Health affairs (Project Hope)最新文献

Opening The Black Box Of Medicaid Physician Payment: Medicaid Managed Care And State-Directed Payments. 打开医疗补助医生支付的黑盒子：医疗补助管理和国家指导支付。

Health affairs (Project Hope) Pub Date : 2026-10-21 DOI: 10.1377/hlthaff.2026.00382

Diane Alexander, Molly Frommer, Eric T Roberts

{"title":"Opening The Black Box Of Medicaid Physician Payment: Medicaid Managed Care And State-Directed Payments.","authors":"Diane Alexander, Molly Frommer, Eric T Roberts","doi":"10.1377/hlthaff.2026.00382","DOIUrl":"https://doi.org/10.1377/hlthaff.2026.00382","url":null,"abstract":"Provider payment rates in Medicaid are often assessed by comparing Medicaid fee-for-service rates with Medicare rates. However, this approach may poorly approximate payments in Medicaid managed care, where most enrollees receive coverage. State-directed payments (SDPs)-requirements that managed care plans increase Medicaid payments-have become a major means of increasing provider payment in Medicaid managed care. We used Centers for Medicare and Medicaid Services preprints from the period 2023-25 to estimate Medicaid managed care payments for primary care services and professional services at academic medical centers. For primary care services not performed in academic medical centers, most SDPs raised Medicaid managed care payment levels toward Medicare rates. In contrast, SDPs for services performed at academic medical centers varied widely across states and often raised payments well above Medicare rates, placing them above the caps established by the One Big Beautiful Bill Act. These patterns suggest that SDPs are being used both to bolster primary care payment and to deliver large supplemental payments to academic medical centers, underscoring a need for monitoring and policy guardrails to align SDPs with access and value in Medicaid.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"101377hlthaff202600382"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Price Negotiations, Health Care Spending, And More. 价格谈判、医疗保健支出等等。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2026.01506

Donald E Metz, The Editorial Staff

引用次数: 0

Criminal Legal Referrals Were Associated With Delayed Substance Use Treatment, Disparity By Housing Status. 刑事法律转介与延迟药物使用治疗，住房状况差异有关。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2025.01733

Anna C Holdiman, Dale S Mantey, Tim Mercer, Alexander Testa, Shreya Jain, John Embers-Weems, Kasey Claborn, Justin Benzer

{"title":"Criminal Legal Referrals Were Associated With Delayed Substance Use Treatment, Disparity By Housing Status.","authors":"Anna C Holdiman, Dale S Mantey, Tim Mercer, Alexander Testa, Shreya Jain, John Embers-Weems, Kasey Claborn, Justin Benzer","doi":"10.1377/hlthaff.2025.01733","DOIUrl":"https://doi.org/10.1377/hlthaff.2025.01733","url":null,"abstract":"Timely access to substance use disorder (SUD) treatment is critical to improving health outcomes, yet treatment delays remain a barrier. Using national Treatment Episode Data Set-Admissions data from the period 2017-22, we conducted the first national study to examine the association of referral pathways and housing status with treatment delays among 962,702 first-time SUD admissions. Compared with individual referrals, criminal legal referrals were associated with more than twice the odds of delayed admission. This association differed by housing status and was strongest among people experiencing homelessness. These findings suggest that homelessness may intensify barriers to timely SUD treatment for people referred via criminal legal referral pathways. Our results are concerning in light of the 2025 executive order, \"Ending Crime and Disorder on America's Streets,\" which emphasizes the use of civil commitment and institutionalization for people experiencing homelessness and people with SUD. To improve treatment retention and reduce substance use, policy efforts should prioritize removing administrative and legal barriers to SUD treatment. Low-threshold treatment models and treatment with low barriers to participation should be expanded.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"45 10","pages":"1155-1164"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Dementia Care Patterns In The US Vary By Clinician Type: Evidence From A National Workforce Study, 2024-25. 美国痴呆症护理模式因临床医生类型而异：来自国家劳动力研究的证据，2024-25。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2025.01424

Sumedha Gupta, Rushil Zutshi, Kosali Simon, John R Bowblis

{"title":"Dementia Care Patterns In The US Vary By Clinician Type: Evidence From A National Workforce Study, 2024-25.","authors":"Sumedha Gupta, Rushil Zutshi, Kosali Simon, John R Bowblis","doi":"10.1377/hlthaff.2025.01424","DOIUrl":"https://doi.org/10.1377/hlthaff.2025.01424","url":null,"abstract":"The prevalence of Alzheimer's disease and related dementias (ADRD) is increasing. Amid specialist shortages and growing reliance on advanced practice providers, high-quality dementia care across clinician types is a public health priority in the US, with important implications for workforce and care delivery policy. However, little is known about how dementia care varies by clinician type. Using novel, nationally representative data from 4,699 clinicians in the 2024-25 Community Clinician survey of the National Dementia Workforce Study, we conducted multivariable analyses to compare diagnostic confidence, assessment practices, and care delivery among advanced practice providers, primary care physicians, and specialists. Compared with primary care physicians, specialists reported greater confidence in diagnosing dementia and mild cognitive impairment among patients younger than age sixty-five and among those with Alzheimer's dementia, whereas advanced practice providers reported lower diagnostic confidence and were less likely to order or perform most advanced diagnostic testing and cognitive assessments. Specialists were more likely to focus on screening and managing behavioral symptoms, whereas advanced practice providers were more likely to prescribe anti-amyloid therapy. These findings highlight the importance of payment and workforce policies that support team-based dementia care and effectively integrate clinicians with different roles and training.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"45 10","pages":"1174-1183"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Childhood Housing Assistance Associated With Lower Rates Of Adult Diabetes And Hypertension, 1970-2021. 1970-2021年儿童住房援助与成人糖尿病和高血压发病率降低相关

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2025.01697

Jeffrey D Colvin, Isabella Zaniletti, Kirk McClure, Matt Hall, Donna Ginther, Jordan A Carlson, Narayan Sastry, Paul J Chung

{"title":"Childhood Housing Assistance Associated With Lower Rates Of Adult Diabetes And Hypertension, 1970-2021.","authors":"Jeffrey D Colvin, Isabella Zaniletti, Kirk McClure, Matt Hall, Donna Ginther, Jordan A Carlson, Narayan Sastry, Paul J Chung","doi":"10.1377/hlthaff.2025.01697","DOIUrl":"https://doi.org/10.1377/hlthaff.2025.01697","url":null,"abstract":"Prior research has demonstrated potential health and social benefits associated with receipt of housing assistance during childhood. However, those findings have been primarily limited to health benefits experienced during childhood, rather than potential latent effects experienced as adults. Building on this work, we assessed whether there was an association between receipt of housing assistance during childhood and rates of adult obesity, diabetes, and hypertension. Using data from the Panel Study of Income Dynamics over the course of a fifty-two-year period (1970-2021), we matched children whose families received housing assistance with similar children whose families did not, and we tracked them from preconception to middle adulthood. Compared with not receiving childhood housing assistance, receiving five years or more of childhood housing assistance was associated with a 69 percent lower risk for diabetes and a 39 percent lower risk for hypertension in adulthood. First receiving housing assistance in the period from preconception through infancy was associated with a 67 percent lower risk for diabetes and a 41 percent lower risk for hypertension in adulthood. Results suggest that housing assistance deserves further consideration as a possible policy approach to address the rise of diabetes and hypertension in the US.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"45 10","pages":"1146-1154"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Supplemental Rebates From Drug Makers To State Medicaid Programs Grew Fivefold From 2017 To 2024. 从2017年到2024年，制药商给州医疗补助计划的补充回扣增长了五倍。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2026.00122

Max C Yates, Jason B Gibbons, Aaron S Kesselheim, Benjamin N Rome

{"title":"Supplemental Rebates From Drug Makers To State Medicaid Programs Grew Fivefold From 2017 To 2024.","authors":"Max C Yates, Jason B Gibbons, Aaron S Kesselheim, Benjamin N Rome","doi":"10.1377/hlthaff.2026.00122","DOIUrl":"https://doi.org/10.1377/hlthaff.2026.00122","url":null,"abstract":"State Medicaid agencies receive discounted prescription drugs through the Medicaid Drug Rebate Program. States also can negotiate supplemental manufacturer rebates, but evidence on the variation and size of these rebates is limited. Using Centers for Medicare and Medicaid Services data, we found that mean supplemental rebates per beneficiary grew from $19 (2 percent of gross Medicaid drug spending) in fiscal year 2017 to $93 (7 percent) in FY 2024. Rebates varied between states (range: $2-$183 per beneficiary in FY 2024). Mean rebates per beneficiary were $20 higher in thirty-five states that participated in multistate purchasing groups compared with rebates in states negotiating independently, adjusting for number of beneficiaries, fiscal year, and managed care use. Using a difference-in-differences approach, we found that rebates per beneficiary increased by $21 after four states joined purchasing groups compared with rebates in states that had not joined, but these results were not significant. Supplemental rebates may represent a meaningful tool for states to offset growing prescription drug spending.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"45 10","pages":"1117-1124"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Accessing Cancer Screening As A Person With Quadriplegia. 作为一个四肢瘫痪的人进行癌症筛查。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2025.01749

Sharifa Abu-Hamda

引用次数: 0

Spending Growth In A Large Massachusetts Insurer Driven By Volume And Intensity. 马萨诸塞州一家大型保险公司的支出增长受到数量和强度的推动。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2026.00282

Michael E Chernew, Matthew P Day, David M Cutler, Michael Guerriere

引用次数: 0

Real-World Brinkmanship In Hospital-Insurer Negotiations. 医院与保险公司谈判中的现实边缘政策。

Health affairs (Project Hope) Pub Date : 2026-10-01 Epub Date: 2026-09-23 DOI: 10.1377/hlthaff.2025.01663

Jason D Buxbaum, Neil Mehta, Andrew M Ryan

{"title":"Real-World Brinkmanship In Hospital-Insurer Negotiations.","authors":"Jason D Buxbaum, Neil Mehta, Andrew M Ryan","doi":"10.1377/hlthaff.2025.01663","DOIUrl":"10.1377/hlthaff.2025.01663","url":null,"abstract":"Hospital prices for Americans with commercial health insurance are determined through thousands of negotiations between hospitals and insurers. Threats of network departicipation (brinkmanship) in these negotiations may help parties secure more favorable terms. We studied 14,918 relationships between 3,772 unique hospitals and 92 unique in-market insurers to better understand the relationships among organizational characteristics (including market conditions), public brinkmanship, and departicipation. We documented 1,249 episodes of public brinkmanship, corresponding to about 8 percent of hospital-insurer relationships, for contracts ending between August 2021 and July 2025. About 28 percent of these public threats culminated in withdrawal. Profitable hospitals, for-profit hospitals, and hospitals commanding relatively high prices were most likely to engage in public brinkmanship; national insurers were more likely to engage in brinkmanship than single-state or regional insurers. We observed brinkmanship in about 16 percent of relationships where the hospital system and insurer each controlled roughly 25-45 percent and 30-45 percent of local beds and commercial lives, respectively. Our findings emphasize the importance of local contexts in shaping hospital-insurer relationships. Policy makers should assess the effectiveness of aggressive negotiations as a means to control costs and the impact of brinkmanship and departicipation on consumers' access and experiences.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":" ","pages":"1078-1087"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149032588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Charting A Path Forward For Medicare Advantage: Expert Consensus On Policy Priorities And Trade-Offs. 绘制医疗保险优势的前进道路：专家对政策优先事项和权衡的共识。

Health affairs (Project Hope) Pub Date : 2026-10-01 DOI: 10.1377/hlthaff.2025.01724

Dmitry Khodyakov, Erin A Taylor, Christine Buttorff, Hannah James, Melony E Sorbero, Rachel O Reid, Michael Dworsky

{"title":"Charting A Path Forward For Medicare Advantage: Expert Consensus On Policy Priorities And Trade-Offs.","authors":"Dmitry Khodyakov, Erin A Taylor, Christine Buttorff, Hannah James, Melony E Sorbero, Rachel O Reid, Michael Dworsky","doi":"10.1377/hlthaff.2025.01724","DOIUrl":"10.1377/hlthaff.2025.01724","url":null,"abstract":"More than half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), yet concerns persist about overpayments to MA plans, inadequate plan oversight, and limits on beneficiaries' access to care. To identify MA reform options, we conducted a two-round e-Delphi panel with thirty-nine experts, including researchers, industry representatives, patient advocates, and former policy makers. Panelists rated fifteen policy reform ideas on their impact on beneficiaries, the federal government, and MA plans. Experts agreed that six policy ideas would benefit beneficiaries, three would benefit the government, and one would benefit plans. The most feasible near-term options are standardizing supplemental benefits, limiting the number of MA plans that insurers can offer, and reforming agent commissions. These incremental reforms could improve beneficiaries' decision making and financial protections without harming the government or plans and could be implemented through Centers for Medicare and Medicaid Services administrative action. Nonetheless, achieving the cost savings critical for Medicare's long-term financial sustainability will require policies that may cause market disruption and negatively impact MA plans.","PeriodicalId":519943,"journal":{"name":"Health affairs (Project Hope)","volume":"45 10","pages":"1125-1132"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0