JAMA Health Forum最新文献

{"title":"Primary Care Cost Sharing in Medicare Advantage.","authors":"Changchuan Jiang, Chuan Angel Lu, Lesi He, Arthur S Hong, Xin Hu, Megan Mullins, Boshen Jiao, Joshua M Liao","doi":"10.1001/jamahealthforum.2026.2232","DOIUrl":"10.1001/jamahealthforum.2026.2232","url":null,"abstract":"<p><strong>Importance: </strong>Medicare Advantage (MA) plans increasingly leverage cost-sharing structure to incentivize high-value care utilization, yet national adoption and distribution of $0 cost sharing for in-network primary care physician (PCP) visits remain poorly characterized.</p><p><strong>Objective: </strong>To examine longitudinal trends and plan- and county-level characteristics of $0 cost sharing for in-network PCP visits among MA plans.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study involved a retrospective ecological analysis of MA plan-county observations, including general enrollment MA plans (health maintenance organization, preferred provider organization, and health maintenance organization point-of-service plans) offered across US counties from 2019 to 2025. Data were analyzed from December 2025 to March 2026.</p><p><strong>Exposures: </strong>Plan-level characteristics (plan type, premium status, geographic region, and Centers for Medicare & Medicaid Services star rating) and county-level characteristics (MA penetration, urbanicity, federal poverty level, racial and ethnic composition, and PCP accessibility).</p><p><strong>Main outcomes and measures: </strong>The primary outcome was the enrollment trend in MA plans offering $0 cost sharing for in-network PCP visits from 2019 to 2025. Secondary outcomes included plan- and county-level factors associated with offering this benefit in 2025, estimated using multivariable mixed-effects logistic regression with county-level random intercepts.</p><p><strong>Results: </strong>The proportion of MA beneficiaries enrolled in plans requiring no cost sharing for in-network PCP visits increased from 46.4% in 2019 to 78.1% in 2025 (P for trend < .001), equating to approximately 15 million additional beneficiaries. In 2025, plans offering this benefit were more likely preferred provider organization plans than health maintenance organization plans (adjusted odds ratio [AOR], 2.14; 95% CI, 2.05-2.23) and featured better performances (5-star rating: AOR, 6.71; 95% CI, 4.83-9.32). Geographically, plans offering this benefit were more prevalent in urbanized counties (AOR, 1.17; 95% CI, 1.11-1.24), had higher MA penetration (AOR, 1.31; 95% CI, 1.22-1.40, and had larger proportions of racial and ethnic minority populations (AOR, 1.18; 95% CI, 1.09-1.28). In contrast, zero-premium plans (AOR, 0.70; 95% CI, 0.68-0.73) and plans offered in high-poverty counties (AOR, 0.82; 95% CI, 0.74-0.90) showed considerably lower availability of $0 cost sharing.</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study demonstrates that $0 cost sharing for PCP visits has expanded rapidly under MA but remains unevenly distributed. Lower availability in zero-premium plans and high-poverty areas suggest strategic trade-offs between premiums and point-of-service costs, raising equity concerns that underscore the need to assess whether market-driven benefit ","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262232"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13355145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148426432","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":"Expanded Alcohol Screening and Brief Intervention to Address Premature Mortality.","authors":"Julia M Lemp, Carolin Kilian, Xinyi Kou, Charlotte Buckley, Laura Llamosas-Falcón, Yachen Zhu, Jürgen Rehm, Nina Mulia, Robin Purshouse, Charlotte Probst","doi":"10.1001/jamahealthforum.2026.2348","DOIUrl":"10.1001/jamahealthforum.2026.2348","url":null,"abstract":"<p><strong>Importance: </strong>Alcohol use is a leading cause of premature mortality in the US. Despite public health recommendations and insurance coverage mandates, alcohol screening and brief intervention (ASBI) in primary care remains underused.</p><p><strong>Objective: </strong>To estimate the population-level impact of expanded ASBI delivery on alcohol use and potential years of life lost (YLL) from major alcohol-related causes of death in US adults through 2030, by sex, race and ethnicity, and educational attainment as a proxy for socioeconomic status.</p><p><strong>Design, setting, and participants: </strong>This was a decision analytical study that used a dynamic individual-level microsimulation model of nationally representative of US adults (age ≥18 years) from 2000 to 2030 and considered sociodemographic variables, alcohol use, and mortality risks.</p><p><strong>Interventions: </strong>Four expansion scenarios increasing the annual number of eligible individuals receiving ASBI from 2025 to 2030: scenario 1, expanding alcohol screening (AS) only; scenario 2, expanding brief intervention (BI) by 4 million; scenario 3, expanding BI by 8 million; and scenario 4, universal ASBI delivery. Scenarios were compared with a no-expansion counterfactual assuming historical trends.</p><p><strong>Main outcomes and measures: </strong>Prevalence of hazardous alcohol use (>20 or >40 g of alcohol per day for women and men) and YLL per 100 000 before age 75 years from 5 key alcohol-related causes of death (alcohol use disorder, liver disease and cirrhosis, motor vehicle injuries, other unintentional injuries, and suicide) in 2030.</p><p><strong>Results: </strong>The analysis of the microsimulation model found that scenario 3 (additional 8 million BI) and scenario 4 (universal ASBI) had the strongest impact on alcohol use and mortality, and were projected to reduce annual alcohol-related YLL per 100 000 by -51.3 (95% credible interval [CrI], -73.2 to -32.8) and -68.9 (CrI, -102.2 to -44.8) among men, respectively, and -34.1 (CrI, -54.5 to -16.1) and -52.0 (CrI, -75.0 to -30.2) among women, respectively, by 2030. In scenario 4, the gap in YLL from causes associated with alcohol use between low and high education narrowed by -3.5% (-64.5 YLL per 100 000; 95% CrI, -106.3 to -35.9) among men and -4.9% (-31.4 YLL per 100 000; 95% CrI, -56.2 to -12.4) among women.</p><p><strong>Conclusions and relevance: </strong>In decision analytical model expanding ASBI delivery in primary care was projected to reduce premature mortality and may represent an important strategy for improving population health. Substantial expansion had measurable but modest potential to narrow socioeconomic inequalities in premature mortality from causes of death associated with alcohol use.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262348"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632811","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":"Representation in Medicare's Value-Based Payment Models.","authors":"Aidan Crowley, Qian Erin Huang, Erkuan Wang, Marcella Alsan, Austin S Kilaru, Joshua M Liao, Amol Navathe","doi":"10.1001/jamahealthforum.2026.2202","DOIUrl":"10.1001/jamahealthforum.2026.2202","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262202"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581195","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":"Characteristics of US Veterans Potentially Susceptible to SNAP Time Limits.","authors":"Patrick D Smith, Felisha Gonzalez, Debra Saliba","doi":"10.1001/jamahealthforum.2026.2212","DOIUrl":"10.1001/jamahealthforum.2026.2212","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262212"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474049","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":"Five Building Blocks for Creating a Bipartisan Post-Trump US Health Care System.","authors":"Stuart M Butler","doi":"10.1001/jamahealthforum.2026.3485","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3485","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e263485"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622037","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":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2025.6025","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.6025","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e256025"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377989","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":"Ultralow-Volume Treatments for Mosquito-Borne Diseases.","authors":"Randall J Nett, Andrea M McCollum, Casey Parker-Crockett","doi":"10.1001/jamahealthforum.2026.1553","DOIUrl":"10.1001/jamahealthforum.2026.1553","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e261553"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387354/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148377954","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":"Policy Approaches to Ensuring an Adequate Nursing Workforce in Coming Decades.","authors":"Sandro Galea, Angela Clark","doi":"10.1001/jamahealthforum.2026.0154","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.0154","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e260154"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148474089","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":"School Vaccination Requirements as Preventive Care Infrastructure.","authors":"Y Tony Yang","doi":"10.1001/jamahealthforum.2026.2215","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2215","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262215"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632813","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 AI Regulatory 2-Step and Implications for Responsibilities of Health Systems.","authors":"Zachary Griffen, Kellie Owens, Lauren Taylor","doi":"10.1001/jamahealthforum.2026.2105","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2105","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 7","pages":"e262105"},"PeriodicalIF":12.5,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581242","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}