centered medical homes, demonstrating that the PCMH model is implemented differently across practices. In the first paper, David and coauthors Philip Saynisch and Aaron Smith-McLallen show how these differences drive variation in health care utilization and spending. In the second, David, Saynisch and Smith-McLallen, along with Spencer Luster and Ravi Chawla, explore the impact of variation in PCMH implementation on medication adherence.
[Reposted: Jalpa A. Doshi, Amy R. Pettit, and Pengxiang Li. Addressing Out-Of-Pocket Specialty Drug Costs In Medicare Part D: The Good, The Bad, The Ugly, And The Ignored, Health Affairs Blog, July 25, 2018. https://www.healthaffairs.org/do/10.1377/hblog20180724.734269/full/: Copyright ©2018 Health Affairs by Project HOPE – The People-to-People Health Foundation, Inc.]
The cost of prescription drugs in the United States has been a popular topic of debate in recent years, particularly when it comes to specialty drugs with very high price tags. High-profile proposals and reports have made a variety of recommendations, leading to a flurry of reactions from all segments of the health care industry. But how would these recommendations directly or indirectly affect out-of-pocket costs for elderly and disabled individuals who are actually taking the most expensive medications? The combination of high drug prices and cost-sharing requirements under Medicare Part D’s current benefit structure results in a high out-of-pocket burden for patients needing specialty drugs. Our research offers insights into how key recommendations would alleviate some burdens, intensify others, and fail to address additional concerns. In particular, many proposals to date have omitted a critical issue: It’s not just how much Medicare Part D patients are asked to pay out of pocket in a given year, but when they are required to pay it.
July 25, 2018
In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity -- detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance. In the Journal of Law, Medicine, & Ethics, Jalayne Arias, Jason Karlawish, and colleagues analyze whether, under current state laws, insurers could use biomarkers to deny coverage; in a companion commentary, Allison Hoffman places these findings in a larger context of a failing private market for long-term care insurance, and uses the study to make a case for social insurance for long-term care (LTC).
July 23, 2018
Earlier this year, Pennsylvania Governor Wolf declared the opioid epidemic a disaster emergency. Pennsylvania has the fourth highest rate of overdose deaths in the country, and its rural counties experienced a 42% increase in drug overdose deaths from 2015 to 2016. But to successfully treat the epidemic as a disaster, the Commonwealth needs timely overdose data. An effective disaster response requires up-to-date information, to allocate resources efficiently and promote recovery. A new app may provide a way to track overdoses in real-time.
July 23, 2018
The proposed $69 billion merger of CVS and Aetna drew sharp criticism in a recent California Insurance Commission hearing, including from LDI Senior Fellow Lawton R. Burns, PhD, MBA. In his written testimony, Burns offers a comprehensive review of the evidence that vertical integration fosters higher prices and harms consumers. The testimony is a master class in challenging unsupported claims and wishful thinking about the likely benefits of the merger.