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.
[cross posted from the Health Cents blog on philly.com] Two models for redesigning our health insurance system both involve replacing private insurance and out-of-pocket payments with public insurance subsidized by tax collections. Whether the solution is Medicare for All (with no explicit premium or out-of-pocket payments) or a more heavily subsidized Medicare-like public option added to Obamacare, these plans promise the eventual replacement of all or a large part of current privately insured payments by public ones, immediately or sometime in the future.
“How long do I have?” It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail? A new study from LDI Fellows Ravi Parikh, Christopher Manz, Amol Navathe, Mitesh Patel and colleagues tackles the question head on.
Outside of the brick and mortar walls of academic institutions – and conferences attended by researchers -- there is an invisible conversation happening. Academic Twitter, as it’s affectionately known, is a world unto itself. Yet, it turns out, there are ways in which it bears a striking resemblance to the familiar “old boys’ club.”
In a new article, University of Pennsylvania Law School Professor Allison Hoffman elucidates a fundamental problem afflicting health care in the United States: policymakers’ stubborn reliance on market-based theories and increased consumer choice to resolve the high spending and relatively poor health outcomes that have become endemic to the system. In “Health Care’s Market Bureaucracy,” forthcoming in the UCLA Law Review, Hoffman closely examines the economic theories underlying market-based health care policies, the empirical evidence demonstrating how such policies have failed in practice, and the regulatory infrastructure that has grown in an attempt to mitigate those failures.
Policies have reformed the health care system so that millions of Americans are able to access health coverage. However, for many, health coverage does not always translate to access to health care. The health care safety net plays a key role in filling coverage gaps that the traditional insurance system creates and ensures that health care is accessible and affordable for those who are uninsured or have high-deductible or high cost-sharing plans that leave them unable to access care. A new brief by Penn LDI and US of Care examines opportunities for the safety-net post-health reform.
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.