A Health Podyssey
Health Affairs
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Each week, Health Affairs Editor-in-Chief Alan Weil brings you in-depth conversations with leading researchers and influencers shaping the big ideas in health policy and the health care industry.
A Health Podyssey goes beyond the pages of the health policy journal Health Affairs to tell stories behind the research and share policy implications. Learn how academics and economists frame their research questions and journey to the intersection of health, health care, and policy. Health policy nerds rejoice! This podcast is for you.
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1 day ago
Yanlei Ma on Paid Sick Leave Mandates and Health Care Use
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Paid sick leave is a benefit many of us take as a given, but almost one-quarter of workers in the United States don't get any paid sick leave at all.
That puts the employee in a very difficult position - reluctant to not go to work even when sick because they can't afford to lose their wages. Other high-income countries mandate sick leave and in 2012 Connecticut became the first state to adopt a sick leave mandate.
Fifteen other states and the District of Columbia have followed suit.
It might not be surprising to learn that paid sick leave mandates reduce the likelihood of people going to work when they're sick. But do these mandates affect the use of emergency room?
Yanlei Ma from the Harvard Pilgrim Health Care Institute joins A Health Podyssey to discusses the relationship between state paid sick leave mandates and emergency department use.
Ma and coauthors published a paper in the August 2022 edition of Health Affairs examining the effect of state-level mandatory sick leave policies on emergency department visits. Listen to learn about the relationship they found.
Order the August 2022 issue of Health Affairs for research on spending, payments, and more.
Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Aug 2, 2022
Barak Richman On The Heavy Costs of Health Care Coding
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In the United States we have multiple commercial health insurers, each with their own rules regarding filing and documenting claims for payment.
Medicare and Medicaid have their own rules and both of those programs rely heavily on insurers who impose their own rules. All this adds up to is significant burden on health care providers who rely upon staff and technology to navigate this complex system.
While there are various estimates, all told administrative costs account for at least a few hundred billion dollars of health care spending each year. This figure is much lower in other countries.
Barak Richman from Duke University joins A Health Podyssey to discuss how insurance-related health spending in the United States compares to that in other countries.
Richman and coauthors published a paper in the August issue of Health Affairs comparing administrative spending in five countries with spending in the United States. In the paper, they provide insights for reasons for the differences.
Order the August 2022 issue of Health Affairs.
Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Jul 26, 2022
Rozalina McCoy on Modernizing Diabetes Care Quality Measures
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There are currently an estimated 37.3 Americans living with diabetes, more than a 40 percent increase from a decade ago. Thus, it isn't surprising that efforts to measure and improve the quality of health care focuses a significant amount of attention on diabetes.
Major health care quality datasets all include a number of measures related to the quality of diabetes care. Given the continuing growth in the burden of diabetes, it's appropriate to ask the question: What are we actually getting from measuring the quality of diabetes care as we do it today?
Rozalina McCoy from Mayo Clinic joins A Health Podyssey today to discuss just that very topic.
McCoy and coauthors published a paper in the July 2022 issue of Health Affairs examining diabetes quality measures in the US since the mid-1990s. They recommend some pretty significant changes in how we measure and report on the quality of diabetes care.
McCoy's research was part of a six-paper cluster of research on type 2 diabetes, all of which were published in the July 2022 issue of Health Affairs.
Order the July 2022 issue of Health Affairs for research on type 2 diabetes and more.
Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Jul 19, 2022
Marcia Weaver Explains Two Decades of Health Care Spending Effectiveness
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It's well known that the United States spends much more than other high-income countries on health care, the most recent estimates from the Centers for Medicare and Medicaid Services published in Health Affairs show that nearly a fifth of US GDP is spent on health care services.
It's perhaps somewhat less well known that health outcomes lag those of many other countries. Life expectancy and infant mortality rates rank well below not just other high-income countries, but many middle-income countries as well.
The combination of these two facts leads many to ask the question, "Are we getting our money's worth for all that we spend on health care?"
However, simply establishing that the US spends a lot on health care and has sub-optimal health outcomes doesn't fully answer the question.
Marcia Weaver from the University of Washington joins A Health Podyssey to discuss whether we receive value for our high levels of health spending.
Weaver and coauthors published a paper in the July 2022 of Health Affairs examining the relationship between health spending and disease burden in the United States. They reached some optimistic conclusions based on the data.
Order the July 2022 issue of Health Affairs for research on Type 2 diabetes and more.
Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Jul 12, 2022
Jane Zhu Gets Spooky About Phantom Providers
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Finding access to mental health services can be challenging in the United States.
The explosion of the demand for services, the inadequate workforce to provide them, and payment levels and methods that don't always support the care people need all contribute to these challenges.
There are also longstanding concerns around access to all types of care for people enrolled in Medicaid, primarily due to low payment rates for services.
If you put those together, it's not surprising that access to mental health services for people on Medicaid poses particular challenges. And since Medicaid is the largest payer for mental health services and treatment in the United States, these are challenges that need to be addressed.
Jane Zhu from Oregon Health and Science University joins A Health Podyssey to discuss access to mental health services for Medicaid enrollees.
Zhu and colleagues published a paper in the July 2022 issue of Health Affairs assessing the prevalence of what they call "phantom providers" in Oregon Medicaid managed care networks.
These are providers who are listed in network directories but not providing many services to Medicaid patients. They found that a large share of mental health providers listed in these network directories saw four or fewer Medicaid patients in 2018. The shares were largest for specialists and people authorized to prescribe medication.
Order the July 2022 issue of Health Affairs for research on type 2 diabetes and more.
Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Jul 5, 2022
Juan Andino Breaks Down Interstate Telehealth Waivers
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Telemedicine burst onto the scene as the nation locked down at the start of the COVID-19 pandemic. Historically, telehealth, or telemedicine, was tightly restricted both by regulation and by payment policy.
But in response to COVID-19's disruption of in-person care, all 50 states and Washington, DC issued temporary waivers that allowed clinicians to administer telehealth care to patients who live in a different state than their provider.
Juan Andino from the University of Michigan joins A Health Podyssey to discuss how interstate telehealth use changed in the face of COVID-19.
Andino and colleagues published a paper in the June 2022 issue of Health Affairs assessing the effect of waivers on interstate telehealth use among Medicare beneficiaries during the COVID-19 pandemic.
They found that while the volume of interstate telehealth use increased in 2020, out of state telehealth use continued to make up only a small share of all outpatient visits and all telehealth visits. They also found some interesting patterns on how interstate telehealth has changed.
Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.
Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.
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Jun 28, 2022
Sherry Glied Thinks Health Savings Accounts Have Outgrown Their Original Purpose
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High prices are an enduring feature of the United States health care system. Traditional market forces haven't seemed to bring them down, which leads some to wonder if we need a new approach.
Some may wonder, why not harness the purchasing behavior of consumers who provide downward cost pressure in pretty much every other sector of the economy?
Enter the idea of high-deductible health plans - health insurance with a high deductible which presumably should make consumers more careful with their purchases.
Sherry Glied from New York University joins A Health Podyssey to discuss the role of high deductible health plans in creating health market efficiencies.
Glied and coauthors published a paper in the June 2022 issue of Health Affairs examining the evolution of high deductible plans and companion health savings accounts, which are tax-favored saving vehicles offered in conjunction with a high deductible plan.
They found that these plans no longer serve their original purpose of encouraging cost consciousness and reducing spending. Instead, they provide regressive tax breaks disproportionally used by higher income people.
Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.
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Jun 21, 2022
Excursion: Andy Slavitt
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Listen to Health Affairs Editor-in-Chief Alan Weil interview Andy Slavitt, co-founder of both United States of Care and Town Hall Ventures and former administrator of the Centers for Medicare and Medicaid Services.
Andy is the host of the podcast In The Bubble with Andy Slavitt and recently published the book, "Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response."
Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and Podcasts free for everyone.
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Jun 14, 2022
Krista Harrison Peers Into the Intersection of Hospice, Dementia & Care Quality
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The concepts that underlie hospice were introduced a few centuries ago but, the modern hospice movement began in London in 1967.
In 1982 hospice was added as a Medicare benefit. Today, half of all Medicare decedents enroll in hospice, at a total cost of $20.9 billion to Medicare in 2019.
Hospice has a strong evidence base for improving end-of-life experiences for the recipient and the recipient's family. But there's limited evidence regarding the effects of hospice for people with dementia.
This is a critical knowledge gap given that one in three adults aged 85 and older has dementia.
Krista Harrison from University of California San Francisco joins A Health Podyssey to discuss how well hospice works for people with dementia.
Harrison and coauthors published a paper in the June 2022 issue of Health Affairs assessing the relationship between hospice enrollment and last month of life care quality for Medicare enrollees living with dementia.
They found that hospice-enrolled people living with dementia had higher quality last month of life care than people who are not enrolled in hospice, with quality levels similar to people without dementia.
Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.
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Jun 7, 2022
Ateev Mehrotra Shines a Light on Indirect Billing
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Recently, there's been dramatic growth in the number of nurse practitioners (NPs) and physician assistants (PAs). The number of NPs has more than tripled in the last decade while the number of PAs has almost doubled.
Yet, due to particular billing practices in Medicare, it can be difficult to know how care these clinicians are providing. That means there's a lot we don't know about access and quality related to this critical part of the health care workforce.
Ateev Mehrotra from Harvard Medical School and Beth Israel Deaconess Medical Center joins A Health Podyssey to discuss how we bill for nurse practitioner and physician assistant services and the implications of those practices.
Mehrotra and colleagues published a paper in the June 2022 issue of Health Affairs examining the prevalence of "indirect billing," where care provided by a PA or NP is billed under the supervising physician.
They found about 11 million instances of Medicare indirect billing in 2010 and 30 million in 2018 and estimate that eliminating indirect billing would have saved Medicare more than $190 million.
Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.
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May 31, 2022
Rachael Bedard Explains Health Care in Jails
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The United States has the highest rate of incarceration of any country in the world.
Health care for people in jails and prisons is rarely part of mainstream health care and health policy conversations. But people who are incarcerated have significant health needs and a legal right to medical treatment.
In addition, with 10 million people released from jail every year, needs that aren't met while people are incarcerated re-emerge in the community.
While the number of incarcerated people in the United States has started to decline, the share of the incarcerated population that's older has grown, placing additional strain on health system's that are already under a great deal of pressure.
Dr. Rachael Bedard joins A Health Podyssey to discuss the health needs of older people in jail.
Bedard and coauthors published a paper in the May 2022 issue of Health Affairs assessing the health and health needs of incarcerated older adults in New York City. They found that older incarcerated had greater health vulnerabilities than their younger counterparts. They are also more likely to suffer from serious mental and physical illnesses.
Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.
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May 24, 2022
Christine Ritchie Reimagines Home-Based Care
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When the Institute of Medicine defined health care quality, patient-centeredness was one of the five core dimensions. Yet as many have noted, the health system often seems to be more organized around the needs of providers than patients.
This reality is particularly true when it comes to older Americans. An entire system of coverage and care has built up around institutional needs and institutional definitions - nursing homes, hospitals, assisted living centers, rehabilitation centers, and more.
Christine Ritchie from Massachusetts General Hospital and Harvard Medical School joins A Health Podyssey to discuss what a reimagined health system truly designed around the needs of older patients could look like.
Ritchie and coauthor Bruce Leff of Johns Hopkins University published a commentary in the May 2022 issue of Health Affairs describing the elements of a new home and community-based care ecosystem for older people.
They argue for a system grounded in…
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May 17, 2022
Caitlin Hicks on Telemedicine and Care Inequities
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When medical offices shut down due to the COVID-19 pandemic and people were encouraged or required to avoid public spaces, there was a dramatic and rapid increase in the use of telemedicine.
Telemedicine has the potential to open up access to care, particularly to people who are geographically isolated or have mobility limitations, but it can also exacerbate existing inequities given its relevance upon broadband internet access and other technologies.
Caitlin Hicks from Johns Hopkins School of Medicine joins A Health Podyssey to discuss whether telemedicine expands or narrows care inequities.
Hicks and colleagues published a paper in the May 2022 issue of Health Affairs examining the impact of Medicare's pandemic-era telemedicine coverage waiver on utilization by geographic area.
They found that Medicare's telemedicine access expansion increased utilization overall and that those beneficiaries in areas of greater depravation, as measured by the Area De…
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May 10, 2022
Vilsa Curto on Vertical Integration's Effect on Health Care Prices
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The health care sector has gone through various waves of consolidation with hospitals purchasing physician practices and hospitals, physicians, and health insurers merging with each other.
We're in the midst of a wave of consolidation.
Two years ago, Health Affairs published a paper that found more than half of US physicians and 72 percent of surveyed hospitals were affiliated with one of 637 health systems in 2018. More recently, some have estimated that the 10 largest health systems now control about a quarter of the health care market.
Consolidation brings with it various opportunities for savings and efficiency but it also concentrates market power and creates opportunities to raise prices.
Vilsa Curto from Harvard University joins A Health Podyssey to discuss the effects of consolidation and integration.
Curto and colleagues published a paper in the May 2022 issue of Health Affairs assessing trends in vertical integration and joint contracting be…
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May 3, 2022
Brian Powers on How Humana Understands Medicare Advantage Enrollees' Social Needs
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More than 40 percent of Medicare enrollees are enrolled in Medicare Advantage (MA) plans, privately-sponsored health plans that provide Medicare benefits often along with other benefits not included in the standard Medicare package such as eye exams, hearing aids, and dental coverage.
Medicare Advantage is growing rapidly. On the current trajectory, it's likely that the majority of Medicare enrollees will be in MA plans within a year or two.
Since MA plans are paid on a capitated basis, insurers have a financial incentive to control health care costs. Recently, much attention has been focused on how addressing social needs can yield health benefits, which save MA plans money.
In order to address those needs, health plans need to know the social needs of their enrollees.
Brian Powers from Humana joins A Health Podyssey to discuss understanding the unmet social needs of Medicare enrollees.
Powers and colleagues published a paper in the April 2022 issue…
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Apr 26, 2022
Alexandra Bhatti Assesses US Child Care Vaccination Laws
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This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.
Vaccine requirements have been much in the news lately tied to the COVID-19 pandemic, but disputes over requiring vaccines have been with us for decades.
How to balance respecting individual autonomy with protecting public health is not a new issue. It's played out in particular force when it comes to children.
All states have vaccine requirements for children as they enter school and those requirements are often pretty widely known. Less well known are those requirements related to child care, which can affect children long before they reach school age.
Alexandra Bhatti from Merck joins A Health Podyssey to discuss vaccine requirements for child care in the United States.
Bhatti and coauthors published a paper in the April 2022 issue of Health Affairs assessing child care vaccination requirements in the United States. They found considerable variation ac…
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Apr 19, 2022
Katie Keith Throws an ACA Birthday Party
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This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.
March 23 marked the 12th anniversary of the passage of the Affordable Care Act (ACA).
This landmark legislation expanded health care access to millions of Americans and accelerated changes in how we organize and pay for health care. Having survived numerous legal challenges and strong political opposition by some, it continues to be the centerpiece of domestic health policy.
If you want to understand the evolution of the Affordable Care Act from enactment to today, there's no one better to learn from than Katie Keith of the Georgetown University Law Center.
Keith is a regular contributor to Health Affairs' Following The ACA Forefront article series and the recently launched Health Reform newsletter. Most recently, she's written about the No Surprises Act rules, the Department of Health & Human Services response to anti-trans youth policies, delay of the Su…
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Apr 12, 2022
Stacie Dusetzina Shares Why Medicare Beneficiaries May Not Fill Specialty Drug Prescriptions
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This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.
The United States is facing a drug affordability crisis.
Even as we celebrate scientific discovery, the health benefits of drugs are limited due to barriers of affordability, often even for people with health insurance. The RAND Corporation reports that on average drug prices in the United States are more than two and a half times those in 32 other nations studied. The disparities are even wider when we focus just on brand name drugs.
Drug pricing is the subject of seemingly perennial debates. One side focuses on access barriers due to high prices while the other side argues that lower prices threaten future innovation.
Stacie Dusetzina from Vanderbilt University Medical Center joins A Health Podyssey to talk about the complex world of drug pricing.
She and colleagues published a paper in the April 2022 issue of Health Affairs examining the degree to whic…
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Apr 5, 2022
Kathryn Phillips Wants to Anticipate Payer Cancer Coverage as Screenings Evolve
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This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.
Cancer diagnosis has changed radically in the era of precision medicine. New techniques like multi-cancer early-detection screening tests can detect up to 50 types of cancer from a single blood draw.
We generally think of early detection, especially of cancer, as an unambiguously good thing. Given that, you might assume and expect that insurers would readily pay for it. But it turns out the considerations regarding insurance coverage for these screening tests are quite complex.
As is often the case, advances in medical technology have accelerated beyond certain policies that were put in place when cancer diagnosis and treatment were very different.
Kathryn Phillips from the University of California San Francisco joins A Health Podyssey to discuss how we can gain the advantages of better cancer screening technologies as they emerge.
Phillips and coauthors…
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Mar 29, 2022
Seth Berkowitz Puts A Figure to Social Determinant Health Spending
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Limited access to transportation is well established as a barrier to people obtaining health care services. If it's hard to get to the doctor, you're less likely to go and that means delays getting needed care, poorer management of chronic conditions, and more use of the emergency room.
While health insurance typically covers emergency transportation, say for an ambulance, coverage of non-emergency transportation to get you to a doctor's visit is less common. Medicaid, which serves people with low incomes, has covered this type of transportation for decades, but it's become increasingly clear that plenty of people with incomes above the Medicaid eligibility threshold face significant transportation barriers.
Thus, some insurers and health systems have begun to offer a non-emergency transportation benefit as well.
Seth Berkowitz from the University of North Carolina School of Medicine joins A Health Podyssey to discuss the effect of providing a transport…
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Mar 22, 2022
Hector Rodriguez Argues Brick-and-Mortar Health Care Consolidation Is Short-Sighted
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There's a tremendous amount of consolidation going on in the health care sector. A lot of the research about consolidation focuses on the economics. But, one of the primary arguments people make for bringing disparate parts of the health system together is that it enables clinical integration.
Patients, they say, should get better care if the clinicians are talking to each other and sharing information, which is easier to do if clinicians are a part of the same health care system.
It turns out that studying clinical integration is hard. How do you define it? How do you measure it or having the desired effect?
Hector Rodriguez from University of California Berkeley School of Public Health joins A Health Podyssey to discuss health care consolidation.
Rodriguez and colleagues published a paper in the March 2022 issue of Health Affairs examining the relationship between physician practice capabilities and service metrics, like quality, utilization, and spe…
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Mar 15, 2022
Jill Horwitz Questions the Role of Nonprofit Hospitals
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Out of about 5,000 community hospitals in the United States, almost 3,000 are nonprofit. More than a thousand are investor-owned, also called for-profit. The balance are owned by state or local governments.
Nonprofit hospitals, like all nonprofit organizations, must have a charitable mission and for hospitals that mission is generally expressed as providing charity care and various benefits to the community.
In exchange, nonprofit hospitals are exempt from various taxes, they can receive tax-deductible charitable donations and they may have access to tax-exempt bonds.
There's a longstanding debate regarding whether nonprofit hospitals deserve the benefits they receive and whether nonprofit hospitals really behave all that differently from investor-owned hospitals.
Jill Horwitz from the UCLA School of Law joins A Health Podyssey to discuss the similarities and differences in hospital behavior based upon ownership.
Horwitz and Austin Nichols published a…
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Mar 8, 2022
Ruth Zambrana Argues Structural Racism is a Social Determinant of Health
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Racism is a social phenomenon. Even though the medical research community has historically relied heavily on racism that treated Black bodies as property that could be experimented upon, clinical medicine has actually been pretty slow to accept racism as a legitimate topic of examination.
Health services, with its ties to the social sciences, has been somewhat more accepting of the notion that racism is a topic worthy of scholarly inquiry. However, direct discourse about racism has been limited.
Despite the squeamishness of mainstream institutions when it comes to talking about racism, a significant and robust body of research has arisen, demonstrating a direct link between racism and health.
Ruth Enid Zambrana from the University of Maryland joins A Health Podyssey to discuss the rich intellectual history of scholarship on racism and health.
Zambrana and coauthor David Williams published a paper in the February 2022 issue of Health Affairs, an issue d…
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Mar 1, 2022
Melanie Sabado-Liwag on the Enduring Impact of Colonialism on Health Inequities in the US
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There are more than 22 million people of Asian descent living in the United States. In the aggregate, Asian Americans have mostly better economic and health outcomes than other groups, including White Americans.
Yet within the broad category of Asian Americans, there are dozens of subgroups often with quite different health outcomes and lived experiences. This within-group heterogeneity is often lost, buried under the so-called model minority myth, which is used to deny attention to unmet needs among Asian Americans and to denigrate the experience of other minority groups such of those of Black and Hispanic Americans.
One subset of the larger Asian American population is people whose history traces to the Philippines.
The relationship between the United States and the Philippines is unique and this history and present day status affect the health of Filipino Americans.
Melanie Sabado-Liwag from California State University, Los Angeles joins A Health Po…
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Feb 28, 2022
Racism & Health In US Medicine, A Conversation with Harriet Washington
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In a bonus episode of A Health Podyssey, Harriet Washington discusses the history of racism in medicine and research with Vabren Watts, Health Affairs’ director of health equity, and Aletha Maybank, chief health equity officer and senior vice president of the American Medical Association.
Washington is the author of several books on medical ethics, including Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.
This featured podcast coincides with the release of "Racism & Health," the February 2022 issue of Health Affairs. Alongside the publication of this special issue, it was important for Health Affairs to provide historical context about the impact of racism on health to inform the research published in the issue.
Listeners can view the video recording of this interview on our website and YouTube page.
Get your copy of the Racism & Health theme issue today.
Find out more on Racism &…
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Feb 22, 2022
Monica Simpson Examines Black Women's Lived Experiences with Sexual and Reproductive Health Care Services
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Racism manifests in different ways for different people in different environments.
For many Black women, experiences with sexual and reproductive health reveal cross-cutting themes of racism, sexism, and classism, all expressed in the context of strong social norms and prejudices regarding Black women and reproduction.
Attention to poor health outcomes for Black women has grown recently in part due to stories of negative maternity experiences of prominent Black women, such as Serena Williams. Congress has gotten into the act as well and taken steps to address the crisis of high rates of maternal mortality among Black women.
But what are the individual experiences behind this crisis?
Monica Simpson, executive director of Sister Song, joins A Health Podyssey to discuss a paper her and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They examined the reproductive health experie…
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Feb 17, 2022
Narrative Matters: Honoring Dr. Shalon Irving, A Champion for Health Equity
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Listen to this bonus episode from Health Affairs' Narrative Matters podcast, which highlights personal stories from the front lines of care.
In this episode, host Jessica Bylander interviews Wanda Irving, chair of the board of Dr. Shalon’s Maternal Action Project, before Irving reads an essay from the February 2022 issue of Health Affairs, dedicated to the theme of racism and health.
This essay remembers the life and legacy of Shalon Irving, whose 2017 death brought national attention to maternal mortality among Black women in the US.
Subscribe to the Narrative Matters Podcast.
If you enjoy this essay, order the February 2022 Health Affairs Racism & Health theme issue.
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Feb 15, 2022
Ruqaiijah Yearby Reviews Structural Racism in US Health Care Policy
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"Members of racial and ethnic minority groups have long suffered from health inequities in the United States. These inequities result, in large part, from racial and ethnic minority populations' inequitable access to health care, which persists because of structural racism in health care policy.
Racism includes a complex array of social structures, interpersonal interactions, and beliefs by which the group in power categorizes people into socially constructed 'races' and creates a racial hierarchy in which racial and ethnic minority groups are disempowered, devalued, and denied equal access to resources."
These words come from the opening paragraphs of one of four overview papers in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health.
Ruqaiijah Yearby from Saint Louis University joins the A Health Podyssey to discuss how structural racism is embedded in US health policy.
Yearby and coauthors describe s…
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Feb 8, 2022
Michael Sun on Racial Biases Hiding in EHRs
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The February 2022 issue of Health Affairs focuses entirely on racism and health.
It includes papers that trace the long history of racism to present day policies and practices that are the reasons for large and sustained health disparities.
Racism and bias come in many forms and given the social stigma associated with them, they can be difficult to study. When a study comes along that provides new empirical data on bias, it makes a major contribution to our understanding of this important topic.
One such study in the February issue from Michael Sun, a medical student from the University of Chicago, and colleagues is the focus of today's A Health Podyssey.
Sun and coauthors studied bias in how patients are characterized by clinicians through the history and physical notes entered into a patient's electronic health record, or EHR. When a patient is admitted as an inpatient or an outpatient, the notes document the patient's reason for seeking medical care…
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Feb 1, 2022
George Wehby on Mask Mandates and How Health Services Research Has Changed Since COVID
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The COVID-19 pandemic has made the relationship among research, policy, and public health strikingly clear. People who may have given little thought to health policy and research began following the latest study results to guide their own behavior and push governments and businesses to make decisions that reflect a combination of science and their own values and risk tolerance.
Health journals like Health Affairs responded by accelerating editorial processes and publishing free content to meet growing consumer demand. The new environment affected health services researchers as well as placed a new emphasis on timeliness and attention to issues affecting the public.
In this context, George Wehby from the University of Iowa College of Public Health joins Health Affairs Editor-in-Chief Alan Weil for a new A Health Podyssey Excursion.
Wehby co-authored the most read Health Affairs article in 2020. In that paper, Wehby and coauthor Wei Lyu showed the value o…
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Jan 25, 2022
Kayte Spector-Bagdady on Racial Diversity and Inclusion in Precision Medicine and Big Data
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Precision medicine is built on a platform of big data, or large data bases that permit analysis of correlations among environmental and personal factors, treatments, and health outcomes.
Data bases that once included only paper records now include tissue samples, air and water samples, and more. There's vast potential for significant advances in health care from precision medicine.
But existing large data bases tend to be drawn almost entirely from European and Asian populations, limiting the reach of the benefits of precision medicine. Since big data analytics are often hidden from the patient (and sometimes even the clinician), non-representative data also contributes to mistrust in a health care system that has a long history of excluding certain people.
Kayte Spector-Bagdady from the Center for Bioethics and Social Sciences in Medicine from the University of Michigan Medical School joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey…
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Jan 18, 2022
Keren Ladin on Why Medicare's Advance Care Planning Payment Is A Work In Progress
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Advance care planning is a term used to describe when a person prepares for future management of serious or terminal illness, including developing an advance care directive or what is sometimes is called a living will.
Beginning in January of 2016, Medicare made it possible for certain clinicians to bill for their work for patients to develop advance care plans.
Despite the new billing option, uptake has been quite slow.
In health care, we often use financial incentives to motivate behavior change. You might have expected that simply creating a payment option for advance care planning would make it happen.
Keren Ladin from Tufts University joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the reasons Medicare's payment policy has not led to the greater pursuit of advance care planning.
Ladin and coauthors published a paper in the January 2022 issue of Health Affairs examining the limited use of advance care planning billin…
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Jan 11, 2022
LIVE with Sherry Glied and Craig Garthwaite on National Health Care Spending in 2020 and the COVID-19 Pandemic
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"Let us hope that this is a one in a hundred years pandemic. We don't want to build our health care system to operate at all times as if tomorrow will be COVID." - Sherry Glied
On December 15, Health Affairs published ahead-of-print, “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic,” the annual national health expenditures article prepared by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary. Always one of Health Affairs’ most-read articles, this year’s provides the first official report on spending that reflects the effects of COVID-19.
During a live Lunch and Learn event, a discussion was held on the findings with economists Sherry Glied from the Robert F. Wagner Graduate School of Public Service at New York University and Craig Garthwaite from Northwestern University’s Kellogg School of Management.
The event was held on January 5, 2022.
Listen to Health…
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Jan 4, 2022
Matthew Trombley on Why Many Providers Run From Downside Risk In ACOs
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The Medicare program has placed considerable emphasis on creating accountable care organizations (ACOs), which are groups of health care providers that together take responsibility for providing necessary care and can reap financial rewards if they do so at lower than projected costs.
While the American Hospital Association reports that 56 percent of community hospitals participate in an ACO, ACOs have developed more slowly in rural than in urban areas.
Observing that not all health care providers can afford the infrastructure cost necessary to make an ACO work, the Center for Medicare and Medicaid Innovation developed the ACO Investment Model (AIM) which supports physicians, clinicians, and smaller hospitals in their formation of ACOs.
The AIM Program evaluation has some interesting lessons for those seeking to promote accountable care.
Matthew Trombley from Abt Associates joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss…
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Dec 14, 2021
Esther Friedman Explains Home Care and Nursing Home Workforce Changes
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When you think of the health care workforce, nurses and physicians are probably the first professions which come to mind.
But there are actually more personal care aides in the US than physicians. Together with home health aides and nursing assistants, personal care aides comprise one-fifth of the US health care workforce. These workers provide essential supports to people who face limitations in basic activities such as eating, bathing, and moving around.
As the US population ages, the demand for home health and personal care aides is projected to increase by nearly 1.2 million additional jobs by 2030.
Esther Friedman from the University of Michigan joins A Health Podyssey to discuss the changing size in employment in the personal care workforce.
Friedman and colleagues published a paper in the December 2021 edition of Health Affairs investigating state level changes in the nursing home and home care workforce between 2009 and 2020. While almost all s…
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Dec 7, 2021
Jennifer Attonito on Lessons Learned from the COVID-19 Vaccine Rollout In Florida
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The availability of pharmacist-administered vaccination has grown in recent decades. Proximity to a pharmacy has found to be predictive of vaccine use.
In Florida, Publix grocery stores were the first retail pharmacies to provide COVID-19 vaccinations to eligible members of the public. For more than a month after the initial rollout, Publix remained the sole retail pharmacy authorized to administer COVID-19 vaccines.
Grocery stores seem like a natural place to reach a large share of the population, but grocery stores are not located evenly throughout communities.
Jennifer Attonito, an instructor of health administration from Florida Atlantic University, joins A Health Podyssey to discuss disparities in access to COVID-19 vaccines during the initial vaccine rollout in Florida.
Attonito and co-authors published a paper in the December 2021 issue of Health Affairs that analyzed the locations of Publix stores in Florida. They found that the Publix location…
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Nov 30, 2021
Is fee-for-service the smoking gun for U.S. health care spending?
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This episode originally aired on November 10, 2020.
The U.S. health policy community recognizes that fee-for-service models incentivize physicians and health systems to perform more tasks than may be needed. And, these models can contribute to industry fragmentation as organizations chase revenue.
But is fee-for-service really the smoking gun when it comes to the high levels of U.S. health care spending?
The answer is, unsurprisingly, complicated.
To discuss, Health Affairs Editor-in-Chief Alan Weil interviews Dr. Michael K. Gusmano, professor at the Rutgers School of Public Health and research scholar at The Hastings Center, to examine how physician payments are set in France, Germany, and Japan. These countries all employ fee-for-service models but pay less than the U.S. when it comes to health spending.
What can the U.S. learn from these countries? Is policy importation even possible?
Alan Weil and Dr. Gusmano explore these questions and more on A…
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Nov 16, 2021
Sabrina Poon on the Controversial Two-Midnight Rule & Its Effects on Hospital Admissions
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Medical advances have enabled many people to be cared for appropriately in an outpatient setting rather than being admitted to a hospital.
Yet, since Medicare payment rates are generally lower for outpatient visits than inpatient hospital stays, hospitals have a financial incentive to admit patients.
Observing what were believed to be inappropriate admissions, in 2013 Medicare adopted the "two-midnight rule" stating that hospitals would only be paid inpatient rates if the patient was expected to stay in the hospital over two nights. The rule was controversial, but data show that it changed hospital visit behavior.
The two-midnight rule is part of a larger effort to ensure appropriate payments within Medicare.
Sabrina Poon from the Vanderbilt University Medical Center joins A Health Podyssey to discuss the effects of the rule and whether or not it obtained its objective.
Poon and colleagues published a paper in the November 2021 issue of Health Affairs…
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Nov 9, 2021
Ashish Jha on Healthcare Payment Reform, COVID-19 & Health Policy Twitter
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When we launched A Health Podyssey in 2020, our goal was to take listeners beyond the research published in Health Affairs.
For A Health Podyssey's one-year anniversary, we wanted to take listeners on an Excursion and speak with someone who epitomizes so much of what brings professionals into the fields of health policy and health services.
Ashish Jha from the Brown University School of Public Health is a widely published researcher whose public voice arises from a combination of deep expertise and a unique ability to explain complex concepts in an accessible language. Over the course of the COVID-19 pandemic, Jha's insights on the virus have helped many navigate thorny, complicated public health issues.
Jha's most recent publication in Health Affairs was a commentary article where he and coauthors discussed adding a climate lens to health policy discussion in the U.S. Before joining Brown University, he was at the Harvard T. H. Chan School of Public He…
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Nov 2, 2021
Susanna Trost on Addressing Perinatal Mental Health to Curb Maternal Mortality
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With about 700 pregnancy-related deaths every year, the United States has the worst maternal mortality rates among developed countries.
One response to this crisis has been the creation of state and local maternal mortality review committees (MMRCs), which are multidisciplinary committees that examine the context in which maternal deaths occur.
The October 2021 issue of Health Affairs is focused on the topic of perinatal mental health. MMRC reports provide a treasure trove of information that can help us understand the role perinatal mental health plays in maternal mortality and what it might take to achieve better results.
Susanna Trost, an Oak Ridge Institute for Science and Education Fellow at the Centers for Disease Control and Prevention, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss addressing perinatal mental health as a factor in maternal mortality.
Trost and co-authors published a paper in the October 2021 issu…
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Oct 26, 2021
Sara Kornfield on Postpartum Depression, Mental Health and Mother-Infant Bonding During COVID-19
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Postpartum depression is a common condition among people who give birth. Within four weeks of childbirth, 13% of women experience postpartum depression with as many as 19% of women affected three months postpartum.
Mothers who experienced postpartum depression are more likely to experience impaired mother-infant bonding, which has been linked to increased risk for infant maltreatment and socio-emotional behavior and cognitive problems.
Now, acute stress during pregnancy can increase the risk of postpartum depression. The current global COVID-19 pandemic represents a stressor that may have significant repercussions for postpartum depression risk and mother-child relationship development.
Sara Kornfield, assistant professor of psychiatry at the University of Pennsylvania, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the relationship between COVID-19, postpartum depression, and mother-infant bonding.
Kornfield and coautho…
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Oct 19, 2021
Pathways to Equitable and Anti-Racist Maternal Mental Health Care
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Systems of oppression like racism, sexism, and classism lead to poor health outcomes. These factors are a source of poor mental health and have particular implications for pregnant and birthing people.
Black women who face multiple axes of oppression experience higher rates of maternal mental health conditions than the population as a whole. Yet maternal mental health issues among black women are under reported and often under addressed.
Isabel Morgan, director of the Birth Equity Research Scholars Program at the National Birth Equity Collaborative, joins A Health Podyssey to discuss the effects of structural racism on black birthing people's mental health and how we can do better.
Morgan and coauthors published a paper in the October 2021 issue of Health Affairs - which is dedicated to the topic of perinatal mental health - describing what they call pathways to equitable and anti-racist maternal mental health care. Through interviews with black materna…
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Oct 12, 2021
Perinatal Mental Illness is Very Common. How Can It Be Improved?
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Mental health conditions, such as mood and anxiety disorders are diagnosed in one of every five pregnant or postpartum people. Despite this high burden of morbidity and mortality and economic costs, perinatal mental illness is poorly addressed by the current US healthcare system.
Jennifer Moore, founding executive director of the Institute for Medicaid Innovation, joins A Health Podyssey to discuss perinatal mental health and what we know about it. Moore was the advisor for the October issue of Health Affairs, which collects a number of articles all on perinatal mental health.
Those papers discuss several dimensions of the issue, including the health and economic costs of poor perinatal mental health; the relationship between mental health and physical health; and the role of race and racism and how the US approaches mental illness among birthing people.
In the issue, Moore co-authored two papers. In the overview, she and colleagues explore policy oppor…
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Oct 5, 2021
The Health Benefits of Paid Sick Leave Reach Farther Than You Think
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Most office workers think of paid sick leave as a benefit for them and their family members, but there are societal benefits to paid sick leave as well.
Since 1993, the United States has guaranteed access to unpaid sick leave through the Family and Medical Leave Act (FMLA) but that guarantee leaves out a large number of workers. A growing number of US states and localities have sought to fill-in some gaps of the FMLA, but many remain.
Jody Heymann from the University of California, Los Angeles joins A Health Podyssey to talk about access to sick leave, both paid and unpaid.
Heymann and colleagues published a paper in the September 2021 issue of Health Affairs documenting how FMLA eligibility requirements contribute to racial and ethnic disparities. They found that FMLA eligibility restrictions exclude over half of private sector and self-employed workers from coverage. In addition, they found higher rates of exclusion among female black, Indigenous and…
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Sep 28, 2021
How Dementia Care Integrates Formal and Informal Care Services
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Roughly 6 million adults ages 65 and older in the United States have dementia. That number is projected to more than double by 2050.
Family caregivers play an essential role in caring for people with dementia, including help with dressing to eating assistance and more.
In 2020, it's estimated that more than 11 million family members and other unpaid caregivers provided care to people with dementia. But what about those who don't have family members who can provide this needed care?
HwaJung Choi, a research assistant professor from the University of Michigan, joins A Health Podyssey to talk about the availability of family members to provide care to adults with dementia.
Choi and colleagues published a paper in the September 2021 issue of Health Affairs which found that 18% of dementia patients received care from their spouse and 27% received it from an adult child.
The authors also identified racial disparities in caregiver availability, and much more…
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Sep 21, 2021
The Burden of Morbidity Among Transgender People
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Recent reports suggest about six-tenths of a percent of the United States population, or 1.4 million people, identify as transgender. Transgender individuals are people whose personal and gender identity are different from the gender they were thought to be at birth.
Good information about the health status of this group has been hard to come by although research is growing. Some data come from Medicare, which is useful but not representative of the population as a whole.
Landon Hughes, a doctoral candidate at the University of Michigan, joins A Health Podyssey to discuss a paper he and coauthors published in the September issue of Health Affairs describing the morbidity of privately-insured, transgender individuals as compared to cisgender people, or those whose personal identity and gender corresponds with their birth sex.
Using insurance claims data from 2001 to 2019, Hughes and colleagues report that transgender people were at an overall greater ris…
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Sep 14, 2021
Leemore Dafny on Hospital Prices, Markets, and Antitrust Regulations
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The US government reports that the total spending on hospital care in 2019 was almost $1.2 trillion. High and highly variable hospital prices have been in the news recently in part due to new information made available under the price transparency rules implemented by the Trump administration.
Competitive markets are supposed to constrain prices, but in much of the US, there's little competition among hospitals and consolidation throughout the healthcare sector has contributed to that consolidation. The result is a number of proposals to regulate health care prices in general and for hospital prices in particular.
Leemore Dafny from the Harvard Business School and Harvard Kennedy School joins Health Affairs Editor-in-Chief Alan Weil to discuss her latest research on hospital prices and market concentration.
Dafny and colleagues published a paper in the September 2021 issue of Health Affairs analyzing hospital prices and relating them to market concentra…
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Sep 7, 2021
Pushing Against the QALY Criticism in Drug Pricing
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The quality-adjusted life-year (QALY) combines the expected effects on longevity and the expected effects on quality-of-life into a single standard measure. QALYs are often used as part of cost effectiveness analysis, particularly when analyzing the effectiveness of drugs.
QALY as a measurement has received a lot of criticism. It's been criticized in concept or in the specifics of how it's defined or used. This criticism often forms the basis for opposition to price negotiations or any limitations on access to a particular drug.
This kind of criticism can make it difficult to reach a consensus on processes that might yield negotiated or regulated drug prices.
Leah Rand, a postdoctoral fellow at Harvard Medical School and Brigham and Women’s Hospital, joins A Health Podyssey to talk about QALY, its criticism, and how to respond to that criticism.
Rand and coauthor Aaron Kesselheim published in the September 2021 issue of Health Affairs a systematic li…
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Aug 31, 2021
Julian Harris on the Connection Between Unmet Social Needs and Health Care Costs
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If you're a regular listener of A Health Podyssey, you know that most episodes revolve around a particular study published in Health Affairs. Every once in awhile, a person's experience as it relates to health care warrants an excursion from the constraints of discussing a single study. For those, we want to offer listeners a broader conversation.
Welcome to A Health Podyssey Excursion.
Dr. Julian Harris is the CEO of ConcertoCare, a provider of integrated care for seniors living at home. His career touches both the public and private sectors.
Before joining ConcertoCare in 2021, Harris served as President of Care Allies, a group of Cigna-affiliated population health management and home-based primary care companies. Prior to Cigna, Dr. Harris served as an adviser to Google Ventures (GV) with a focus on tech-enabled health care services.
In the public sector, Harris led the health care team in the White House Office of Management of Budget (OMB). As the…
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Aug 24, 2021
Scott Howell on the Very Large Costs of Drug Utilization Management
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While estimates vary, spending on prescription drugs in the United States exceeds $500 billion per year. This makes drug prices a perennial health policy topic.
In this context, payers and manufacturers are in a constant battle. Manufacturers seek to expand their market while payers attempt to use their leverage to negotiate lower drug prices. Often, patients and clinicians are caught in the middle and left to navigate increasingly complex pharmaceutical insurance benefit design, tiered formularies, drug rebates, and drug coupon programs.
On today's A Health Podyssey, Scott Howell, chief strategy officer of US pharmaceuticals at Novartis Pharmaceuticals, joins Health Affairs Editor-in-Chief Alan Weil to discuss how much the United States health system spends on drug utilization management.
Howell and co-authors published a paper in the August 2021 issue of Health Affairs exploring the growing burden of drug utilization management and seeking to quantify…
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Aug 17, 2021
LIVE with Chiquita Brooks-LaSure, Centers for Medicare and Medicaid Services Administrator
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As part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Chiquita Brooks-LaSure, the new Administrator of the Centers for Medicare and Medicaid Services (CMS) at the US Department of Health and Human Services for a one-on-one discussion about her priorities at CMS, where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.
A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Brooks-LaSure has decades of experience in the federal government, Capitol Hill, and the private sector. In March 2020, Ms. Brooks-LaSure was the lead author on Building On The Gains Of The ACA: Federal Proposals To Improve Coverage And Affordability in Health Affairs' thematic issue on “The Affordable Care Act Turns 10.”
The interview was conducted on Aug…
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Aug 10, 2021
James Robinson On The Drug Market, Innovation, Biosimilars, and What The French Get Right
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In our multi-payer health care system, the pharmaceutical market involves the complex interplay of manufacturers, insurers, prescribers, and patients. Each seeks to protect its own interest, which can be counterproductive for overall system efficiency.
The United States also has a high rate of generic drug use, which is considered a success story as the introduction of generics can rapidly and dramatically reduce drug prices. But we've had much less success with biosimilars, the generic equivalent of high-cost biologic drugs.
James Robinson from the University of California, Berkeley School of Public Health joins A Health Podyssey to discuss pharmaceuticals, how they're priced, and how competition in the United States compares to other countries.
Robinson is a contributing editor to Health Affairs and the co-author of two papers published in the August 2021 issue. In one, Robinson and coauthor Quentin Jarrion analyze prices for three drugs and 11 compet…
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Aug 3, 2021
Health Care Gaps For Migrants & Asylum Seekers On The Mexican Border During COVID-19
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Migrants on their way to another country and people seeking asylum are often overlooked in health policy. During the COVID-19 pandemic as immigration and asylum processes stalled, thousands of people were stranded at Mexico's northern border. With limited health care and sometimes crowded and unsanitary living conditions, COVID posed a significant risk.
How Mexico's response to COVID-19 took into account the particular needs of in-transit migrants and asylum seekers is the topic of today's episode of A Health Podyssey.
Ietza Bojorquez-Chapela from the College of the Northern Border and Cesar Infante from the National Institute of Public Health join Health Affairs Editor-in-Chief Alan Weil to discuss their research they and co-authors published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.
In the issue, the authors examine COVID-19 health policy documents issued by Mexican federal, state, and municipal a…
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Jul 27, 2021
Many US Citizen Migrant Children Living In Mexico Have Inadequate Health Coverage
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Children born in the United States are born US citizens. Some of these children are born to immigrant parents who returned to their country of origin, either voluntarily or because they were deported.
In 2015, more than half a million US citizen children lived in Mexico having returned with their parents. These children may face language and school adjustments, stressful living arrangements and economic and heath challenges. Fewer than half of them report holding Mexican citizenship, complicating their access to health and social services.
The well-being of US citizen children living in Mexico is the topic of today's A Health Podyssey. Sharon Borja, an assistant professor from the University of Houston, joins the program to discuss research she and colleagues published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.
In the issue, Borja and colleagues investigated health insurance coverage among US citizen…
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Jul 22, 2021
LIVE with Micky Tripathi, National Coordinator for Health IT
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BONUS EPISODE
As part of Policy Spotlight, a new virtual event series from Health Affairs, The Commonwealth Fund President David Blumenthal welcomed Micky Tripathi, the national coordinator for health information technology (IT), to an in-depth discussion of Biden administration's plans and priorities for health care data.
The interview was conducted on July 1, 2021.
At the Department of Health and Human Services, Micky Tripathi leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. Guest host David Blumenthal held the same post during the Obama administration from 2009 to 2011.
The discussion covered a number of topics, including information blocking, interoperability, Biden's equity project, social determinants of health data, artificial intelligence, data privacy, and much more.
Policy Spotlights feature conversations with influential health policy experts in Washing…
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Jul 20, 2021
Many US Immigrants May Defer Health Care to Avoid ICE
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Sixty-eight percent of undocumented immigrants in the United States come from Mexico or Central America. As a result, deportation policies have a disproportionate effect on people of Hispanic origin.
Immigration enforcement activity may influence behaviors like obtaining health care services; the effects of which can be felt throughout the community. On today's episode of A Health Podyssey, Abigail Friedman from the Yale School of Public Health joins the program to discuss the relationship between immigration enforcement and health care use.
In the July issue of Health Affairs, which focuses exclusively on Borders, Immigration & Health, Dr. Friedman and coauthor Atheendar Venkataramani from the University of Pennsylvania analyzed the relationship between immigration enforcement activity and health care use. They focused on the comparison between adults of Hispanic origins and those not of Hispanic origin.
The study ultimately found that aggressive depor…
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Jul 13, 2021
An Aging Immigrant Population and the Health Policy Questions It Raises
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Roughly 45 million immigrants live in the United States today, a fourfold increase since the 1960s.
Immigrants face unique challenges obtaining health care services. Some of the challenges are caused by explicit policies designed to limit or exclude immigrants from programs and benefits available to people born in the US. Other barriers relate to household income or the greater likelihood of having limited English proficiency.
The health of immigrants in the United States is the topic of today's A Health Podyssey.
Arturo Vargas Bustamante is a professor at the UCLA Fielding School of Public Health and faculty director of research at the UCLA Latino Policy and Politics Initiative. For the July issue of Health Affairs - focused exclusively on borders, immigrants and health - Bustamante and coauthors published a paper describing a range of health policy issues raised by the shifting demography of US immigrants.
They explored health insurance, health statu…
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Jul 6, 2021
The importance of mental health workers for mobile crisis response
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With the US becoming more focused on addressing mental health, one important topic is how society responds to people experiencing mental health crises.
A typical crisis response involves a 911 dispatcher sending a police officer to respond and provide support. However, the vast majority of police officers have little or no training for how to best respond to those in mental health crises. In addition, people with serious mental health disorders are at elevated risk of being harmed in confrontations with the police.
About 30 years ago in Eugene, Oregon, a small group created an alternative program for people in crisis by sending trained mental health workers and EMTs to people experiencing mental health crises instead of the police. The program is called CAHOOTS (Crisis Assistance Helping Out On The Streets) and it's become a model for similar efforts around the country.
The organization, run by White Bird Clinic, is the subject of a Leading To Health ar…
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Jun 29, 2021
What gun violence does to health
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Gun violence harms the health of victims and witnesses, but it also disrupts community social cohesion and behavioral norms. The people in communities that have experienced violence can suffer adverse health consequences, including post-traumatic stress disorder.
Exposure to gun violence and the disproportionate burden of that violence in certain communities is the topic of today's A Health Podyssey.
Sarah James, a postdoctoral fellow at Cornell University, joins Health Affairs Editor-in-Chief Alan Weil to discuss her research on adolescent exposure to deadly gun violence published in the June 2021 issue of Health Affairs.
She and her coauthors analyzed data about adolescents living or attending school near a deadly gun violence incident in the past year. They found stark trends by race and ethnicity as well as income level.
Listen to Health Affairs Editor-in-Chief Alan Weil interview Sarah James on the effects of adolescent exposure to deadly gun viol…
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Jun 22, 2021
Timing out-of-pocket spending in health care is challenging
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Almost all commercial insurance plans have cost-sharing provisions where patients help pay for their health care services.
Annual deductibles — which patients have to meet before insurance pays anything at all — and co-payments — where the patient pays either a fixed amount for or a share of the cost of each service received — are common examples.
Cost-sharing generally reduces the health insurance premium by simply shifting a share of the costs to enrollees. But it also affects utilization because having to pay for a share of the care can deter people from getting it.
How cost-sharing actually works in practice is the subject of this episode's A Health Podyssey.
Stacie Dusetzina from Vanderbilt University School of Medicine and Michal Horný from Emory University published a paper in the February 2021 edition of Health Affairs that analyzes the out-of-pocket spending patterns for commercially-insured individuals. They focused on the timing for…
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Jun 15, 2021
How biosimilars are affecting the drug markets
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Lowering prescription drug prices continues to be a hot topic. Spending on biologic products, which includes most vaccines and gene therapies, was estimated at $125 billion in the United States in 2018, representing about a quarter of total pharmaceutical spending.
Biosimilars, follow-on products to biologic drugs with essentially the same molecular composition to produce comparable clinical effects, are viewed by many as a way to promote competition and bring down drug prices. But the biosimilar market is young, with half of the 10 key product classes seeing marketing entry in 2018 or later.
Understanding the evolving market for biosimilars is the topic of this episode of A Health Podyssey.
Ariel Dora Stern, associate professor at Harvard Business School and a faculty affiliate of the Harvard-MIT Center for Regulatory Science, and coauthors published a paper in the June 2021 issue of Health Affairs examining how quickly biosimilars and follow-on produc…
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Jun 9, 2021
LIVE with Liz Fowler, director of the Center for Medicare & Medicaid Innovation
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BONUS EPISODE
As part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Elizabeth "Liz" Fowler, the new deputy administrator of the Centers for Medicare and Medicaid Services and director of its Center for Medicare and Medicaid Innovation to an in-depth discussion of Biden administration's plans and priorities for health care.
The interview was conducted on June 3, 2021.
As chief health council to then-Senate Finance Committee Chair Max Baucus (D-MT) at the time of the passage of the Affordable Care Act, Liz Fowler was a major force in crafting and shepherding the landmark legislation through the Senate. Later, as a vice president at The Commonwealth Fund, she was a contributor to Health Affairs’ 2020 special issue marking the 10-year anniversary of the signing of the Affordable Care Act: The ACA At 10.
In her current post, Dr. Fowler will play a key role setting priorities for the future of the A…
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Jun 8, 2021
Features of a zero-burnout primary care practice
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Rates of burnout among primary care physicians is a growing concern in the health care workforce.
Major shifts in the practice environment — from truncated office visits and growing documentation requirements to practice consolidation — have changed physicians' sense of efficacy and autonomy, both of which are important factors in work satisfaction.
The COVID-19 pandemic has heightened these concerns as many physicians have been working long hours while experiencing supply shortages and facing significant health risks themselves.
Samuel Edwards, assistant professor of medicine at the Oregon Health and Science University, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss his new research published in the June 2021 issue of Health Affairs investigating burnout in primary care practices.
They describe the characteristics of practices where clinical and nonclinical staff both report an absence of burnout and compare them to…
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Jun 1, 2021
How shortening skilled nursing facility stays might identify waste in health care delivery
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Skilled nursing care is an important Medicare benefit but it also accounts for significant spending.
In Medicare, cost sharing applies to patients' care in skilled nursing facilities after the twentieth day of residence. This prompts a spike in discharges from facilities at that time. But does cutting short these skilled nursing facility stays at day 20 negatively impact patient health?
J. Michael McWilliams, a researcher from Harvard Medical School and Brigham and Women's Hospital, and coauthors aimed to answer this question in a paper they published in the May 2021 issue of Health Affairs. They studied the extent to which skilled nursing facility discharges accelerated by Medicare cost sharing are safe.
McWilliams and coauthors found no clear evidence that those who are discharged face increased risk of death, hospitalization for fall-related injuries, or all-cause hospitalizations.
On this episode of A Health Podyssey, J. Michael McWilliams joins He…
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May 25, 2021
Julia Adler-Milstein on tracking the evolution of health information exchange
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The HITECH Act, part of the broad American Recovery and Reinvestment Act of 2009, ushered in major changes for health care's information and informatics landscape. The legislation may best be known for "meaningful use" requirements attached to hospital and/or physician funding to support the adoption of electronic health records (EHRs).
The law also greatly boosted health information exchanges, or networks that share clinical information across different health care settings.
On today's episode of A Health Podyssey, Dr. Julia Adler-Milstein, director of the Center for Clinical Informatics and Improvement Research at the University of California San Francisco, joins Health Affairs Editor-in-Chief Alan Weil to discuss a survey of health information exchange organizations she and colleagues published in the May 2021 issue of Health Affairs.
The survey reveals a level of maturity in the field of health information exchange, but a few critical issues continu…
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May 18, 2021
Lowering Medicare eligibility may improve cancer outcomes
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"I think we need to step back first before we even ask the policy question and ask this simple question, is it okay in the United States to die of cancer simply because you don't have health insurance?" - Dr. Gerard Silvestri
Cancer is a leading cause of death in the United States. Although there have been declines in cancer deaths in recent years, improvements have not been equally distributed across the population.
The risk of cancer increases with age and nearly a quarter of all new cancers diagnosed each year in the US occur among those aged 55 to 64 years old. At age 65, most Americans gain Medicare coverage, creating a ready comparison of cancer outcomes between those just below age 65 — who may have private insurance, Medicaid, or are uninsured — and those above 65 who are on Medicare.
The relationship between insurance coverage and cancer outcomes is the subject of this episode of A Health Podyssey.
Dr. Gerard Silvestri, a professor of thor…
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May 11, 2021
Breaking down how pharmacy deserts and access relate to health equity
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Many think of pharmacies primarily as places to get prescription medications, but pharmacists are highly trained clinicals who offer other important health care services.
Pharmacies are a valuable health care resource, and access to pharmacies may be an overlooked contributor to health inequities. Individuals who live in pharmacy deserts aren't able to easily obtain prescription medications or essential health care services. While the overall number of pharmacies in the US has increased gradually in recent years, research shows inequitable distribution of pharmacy and pharmacy closures.
On today's episode of A Health Podyssey, Jenny Guadamuz from the University of Southern California School of Pharmacy joins Health Affairs Editor-in-Chief Alan Weil to discuss her research published in the May 2021 edition of Health Affairs. Guadamuz and colleagues investigated the accessibility of pharmacies by neighborhood racial and ethnic composition in large US citie…
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May 4, 2021
Understanding private equity investment in hospitals
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To say the role of private equity investment in the health care system is growing would be an understatement. In 2018, the valuation of private equity deals in the US health care sector surpassed $100 billion, a 20-fold increase from 2000 when it was less than $5 billion.
Now, many are concerned that the incentive structures built into private equity financing have exacerbated trends such as surprise medical billing and contribute to increasing health care prices.
Despite the increased presence of private equity in health care, there's been little systematic examination of its scope and its effect on health care access and spending.
Published in the May 2021 edition of Health Affairs, Dr. Anaeze Offodile II from the University of Texas MD Anderson Cancer Center and colleagues reviewed private equity acquisitions of hospitals from 2003 to 2017. They found that private equity acquisitions occurred mostly in the Mid-Atlantic and Southern US regions and wer…
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Apr 27, 2021
Should social risks factor into health care quality measures?
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A central tenant of the move to value-based payment in health care is that quality can be measured and high quality providers should be rewarded for their excellence. But efforts to define and measure quality of care can run into challenges.
It's considered benign to take certain types of risk factors, such as disease severity, into account when measuring quality of care. But accounting for social risk factors, like poverty or housing instability, is a lot more controversial.
It's also the subject of today's A Health Podyssey.
In an April 2021 paper as part of Health Affairs' Policy Insights series, David Nerenz, director emeritus of the Center for Health Policy and Health Services Research at the Henry Ford Health System, and colleagues reviewed the arguments surrounding social risk factors and their inclusion in quality metrics. They concluded that "social risk adjustment should be the default option," and that is can be an important tool for promotin…
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Apr 20, 2021
ACA closed health coverage gaps for pregnant women. There’s still a long way to go
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The Affordable Care Act (ACA) has been the law of the land in the U.S. for 11 years and helped more than 20 million Americans gain health coverage. Still, some are losing it, even at times when they arguably need it most.
There are demonstrated health benefits for the mother and baby to having insurance before and during pregnancy and after giving birth. But a patchwork of programs leaves care gaps for this population. Typically, Medicaid only covers eligible pregnant women until they’re 60 days postpartum. The ACA allowed states that expanded Medicaid to offer longer coverage protections for eligible pregnant women.
How big of a step was that, and what remains to be done? That's the topic of today's A Health Podyssey.
Dr. Emily Johnston from the Health Policy Center at the Urban Institute joins Health Affairs Editor-in-Chief Alan Weil to discuss a new paper she published in the April 2021 edition of Health Affairs. Weil and Johnston talk about her re…
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Apr 13, 2021
Urgent care centers cost more than you think
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The number of urgent care centers grew significantly in the last decade, thanks in part by private equity investments. They seek to lower health costs and be cheaper than the ER by conveniently providing on-demand care for easily treatable conditions.
But, when looking at the economics, urgent care clinics may increase net health care spending.
In a new research article published in the April 2021 edition of Health Affairs, Dr. Ari Friedman, assistant professor of emergency medicine, medical ethics, and health policy at the University of Pennsylvania, and colleagues studied the impact on urgent care centers on emergency department (ED) visits.
Their research found that although the entry of urgent care deterred lower-acuity ED visits, the impact was small. They estimate that 37 additional urgent care visits were associated with a reduction of a single lower-acuity ED visit. In addition, each $1,600 lower-acuity emergency department visit prevented was o…
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Apr 6, 2021
The ACA led to an increase in the contraceptive-curious
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The Affordable Care Act requires all private health insurance to fully cover birth control. According to new research published in the April 2021 edition of Health Affairs, this contraception mandate led to increased use of long-acting reversible contraceptives (LARCs) among women enrolled in high-deductible health plans. LARCs, such as IUDs, previously had high one-time, out-of-pocket expenses.
This is a positive development for women, according to Dr. Nora Becker, the lead researcher and an assistant professor at the University of Michigan. "LARCs are the best contraceptive methods available so having access to LARCs is really important for patients," she says on today's episode of A Health Podyssey.
Becker argues that the benefits of contraception go beyond health: Women with access to contraception earn more money and have better professional outcomes.
Listen to Health Affairs Editor-in-Chief Alan Weil interview Becker about her research on how the…
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Mar 30, 2021
Nursing homes have a staff turnover crisis – even before COVID-19
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Nursing homes are challenging places to work. As David Grabowski, a professor of health care policy at Harvard Medical School, notes in today's episode of A Health Podyssey, "we knew the nursing home system was broken before the COVID-19 pandemic."
Grabowski recently co-authored two papers in the March 2021 edition of Health Affairs on the topic of nursing home staffing using a new Medicare data set (Payroll Based Journal) that spanned 2017-2019 and is a game changer for measuring quality. One article noted that Medicare's new patient-driven payment model resulted in reductions in therapy staffing in skilled nursing facilities. A second found that mean annual nursing staff turnover rate was an eye-popping 128 percent.
Post-pandemic, the implications of a nursing home's high staffing turnover rate is clear: it could lead to health and safety risks for residents.
David Grabowski joins Health Affairs Editor-in-Chief Alan Weil on today's episode to discuss…
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Mar 23, 2021
Do teams work better than solo providers? Spoiler alert: Yes
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Medical training has historically focused almost exclusively on the skills and actions of individual physicians. Increasingly, clinical training is incorporating an understanding of how team-based care affects patient outcomes.
For patients with chronic disease such as diabetes, hypertension and high cholesterol, can teams provide better care?
Maximilian Pany and Lucy Chen, both MD-PhD candidates in health policy at Harvard Medical School, and coauthors recently published research on that very question in the March 2021 edition of Health Affairs. They found that provider teams outperformed solo providers in managing chronic diseases.
Both Maximilian Pany and Lucy Chen join Alan Weil on A Health Podyssey to discuss their research, team-based care, and how team composition and scope-of-practice fit into their findings.
Listen to find out more.
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Mar 16, 2021
Examining the telehealth digital divide for patients with limited English proficiency
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The COVID-19 pandemic has prompted an increase in telehealth utilization. Since that growth, researchers have made calls to ensure that telehealth's subsequent growth does not exacerbate disparities in care.
Evidence of the “digital divide,” or differences in the technology or skills needed to access telehealth care, is widely documented. Race, age, geography, health coverage, and more can all impact how and if one adopts and uses telehealth services. English language proficiency is one factor closely connected to telemedicine use, even before the COVID-19 pandemic began.
Jorge Rodriguez, an instructor of medicine at Brigham and Women's Hospital and Harvard Medical School, and colleagues recently published research in the March 2021 edition of Health Affairs on telehealth use among patients with limited English proficiency using data from 2015-2018. They found that patients with limited English proficiency had lower rates of telehealth use when comp…
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Mar 9, 2021
Commercial insurers take note: bundled payments can save thousands per procedure
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Bundled payments have long been an experiment in the Medicare program to help reduce health care spending. The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services broad authority to test bundled payments, or paying providers for episodes of care instead of for each service provided.
Research has found savings associated with participating in the Bundled Payment for Care Improvement (BPCI) initiative. While there have been encouraging results, Medicare has experienced net losses under BPCI when taking reconciliation payments into account.
However, some alternative payment models have seen significant savings. There's still much to learn as the new iteration of BPCI — BCPI Advanced — continues.
For example, Christopher Whaley, a policy researcher at the RAND Corporation, and coauthors recently published research in the March 2021 issue as part of the Health Affairs Considering Health Spending series. They found a bundled pa…
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Mar 2, 2021
What new pandemic unemployment benefits taught us about health
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The COVID-19 pandemic caused an enormous wave of disruption to the U.S. economy, leading the unemployment rate to rise to a record high of 14.7% in April 2020.
While unemployment has since improved — the unemployment rate in January 2021 was 6.3% — America has yet to reach the employment levels it held before the pandemic.
In response to so many out of work, the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March 2020 expanded eligibility for unemployment benefits. Within that legislative package, the Federal Pandemic Unemployment Compensation (FPUC) increased the amount of money people could receive through such programs.
FPUC expired for the first time in July 2020, leading to insurance beneficiaries receiving smaller benefits.
Employment and job security is a known social determinant of health and the relationship to suddenly losing a job and a person's health isn't yet widely understood. To study the how FPUC may have affected u…
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Feb 23, 2021
Yes, COVID-19 changed telemedicine use — but it's complicated
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There's no doubt that the COVID-19 pandemic spurred an increase in telemedicine use. As Americans were reluctant to venture out of their homes in the pandemic's early months, both public and private payers were quick to change telehealth reimbursement policies as admissions plummeted.
According to new research published in the February edition of Health Affairs, 30.1% of all outpatient visits were provided via telemedicine from January 2020 to June 2020. The weekly number of telemedicine visits rose by a 23-fold increase during the same time period.
Prior to 2020, telehealth hadn't yet become a mainstream avenue of care despite the technology being in place for at least a decade. As COVID-19 vaccines are deployed and mutations spread, a question remains whether telemedicine will finally become a popular care delivery option.
On this episode of A Health Podyssey, Alan Weil interviews Dr. Michael Barnett, from the T.H. Chan School of Public Health, and Dr…
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Feb 16, 2021
Building the next generation of American Indian doctors
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"Quite honestly, it is not easy to be a nerd on the reservation." - Dr. Donald Warne
Pathways are not predetermined in life. But, without readily available role models to point to, it can be difficult for young people to know what options may be available as they advance toward adulthood.
Currently, there's a shortage of health care providers for Indigenous populations, which have been linked to limited access to care and higher rates of chronic health conditions. As native physicians are more likely than non-native physicians to serve these populations, increasing the number of native physicians is a critical strategy for improving access for this population.
At the University of North Dakota, role-modeling is a key component to increase interest and build the next generation of American Indian physicians. Currently, American Indian or Alaskan native students make up about 1% of medical school students nationwide. At the University of North Dakota's me…
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Feb 9, 2021
What the Biden administration urgently needs to address in health care
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In the February 2021 edition, Health Affairs presented a collection of papers from the National Academy of Medicine (NAM) for their Vital Directions for Health and Health Care project.
While originally established in 2016, NAM reassessed its priorities and found a vastly different health care landscape in 2020. Not only had the COVID-19 pandemic ripped through the health care ecosystem nationwide, but issues regarding maternal health, mental health, and elder care surfaced as pressing concerns. And, as always, health costs and financing was flagged for appraisal.
But, as Dr. Victor Dzau, president of the National Academy of Medicine, and colleagues note in their opening commentary, health equity was present throughout every priority.
The collection of commentaries from NAM sets forth health and health care priorities for 2021 and the new Biden administration. Vital Directions for Health and Health Care: Priorities For 2021 identifies the overarching the…
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Feb 2, 2021
Auditing the admission practices for opioid use disorder treatment
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The opioid epidemic has ravaged American life.
It has claimed more than 750,000 lives as a result of a drug overdose since 1999. In 2018 alone, more than 2 million people had an opioid use disorder and more than 800,000 people used heroin.
To alleviate these deaths of despair and get people the treatment they need, many individuals are looking to short-term residential facilities for substance use treatment programs, commonly referred to as rehabilitation, or rehab.
But, as a paper in the 2021 February issue of Health Affairs notes, recruitment practices and cost of care at these facilities can raise concerns. The authors found most programs required up-front payments, with for-profit programs charging more than twice as much as nonprofits.
Listen to Alan Weil interview Tamara Beetham, a PhD student in health policy and management at the Yale School of Medicine and lead author of the paper.
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Jan 25, 2021
Health economists may be getting the supply-and-demand framework all wrong
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Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That's certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.
As Gaffney and co-authors note in their paper, "focusing only on the impact of health care reform on government expenditures is short-sighted." On the supply side, there's a natural limit to doctor and nurses' time as well as the number of hospital beds in a given facility.
Their analysis suggest that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.
On this episode of A Health Podyssey, Alan Weil and Ad…
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Jan 19, 2021
If you give people coverage, they use it
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More than 500,000 individuals in the U.S. experience homeless at any given time, and many of those individuals qualify for Medicaid in states that expanded the program under the Affordable Care Act.
Medicaid expansion can be helpful for individuals unable to afford private health insurance. Medicaid expansion has been found to slow rates of health decline for some low-income adults, for example. But to date, little is known about the relationship between those experiencing homelessness gaining coverage through Medicaid expansion and health care service use.
With homelessness on the rise in the United States, it is important to study such trends and what implications they may have for both those experiencing homelessness and health care providers.
On today's episode of A Health Podyssey, Alan Weil interviews Dr. Jeral Self, a researcher at Mathematica and an adjunct faculty member at the Tulane School of Public Health and Tropical Medicine, on how Medica…
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Jan 12, 2021
And the value of an additional star for physicians and hospitals is...
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For better or worse, online platforms and social media have enabled individuals to publicly post their opinions of businesses online. As a result, business are at the mercy of public feedback, which can have an impact on their success.
Hospitals and physicians are not immune to this trend. The Centers for Medicare and Medicaid Services has pushed the idea of consumerization through price transparency policies and the Five-Star Quality Rating System so that patients can rate their providers, for example.
But what is the actual value of a star rating?
On this episode of A Health Podyssey, Alan Weil interviews Dr. Adam Schwartz, associate professor of orthopedic surgery at the Mayo Clinic College of Medicine and Science, who wrote a research paper with colleagues in the January 2021 issue of Health Affairs on the monetary value of an additional hospital or physician star rating when choosing a provider for total joint replacement.
While patients' interpre…
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Jan 5, 2021
Value-based care isn’t transforming healthcare spending
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Every year, Health Affairs publishes a retrospective look at national healthcare spending. In 2020, Anne Martin and colleagues from the CMS Office of the Actuary found that U.S. healthcare spending increased 4.6% to $3.8 trillion in 2019.
The rate of health spending declined slightly from 2018, which noted a growth rate of 4.7%. Hospital care, physician and clinical services, and retail purchase of prescription drugs, which accounted for 61% of total national health spending, saw faster growth rates in spending in 2019.
These figures predate the coronavirus, which has led to major changes in healthcare delivery and spending.
In this week’s episode of A Health Podyssey, Alan Weil invites Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University, to the program. They take a step back from the main findings from the paper and discuss the relationship between administrative costs and the high costs of healthcare p…
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Dec 29, 2020
From Colorado to Washington: Editor-in-Chief Alan Weil discusses his past, healthcare’s future
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As we close the books on the year 2020, we turn the tables on Health Affairs Editor-in-Chief Alan Weil wherein the interviewer becomes the interviewee.
Alan shares a bit about his educational background, what it actually means to be the editor for the leading health policy journal, and how empirical research has changed since the COVID-19 pandemic.
Looking back at the year's event, he elaborates on his blog post from June explaining his skepticism that the healthcare system can actually address social determinants of health. Looking forward to 2021, he predicts that administrative moves may continue to dominate the health policy landscape as a result of the 2020 election.
Listen to Alan Weil talk about these topics and more on a special episode of A Health Podyssey.
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Dec 22, 2020
Healthcare take note: every greenhouse gas emission matters
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From severe weather such as the destructive wildfires in California to air pollution nationwide, there's a growing body of knowledge linking climate change to human health.
On this episode of A Health Podyssey, host Alan Weil interviews Dr. Kristie Ebi, a professor in the Department of Global Health at the University of Washington, to discuss this complex relationship.
Ebi served as the theme advisor for the December edition of Health Affairs, which is fully dedicated to exploring that link between climate and health. She published two papers in the issue. One notes that the people most harmed by climate change are those who have so far contributed the least to greenhouse gas emissions. The second connects how detection and attribution studies could quantify how climate change is affecting health.
They note that while emissions have fallen during the COVID-19 pandemic, it's not enough to make a long-term impact. With the healthcare industry responsible…
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Dec 15, 2020
Can climate change solutions be served with school lunches?
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Does America have a healthy relationship with food?
In addition to the direct health effects of diet, food production and distribution affects environmental factors, which then trickles down to our health statuses. For example, an estimated one quarter of global greenhouse gas emissions relate to food production.
In a new paper published in the climate-centric December edition of Health Affairs, Mary Kathryn Poole, a PhD student in population health sciences at the Harvard T.H. Chan School of Public Health, and colleagues explored the relationship between The National School Lunch Program, one of the largest federal food programs, and its impacts on the environment.
In this week’s episode of A Health Podyssey, Alan Weil interviews Mary Kathryn Poole to discuss her paper, the EAT-Lancet Commission’s reference diet, strategies to reduce red meat consumption, and how they relate to planetary health diets.
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Dec 8, 2020
When climate change impacts Indigenous identities, mental health suffers
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How are Indigenous communities responding to climate change?
It’s an important but often under-looked question. As a new paper published in the climate-centric December edition of Health Affairs posits, Indigenous communities are uniquely vulnerable as climate-related events can impact their day-to-day lives, self-determination, and physical and emotional health.
In 2016, the Pala Band of Mission Indians tribe, who are located in southern California, conducted a vulnerability assessment regarding the effects of climate change. High temperatures, wildfires, storm flooding and drought were all identified as major concerns.
And yet, the assessment revealed few participants were aware of many of the potential health consequences at the individual and community levels as a result of these threats.
Indigenous communities have a history of adapting to their environment but some impacts from climate change for these communities are unexpected.
In this week…
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Dec 1, 2020
'What are we going to do about it?': An essay on racism and health inequities
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Brooke Cunningham is a general internist, sociologist, and assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota.
After George Floyd's killing, she wrote and published a Narrative Matters essay in Health Affairs on how the health effects of racism become embodied for her and other Black Americans.
On this episode of A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil interviews Brooke Cunningham about the essay and what she hopes listeners and readers take from her writing. After the interview, Brooke reads her essay in full.
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Nov 24, 2020
Ensuring equitable access to a COVID-19 vaccine once it's here
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In November, the pharma companies Pfizer and Moderna both announced substantial progress on a potential COVID-19 vaccine. While both vaccines showed promising results during clinical trials, questions remain for what's next and how to distribute a vaccine once it's available for public use.
One major question mark concerns logistics. For example, the Pfizer vaccine needs to be kept at extremely cold temperatures while traveling through the supply chain — though that doesn't seem to be the case for Moderna's vaccine.
Another worry is ensuring equitable access to an effective vaccine. Dr. Angela Shen, visiting scientist at the Children's Hospital of Philadelphia and vaccine policy expert, recently published a paper on the topic in a special cluster on COVID-19 vaccines in Health Affairs. She joins A Health Podyssey to discuss her paper, as well as the challenges and opportunities the US will face to secure equitable access to a COVID-19 vaccine.
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Nov 17, 2020
What Milwaukee tells us about COVID-19 and its impact on race
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New York City was an initial focal point for COVID-19 outbreaks in the U.S. with the virus then quickly spreading across the country. With time, data, and analysis, researchers are learning more about how the novel coronavirus is affecting different swaths of the U.S. population.
Leonard Egede, division chief of the Division of General Internal Medicine in the Department of Medicine and director of the Center for Advancing Population Science at the Medical College of Wisconsin, and colleagues recently published a paper in Health Affairs which aimed to understand the racial and ethnic differences in COVID-19 screening, hospitalization, and mortality rates in Milwaukee and Southeast Wisconsin.
Using data from more than 31,500 adults, Egede and his colleagues found that blacks and Hispanics were both more than three times more likely to test positive for COVID-19 than non-Hispanic whites. In addition, both blacks and Hispanics were two times more likely to…
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Nov 5, 2020
A first take on health policy after the 2020 election
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No matter which side of the aisle you sit, the 2020 U.S. presidential election has been as memorable as it's been remarkable.
On November 4th — less than 24 hours after the final polls closed — Health Affairs' Alan Weil sat down with Kimberly Leonard, Senior Healthcare Reporter at Business Insider, and Shannon Muchmore, Editor at Healthcare Dive, to share his perspective on what the future of health policy may look like when the election is finally in the rearview mirror.
The group touches on the fate of the Affordable Care Act, what's on deck for future coronavirus relief packages, and how the next administration may continue federal policies on pricing transparency. We also hear how Alan, Kimberly, and Shannon maintain bipartisanship in their publications in the face of increasing polarization.
Listen to hear what Alan, Kimberly, and Shannon are hearing across Washington, D.C. and how it could influence future health policies.
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Oct 27, 2020
Where a child grows up shapes their health
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We’ve long known that community resources — good schools, walkability, food security, etc. — affect opportunities for children’s health and behaviors to develop. But how do we measure these characteristics and use our knowledge to create better policy?
In this episode of A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil interviews Brandeis University’s Dr. Dolores Acevedo-Garcia to discuss her research on racial and ethnic inequities in children’s neighborhoods.
The results are stunning as they are surprising. While differences across the country were expected and noted, more than 90% of the variation in neighborhood opportunity occurs in metro areas.
What are the implications at the policy level for these results? Alan Weil and Dr. Acevedo-Garcia discuss.
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Oct 20, 2020
Education isn’t the only thing disrupted when schools close
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Schools and childcare centers quickly closed in reaction to COVID-19 in the spring of 2020 — and many remain closed or only provided remote services well into the fall.
While school closures appear to slow the spread of the virus, for many children the health ramifications are far broader. Children who depend on schools for meals or special needs are suddenly at a loss when schools close.
In this episode, Health Affairs Editor-in-Chief Alan Weil interviews Health Affairs Senior Editor Jessica Bylander to discuss her EntryPoint article published in the October 2020 issue of Health Affairs. She finds that when schools close, it’s not just education that’s disrupted.
Jessica also shares details about the newly published Narrative Matters essay collection (Johns Hopkins University Press), which features essays from the leading voices in health care today, including George Washington University’s Leana Wen and The Emperor of All Maladies author Siddh…
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Oct 13, 2020
How new pediatric programs take root and grow
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How do you take a good idea — like screening children to see if they're on a healthy developmental trajectory — and get that idea adopted by thousands of small separate pediatric practices spread across a state or the entire country?
The answer is collaboration and leadership.
Vermont Child Health Improvement Program (VCHIP) is a pediatric program run by the University of Vermont to help pediatric providers, payers, and policy makers navigate the complex health care ecosystem. It’s also the latest subject for Health Affairs’ Leading to Health Series.
Leading to Health focuses on transforming health systems and is published with support from the Robert Wood Johnson Foundation.
In this episode, Health Affairs Editor-in-Chief Alan Weil interviews journalist and Leading to Health author Rebecca Gale on what gives VCHIP a programmatic edge in implementing new health care programs — and how other states can consider and benefit from this approach.…
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Oct 6, 2020
Improving teen driver safety with virtual driving assessments
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Tragically, motor vehicle crashes are the leading cause of adolescent mortality and injury in the United States with new, inexperienced drivers at particular risk.
The risk is under-recognized in health care. One way forward could be virtual driving simulations.
Recently, the Children's Hospital of Philadelphia, through its spun out business Diagnostic Driving, partnered with the state of Ohio to assess a virtual driving simulation in driver education courses. Initial findings were recently published in the October 2020 edition of Health Affairs.
At this time, the partnership’s work is informing policy changes around integrating the virtual driving assessment system into licensing and driver training with the aim of reducing crashes in the first months of independent driving. The system can be developed to identify deficits in safety-critical skills that lead to crashes in new drivers and to address challenges that the COVID-19 pandemic has introduced…
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