JAMA Health Forum最新文献

{"title":"The Domestic Consequences of Defunding Global Health.","authors":"Joseph Amon, Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2025.2462","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.2462","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252462"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082048","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":"The Ongoing, and Heightened, Threat to Health Insurance Coverage in the US.","authors":"Sandro Galea","doi":"10.1001/jamahealthforum.2025.1155","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1155","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e251155"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082050","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":"Error in Discussion.","authors":"","doi":"10.1001/jamahealthforum.2025.2210","DOIUrl":"10.1001/jamahealthforum.2025.2210","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e252210"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188539","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":"Global Adoption of Value-Based Health Care Initiatives Within Health Systems: A Scoping Review.","authors":"Ayooluwa O Douglas, Senthujan Senkaiahliyan, Caroline A Bulstra, Carol Mita, Che L Reddy, Rifat Atun","doi":"10.1001/jamahealthforum.2025.0746","DOIUrl":"10.1001/jamahealthforum.2025.0746","url":null,"abstract":"<p><strong>Importance: </strong>Health systems worldwide are facing several contextual challenges threatening their sustainability, including aging populations with complex health care needs, workforce shortages, and persistent health disparities, which are driving health care costs. Optimizing health systems to respond to contextual challenges and offer quality care for all requires innovative frameworks like value-based health care (VBHC) and high-value health systems (HVHS) frameworks that focus on improving patient outcomes while minimizing costs.</p><p><strong>Objective: </strong>To examine how value-based initiatives have been introduced in health systems worldwide.</p><p><strong>Evidence review: </strong>A comprehensive literature search was conducted across MEDLINE/PubMed, Embase, Health Business Elite, and Web of Science Core Collection. The search included controlled vocabulary terms relevant to VBHC and covered publications between January 1, 2007, and July 7, 2023. After title and abstract screening, followed by full-text review, experimental, observational, and case studies that examined the implementation of the VBHC framework or its elements were included. Articles that focused solely on insurance, cost-effectiveness analysis, theoretical models without implementation, nonempirical studies (eg, reviews, commentaries), and gray literature (eg, news articles) were excluded.</p><p><strong>Findings: </strong>Of 11 948 articles initially identified for potential inclusion, the final sample included 50 initiatives, with 47 from high-income countries, 2 from upper-middle-income countries, and 1 from a lower-middle-income country. The review revealed that VBHC adoption remains confined to the departmental or institutional level, with few examples of systemwide or national implementation. Although many initiatives integrated various elements of the VBHC framework and components of the HVHS model, none achieved full implementation of all aspects.</p><p><strong>Conclusions and relevance: </strong>This scoping review showed that since its formal introduction in 2006, VBHC has been widely recognized as a strategy for improving health system performance, but large-scale adoption will require a strategic shift toward integrating value-based components at national and regional levels. These findings highlight the need for research on effective implementation models, particularly in lower-resource settings, to guide policymakers and health system leaders in scaling VBHC and transitioning toward HVHS.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 5","pages":"e250746"},"PeriodicalIF":9.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082041","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":"Buprenorphine Treatment in Pregnancy and Maternal-Infant Outcomes.","authors":"Sunaya R Krishnapura, Elizabeth McNeer, Sarah F Loch, Thomas Reese, Judith Dudley, Julia C Phillippi, Andrew D Wiese, William D Dupont, Ashley A Leech, Stephen W Patrick","doi":"10.1001/jamahealthforum.2025.1814","DOIUrl":"10.1001/jamahealthforum.2025.1814","url":null,"abstract":"<p><strong>Importance: </strong>Opioid use disorder (OUD) in pregnancy has grown in the US. Buprenorphine, a medication to treat OUD, may improve pregnancy outcomes; however, most pregnant individuals do not receive it. Research evaluating buprenorphine use in pregnancy, its effects on the maternal-infant dyad, and in comparison to no treatment is limited.</p><p><strong>Objective: </strong>To determine if treatment with buprenorphine for opioid use disorder in pregnancy is associated with improved maternal and infant outcomes compared to no treatment among mothers with OUD.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study included maternal-infant dyads continuously enrolled in the Tennessee Medicaid program from 20 weeks' estimated gestational age to 6 weeks post partum between 2010 and 2021. Medicaid administrative was linked to birth and death certificates. Data analysis was conducted from April to October 2024.</p><p><strong>Exposure: </strong>Buprenorphine use during pregnancy.</p><p><strong>Main outcomes and measures: </strong>Adverse pregnancy outcomes included preterm birth, neonatal intensive care unit (NICU) admission, infant death, severe maternal morbidity (SMM), intensive care unit admission, and maternal death. Logistic regression and propensity scores with overlap weighting were used to calculate adjusted predicted probabilities for adverse outcomes.</p><p><strong>Results: </strong>Among 14 463 maternal-infant dyads, 7469 (51.6%) received buprenorphine treatment (median [IQR] maternal age, 27 [24-31] years). There was a statistically significant lower rate of adverse pregnancy outcomes among dyads treated with buprenorphine compared to untreated dyads (25.4% vs 30.8%; P < .001); the treatment group also had a lower rate of SMM events (5.4% vs 6.9%; P < .001), preterm births (14.1% vs 20.0%; P < .001), and NICU admissions (15.2% vs 17.2%; P = .001). In adjusted analyses, those with buprenorphine treatment had a 5.1 percentage point (pp; 95% CI, 3.5-6.7 pp) lower probability of any adverse outcomes, including a 1.2 pp (95% CI, 0.4-2.1 pp) lower probability of SMM, 1.7 pp (95% CI, 0.4-2.9 pp) lower probability of NICU admission, and 5.3 pp (95% CI, 4.0-6.6 pp) lower probability of preterm birth. The number needed to treat to avoid an adverse pregnancy outcome was 20.</p><p><strong>Conclusions and relevance: </strong>In this cohort study of pregnant individuals with OUD, buprenorphine treatment was associated with improved outcomes for the mother and infant, underscoring the need to improve access to treatment nationwide.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4.11","pages":"e251814"},"PeriodicalIF":9.5,"publicationDate":"2025-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12035657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039331","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":"Year 1 of Medicare's Accountable Care Organization Realizing Equity, Access, and Community Health Model.","authors":"Gmerice Hammond, Sunny Lin, Sukruth A Shashikumar, R J Waken, Fengxian Wang, Khavya Avula, Vi-Anh Hoang, Kenton J Johnston, Karen Joynt Maddox","doi":"10.1001/jamahealthforum.2025.0724","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0724","url":null,"abstract":"<p><strong>Importance: </strong>The US Centers for Medicare & Medicaid Services launched the Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) payment model in January 2023. In contrast to prior ACO initiatives, such as the Medicare Shared Savings Program (MSSP), ACO REACH includes equity-focused measures and payment adjustments, including an equity plan and financial risk adjustment for ACOs with higher proportions of underserved beneficiaries. However, it is unknown whether these changes have incented participation from organizations that serve beneficiaries from marginalized communities.</p><p><strong>Objective: </strong>To compare characteristics between participants in ACO REACH with those in MSSP and the broader pool of Medicare beneficiaries, organizations, and clinicians.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included all Medicare beneficiaries clinicians, and ACOs enrolled in fee-for-service Medicare, MSSP, and ACO REACH from January 2022 to January 2023.</p><p><strong>Exposure: </strong>Enrollment in fee-for-service Medicare, MSSP, or ACO REACH.</p><p><strong>Main outcomes and measures: </strong>Beneficiary, clinician, and ACO characteristics.</p><p><strong>Results: </strong>In 2023, among 35 801 118 beneficiaries in the overall fee-for-service Medicare program, 18 911 213 (52.8%) were female, and 163 706 (0.5%) were American Indian or Alaska Native, 1 251 553 (3.5%) were Asian or Pacific Islander, 2 952 244 (8.2%) were Black, 2 396 771 (6.7%) were Hispanic, 27 642 765 (77.2%) were White, and 1 394 079 (3.9%) were another race (includes individuals who did not identify with a listed race, including those who self-identified as multiracial) or unknown race. A total of 1 958 881 beneficiaries were attributed to ACO REACH, and 11 340 987 were attributed to MSSP. A total of 132 ACOs participated in ACO REACH, while 456 ACOs participated in the MSSP. Compared with Medicare beneficiaries overall, REACH beneficiaries were older (85 years or older: 14.2% vs 10.3%; standardized mean difference [SMD], 0.44) and more often White (80.2% vs 77.2%) and less often Black (5.9% vs 8.2%) or Hispanic (5.8% vs 6.7%) (SMD, 0.24). REACH beneficiaries were slightly less likely to have Medicare entitlement due to disability (15.2% vs 17.6%) or be dually enrolled (15.1% vs 15.8%) (SMD, 0.07). REACH beneficiaries were less likely to be rural (3.9% vs 8.4%; SMD, 0.19) and less likely to reside in highly vulnerable geographic areas based on the Social Vulnerability Index (27.7% vs 29.4%; SMD, 0.08) compared with beneficiaries overall.</p><p><strong>Conclusions and relevance: </strong>These findings suggest that, in its first year, ACO REACH did not achieve its goal of enrolling organizations that serve beneficiaries with high levels of social risk. Without broader participation, ACO REACH is unlikely to achieve its goal of reducing health inequities.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250724"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032566/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065076","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":"Changes in Primary Care Practice Setting and Practice Type for Medicare Beneficiaries.","authors":"Amelia M Bond, William L Schpero, Yasin Civelek, Kayla N Tormohlen, Lawrence P Casalino, David J Jones, Manyao Zhang, Reekarl Pierre, Dhruv Khullar","doi":"10.1001/jamahealthforum.2025.0445","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.0445","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250445"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12032562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039328","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":"Can Prevention Save Money?","authors":"Katherine Baicker, Amitabh Chandra","doi":"10.1001/jamahealthforum.2025.1464","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.1464","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e251464"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774871","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":"Trends in Access to Medications for Opioid Use Disorder.","authors":"Sumedha Gupta, Aditya James, Jennifer Miles, Hillary Samples, Stephen Crystal, Kosali Simon","doi":"10.1001/jamahealthforum.2025.0393","DOIUrl":"10.1001/jamahealthforum.2025.0393","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Medicaid, the largest payer for medications for opioid use disorder (MOUD), disenrolled more than 19.1 million individuals by March 2024 after the continuous coverage requirement ended in April 2023-a process termed Medicaid unwinding-but the impact on buprenorphine receipt remains unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To assess the association between Medicaid unwinding and dispensing of prescription buprenorphine, overall and by payment sources nationally and by state.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;Cross-sectional study of buprenorphine dispensing (age ≥18 years) from April 2020 to March 2024 using the IQVIA Longitudinal Prescription (LRx) database containing more than 90% of US retail pharmacy claims. Interrupted time-series estimated levels and trends of buprenorphine prescription dispensation before and after Medicaid unwinding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The number of patients with filled buprenorphine prescriptions each month was analyzed by payer type (Medicaid, Medicare, commercial, or self-pay) and by state. Stratified analyses assessed state factors, including automated (ex parte) Medicaid renewal rates (higher or lower than the median), income verification sources used for automated renewals (≤3, 4-5, or 6-7), and Affordable Care Act Medicaid expansion status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 2 405 970 adults who filled buprenorphine prescriptions between April 2020 and March 2024, 1 154 866 (48%) had at least 1 fill covered by Medicaid, 288 716 (12%) by Medicare, 1 106 746 (46%) by commercial insurance, and 264 657 (11%) by self-pay. Medicaid unwinding was associated with reversal of previously increasing trends in buprenorphine prescriptions, with 2.9% fewer patients (-23 855 [95% CI, -32 661 to -15 054]) receiving buprenorphine each month by 8 months after unwinding vs the month before unwinding began. This decline was driven by a 12.7% drop in patients with Medicaid-paid fills (-46 545 [95% CI, -51 362 to -41 730]), partially offset by increases in patients with commercial (6.12%, 19 809 [95% CI, 12 109 to 27 509]) and self-paid (7.24%, 2525 [95% CI, 1246 to 3805]) fills. Sixteen states saw overall declines in buprenorphine use after unwinding, with reductions among patients with Medicaid-covered prescriptions in 36 states, partially offset by increases in patients with commercial insurance covered fills (32 states) and self-paid fills (23 states). Buprenorphine prescriptions remained stable in states with above-median automated Medicaid renewal rates and more income verification sources, whereas states with below-median automated renewal rates, fewer verification sources, and nonexpansion state status experienced smaller offsets for Medicaid-related losses, highlighting importance of state-specific policies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This cross-sectional study of Medicaid unwinding and filled buprenorphine prescr","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250393"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11971676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781917","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":"Quantifying Indirect Billing Within the Medicare Physician Fee Schedule.","authors":"John F Mulcahy, Sadiq Y Patel, Ateev Mehrotra, Hannah T Neprash","doi":"10.1001/jamahealthforum.2025.0433","DOIUrl":"10.1001/jamahealthforum.2025.0433","url":null,"abstract":"<p><strong>Importance: </strong>Under certain circumstances, advance practice clinicians (APCs), such as physician assistants and nurse practitioners, can bill Medicare directly or indirectly (ie, incident to the services of a physician). With indirect billing, the submitted claim states the care was provided by the physician, and the reimbursement is higher.</p><p><strong>Objective: </strong>To quantify volume and spending on office-based encounters billed indirectly in the Medicare program.</p><p><strong>Design, setting, and participants: </strong>This cohort study used Medicare fee-for-service and Medicare Advantage claims data to identify indirectly billed APC services. To do so, office-based Medicare Part B claims (ie, clinician services) were linked to Part D claims for prescription drug fills. Because the latter contains the prescribing clinician's unique identifier, this linkage distinguished between directly and indirectly billed services provided by APCs. In this way, the fraction of encounters and component services billed indirectly by APCs and physicians were quantified.</p><p><strong>Main outcomes and measures: </strong>Share of fee-for-service and Medicare Advantage office encounters provided by APCs and billed indirectly. Share of a physician's billed claims actually provided by an APC and billed indirectly.</p><p><strong>Results: </strong>In 2022, of all office encounters provided by an APC, 38.9% were billed indirectly. Conversely, for the median physician in 2022, indirect billing on behalf of APCs represented 11.1% of all billed encounters. Billing for care delivered by APCs was most common among surgical specialists (29.7% of encounters) and least common for primary care physicians (3.9%). If all indirectly billed APC-provided care was billed directly by the APC, Medicare would have saved $270 million in 2022.</p><p><strong>Conclusions and relevance: </strong>The results of this cohort study suggest that APCs provide a substantial fraction of office-based care received by Medicare beneficiaries. Identifying indirectly billed APC-provided care is integral to understanding who serves Medicare beneficiaries.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 4","pages":"e250433"},"PeriodicalIF":9.5,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11992606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052604","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}