Health care “affordability” is a top concern for most Americans, but it means different things to different people. Affordability can be examined as an economic concept, a policy threshold, or through the decisions made by individuals and families. As part of Penn LDI's research partnership with United States of Care, we have developed a brief that explores the concept of affordability through these different lenses, and outlines key issues for policymakers to consider as they try to tackle this pressing problem. It is the first in a series that will examine the cost burden of health care in the United States.
Recognizing that nations with strong primary care systems achieve better health outcomes, we have made important gains in the U.S. pediatric primary care over the past 10 years. In fact, primary care pediatricians are delivering more care to more children and adolescents than ever before. Importantly, we are not just providing more care, but improving access for minorities and impoverished children and addressing a growing range of complex chronic conditions and social problems, such as adverse childhood experiences. Even with these advances, we need continued innovation in pediatric primary care to deliver the best possible outcomes to children.
On September 13 and 14, 2018, more than 80 senior policymakers, researchers, and state health insurance exchange administrators and insurance commissioners gathered at the University of Pennsylvania Law School for the Sixth Annual Health Insurance Exchange Conference. Jointly hosted by Penn Law, Penn LDI, and Princeton University's Center for Health and Wellbeing, this year’s event focused on how states are pursuing different paths for the individual insurance market, from stabilization to segmentation to expansion. A number of key themes emerged from the two-day nonpartisan, off-the-record workshop.
Despite little evidence, some commentators and policymakers have argued that Medicaid expansion has fueled the opioid epidemic by increasing access to prescription opioids. But a growing number of studies refute this theory, and instead suggest that Medicaid expansion reduces mortality from drug overdoses and increases access to drug treatment.
Conflicts between clinicians and police are not uncommon. Emergency departments are arguably an epicenter of opportunity for this kind of conflict. It is in these clinical settings that intersections between health care and law enforcement activities are most frequent, for example, when police respond to medical emergencies or seek information to inform emerging criminal investigations. The challenge of these interactions is that clinicians and police have distinct professional priorities, and there is notable ambiguity in how best to interpret guiding policy and ethics.
A recent study in Health Affairs by CHERISH Research Affiliate Dr. Yuhua Bao and CHERISH investigators Dr. Zachary Meisel and Dr. Bruce Schackman examined the impact of prescription drug monitoring program policies on high-risk opioid prescriptions. They found that comprehensive use mandates requiring physician use of the PDMP were associated with a 9.2% reduction in the probability of overlapping opioid prescriptions, a 6.6% reduction in the probability of having three or more prescribers, and an 8% reduction in the probability of having overlapping opioid and benzodiazepine prescriptions.
In a new article in Health Care Management Review, LDI Senior Fellow Lawton R. Burns and colleagues examine how the structure of physician-hospital relationships--medical staff model, employment, and alliances--affects physician alignment and engagement with the hospital.
In a study in Geriatrics, my colleagues and I measured illness representation in nearly 200 outpatients with heart failure, kidney disease, and chronic obstructive pulmonary disease (COPD). We used their responses to create three distinct group “profiles” that reflect different perceptions of illness, self-care ability, and responses to hospitalizations.
Biomedical advances in genomics and oncology, combined with rising costs for targeted cancer therapies, challenge the way we currently deliver and pay for cancer care. To foster the economic sustainability of targeted therapies, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, biomedical research, patient advocacy, and the pharmaceutical and insurance industry. Co-chaired by LDI Senior Fellows Justin Bekelman and Steven Joffe, the committee met regularly in 2016-2017 to identify ways to promote economically viable targeted cancer therapies. Dr. Bekelman and Joffe recently published their own conclusions in a JAMA viewpoint, and a new LDI report synthesizes the consortium’s discussions.
While Congressional efforts to repeal the Affordable Care Act (ACA) have stalled, the Administration has made many modifications to one of the law’s key creations: the health insurance exchanges, through which most people buying their own health insurance get coverage. The flurry of new information around the individual market paints a mixed picture of the outlook for 2019. On September 13 and 14, the University of Pennsylvania Law School, Penn LDI, and Princeton University's Center for Health and Wellbeing will host the Sixth Annual Health Insurance Exchange Conference to bring together senior state policymakers and researchers to discuss the latest research on the exchanges and current challenges.
Amidst an unprecedented opioid epidemic, two Congressional committees have led the federal legislative response to the crisis. In a new analysis in JAMA, Matthew McCoy and Genevieve Kanter find that a majority of members on these two committees received campaign contributions from political action committees associated with pharmaceutical manufacturers and distributors being investigated by state or federal officials for having contributed to the crisis.
If value-based payment models can work in Medicare, can they also work in Medicaid? Not without significant changes, according to LDI Senior Fellows Joshua Liao and Amol Navathe and colleague Benjamin Sommers in a NEJMPerspective. In Medicare’s predominant value-based payment models, such as bundled payments and accountable care organizations (ACOs), providers bear a certain amount of financial risk based on cost and quality targets. Liao and colleagues recommend ways to adapt these models to meet the needs of Medicaid’s socioeconomically vulnerable patients.
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.