JAMA Health Forum最新文献

{"title":"Service-Level Utilization in Risk-Based Contracts and a Benchmarking Approach for Fee-Schedule Reforms.","authors":"Aaron L Schwartz, Timothy Bulat, Eli Ben-Michael, Erkuan Wang, Jingsan Zhu, Emily Boudreau, Sumedha Chhatre, Soohyun Kim, David Pagnotti, Sara Riaz, Amanda Sutherland, Amol Navathe","doi":"10.1001/jamahealthforum.2026.3533","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3533","url":null,"abstract":"<p><strong>Importance: </strong>Despite revived interest in reforming the physician fee schedule, it is unclear how policymakers should modify more than 1000 different physician service prices to promote high-value care. One systematic approach could leverage service-level utilization patterns in full-risk contracts, which have not been previously characterized.</p><p><strong>Objective: </strong>To compare service-level utilization patterns between health care professional organizations in full-risk contracts and those in a traditional fee-for-service (FFS) payment structure, adjusted for detailed patient-level differences, and to simulate an FFS fee schedule reform that would encourage the service patterns observed in risk-based contracts.</p><p><strong>Design, setting, and participants: </strong>This retrospective cross-sectional study used Humana Medicare Advantage claims, encounter, and administrative data from 2015 to 2019 for 585 487 beneficiaries attributed to full-risk contract, with 100% downside risk for total medical spending, and 1 153 455 beneficiaries in fee-for-service contract arrangements. Data were analyzed from September 2025 to June 2026.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was service-specific utilization (count per beneficiary-year), adjusted for beneficiary characteristics. A secondary analysis simulated a modified Medicare FFS schedule based on estimated service-level utilization differences and a supply elasticity drawn from prior literature.</p><p><strong>Results: </strong>Among 1271 services examined, 940 (74%) had lower adjusted utilization in the risk cohort, and 331 (26%) had higher adjusted utilization. For 700 services (55%), adjusted utilization was at least 10% less in the full-risk cohort. For 199 services (16%), adjusted utilization was at least 10% greater. Low-level office visits and laboratory services were more common in risk-based settings, whereas higher-level office visits, hospital and emergency services, and rehabilitative therapies were less common. A simulated budget-neutral reform to the Medicare fee schedule, calibrated to shift utilization levels toward risk-based benchmarks, yielded a possible 6% increase in reimbursement to general practice physicians.</p><p><strong>Conclusion and relevance: </strong>In this cross-sectional study, the association between risk-based contracts and service utilization varied substantially across 1271 individual services. Service-specific utilization levels in risk-based contracts may serve as a benchmark to guide reforms to fee-for-service prices.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263533"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug Spending on Accelerated Approval Indications Subsequently Withdrawn From the Market.","authors":"Shelley A Jazowski, Stacie B Dusetzina","doi":"10.1001/jamahealthforum.2026.3741","DOIUrl":"10.1001/jamahealthforum.2026.3741","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263741"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Navigation and Postpartum Health Care Outcomes: A Randomized Clinical Trial.","authors":"Lynn M Yee, Joe Feinglass, Brittney R Williams, Laura Diaz, Viridiana Carmona-Barrera, Ying Cheung, Ka'Derricka Davis, Chen Yeh, Charlotte M Niznik, Michelle A Kominiarek, William A Grobman","doi":"10.1001/jamahealthforum.2026.3338","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3338","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Postpartum care in the US is fragmented and inadequate, with major disparities in quality. Patient navigation is a promising health services intervention to improve health care provision and reduce disparities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate whether postpartum patient navigation improved postpartum health care quality among people with low incomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This randomized clinical trial was conducted at a single urban academic medical center from January 2020 to July 2024 and included English- or Spanish-speaking pregnant people 16 years or older with Medicaid insurance. Data analysis started in October 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Participants were randomly assigned to 1 year of patient navigation vs usual care. Those randomized to navigation received individualized services that were designed to overcome postpartum-specific barriers to care from a trained lay navigator.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome, as ascertained from medical records, was receipt of 6 care elements considered to be essential to optimal postpartum care by 12 weeks postpartum. Secondary outcomes included the proportion of components received by 12 weeks and receipt of health services at 11 to 13 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 405 people (mean [SD] age, 28.2 [5.7] years; 10 [2%] were Asian, multiracial, or another race; 166 [41%] were Hispanic; 202 [50%] were non-Hispanic Black; and 27 [7%] were non-Hispanic White) were randomized (203 [50%] in patient navigation; 202 [50%] received usual care). The frequency of the primary outcome (ie, receipt of all 6 essential components of postpartum care) was similar between the groups (19 [9.4%] in patient navigation vs 16 [7.9%] in usual care; P = .60). However, the mean (SD) proportion of components received was significantly higher among navigation recipients (71% [17%] vs 64% [23%]; P = .002). Three components drove this difference: postpartum visit completion (195 [96%] vs 161 [80%]; P &lt; .001), receipt of all indicated anticipatory guidance (131 [65%] vs 104 [51%]; P = .01), and postpartum depression screening and care (174 [86%] vs 145 [72%]; P &lt; .001). At 11 to 13 months, participants randomized to navigation were more likely to have attended a primary care visit, be using their desired family planning method, and have received depression screening and linkage, cardiometabolic screening, and recommended vaccines.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The results of this randomized clinical trial suggest that although patient navigation did not result in a higher frequency of achieving all 6 components of postpartum care, the proportion of care components received was significantly higher. At 1 year postpartum, those randomized to patient navigation demonstrated multiple improved health services outcomes, including more frequent transition to primary care.&lt;/p&gt;&lt;p&gt;&lt;str","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263338"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implications of Site-Neutral Rate-Setting Methods for Medicare Spending.","authors":"Kathryn E Linehan, Bijan A Niknam, Melinda B Buntin","doi":"10.1001/jamahealthforum.2026.3768","DOIUrl":"10.1001/jamahealthforum.2026.3768","url":null,"abstract":"<p><strong>Importance: </strong>Medicare pays more for some procedures in the hospital outpatient department (HOPD) setting than it does for the same procedures in physician offices because of the facility fees paid to HOPDs under Medicare's Outpatient Prospective Payment System (OPPS). In recent years, Medicare has reduced facility fees for some services and certain types of HOPDs to make reimbursement site neutral, both to rein in Medicare spending and to avoid incentivizing the migration of services from physician offices to HOPDs.</p><p><strong>Objective: </strong>To quantify Medicare payments and savings under 2 approaches of setting site-neutral payment rates for HOPDs.</p><p><strong>Design and setting: </strong>In this cross-sectional study, outpatient claims from 2024 and payment rates for 2026 were used to model Medicare payments using 2 rate-setting approaches. Overall payments and payments by service type were then assessed to investigate whether the payments were similar between the 2 approaches, and the savings generated by each approach were compared with payments made under current OPPS rules. The study used HOPDs paid under Medicare's OPPS and included Medicare beneficiaries in the 20% sample of 2024 HOPD claims paid under Original Medicare's OPPS.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was Medicare payment amounts for select Ambulatory Payment Classification (APC) groups under 2 alternative approaches of determining site-neutral payment amounts and the savings that were associated with each payment approach, calculated as follows: (1) a fixed discount that pays 40% of the OPPS rate, and (2) applicable Physician Fee Schedule (PFS) rates for practice expenses inclusive of packaged services.</p><p><strong>Results: </strong>Savings were calculated for 57 APC groups in 23 categories. Across all 57 APCs, combined savings relative to current Medicare OPPS rates would total 58.7% at PFS rates vs 60.0% at the discounted OPPS rate. Across the 23 APC categories examined, 13 had PFS-equivalent payments below the discounted OPPS payments, whereas 10 categories had PFS payments above the discounted OPPS payments.</p><p><strong>Conclusions and relevance: </strong>Results of this cross-sectional study suggest that as policymakers consider expanding Medicare site-neutral policy to additional services provided in HOPDs, payment rates deserve more attention. An approach that considers service-specific PFS-equivalent rates inclusive of packaged services may better serve the policy goal of equalizing payments for the same services across settings.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263768"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Precedent for Regulating Clinical AI Models.","authors":"Scott Gottlieb","doi":"10.1001/jamahealthforum.2026.4704","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.4704","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e264704"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139245","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}

{"title":"Avoiding a 2-Tier AI Ecosystem in Health Care.","authors":"Brett Moran, Kedar S Mate","doi":"10.1001/jamahealthforum.2026.3241","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3241","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263241"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207931","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}

{"title":"Psychotherapy and Antidepressant Use After the US Preventive Services Task Force-Recommended Depression Screening.","authors":"Sonia M Tetlow, Benjamin G Druss","doi":"10.1001/jamahealthforum.2026.3759","DOIUrl":"10.1001/jamahealthforum.2026.3759","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Fewer than one-third of adults with depression receive any treatment for depression. It is important to evaluate the association between the 2016 US Preventive Services Task Force (USPSTF) recommendation and depression treatment nationally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To examine changes in the likelihood of psychotherapy and antidepressant use after the USPSTF-recommended routine adult depression screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This policy evaluation used a single-group, interrupted time series design with logistic regression. Medical Expenditure Panel Survey Household Component data from 2008 to 2023 were analyzed from November 3, 2025, to March 31, 2026. The sample included adults aged 18 years and older.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;2016 USPSTF grade B recommendation for routine adult depression screening.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Likelihood of psychotherapy or antidepressant use immediately (level change) and over time (post-USPSTF slope change [trend]) using an interrupted time series design and logistic regression models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis included 372 962 adults. Using the Medical Expenditure Panel Survey person-level survey weights, this corresponded to a nationally representative sample of 244 316 623 adults (median age, 47 years; IQR, 32-61 years; 51.6% female). The recommendation was associated with a significant level increase (odds ratio [OR], 1.18; 95% CI, 1.02-1.37) and post-USPSTF trend (OR, 1.08; 95% CI, 1.04-1.11) increase in the likelihood of psychotherapy only, level (OR, 0.88; 95% CI, 0.82-0.94) and post-USPSTF trend (OR, 0.98; 95% CI, 0.96-0.99) decreases in the likelihood of antidepressants only, and no significant changes in combined treatment among adults overall. By psychological distress level, it was associated with a significant level increase in the likelihood of psychotherapy only (OR, 1.63; 95% CI, 1.10-2.41) and post-USPSTF trend decrease in the likelihood of antidepressants only (OR, 0.94; 95% CI, 0.89-0.98) among adults reporting serious distress, significant level (OR, 1.38; 95% CI, 1.15-1.66) and post-USPSTF trend (OR, 1.05; 95% CI, 1.01-1.10) increases in the probability of psychotherapy only, and level (OR, 0.88; 95% CI, 0.81-0.96) and post-USPTF trend (OR, 0.96; 95% CI, 0.94-0.98) decreases in the likelihood of antidepressants only among adults reporting mild or moderate distress, and no significant changes among adults reporting no distress. There was a significant level decrease (OR, 0.79; 95% CI, 0.70-0.89) in the probability of seeing a prescriber for psychotherapy after the recommendation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that the USPSTF recommendation for routine adult depression screening was associated with increased likelihood of psychotherapy and decreased likelihood of antidepressant use among adults reporting some level of psycholog","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263759"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recalibrating the Medicare Fee Schedule Using Capitated Care.","authors":"Meredith B Rosenthal","doi":"10.1001/jamahealthforum.2026.3542","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3542","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263542"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118343","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}

{"title":"Inviting Viewpoints on Strategies to Address Health Care Costs.","authors":"Melinda Buntin, Pragya Kakani, Sandro Galea","doi":"10.1001/jamahealthforum.2026.3775","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3775","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263775"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118333","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}

{"title":"Financial Effects of an Out-of-Pocket Cap in Traditional Medicare.","authors":"Andrew M Ryan, Meehir N Dixit, Mathew M Maughan, David J Meyers, Fangli Geng","doi":"10.1001/jamahealthforum.2026.3386","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3386","url":null,"abstract":"<p><strong>Importance: </strong>Traditional Medicare (TM) exposes beneficiaries to substantial financial risk because, unlike Medicare Advantage (MA), there is no out-of-pocket (OOP) maximum for medical spending. Policymakers have proposed introducing an OOP cap, but its fiscal and behavioral effects are uncertain.</p><p><strong>Objective: </strong>To estimate the financial impacts of introducing OOP spending caps of $3000, $5000, or $10 000 annually in TM on beneficiary costs, enrollment patterns, and Centers for Medicare & Medicaid Services expenditures between 2026 and 2034.</p><p><strong>Design, setting, and participants: </strong>This economic evaluation using principles of microsimulation analysis projected enrollment, spending, and health care use outcomes under baseline (no OOP cap) and 3 alternative cap scenarios using publicly available national Medicare and insurance data from 2020 to 2024 with projections through 2034. The model incorporated elasticity-based behavioral responses, including beneficiary switching between TM and MA, changes in service use, and increases to MA benchmarks and spending. Sensitivity analyses varied model assumptions probabilistically.</p><p><strong>Exposure: </strong>Introduction of annual OOP caps for Parts A and B in TM at $3000, $5000, or $10 000.</p><p><strong>Main outcomes and measures: </strong>Projected changes in beneficiary enrollment by coverage type, mean annual beneficiary OOP and premium spending, and annual Medicare expenditures.</p><p><strong>Results: </strong>Between 2026 and 2034, a $3000 OOP cap was projected to reduce mean annual beneficiary expenditures by $1568, compared with $1138 under a $5000 cap and $707 under a $10 000 cap. Corresponding increases in annual Medicare spending were estimated at $96 billion (90% simulation uncertainty interval [SUI], $80-$114 billion), $70 billion (90% SUI, $55-$85 billion), and $39 billion (90% SUI, $29-$50 billion), respectively. OOP caps, especially at lower thresholds, would substantially shift beneficiaries from MA to TM.</p><p><strong>Conclusions and relevance: </strong>Results of this study suggest that implementing an OOP spending cap in TM would provide meaningful financial protection for beneficiaries but impose substantial fiscal costs on Medicare.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263386"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}