Featured Post
May 4, 2021
More than any other sector in health care, nursing homes have suffered during the pandemic. Nursing home residents and staff account for 34% of all COVID-19 deaths, though they make up less than 1% of the population. As a result of COVID-19-related concerns, the number of Americans living in nursing home has dropped by more than 10%. The result is an unprecedented financial crisis for the industry, with nursing homes closing their doors, some laying off their employees, and others being unable to safely staff their facilities.
September 25, 2015
With a price tag of $1,000 per pill and $84,000 for a 12-week course of Sovaldi (sofosbuvir), Gilead Sciences prompted widespread concern about whether its new treatment for hepatitis C (HCV) would bankrupt public and private payers. These concerns were particularly significant for state Medicaid programs, which face both limited state budgets and high HCV prevalence among beneficiaries. Today in the New England Journal of Medicine, LDI Fellow Joshua Liao and colleagues describe early Sovaldi utilization patterns by Medicaid programs in 2014, the first full year after its approval, and report widespread variation across states.
September 25, 2015 [cross-posted from the Field Clinic]
Praluent, a new cholesterol-lowering drug for people who need more than a statin, has been priced at about $40 a day by its suppliers, Regeneron and Sanofi. This compares to about $8 a day for Crestor, the most recent statin on the market, and pennies a day for generics. The introduction of a blockbuster drug at a budget-buster price has thrown Express Scripts, CVS/Caremark, and other drug insurers into the throes of serious anxiety. They warn that widespread use of the new medication at this price could bump up drug spending by as much as a third, which translates to $100 billion annually nationwide.
Is Praluent worth it? A new study has estimated the value of the benefits it provides relative to alternative treatments. It concludes that, if patients value the health benefits (as measured by improvements in both survival and quality of life) at $100,000 for a healthy year of life, the value would be only about 25% of the price. Some commentators have called for political pressure to lower prices and possibly even regulation, based on the results of this study. But that is the wrong conclusion.
September 23, 2015
Enhancing access to primary care is a key component of a patient-centered medical home (PCMH). But little is known about how PCMH status affects the availability of appointments for new patients. In a new analysis of “secret shopper” data, LDI Senior Fellows Jaya Aysola, Karin Rhodes and Daniel Polsky found that PCMHs were 1.26 times more likely to offer a new appointment and 1.36 times more likely to schedule an after-hours appointment than other primary care practices, with no differences in average wait time for a new appointment.
Along with being Interim Chair of the Department of Medicine at the University of California and ranked by Modern Healthcare as the most influential physician-executive in the U.S., Robert Wachter, MD, is the author of 250 articles and 6 books, the latest of which has become a New York Times Best Seller. Entitled The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine's Computer Age, the book is being hailed across the country as the most compelling one yet written on its subject. We spoke with Wachter about the accomplishments and unexpected consequences of health IT, the process of writing the book, and new ideas that might deserve more attention from health care leaders and policymakers.
September 16, 2015
Expanding health coverage and reducing disparities in uninsured populations is an important part of the Affordable Care Act (ACA). Will this ensure access to health services as well as improve the health of minority populations? That’s less clear.
Setember 11, 2015
Summer is officially over and Penn, not to mention Congress, is back in session. If your summer didn’t include following every twist and turn of health policy, here’s some of the research and debate that you may have missed.
September 3, 2015
A new study by LDI Senior Fellow Carolyn Cannuscio and colleagues, including Senior Fellows Rosemary Frasso, David Grande, and Zachary Meisel, examines how a behavioral economics intervention can encourage young adults to carry their epinephrine auto-injectors.
August 25, 2015
Hospital observation, instead of admission, is increasingly common for Medicare beneficiaries. This distinction is important because it means that the hospital stay is not covered by Medicare Part A, and it may mean higher out-of-pocket costs, according to a new study.
August 24, 2015 [cross-posted with US News]
Medicare is going in multiple directions at once. On the one hand, it is trying hard to move away from fee-for-service payments to doctors, where each tiny service has its own code and its own payment, and instead, toward more bundled payment or even payment of a fixed amount per person per month to accountable care organizations. On the other hand, the government just proposed, in response to pressure from organized physicians, a new code and a new doctor payment in traditional Medicare for end-of-life counseling. Somewhat oddly, Medicare will currently pay for such a session, as soon as you go on Medicare, but (thankfully, perhaps) few 65-year-olds are expecting an end to their life anytime soon. And so the benefit often goes begging. The new rules would allow you to claim the benefit anytime you feel you need it.
August 24, 2015
In June, we described the first attempt to measure, in a consumer-friendly way, the breadth of physician networks offered by all silver plans on the 2014 health insurance marketplaces. We estimated network size based on the fraction of office-based physicians participating in the network within relevant rating areas in the state. We categorized networks using "T-shirt" sizes: x-small (less than 10%), small (10%-25%), medium (25%-40%), large (40%-60%), and x-large (more than 60%). We found that nationally, 41% of all networks were either “small” or “x-small”. For simplicity, we combined these two t-shirt sizes as our definition of a narrow network. In our new Data Brief, we take a closer look at the state variation in network size.
August 17, 2015
In the beginning (Web Site 1.0), we measured the success of health insurance marketplace sites by whether they worked. Last year (Web Site 2.0), technical glitches were resolved, and we can start to measure success by whether the sites help people make the best decisions in choosing a health plan. A new study by LDI Fellow Charlene Wong and colleagues takes stock of some features of each web site, and should help state and federal policymakers improve their sites even further in Web Site 3.0 (opening Nov. 1, 2015 on a screen near you).
August 13, 2015
Although health reform has reduced many financial barriers to care, geographic barriers remain. In two separate studies, LDI Fellows David Shalowitz, and LDI Senior Fellows Michael Mullen, Charles Branas, and Brendan Carr looked at the geographic distribution of specialty care in the United States, specifically gynecologic cancer care and comprehensive stroke treatment. In both cases, greater distance to specialized care can put patients at risk for poor outcomes. The studies, one involving actual mapping and the other a virtual trial, found large regions of low access, and recommended data-driven planning to improve the population's geographic access to these services.