Last week LDI hosted a day-long conference on Medicare for All & Beyond. Our goal was to participate in one of today’s most pressing conversations in health care—how to expand health insurance to the 28 million people in the United States who are currently uninsured. We welcomed close to 300 people from across the spectrum to participate in this conversation, to consider the critical questions underlying today’s debate, and to look in depth at the challenges we face in expanding insurance coverage in our country. The conference gave us all plenty to mull over.
There’s good news and bad news. The good news is Medicare drug plans are increasing coverage of newer, better drugs to prevent blood clots in people at risk. The bad news is that coverage comes with significant strings attached, including higher patient copayments that could prevent access to the newer, better drugs.
Health systems and practices are increasingly testing new approaches to integrated care that optimize the use of personnel by incorporating interdisciplinary teams of advanced practitioners and other community stakeholders. A number of initiatives at Penn Medicine showcase this approach.
What if patients could access behavioral health care through a regular visit to a primary care office or during a hospital stay? This is the premise of integrated care, a promising strategy for addressing shortcomings in the traditional model of behavioral health care provision. Though the concept of integrated care isn’t new, changes in reimbursement are hastening its implementation.
More than 100 policymakers, practitioners, and researchers discussed and debated how payment policy can promote evidence-based, cost-effective substance use disorder treatment, in a recent workshop hosted by the Center for Health Economics of Treatment Interventions for Substance Use Disorder, HCV and HIV (CHERISH) and the Leonard Davis Institute of Health Economics at the University of Pennsylvania. By design, the workshop was highly interactive with roundtable discussions among panelists and participants. The day-long event took stock of the many ongoing efforts, examined the evidence, and explored promising models to achieve value in substance use disorder treatment.
[cross-posted from the Health Affairs Blog] The push to discharge more patients directly home after hospitalization may seem preferable in some circumstances. In addition to being financially sensible by decreasing spending on postacute care, patients might prefer to be discharged home rather than to an institutional setting. In this way, getting patients home may represent a rare opportunity to align goals across patients, payers, and health systems. However, these gains must be viewed in the context of the costs borne by those who care for patients once they are discharged home—informal caregivers.
Perhaps you caught the recent two-page spread in the New York Times (August 13) in which health policy experts weighed in on what they thought should be part of the Democrats’ Medicare for All. Ignoring the fact that this speculation will only become relevant if the Democrats capture the presidency and a filibuster-proof majority in the Senate, (we can dream, can’t we?), what might you learn from reading this?
[cross-posted from the CHERISH site] In 2018, the state of Louisiana spent approximately $35 million to treat 1,000 individuals with chronic Hepatitis C Virus (HCV). Unfortunately, these 1,000 treated individuals comprise only about 1% of the state’s 90,000 individuals living with HCV, including about 39,000 covered by the state’s Medicaid program or prison system. Treating everyone would cost more than “the state spends on K-12 education, Veteran’s Affairs, and Corrections combined,” according to the Secretary of the Louisiana Department of Health, University of Pennsylvania Alumna Dr. Rebekah Gee, in an article for Health Affairs.
[cross posted from the Health Affairs Blog] On July 10, 2019, the Centers for Medicare and Medicaid Services (CMS) announced a proposal to test bundled payments for radiation oncology services for 17 types of cancer. Although it shares features with existing bundled payment programs, the Radiation Oncology (RO) Model is positioned to launch CMS payment policy forward with novel features aimed at curbing known inefficiencies in spending on radiation therapy.
Imagine being discharged from the hospital to a two-room apartment badly in need of repair. Your electricity has been cut off and you can barely remember the discharge instructions. You were told to see a specialist in a week, but it will take you 90 minutes one-way on public transportation to get there. Confused about follow-up and juggling the complexities of life, what do you do?
One of the few issues in health policy on which there is bipartisan agreement is that it would be nice to lower the prices for patented brand name drugs. It would be even nicer if this could be done without reducing the flow of profits to drug companies that incentivize them to invest in research on new and better products. One way the Trump administration seeks to pull off this trick is by focusing on other developed countries (think France) who, in the President’s opinion, are freeloading on American taxpayers and consumers. Secretary of Health and Human Services Alex Azar, provided the economics and political science for this outrage: “The American senior and the American patient have too long been asked to overpay for drugs to subsidize the socialist system of Europe.” If Europeans would just pay more, Americans would pay less, and justice would be served. But is this diagnosis correct, and what other remedies are available to us?
There’s something unusual happening on patients’ 20th day in skilled nursing facilities (SNFs). In a JAMA Interal Medicine study, Paula Chatterjee, Norma Coe, Rachel Werner, and colleagues found that more people were discharged on day 20 of their SNF benefit period than days 19 or 21, which reflects how Medicare pays for postacute care at a SNF. While the findings raise more questions than answers, they do demonstrate a higher discharge rate among vulnerable patients when Medicare stops paying on day 20.
LDI Senior Fellows Zack Meisel, Benjamin Sun, and colleagues have a striking and sobering chart in a recent Annals of Emergency Medicine article on initial opioid prescriptions in the emergency department. They tracked how many “opioid-naïve” patients (i.e., those without a record of opioid use in the previous year) had persistent or high-risk opioid prescription use in the subsequent year.