As the Supreme Court mulls yet another challenge to the constitutionality of the Affordable Care Act (ACA), we have new evidence of the law’s positive impact on young adults, who were allowed to stay on their parents’ insurance until age 26 under the Dependent Coverage Provision (DCP). The ACA helped young adults with cancer maintain continuous coverage, which is key to maintaining access to cancer treatment.
In arecent retrospective cohort study, my colleagues and I found that cancer patients who turned 19 in 2010-2012 (who were eligible to stay on their parents’ insurance) were 15% less likely to lose coverage than those who turned 19 in 2007-2009, before the ACA. We used commercial claims data to identify about 2,800 young adults with a cancer diagnosis between 2000 and 2015, and compared them to their peers prior to the ACA’s implementation. We matched the two groups on cancer type, diagnosis date, and clinical characteristics, and compared time to loss of insurance over 5 years.
A new LDI/INQRI Research Brief, written by Mark Pauly, PhD, Mary Naylor, RN, PhD, and me, reviews the evidence of an existing or looming primary care shortage in the wake of the ACA. Will the combined effects of an aging population, an increase in coverage and demand for care, and a decrease in the number of physicians going into primary care create widespread gaps in access? Who will treat the newly insured, and will this exacerbate existing workforce shortages? And if shortages become worse, how will they affect how consumers seek care and how health professionals organize to deliver that care?
The link between handoffs and poor patient outcomes has been a topic of study for more than 15 years. Most of these studies have been small, single-center projects with limited applicability outside the settings where the studies were done. Recently, however, a well-funded multicenter trial of a handoff improvement intervention raised the bar significantly.
In a New England Journal of Medicine article this month, Amy Starmer of Oregon Health Sciences University and her colleagues (the "I-PASS study group") showed that improving the handoffs of pediatric physicians-in-training (residents) decreased multiple types of patient care errors in nine academic hospitals. The I-PASS group found that certain error types (diagnostic errors and those related to history and physical examination) were reduced, while others (medication- and procedure-related errors) were not. This is not surprising. .
Long supported by Disproportionate Share Hospital (DSH) subsidies that offset the costs of uncompenstated care, safety-net hospitals now face significant reductions in those payments as well as the possible loss of more of their paying patients. Speaking at a recent LDI lecture, Director of the Los Angeles County Department of Health Services Mitchell Katz, MD, explained what his office is trying to do about both of these trends.
In a Perspective in today’s New England Journal of Medicine, David Grande, LDI's Co-Director of Health Policy, and colleagues write about new digital forms of pharmaceutical and medical device marketing to physicians. The same technologies that can be used to support clinical practice—such as electronic health records, social media, and mobile applications—can also be used to conduct market research and to market directly to physicians.
Taxes on medical devices, drug firms and insurance companies imposed or facilitated by the Affordable Care Act are likely to be among the first targets of the newly Republicanized Congress, Mark Pauly told a seminar at Drexel University this morning.
Pauly, PhD, a Wharton School professor and Senior Fellow of the Leonard Davis Institute of Health Economics (LDI), was one of four panel members convened by the Philadelphia Inquirer and its Field Clinic Blog to discuss how Tuesday's election results are likely to impact the Affordable Care Act (ACA).
LDI Senior Fellow Mark Pauly wants to have a conversation about the ACA’s mandatory coverage of preventive care. In an article released today in Health Affairs, Pauly, and colleagues from Duke University and the University of Washington, propose that decisionmakers take cost-effectiveness into account when mandating coverage of preventive services.
Despite all the media attention, most of us are only bystanders to the activities surrounding “Obamacare.” That’s because most of us still get our health insurance through our employers. The ACA focused on stabilizing the individual market and making coverage more affordable for people buying health insurance on their own. So why should the 149 million of us getting employer-sponsored insurance (ESI) care so much about what happens to the 19 million non-elderly people who buy their coverage directly?
In a new Data Brief, we look at how essential health benefits (EHBs) vary across states. The Affordable Care Act required qualified health plans to cover a package of essential health benefits (EHBs) and laid out 10 general categories it considered essential. But it did not exactly define those services and the Department of Health and Human Services (DHHS) subsequently allowed each state set its own EHBs. The result is 50 different EHB programs rather than a uniform, national standard. The DHHS has said it will re-evaluate this strategy in 2016.
Janet Weiner, MPH @weinerja Associate Director for Health Policy, LDI
In a study published today in JAMA, LDI Senior Fellows Mark Neuman and Rachel Werner cast doubt on the strategy of reducing hospital readmissions by preferentially choosing skilled nursing facilities (SNFs) with high quality ratings on Nursing Home Compare, Medicare’s five-star rating system. They found that available SNF performance measures were not consistently associated with the risk of 30-day hospital readmission or death.
In a new post on the Robert Wood Johnson's Human Capital Blog, LDI Senior Fellow Linda Aiken and her colleague Olga Yakusheva assess progress toward the IOM’s 2010 recommendation that 80% of nurses in the United States hold at least a baccalaureate in nursing (BSN) by the year 2020. Aiken & Yakusheva report on changing trends in nurse employment and education, market forces contributing to these changes, and the growing evidence base linking BSN-prepared nurses and patient outcomes. They point out that the economics of the nursing market remain a barrier to accomplishing this goal.
We've gathered a collection of live tweets from our joint PennLDI-Wharton Public Policy Institute event held October 9. Three panels of researchers and policymakers shared results and insights about how the research could help improve implementation of health care reform.