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Effects of Dual-Eligible Integrated Care Plans on Medicaid Enrollment and Retention: Evidence From the Implementation of Medicare-Medicaid Plans. 双重资格综合护理计划对医疗补助登记和保留的影响：来自医疗补助计划实施的证据。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-02 DOI: 10.1177/10775587251372267
Eric T Roberts, Eliza Macneal, Kenton J Johnston, José F Figueroa
{"title":"Effects of Dual-Eligible Integrated Care Plans on Medicaid Enrollment and Retention: Evidence From the Implementation of Medicare-Medicaid Plans.","authors":"Eric T Roberts, Eliza Macneal, Kenton J Johnston, José F Figueroa","doi":"10.1177/10775587251372267","DOIUrl":"https://doi.org/10.1177/10775587251372267","url":null,"abstract":"<p><p>Medicare and Medicaid are separate programs that together cover 13 million low-income older adults and people with disabilities, known as dual-eligible individuals. Concern about a lack of coordination across Medicare and Medicaid has prompted the development of Integrated Care Programs (ICPs). Although the primary goal of ICPs is to coordinate financing and care across Medicare and Medicaid, ICPs may also influence whether low-income individuals obtain or keep Medicaid. We evaluated whether the rollout of Medicare-Medicaid Plans (MMPs)-one of the largest ICPs-was associated with changes in Medicaid take-up and retention among Medicare beneficiaries residing in high-poverty zip codes. Using a stacked difference-in-differences design and variation in MMP rollouts across nine states, we found no evidence that MMPs increased monthly or continuous Medicaid enrollment in this population. These findings highlight the need for focused policies to address Medicaid enrollment gaps among low-income Medicare beneficiaries, which could complement broader integration efforts.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251372267"},"PeriodicalIF":2.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Disparities in Access to Serious Mental Illness Care Following the Implementation of Value-Based Payment Reform in the Oregon Medicaid Program. 在俄勒冈州医疗补助计划实施基于价值的支付改革后，获得严重精神疾病护理的差异。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-05-28 DOI: 10.1177/10775587251339969
Benjamin Lê Cook, K John McConnell, Gareth Parry, Michael Flores, Stephanie Renfro, Anika Kumar, Catherine Holmes, Akhil Reddy, Rujuta Takalkar, Brian Mullin, Sharon-Lise T Normand, Marcela Horvitz-Lennon
{"title":"Disparities in Access to Serious Mental Illness Care Following the Implementation of Value-Based Payment Reform in the Oregon Medicaid Program.","authors":"Benjamin Lê Cook, K John McConnell, Gareth Parry, Michael Flores, Stephanie Renfro, Anika Kumar, Catherine Holmes, Akhil Reddy, Rujuta Takalkar, Brian Mullin, Sharon-Lise T Normand, Marcela Horvitz-Lennon","doi":"10.1177/10775587251339969","DOIUrl":"10.1177/10775587251339969","url":null,"abstract":"<p><p>Racial and ethnic disparities in mental health care access are especially consequential for the health outcomes of Medicaid beneficiaries living with serious mental illness (SMI). This descriptive study of Oregon Medicaid claims data assessed for disparities in access to SMI care for Oregon's adult Medicaid beneficiaries from 2010 to 2019, examining changes following the implementation of value-based payment (VBP) in 2012. Multivariable regression analyses compared changes in access to SMI care, pre- and post-VBP implementation, by race and ethnicity. Relative to White beneficiaries, VBP implementation was associated with net increases of 0.28% (95% confidence interval [CI]: [0.01%, 0.55%]) in the rate of access among Black beneficiaries (a complete reduction of the pre-VBP disparity) and 0.34% (95% CI: [0.17%, 0.51%]) among Latinx beneficiaries (narrowing but not closing the pre-VBP disparity). The Oregon policy's focus on access, equity, and beneficiaries with mental illness might have contributed to the observed reductions in disparities.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"376-386"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicare Advantage Plan and Chronic Kidney Disease Care Management Company Partnerships After the 21st Century Cures Act. 医疗保险优势计划和慢性肾脏疾病护理管理公司在21世纪治愈法案后的合作关系。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-06-28 DOI: 10.1177/10775587251349298
Denise A Tyler, Emily A Gadbois, Joan F Brazier, Amal N Trivedi
{"title":"Medicare Advantage Plan and Chronic Kidney Disease Care Management Company Partnerships After the 21st Century Cures Act.","authors":"Denise A Tyler, Emily A Gadbois, Joan F Brazier, Amal N Trivedi","doi":"10.1177/10775587251349298","DOIUrl":"10.1177/10775587251349298","url":null,"abstract":"<p><p>The 21st Century Cures Act opened Medicare Advantage (MA) enrollment to people with end-stage renal disease (ESRD). Previously, most Medicare beneficiaries with ESRD were only permitted to enroll in traditional Medicare. The purpose of our study was to determine how MA plans responded to this policy change. We conducted 48 interviews with representatives from MA plans, dialysis provider organizations, and chronic kidney disease (CKD) care management companies. One major theme that emerged from our interviews was MA plans partnered with CKD care management companies to manage the care of ESRD patients. Plans partnered because they had little experience with and were wary of the costs of this population, and sought to improve the value and quality of services. MA plans varied in how they contracted with these organizations, and the CKD care management companies employed several methods for managing patients. Participants reported both benefits and challenges related to these partnerships.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"413-425"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review. 农村医院关闭和合并对卫生系统生态的影响：范围审查。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-07-24 DOI: 10.1177/10775587251355671
Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz
{"title":"The Impact of Rural Hospital Closures and Mergers on Health System Ecologies: A Scoping Review.","authors":"Alison Coates, Janice Probst, Kanika Sarwal, Suhaib Riaz, Agnes Grudniewicz","doi":"10.1177/10775587251355671","DOIUrl":"10.1177/10775587251355671","url":null,"abstract":"<p><p>Despite playing a pivotal role in rural community health services delivery and in local economies, rural hospitals in the United States have closed or merged with larger health networks at alarming rates. This scoping review examines what is known about the impacts of rural hospital closures and mergers since 2010. Using the literature, we inductively derived a new Health System Ecologies Impact Matrix research tool to assess knowledge related to health system changes. Most of the included studies examined closures, primarily reporting on community impacts. Knowledge gaps remain related to financial-, workforce-, and utilization-related outcomes, and little is known about impacts on neighboring hospitals and communities. Few studies report effects of rural hospital mergers, primarily focusing on financial and utilization outcomes for the merged hospital. No studies examined the impacts of rural hospital mergers on patients or individuals and their social environments.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"359-375"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12414111/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144700311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016-2019. 2016-2019年急性腰痛医疗保险受益人中阿片类药物、加巴喷丁类药物和非药物性疼痛治疗的趋势和差异
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-05-29 DOI: 10.1177/10775587251339917
Jane Vaillant, Richa Gairola, Jessica S Merlin, Amal N Trivedi, Theresa I Shireman, Patience M Dow
{"title":"Trends and Disparities in the Use of Opioid, Gabapentinoid, and Nonpharmacologic Pain Therapies Among Medicare Beneficiaries With Acute Low Back Pain, 2016-2019.","authors":"Jane Vaillant, Richa Gairola, Jessica S Merlin, Amal N Trivedi, Theresa I Shireman, Patience M Dow","doi":"10.1177/10775587251339917","DOIUrl":"10.1177/10775587251339917","url":null,"abstract":"<p><p>Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.5%-6.7%), chiropractic care (11.0%-11.7%), and gabapentinoid (9.6%-8.9%) receipt were limited, whereas prescription opioid use substantially decreased (26.2%-17.8%). Prescription opioid receipt was higher among individuals under age 65, American Indian/Alaskan Native, non-Hispanic Black/African American, and Hispanic individuals, individuals with opioid use disorder, and in Southern states, while the use of nonpharmacologic pain therapies remained low among these subgroups. It is essential to promote equitable access to multimodal and guideline-recommended approaches for aLBP management including nonpharmacologic therapies.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"426-434"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12288438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Whose Role Is It Anyway? Beneficiary Engagement During the Transition to Medicaid Managed Care in North Carolina. 到底是谁的角色？北卡罗莱纳州向医疗补助管理式医疗过渡期间的受益人参与。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-03-18 DOI: 10.1177/10775587251324974
Monisa Aijaz, Paula H Song, Valerie A Lewis, Christopher M Shea
{"title":"Whose Role Is It Anyway? Beneficiary Engagement During the Transition to Medicaid Managed Care in North Carolina.","authors":"Monisa Aijaz, Paula H Song, Valerie A Lewis, Christopher M Shea","doi":"10.1177/10775587251324974","DOIUrl":"10.1177/10775587251324974","url":null,"abstract":"<p><p>Empowering beneficiaries to choose a health plan that meets their health needs during the transition to Medicaid managed care is critical to promote informed decision-making. This study uses North Carolina's transition under the 1115 waiver to examine the role of the state, health plans, and providers in informing beneficiaries about the transition. We reviewed policy documents and interviewed 43 individuals representing provider practices and 10 representing the State Department of Health and Human Services and health plans between December 2020 and September 2021. Interviewees from the state described strategies to encourage beneficiaries to select a health plan. Participating practices shared that their patients were unaware or confused about the transition. These concerns led practices to engage beneficiaries and contract with all health plans to ensure continuity of care, contributing to administrative burdens. While the state made significant efforts to engage beneficiaries, the interaction between beneficiaries and providers was still critical.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"387-398"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Medicaid Telehealth Policy in Marginalized Communities: Perspectives From Virginia Patients and Providers. 边缘化社区的医疗补助远程医疗政策：来自弗吉尼亚州患者和提供者的观点。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-10-01 Epub Date: 2025-05-28 DOI: 10.1177/10775587251331756
Kezia S Edmonson, Constance Elaine Owens-Jasey, Leah M Adams, Alison E Cuellar
{"title":"Medicaid Telehealth Policy in Marginalized Communities: Perspectives From Virginia Patients and Providers.","authors":"Kezia S Edmonson, Constance Elaine Owens-Jasey, Leah M Adams, Alison E Cuellar","doi":"10.1177/10775587251331756","DOIUrl":"10.1177/10775587251331756","url":null,"abstract":"<p><p>We sought to understand stakeholder experience with telehealth services, through interviews with patients, providers, and health plans, to inform Medicaid policy after the COVID-19 public health emergency. Our primary aim was to examine whether and how such telehealth policies affect equitable care delivery and to uncover any remaining policy gaps. Applying the Framework for Digital Health Equity our study identified digital determinants that operate at the individual, interpersonal, community and societal levels. Across respondents, telehealth expansion was viewed as overwhelmingly positive and noted as a significant contributor to increased access among marginalized, minoritized, and rural Medicaid participants in this study. Despite these strengths, patients and health care providers identified several challenges and recommendations.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"399-412"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144162964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Defining and Measuring Organizational Transformation in Health Care: A Systematic Literature Review. 卫生保健组织转型的定义与测量：系统文献综述。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-08-13 DOI: 10.1177/10775587251356130
Lauren Clack, Jason Smith, Martin Charns
{"title":"Defining and Measuring Organizational Transformation in Health Care: A Systematic Literature Review.","authors":"Lauren Clack, Jason Smith, Martin Charns","doi":"10.1177/10775587251356130","DOIUrl":"https://doi.org/10.1177/10775587251356130","url":null,"abstract":"<p><p>Organizational transformation in health care is critical to achieving systemic improvements, yet it lacks a cohesive body of empirical literature. Thirty-six articles met inclusion criteria in this systematic literature review of empirical studies of whole-organization transformation describing the transformation process and measures of transformation. Studies had diverse analytic (<i>n</i> = 14) and descriptive (<i>n</i> = 22) aims and were published in many different journals. Few articles provided definitions of transformation. Most employed weak research designs, about half used models for evaluation, and no common measures of transformation were used across articles. Combinations of distributed leadership, staff engagement, and culture change were recurring themes contributing to successful transformation. Two-thirds of articles used models to guide the transformation process. There was no consistency across articles in which models were used for evaluating or guiding change. Most articles reported successful transformation. The literature is methodologically weak, highlighting the need for more rigorous, theory-driven research on health care transformation.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251356130"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Direct-Entry Midwife Education, Practice, and Patients in California. 加州直接入职助产士教育、实践和患者。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-08-13 DOI: 10.1177/10775587251355573
Joanne Spetz, Kim Q Dau, Amy Quan, Timothy Bates, Rosalind DeLisser, Ulrike Muench
{"title":"Direct-Entry Midwife Education, Practice, and Patients in California.","authors":"Joanne Spetz, Kim Q Dau, Amy Quan, Timothy Bates, Rosalind DeLisser, Ulrike Muench","doi":"10.1177/10775587251355573","DOIUrl":"https://doi.org/10.1177/10775587251355573","url":null,"abstract":"<p><p>Improving access to midwifery care has been identified as a strategy to address shortages of reproductive health clinicians and ensure person-centered, equitable care. This article describes findings from a new survey of licensed midwives (LMs) in California, who enter the profession without a nursing background. The data offer new insights into LMs' demographics, training, client population, and practice experiences. LMs predominantly have their own practices, typically working with another midwife and/or an assistant or student, and have relatively small numbers of clients each year. Most of the births they attend occur in homes and birth centers. Many LMs report a lack of understanding of and support for their expertise by physicians and hospitals. Despite these challenges, most LMs are satisfied with their careers. LMs contribute to person-centered care, offering alternatives to hospital birth and expanding access to the midwifery model of care.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251355573"},"PeriodicalIF":2.2,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association of VA Medication Copayment Restructuring With Pharmacy Use, Medication Costs, and Financial Burden of Medications. 退伍军人事务部药物共同支付重组与药房使用，药物费用和药物财务负担的协会。
IF 2.2 3区 医学
Medical Care Research and Review Pub Date : 2025-08-04 DOI: 10.1177/10775587251356369
Kevin T Stroupe, Talar Markossian, Bella Etingen, Timothy P Hogan, Beverly Gonzalez, Charlesnika T Evans, Katie J Suda, Chad Osteen, Ibuola Kale, Zhiping Huo, Dolores Ippolito, Muriel Burk, Francesca Cunningham, Bridget M Smith
{"title":"Association of VA Medication Copayment Restructuring With Pharmacy Use, Medication Costs, and Financial Burden of Medications.","authors":"Kevin T Stroupe, Talar Markossian, Bella Etingen, Timothy P Hogan, Beverly Gonzalez, Charlesnika T Evans, Katie J Suda, Chad Osteen, Ibuola Kale, Zhiping Huo, Dolores Ippolito, Muriel Burk, Francesca Cunningham, Bridget M Smith","doi":"10.1177/10775587251356369","DOIUrl":"https://doi.org/10.1177/10775587251356369","url":null,"abstract":"<p><p>In February 2017, the Department of Veterans Affairs (VA) restructured outpatient medication copayments, creating three medication tiers comparable with private-sector value-based insurance designs (with copayments: US$5, US$8, US$11 per 30-day supply for Tiers 1-3, respectively); however, Veteran medication management experiences have not been assessed following this change. We invited a random sample of Veterans with chronic conditions (e.g., diabetes, hypertension) who utilized VA services to complete a mailed survey about VA and non-VA pharmacy use and medication management experiences following this restructuring. There were 2,884 respondents (29% response rate). Veterans with the lowest proportion of medications from Tier 1 after the restructuring had the highest predicted probability of non-VA pharmacy use from regression analyses. Among respondents subject to VA copayments, 27% reported being better able to afford medications after the restructuring. However, 29% reported worrying about paying for medications, and 18% reported making tradeoffs (e.g., spending less on utilities, food) to pay for prescriptions.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"10775587251356369"},"PeriodicalIF":2.2,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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