What if health systems provided rides for elderly patients with limited transportation options or poor patients unable to access public transportation? We might applaud them for a creative strategy to improve access for vulnerable populations. However, their actions might be illegal.
This brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage gains in the long term.
We recently convened an expert roundtable to tackle how health systems, payers, and providers can spur the ‘de-adoption’ of medical practices and technologies no longer considered valuable. This got us thinking - while the process by which ineffective practices or technologies are abandoned is neither simple nor automatic, even the language used to describe it is not clear. And language matters. It often reflects an unstated focus on one mechanism or one level of decision-making. Here we review, and potentially clarify, the terminology.
In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...
This is the way it is supposed to work. You develop policy and processes to drive innovation. You design and test innovative ideas in a small, efficient way. You learn and adapt. Successful innovation drives new policy. Rinse and repeat.
And this is the way it appears to have worked, in the case of Medicare bundled payment. Start small with a pilot. Expand in reach and scope if promising. Scale up if successful.
Last week the Surgeon General, Dr. Vivek Murthy, released the groundbreaking, comprehensive report Facing Addiction in American: The Surgeon General’s Report on Alcohol, Drugs, and Health. The report comes at a critical juncture, with more than 27 million Americans misusing illicit and prescription drugs, and more than 66 million misusing alcohol.
The notion of value is at once one of the most widely invoked and variably interpreted in American health care.
[cross-posted from the Health Cents blog on philly.com]
Deaths from Unintentional Injury, Homicide, and Suicide During or Within 1 Year of Pregnancy in Philadelphia
In the American Journal of Public Health, Pooja Mehta and colleagues seek to understand the effect of unintentional injuries, suicide, and homicide on pregnancy-associated death. The authors find that about half of of pregnancy-associated deaths - occurring during or within one year of pregnancy - in Philadelphia between 2010 and 2014 were due to unintentional injuries, homicide, or suicide. Of these deaths, more than 50% were directly or indirectly associated with substance use, more than 40% were associated with serious mental illness, and more than 20% were associated with...