Milbank Quarterly最新文献

{"title":"Toward Monitoring and Addressing the Commercial Determinants of Health: Where Can We Go From Here?","authors":"Raquel Burgess, Tanja Srebotnjak, Christine Lin, Lawrence Grierson, Daniel C Esty, Yusuf Ransome, Nicholas Freudenberg","doi":"10.1111/1468-0009.70012","DOIUrl":"10.1111/1468-0009.70012","url":null,"abstract":"<p><p>Policy Points We describe ways to advance two key priorities related to the commercial determinants of health (CDH): the development of systems to monitor commercial practices and the creation of policy recommendations to address the CDH. Specifically, we discuss corporate nonfinancial reporting as a potential mechanism to obtain data on commercial practices that influence population health, describe the potential risks and benefits, and propose opportunities to advance high-quality corporate reporting on health impacts. We also review previous global agenda-setting exercises to suggest five key considerations to inform the World Health Organization's forthcoming policy recommendations for addressing the CDH.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"254-315"},"PeriodicalIF":4.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Analysis of the Requirements and Implementation of State Prescription Drug Price Transparency Laws.","authors":"Hannah Rahim, Aaron S Kesselheim","doi":"10.1111/1468-0009.70023","DOIUrl":"https://doi.org/10.1111/1468-0009.70023","url":null,"abstract":"<p><p>Policy Points A total of 21 states have passed drug price transparency laws with the goals of creating accountability around drug pricing and facilitating the development of policy solutions to address high prices. These laws vary in design but often require manufacturers to report the wholesale acquisition cost of drugs above a certain threshold for new drugs or of drugs that undergo a price increase above a certain margin, along with other data such as the manufacturer's costs. Initial findings suggest these laws may have contributed toward informing policymaking based on newly available public information but do not appear to have affected drug prices.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County.","authors":"Annette M Dekker, Adrian Yen, Andrea Larco Canizalez, Yesenia Perez, David Salazar, Bita Ghafoori, Dorit Saberi, Breena R Taira","doi":"10.1111/1468-0009.70017","DOIUrl":"https://doi.org/10.1111/1468-0009.70017","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points California government codes 13963.1 and 13963.2 guide the funding and implementation of the Trauma Recovery Center model to provide mental health treatment and case management to underserved victims of violent crime. In Los Angeles County, Trauma Recovery Centers successfully engage underserved victims of crime and improve posttraumatic stress disorder (PTSD) symptoms, quality of life, and social needs for those who receive care. The sustainability of the Trauma Recovery Center model is threatened by current funding policies, including a 2-year grant cycle. California legislators should consider greater flexibility in spending and alternatives to the current model of funding, including integrating the model into continuous care systems CONTEXT: Victimization is widespread in the United States. Marginalized communities are at higher risk of violence and are less likely to receive victim services despite dedicated funding through policies such as the Victims of Crime Act. In California, legislation supports the Trauma Recovery Center (TRC) model, which provides comprehensive mental health and case management services to underserved victims of violent crime. The objective of this study is to describe the implementation of the TRC model in Los Angeles (LA) County.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used an explanatory sequential mixed methods approach to assess implementation of five TRCs in LA County between 2021 and 2023. Descriptive analyses included process and outcome metrics. A Wilcoxon signed-rank test was used to assess the difference between pre- and postassessment measures, including change in the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), World Health Organization Quality of Life (WHOQOL), and social needs. Subsequent qualitative interviews of TRC staff were conducted to identify drivers of process and outcome metrics. Interviews were guided and analyzed using the Consolidated Framework for Implementation Research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;There were 1,662 victims who received care at the TRCs; they were predominantly female (78.6%, n = 1,174) and Latinx (68.1%, n = 970) and had less than a high school education (41.7%, n = 561). Mean PTSD Checklist for the DSM-5 scores improved from 42.3 to 27.6 (p &lt; 0.001), and WHOQOL scores improved by at least 0.8 points across each domain (p &lt; 0.001). A total of 36 TRC staff members participated in interviews that revealed four themes: 1) clients have complex mental health needs, 2) social needs are compounded by a limited safety net, 3) implementation varies by existing infrastructure and leadership, and 4) funding restrictions limit care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The TRC model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TR","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid's Role in Addressing the Mental Health and Substance Use Disorder Challenges of Its Members.","authors":"Kate McEvoy, Hannah Maniates","doi":"10.1111/1468-0009.70010","DOIUrl":"https://doi.org/10.1111/1468-0009.70010","url":null,"abstract":"<p><p>Policy Points Improving care for people with mental health (MH) and substance use disorder (SUD) conditions is a top priority for Medicaid leaders. Medicaid has often led the way for Medicare and other payers in coverage of MH and SUD services and in modeling the applied practice of cross-disciplinary work, but there is more work to be done to develop a comprehensive, community-based system of care for MH and SUD conditions. Medicaid's work in MH and SUD conditions is both standard bearing and an important work in progress.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Mental Health Across US States: the Role of Economic and Social Support Policies.","authors":"Rachel Donnelly, Mateo P Farina","doi":"10.1111/1468-0009.70015","DOIUrl":"https://doi.org/10.1111/1468-0009.70015","url":null,"abstract":"<p><p>Policy Points This perspective argues that state economic and social support policies are key determinants of population mental health. Key policy successes of the past decade include state expansion of Medicaid eligibility, increase in minimum wage, and implementation of paid sick leave. Key policy priorities include the prioritization of evidence-based policies that improve economic security and the expansion of social support policies that are not tied to employment.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Emergent Financing Models for Mental Health Crisis Systems.","authors":"Jonathan Purtle, Amanda I Mauri, David Frederick","doi":"10.1111/1468-0009.70014","DOIUrl":"https://doi.org/10.1111/1468-0009.70014","url":null,"abstract":"<p><p>Policy Points The sources and adequacy of funding for crisis systems currently varies significantly among the US states and across services in the crisis continuum. Crisis services are funded by a wide range of sources, including 988 telecom fees and other state appropriations, community mental health services block grants and other federal funding sources, Medicaid, and commercial insurance. Priority areas for research related to financing crisis systems include evaluating the effects of 988 telecom fees, value-based payment models, and non-Medicaid payors.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Policy Strategies to Promote the Recruitment and Retention of the Behavioral Health Workforce.","authors":"Briana S Last, Jane M Zhu","doi":"10.1111/1468-0009.70013","DOIUrl":"https://doi.org/10.1111/1468-0009.70013","url":null,"abstract":"<p><p>Policy Points To address persistent gaps in behavioral health care access and availability, particularly for underresourced populations, state policymakers have implemented four core strategies to address the shortage of behavioral health providers serving the Medicaid population. In this paper, we describe each of these state policy strategies, discuss their potential workforce and service impacts, and highlight unanswered questions about their effectiveness and implementation. Altogether, our review of these policy strategies suggests that rigorous evaluation of these state policy strategies is needed along with broader transformations to the behavioral health system to sustainably grow and retain the workforce in the long term.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144051888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services.","authors":"Jane M Zhu, Ruth Rowland, Inga Suneson, Deborah J Cohen, K John McCONNELL, Daniel Polsky","doi":"10.1111/1468-0009.70009","DOIUrl":"https://doi.org/10.1111/1468-0009.70009","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services in Medicaid, little is known about MCO strategies to overcome critical access barriers and the factors influencing these strategies. Through semistructured interviews of 27 administrators and executives across 19 local, regional, and national Medicaid MCOs, we describe a number of reported approaches to enhance behavioral health access: 1) contracting with core groups of Medicaid-focused behavioral health providers to provide a substantial share of care, and 2) targeted strategies to enhance the existing workforce through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high-touch case management. Findings highlight MCO perspectives on barriers and facilitators of access to behavioral health care, as well potential strategies that hold promise for other MCOs. Future research should evaluate the outcomes associated with these strategies and identify best practices that can be adapted across MCOs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We interviewed 27 administrators and executives across 19 Medicaid MCO carriers with local, regional, or national operating presence to understand strategies to address behavioral health access barriers and the factors influencing these strategies. To achieve maximum heterogeneity, we employed iterative purposive sampling using a sampling matrix of plan and state characteristics. One-hour interviews were recorded, professionally transcribed, and analyzed using a coding scheme that was developed iteratively. Codes were bundled into major themes after iterative discussions, with analysis conducted at the MCO level.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;MCOs perceived acute access challenges for children and adolescents, rural geographies, and crisis and transitional services. To address these challenges, MCOs reported contracting with core groups of Medicaid-focused behavioral health providers, supplemented with targeted strategies to enhance the existing workforce. These strategies focused on enhancing provider retention and capacity through outreach, training, and workforce support programs; rate enhancements; telehealth and mobile unit care models; and high-touch case management to align members to appropriate providers or service levels. Strategies were influenced by state policy contexts, including by regional financing and organization of behavioral health services, rate setting procedures, and administrative and regulator","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward.","authors":"Brendan Saloner","doi":"10.1111/1468-0009.70007","DOIUrl":"10.1111/1468-0009.70007","url":null,"abstract":"<p><p>Policy Points The role of Medicaid in financing, organizing, and delivering substance use disorder (SUD) treatment has grown tremendously over time owing to expansions of eligibility and a push toward more uniformity in benefits. Current innovations in SUD treatment focus on expanding the delivery system to create a comprehensive continuum of care, using more value-based payment to reward quality care, and integrating SUD treatment with other systems (e.g., housing, employment, and the criminal legal system). Many of the promising innovations in delivery have not yet been rigorously studied, and implementation of effective models is often stymied because of the lack of flexibility in program requirements and variation in needs and resources across communities. Although policymakers can justifiably laud the great strides Medicaid has made in raising the standards for SUD treatment, there is a huge remaining gap in access to services amidst an unprecedented overdose crisis and looming turmoil in the program.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143677332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Are You Doing… Really? A Review of Whole Person Health Assessments.","authors":"Stephanie B Gold, Allison Costello, Maura Gissen, Selin Odman, Larry A Green, Kurt C Stange, Réna Swann, Rebecca S Etz","doi":"10.1111/1468-0009.12727","DOIUrl":"10.1111/1468-0009.12727","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points A redirection of measurement in health care from a narrow focus on diseases and care processes towards assessing whole person health, as perceived by the person themself, may provide a galvanizing view of how health care can best meet the needs of people and help patients feel heard, seen, and understood by their care team. This review identifies key tensions to navigate as well as four overarching categories of whole person health for consideration in developing an instrument optimized for clinical practice. The categories (body and mind, relationships, living environment and finances, and engagement in daily life) include nine constituent domains. To maximize value and avoid unintended consequences of implementing a new measure, it is essential to ensure adequate time with the person providing the responses. Use of the instrument should be framed around the goal of better understanding a person's whole health and strengthening their relationship with the care team and not for comparisons across physicians or meeting a target score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Frustration with the burden of proliferating measures in health care focused on diseases and care processes has added to the growing desire to measure what matters to people, including understanding how people are doing in terms of their whole health. There is no consensus in the literature on an ideal whole person health instrument for use in practice. To provide a foundation for assessing whole person health and support further instrument development, this review summarizes past work on assessing person-reported whole health, articulates conceptual domains encompassing whole health, and identifies lessons from existing instruments, including considerations for administration.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A scoping literature review and instrument review were conducted. Concepts from the literature and instruments were thematically coded using a grounded theory approach.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;We identified four overarching categories of whole person health, consisting of nine domains: body and mind (physical well-being, mental/emotional well-being, meaning and purpose [spiritual well-being], sexual well-being), relationships (social well-being), living environment and finances (financial well-being, environmental well-being), and engagement in daily life (autonomy and functioning, activities). A tenth domain of global well-being was used for instruments that assessed well-being as a whole. In total, 281 instruments were examined; most were specific to a single domain or subdomain. Fifty instruments assessed at least three domains; only five assessed all domains identified. Two key tensions must be navigated in the development of a whole person health instrument: comprehensiveness versus brevity, and standardization versus flexibility.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The array of whole person health domains identified in this review and lack of con","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"205-241"},"PeriodicalIF":4.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}