Late last year, the Centers for Disease Control and Prevention (CDC) announced that more than 70,000 people died from drug overdoses in 2017, a 9.6% increase from 2016. Deaths continue to soar, even as states and health systems implement policies to curb the overprescribing of opioids that led to the epidemic in the first place. It’s hard not to be discouraged by these numbers and our failure to reduce overdose deaths. To fully appreciate the shifting dynamics of the opioid crisis, we need to understand both the nature of the policies we are implementing as well as their likely short- and long-term effects.
Following Medicaid expansion in Pennsylvania in 2015, more than one in five non-elderly adults in Philadelphia are now covered by Medicaid. This population faces unique challenges with accessing primary care, including fewer providers accepting Medicaid patients. On October 23rd, Philadelphia’s Department of Public Health released a report on access to primary care, which includes a specific look at the city’s Medicaid population. Our team contributed data and analyses to this report.
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.