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Experiences and Interest in Value-Based Payment Arrangements for Medical Products Among Medicaid Agencies: An Exploratory Analysis. 医疗补助机构对基于价值的医疗产品支付安排的经验和兴趣:探索性分析。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-06-07 DOI: 10.1111/1468-0009.12703
Beena Bhuiyan Khan, Victoria Gemme, Ethan Chupp, Aparna Higgins, Corinna Sorenson
{"title":"Experiences and Interest in Value-Based Payment Arrangements for Medical Products Among Medicaid Agencies: An Exploratory Analysis.","authors":"Beena Bhuiyan Khan, Victoria Gemme, Ethan Chupp, Aparna Higgins, Corinna Sorenson","doi":"10.1111/1468-0009.12703","DOIUrl":"10.1111/1468-0009.12703","url":null,"abstract":"<p><p>Policy Points State Medicaid experience with value-based payment (VBP) arrangements for medical products is still relatively limited, and states face a number of challenges in designing and implementing such arrangements, particularly because of the resource-intensive nature of arrangements and data needed to support measurement of desired outcomes. A number of success factors and opportunities to support VBP arrangement efforts were identified through this study, including leveraging established venues or processes for collaboration with manufacturers, engaging external and internal partners in VBP efforts to bolster capabilities, acquiring access to new data sources, and utilizing annual renegotiation of contracts to allow for adjustments.</p><p><strong>Context: </strong>To date, uptake of value-based payment (VBP) arrangements for medical products and knowledge of their design and impact have been mainly concentrated among private payers. Interest and activity are expanding to Medicaid; however, their experiences and approaches to VBP arrangements for medical products are not well characterized.</p><p><strong>Methods: </strong>This study sought to characterize the use of VBP arrangements for medical products among state Medicaid agencies through the use of a two-staged, mixed-methods approach. A survey and semistructured interviews were conducted to gain an understanding of state experiences with VBP arrangements for medical products. The survey and interviews were directed at senior leaders from nine states through the survey, with respondents from seven of these states additionally participating in the semistructured interviews.</p><p><strong>Findings: </strong>Although experience with VBP arrangements for medical products among states varied, there were similarities across their motivations and general processes or phases employed in their design and implementation. States collectively identified a number of significant challenges to VBP arrangements, such as manufacturer engagement, outcomes measurement, and the time, expertise, and resources required to design and implement them. We outline a range of strategies to help address these gaps and make it easier for states to pursue VBP arrangements, including more direct engagement from the Center for Medicare and Medicaid Services, state-to-state peer learning and collaboration, data infrastructure and sharing, and additional research to inform fit-for-purpose VBP arrangement approaches.</p><p><strong>Conclusions: </strong>Findings from this study suggest that it may be easier for states to pursue VBP arrangements for medical products if there is greater clarity on processes employed that support design and implementation as well as effective strategies to address common challenges associated with contract negotiations. As states gain more experience, it will be important to monitor the design and implementation of common VBP arrangements to assess impact on the Medicaid program and th","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"713-731"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285166","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}
引用次数: 0
Targeting Machine Learning and Artificial Intelligence Algorithms in Health Care to Reduce Bias and Improve Population Health. 在医疗保健中瞄准机器学习和人工智能算法,以减少偏差并改善人群健康。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-08-08 DOI: 10.1111/1468-0009.12712
Thelma C Hurd, Fay Cobb Payton, Darryl B Hood
{"title":"Targeting Machine Learning and Artificial Intelligence Algorithms in Health Care to Reduce Bias and Improve Population Health.","authors":"Thelma C Hurd, Fay Cobb Payton, Darryl B Hood","doi":"10.1111/1468-0009.12712","DOIUrl":"10.1111/1468-0009.12712","url":null,"abstract":"<p><p>Policy Points Artificial intelligence (AI) is disruptively innovating health care and surpassing our ability to define its boundaries and roles in health care and regulate its application in legal and ethical ways. Significant progress has been made in governance in the United States and the European Union. It is incumbent on developers, end users, the public, providers, health care systems, and policymakers to collaboratively ensure that we adopt a national AI health strategy that realizes the Quintuple Aim; minimizes race-based medicine; prioritizes transparency, equity, and algorithmic vigilance; and integrates the patient and community voices throughout all aspects of AI development and deployment.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"577-604"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908127","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}
引用次数: 0
The Spectrum of State Approaches to Medicaid Maternity Care Contracting. 各州对医疗补助孕产妇护理合同的处理方式。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1111/1468-0009.12707
Caitlin Murphy, Anne Rossier Markus, Rebecca Morris, Kay Johnson, Sara Rosenbaum, Laurie C Zephyrin
{"title":"The Spectrum of State Approaches to Medicaid Maternity Care Contracting.","authors":"Caitlin Murphy, Anne Rossier Markus, Rebecca Morris, Kay Johnson, Sara Rosenbaum, Laurie C Zephyrin","doi":"10.1111/1468-0009.12707","DOIUrl":"10.1111/1468-0009.12707","url":null,"abstract":"<p><p>Policy Points Maternal health is influenced by the quality and accessibility of care before, during, and after pregnancy. Nationwide, Medicaid covers nearly one in two births and uses managed care as a central means for carrying out these responsibilities. Thus, managed care plays a fundamental role in assuring timely, equitable, quality care and improving maternal health outcomes. A close review of managed care contracts makes evident that the absence of a national set of maternal health standards has caused challenges in setting expectations for managed care performance. State Medicaid agencies adopt a variety of approaches and underlying philosophies for contracting.</p><p><strong>Context: </strong>Managed care is how Medicaid agencies principally furnish maternity care. For this reason, the contracts that Medicaid agencies enter into with managed care organizations have attracted strong interest as a means of improving maternal health access, quality, and equity. However, limited research has documented the extent to which states use these agreements to set binding expectations across the maternal health continuum and how states approach the task of maternal health contracting.</p><p><strong>Methods: </strong>To explore maternal health contracting within Medicaid Managed Care, this study took a three-phase, sequential approach: (1) an extensive literature review to identify clinical guidelines and expert recommendations regarding maternal health \"best practices\" for people with elevated health and social needs, (2) a review of the managed care contracts in use across 40 states and Washington, DC, to determine the extent to which they incorporate these best practices, and (3) interviews conducted with four state Medicaid agencies to better understand how states approach maternal health when developing their contracts.</p><p><strong>Findings: </strong>The evidence on maternal health best practices reveals nearly 60 \"best practices,\" although the literature review also underscored the extent to which these recommendations are fragmented across numerous professional bodies and government agencies and are thus difficult for Medicaid agencies to ascertain. The contracts themselves reflect an approach to the maternal health continuum in a fragmented and incomplete way. Thematic analysis of interviews with state Medicaid agencies revealed three key approaches to contracting for maternity care: an \"organic\" approach, an \"intentional\" approach, and an approach \"grounded\" in state strategy.</p><p><strong>Conclusions: </strong>The absence of comprehensive, integrated guidelines reflecting the full maternal health continuum likely complicates the contracting task and contributes to incomplete, ambiguous contracts. A major step would be the development of a \"best practices tool\" that helps state Medicaid agencies translate evidence into comprehensive, clear contracting expectations.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"692-712"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312127","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}
引用次数: 0
State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment. 州级教育质量与按种族和受教育程度划分的认知功能轨迹》(State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment)。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-07-10 DOI: 10.1111/1468-0009.12709
Katrina M Walsemann, Heide Jackson, Emily Abbruzzi, Jennifer A Ailshire
{"title":"State-Level Education Quality and Trajectories of Cognitive Function by Race and Educational Attainment.","authors":"Katrina M Walsemann, Heide Jackson, Emily Abbruzzi, Jennifer A Ailshire","doi":"10.1111/1468-0009.12709","DOIUrl":"10.1111/1468-0009.12709","url":null,"abstract":"<p><p>Policy Points Education-cognition research overlooks the role of education quality in shaping cognitive function at midlife and older ages, even though quality may be more responsive to federal and state investment in public schooling than attainment. For older US adults who attended school during the early to mid-20th century, the quality of US education improved considerably as federal and state investment increased. Ensuring access to high-quality primary and secondary education may protect against poor cognitive function at midlife and older ages, particularly among Black Americans and persons who complete less education. It may also play an important role in reducing health inequities.</p><p><strong>Context: </strong>Although educational attainment is consistently associated with better cognitive function among older adults, we know little about how education quality is related to cognitive function. This is a key gap in the literature given that the quality of US education improved considerably during the early to mid-20th century as state and federal investment increased. We posit that growing up in states with higher-quality education systems may protect against poor cognitive function, particularly among Black adults and adults who completed fewer years of school.</p><p><strong>Methods: </strong>We used prospective data on cognitive function from the Health and Retirement Study linked to historical data on state investment in public schools, restricting our sample to non-Hispanic White and Black adults born between 1914 and 1959 (19,096 White adults and 4,625 Black adults). Using race-stratified linear mixed models, we considered if state-level education quality was associated with level and decline in cognitive function and if these patterns differed by years of schooling and race.</p><p><strong>Findings: </strong>Residing in states with higher-resourced education systems during childhood was associated with better cognitive function, particularly among those who completed less than 12 years of schooling, regardless of race. For White adults, higher-resourced state education systems were associated with higher scores of total cognitive function and episodic memory, but there were diminishing returns as resources increased to very high levels. For Black adults, the relationship between state education resources and cognitive function varied by age with positive associations in midlife and generally null or negative associations at the oldest ages.</p><p><strong>Conclusions: </strong>Federal and state investment in public schools may provide students with opportunities to develop important cognitive resources during schooling that translate into better cognitive function in later life, especially among marginalized populations.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"765-821"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141565008","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}
引用次数: 0
Impacts of State-Level Opioid Review Programs on Injured Workers and Their Health Care Providers: A Qualitative Study in Washington and Ohio. 州级阿片类药物审查计划对受伤工人及其医疗服务提供者的影响:华盛顿州和俄亥俄州的定性研究。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-06-11 DOI: 10.1111/1468-0009.12705
Tasleem J Padamsee, Courtni Montgomery, Stefan Kienzle, Jeremy B Straughn, Andrea Elmore, Deborah L Fulton-Kehoe, Beryl Schulman, Thomas M Wickizer, Gary M Franklin
{"title":"Impacts of State-Level Opioid Review Programs on Injured Workers and Their Health Care Providers: A Qualitative Study in Washington and Ohio.","authors":"Tasleem J Padamsee, Courtni Montgomery, Stefan Kienzle, Jeremy B Straughn, Andrea Elmore, Deborah L Fulton-Kehoe, Beryl Schulman, Thomas M Wickizer, Gary M Franklin","doi":"10.1111/1468-0009.12705","DOIUrl":"10.1111/1468-0009.12705","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points Workers' compensation agencies have instituted opioid review policies to reduce unsafe prescribing. Providers reported more limited and cautious prescribing than in the past; both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients. Despite the fears articulated by pharmaceutical companies and patient advocates, opioid review programs have not generally resulted in unmanaged pain or reduced function in patients, anger or resistance from patients or providers, or damage to patient-provider relationships or clinical autonomy. Other insurance providers with broad physician networks may want to consider similar quality-improvement efforts to support safe opioid prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Unsafe prescribing practices have been among the central causes of improper reception of opioids, unsafe use, and overdose in the United States. Workers' compensation agencies in Washington and Ohio have implemented opioid review programs (ORPs)-a form of quality improvement based on utilization review-to curb unsafe prescribing. Evidence suggests that such regulations indeed reduce unsafe prescribing, but pharmaceutical companies and patient advocates have raised concerns about negative impacts that could also result. This study explores whether three core sets of problems have actually come to pass: (1) unmanaged pain or reduced function among patients, (2) anger or resistance to ORPs from patients or providers, and (3) damage to patient-provider relationships or clinical autonomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In-depth semistructured interviews were conducted with 48 patients (21 from Washington, 27 from Ohio) and 32 providers (18 from Washington, 14 from Ohio) who were purposively sampled to represent a range of injury and practice types. Thematic coding was conducted with codebooks developed using both inductive and deductive approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The consequences of opioid regulations have been generally positive: providers report more limited prescribing and a focus on multimodal pain control; patients report satisfactory pain control and recovery alongside collaborative relationships with providers. Participants attribute these patterns to a broad environment of opioid caution; they do not generally perceive workers' compensation policies as distinctly impactful. Both patients and providers comment frequently on the difficult aspects of interacting with workers' compensation agencies; effects of these range from simple inconvenience to delays in care, unmanaged pain, and reduced potential for physical recovery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In general, the three types of feared negative impacts have not come to pass for either patients or providers. Although interacting with workers' compensation agencies involves difficulties typical of interacting with other insurers, opioid controls seem to have generally positive effects ","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"605-631"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307277","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}
引用次数: 0
Policy Recommendations for Coordinated and Sustainable Growth of the Behavioral Health Workforce. 关于行为健康工作人员队伍协调和可持续增长的政策建议。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-09-01 Epub Date: 2024-07-23 DOI: 10.1111/1468-0009.12711
Briana S Last, Erika L Crable
{"title":"Policy Recommendations for Coordinated and Sustainable Growth of the Behavioral Health Workforce.","authors":"Briana S Last, Erika L Crable","doi":"10.1111/1468-0009.12711","DOIUrl":"10.1111/1468-0009.12711","url":null,"abstract":"<p><p>Policy Points Demand for behavioral health services outpaces the capacity of the existing workforce, and the unmet need for behavioral health services is expected to grow. This paper summarizes research and policy evidence demonstrating that the long-standing challenges that impede behavioral health workforce development and retention (i.e., low wages, high workloads, training gaps) are being replicated by growing efforts to expand the workforce through task-sharing delivery to nonspecialist behavioral health providers (e.g., peer specialists, promotores de salud). In this paper, we describe policy opportunities to sustain behavioral health workforce growth to meet demand while supporting fair wages, labor protections, and rigorous training.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"526-543"},"PeriodicalIF":4.8,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749528","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}
引用次数: 0
Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population. 提出多重批判性问题:促进多种族人口健康数据平等的反思性和批判性框架》(A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population)。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-06-01 Epub Date: 2024-02-29 DOI: 10.1111/1468-0009.12696
Tracy Lam-Hine, Sarah Forthal, Candice Y Johnson, Helen B Chin
{"title":"Asking MultiCrit Questions: A Reflexive and Critical Framework to Promote Health Data Equity for the Multiracial Population.","authors":"Tracy Lam-Hine, Sarah Forthal, Candice Y Johnson, Helen B Chin","doi":"10.1111/1468-0009.12696","DOIUrl":"10.1111/1468-0009.12696","url":null,"abstract":"<p><p>Policy Points Health equity work primarily centers monoracial populations; however, the rapid growth of the Multiracial population and increasingly clear health disparities affecting the people in that population complicate our understanding of racial health equity. Limited resources exist for health researchers and professionals grappling with this complexity, likely contributing to the relative dearth of health literature describing the Multiracial population. We introduce a question-based framework built on core principles from Critical Multiracial Theory (MultiCrit) and Critical Race Public Health Praxis, designed for researchers, clinicians, and policymakers to encourage health data equity for the Multiracial population.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"398-428"},"PeriodicalIF":4.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11176410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139998102","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}
引用次数: 0
Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health. 解决健康的社会决定因素的多部门合作与社会民主。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-06-01 Epub Date: 2023-12-29 DOI: 10.1111/1468-0009.12685
Seth A Berkowitz
{"title":"Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health.","authors":"Seth A Berkowitz","doi":"10.1111/1468-0009.12685","DOIUrl":"10.1111/1468-0009.12685","url":null,"abstract":"<p><p>Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax-and-transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"280-301"},"PeriodicalIF":4.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11176409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075727","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}
引用次数: 0
Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement. 实现气候就绪的医疗保健系统:机构动机与员工参与。
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-06-01 Epub Date: 2024-01-16 DOI: 10.1111/1468-0009.12687
Caleb Dresser, Zachary Johns, Avery Palardy, Sarah McKINNON, Suellen Breakey, Ana M Viamonte Ros, Patrice K Nicholas
{"title":"Toward a Climate-Ready Health Care System: Institutional Motivators and Workforce Engagement.","authors":"Caleb Dresser, Zachary Johns, Avery Palardy, Sarah McKINNON, Suellen Breakey, Ana M Viamonte Ros, Patrice K Nicholas","doi":"10.1111/1468-0009.12687","DOIUrl":"10.1111/1468-0009.12687","url":null,"abstract":"<p><p>Policy Points The US health care system faces mounting pressure to reduce greenhouse gas emissions and adapt to the impacts of climate change; motivated institutions and an engaged health care workforce are essential to the development, implementation, and maintenance of a climate-ready US health care system. Health care workers have numerous profession-specific and role-specific opportunities to address the causes and impacts of climate change. Policies must address institutional barriers to change and create incentives aligned with climate readiness goals. Institutions and individuals can support climate readiness by integrating content on the health care implications of climate change into educational curricula.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"302-324"},"PeriodicalIF":4.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11176402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479434","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}
引用次数: 0
Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature. 评估 340B 药品定价计划的影响:同行评议文献实证范围综述》(A Scoping Review of the Empirical, Peer-Reviewed Literature.
IF 4.8 2区 医学
Milbank Quarterly Pub Date : 2024-06-01 Epub Date: 2024-01-28 DOI: 10.1111/1468-0009.12691
Timothy W Levengood, Rena M Conti, Sean Cahill, Megan B Cole
{"title":"Assessing the Impact of the 340B Drug Pricing Program: A Scoping Review of the Empirical, Peer-Reviewed Literature.","authors":"Timothy W Levengood, Rena M Conti, Sean Cahill, Megan B Cole","doi":"10.1111/1468-0009.12691","DOIUrl":"10.1111/1468-0009.12691","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points The 340B Drug Pricing Program accounts for roughly 1 out of every 100 dollars spent in the $4.3 trillion US health care industry. Decisions affecting the program will have wide-ranging consequences throughout the US safety net. Our scoping review provides a roadmap of the questions being asked about the 340B program and an initial synthesis of the answers. The highest-quality evidence indicates that nonprofit, disproportionate share hospitals may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Despite remarkable growth and relevance of the 340B Drug Pricing Program to current health care practice and policy debate, academic literature examining 340B has lagged. The objectives of this scoping review were to summarize i) common research questions published about 340B, ii) what is empirically known about 340B and its implications, and iii) remaining knowledge gaps, all organized in a way that is informative to practitioners, researchers, and decision makers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a scoping review of the peer-reviewed, empirical 340B literature (database inception to March 2023). We categorized studies by suitability of their design for internal validity, type of covered entity studied, and motivation-by-scope category.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The final yield included 44 peer-reviewed, empirical studies published between 2003 and 2023. We identified 15 frequently asked research questions in the literature, across 6 categories of inquiry-motivation (margin or mission) and scope (external, covered entity, and care delivery interface). Literature with greatest internal validity leaned toward evidence of margin-motivated behavior at the external environment and covered entity levels, with inconsistent findings supporting mission-motivated behavior at these levels; this was particularly the case among participating disproportionate share hospitals (DSHs). However, included case studies were unanimous in demonstrating positive effects of the 340B program for carrying out a provider's safety net mission.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In our scoping review of the 340B program, the highest-quality evidence indicates nonprofit, DSHs may be using the 340B program in margin-motivated ways, with inconsistent evidence for increased safety net engagement; however, this finding is not consistent across other hospital types and public health clinics, which face different incentive structures and reporting requirements. Future studies should examine heterogeneity by covered entity types (i.e., hospitals vs. public health clinics), characteristics, and time period of 340B enrollment. Our findings provide additional context to current health policy disc","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":"429-462"},"PeriodicalIF":4.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11176403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139571948","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}
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