Health affairs scholar最新文献

How to make one line in the FDA Commissioner's new drug review program into a force for affordable access for patients. 如何使FDA专员的新药审查项目成为一股力量，为患者提供负担得起的药物。

IF 2.7

Health affairs scholar Pub Date : 2025-10-03 eCollection Date: 2025-10-01 DOI: 10.1093/haschl/qxaf182

Sarah K Emond, Daniel A Ollendorf

引用次数: 0

Why the Medicare physician fee schedule misvalues fee levels and how to fix it. 为什么医疗保险医生收费时间表错误估计费用水平，以及如何解决它。

IF 2.7

Health affairs scholar Pub Date : 2025-10-01 DOI: 10.1093/haschl/qxaf189

Laura Skopec, Robert A Berenson

引用次数: 0

Unfairness toward rural beneficiaries in Medicare's hierarchical conditions categories score. 在医疗保险的等级条件类别中，对农村受益人的不公平得分。

IF 2.7

Health affairs scholar Pub Date : 2025-09-23 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf167

Ravi B Parikh, Kristin A Linn, Junning Liang, Sae-Hwan Park, Torrey Shirk, Deborah S Cousins, Caleb Hearn, Matthew Maciejewski, Amol S Navathe

{"title":"Unfairness toward rural beneficiaries in Medicare's hierarchical conditions categories score.","authors":"Ravi B Parikh, Kristin A Linn, Junning Liang, Sae-Hwan Park, Torrey Shirk, Deborah S Cousins, Caleb Hearn, Matthew Maciejewski, Amol S Navathe","doi":"10.1093/haschl/qxaf167","DOIUrl":"10.1093/haschl/qxaf167","url":null,"abstract":"Risk adjustment is used in healthcare payment to mitigate the payer incentive to select for healthier populations and to improve fairness of quality assessment. The Centers for Medicare and Medicaid Services (CMS) has used a spending-based metric, the CMS Hierarchical Condition Category (HCC) score, to determine risk. However, the HCC score is potentially confounded by access and utilization differences, which are related to income and rurality. In this study, we investigate how related HCC scores are to mortality, a more objective indicator of clinical risk state, and whether that relationship differs between rural and urban populations. We examined calibration of the HCC spending model by calculating the predicted-to-observed spending ratio within deciles of the HCC score. We then compared urban and rural beneficiaries' clinical risk by comparing observed mortality rates within deciles. Our results demonstrate that the HCC model underpredicts mortality, while overpredicting spending, for rural beneficiaries. In contrast, it is well-calibrated for urban beneficiaries. These findings suggest that risk models based on HCCs may systematically disadvantage rural beneficiaries because HCC-based risk-adjusted spending may not fully account for baseline clinical risk.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf167"},"PeriodicalIF":2.7,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139844","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}

引用次数: 0

Caregivers at the crossroads: shifting policies and the challenges faced by employed caregivers. 十字路口的护理人员：政策变化和就业护理人员面临的挑战。

IF 2.7

Health affairs scholar Pub Date : 2025-09-22 eCollection Date: 2025-10-01 DOI: 10.1093/haschl/qxaf185

Amber D Thompson, Megan C Thomas Hebdon, Rebecca L Utz, Sara E Hart, Lee Ellington, Erin D Bouldin

{"title":"Caregivers at the crossroads: shifting policies and the challenges faced by employed caregivers.","authors":"Amber D Thompson, Megan C Thomas Hebdon, Rebecca L Utz, Sara E Hart, Lee Ellington, Erin D Bouldin","doi":"10.1093/haschl/qxaf185","DOIUrl":"10.1093/haschl/qxaf185","url":null,"abstract":"Introduction: Family caregiving is receiving increased attention in state and national policy, while caregivers face constrictions in workplace flexibility.Methods: A survey of employed caregivers in Utah (n = 226) was used to assess how often they reported having trouble managing paid work and caregiving responsibilities, the challenges they encountered in finding balance between roles, and effective strategies for caregivers to manage both roles.Results: Almost half (44%) experienced moderate to severe difficulties balancing paid work and caregiving. Based on open-ended responses, time burden was the most commonly difficult aspect of balancing. Caregivers who had difficulty managing caregiving and work were twice as likely to have made employment changes, including hybrid/remote work or reducing hours. Caregivers said flexibility in work schedule and help with caregiving from family and friends were important to helping them achieving balance.Conclusion: Difficulties balancing caregiving with paid employment are common and span health, financial, and time challenges. Policies supporting caregivers in their dual roles should address the common difficulties that caregivers experience. These policies could benefit employers, workers, and people with chronic health conditions and disability.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 10","pages":"qxaf185"},"PeriodicalIF":2.7,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282421","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}

引用次数: 0

Zero-premium Medicare Advantage plans: trends in areas with socioeconomic vulnerability and health needs. 零保费医疗保险优势计划：社会经济脆弱性和健康需求地区的趋势。

IF 2.7

Health affairs scholar Pub Date : 2025-09-19 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf177

Changchuan Jiang, Lesi He, Chuan Angel Lu, Arthur S Hong, Xin Hu, Joseph H Joo, Ryan D Nipp, Ya-Chen Tina Shih, K Robin Yabroff, Joshua M Liao

{"title":"Zero-premium Medicare Advantage plans: trends in areas with socioeconomic vulnerability and health needs.","authors":"Changchuan Jiang, Lesi He, Chuan Angel Lu, Arthur S Hong, Xin Hu, Joseph H Joo, Ryan D Nipp, Ya-Chen Tina Shih, K Robin Yabroff, Joshua M Liao","doi":"10.1093/haschl/qxaf177","DOIUrl":"10.1093/haschl/qxaf177","url":null,"abstract":"Introduction: Zero-premium Medicare Advantage (MA) plans are increasingly popular, yet knowledge gaps exist regarding their distribution, enrollment, and quality, particularly in areas with greater socioeconomic vulnerability and clinical need.Methods: We conducted a serial cross-sectional study of publicly available CMS data from 2019-2024, analyzing 2472 US counties. Annual plan counts and enrollment rates were examined, stratified by county-level socioeconomic and health characteristics (racial/ethnic minority percentage, poverty rate, and prevalence of fair/poor health). Counties were categorized into quartiles for comparison.Results: Zero-premium MA plans expanded substantially from 2019-2024, rising from 46.02% of MA plans (9.12 million enrollees) to 66.3% (18.76 million). These plans were more likely to feature restrictive provider networks and showed disproportionate enrollment growth in counties with greater socioeconomic and health needs (higher proportions of racial/ethnic minority residents, poverty, and poor health status; P < 0.001). Across all county-characteristic subgroups, zero-premium plans consistently had lower star ratings (1-3.5).Conclusion: Rapid zero-premium MA plan adoption raises concerns about the quality of care, especially among vulnerable populations. Further examination of plan quality standards and patient outcomes, transparency of enrollment incentives (eg, insurance broker commissions), and enrollee navigation and decision-making about plan options is warranted.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf177"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145115678","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}

引用次数: 0

From 4Ms to 5 domains: ensuring new CMS Age-Friendly hospital measure improves care for older adults. 从4个ms到5个域：确保新的CMS老年友好医院措施改善老年人的护理。

IF 2.7

Health affairs scholar Pub Date : 2025-09-17 eCollection Date: 2025-10-01 DOI: 10.1093/haschl/qxaf184

Julia Adler-Milstein, Sarah W Rosenthal, Robert Thombley, Stephanie Rogers, Benjamin Rosner, Jarmin Yeh, James D Harrison

{"title":"From 4Ms to 5 domains: ensuring new CMS Age-Friendly hospital measure improves care for older adults.","authors":"Julia Adler-Milstein, Sarah W Rosenthal, Robert Thombley, Stephanie Rogers, Benjamin Rosner, Jarmin Yeh, James D Harrison","doi":"10.1093/haschl/qxaf184","DOIUrl":"10.1093/haschl/qxaf184","url":null,"abstract":"In 2024, the Centers for Medicare and Medicaid Services (CMS) added a novel Age-Friendly Hospital Inpatient Quality Reporting (IQR) Measure, composed of 10 attestation statements in 5 domains. The measure is designed to improve care for older adults through promoting care processes and structural capabilities drawn from evidence-based standards included in the 4Ms Framework (What Matters, Medication, Mentation, and Mobility) and operationalized in 3 programs: Geriatric Surgery Verification, Geriatric Emergency Department Accreditation, and the Institute for Healthcare Improvement's Age-Friendly Health System recognition. We highlight synergies and gaps between these programs and the CMS Age-Friendly IQR measure to guide hospital efforts as they prepare for their first attestation in 2026. In addition, we make recommendations to CMS to improve measure validity through better specifications that ensure meaningful impact on care for older adults and to reduce associated reporting burden. Notably, there is little overlap in the outcome measures incorporated into each program. Attending to these considerations is critical to maximize the potential of this new national quality measure to address persistent shortcomings in evidence-based care for older adults.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 10","pages":"qxaf184"},"PeriodicalIF":2.7,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282462","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}

引用次数: 0

Diagnosed health conditions and health care use among Medicaid expansion enrollees, 2019 and 2022. 2019年和2022年医疗补助扩张参保者的诊断健康状况和医疗保健使用情况。

IF 2.7

Health affairs scholar Pub Date : 2025-09-15 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf172

William L Schpero, Manyao Zhang, Yasin Civelek

引用次数: 0

Trends in consolidation of outpatient providers into health systems and corporate owners, 2020-2023. 2020-2023年门诊服务提供者并入卫生系统和企业所有者的趋势。

IF 2.7

Health affairs scholar Pub Date : 2025-09-11 eCollection Date: 2025-10-01 DOI: 10.1093/haschl/qxaf181

Michael F Furukawa, Jesse Crosson, Lingrui Liu, Leeann Comfort, Daniel Miller

{"title":"Trends in consolidation of outpatient providers into health systems and corporate owners, 2020-2023.","authors":"Michael F Furukawa, Jesse Crosson, Lingrui Liu, Leeann Comfort, Daniel Miller","doi":"10.1093/haschl/qxaf181","DOIUrl":"10.1093/haschl/qxaf181","url":null,"abstract":"Introduction: This study examined the extent of provider consolidation across the outpatient sector overall and analyzed variation by ownership type, including vertically integrated health systems and large corporate owners.Methods: Using data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of US Health Systems and the IQVIA OneKey Database, we analyzed changes from 2020 to 2023 in the number and share of outpatient sites and outpatient physicians affiliated with health systems and corporate owners, overall and variation by profit status, owner size, and geographic scope.Results: The number of outpatient physicians classified as independent or other type decreased by 34 770 (-7.0 percentage points) from 2020 to 2023. Outpatient consolidation into health systems and corporate owners was relatively high in 2020 and increased modestly from 2020 to 2023. Data validation identified some risk of misclassification of parent ownership status with a potential to bias upwards the prevalence of corporate ownership.Conclusion: Our findings on changes in outpatient consolidation provide a baseline for tracking the growth in parent ownership across the outpatient sector overall and highlight the critical need for more accurate and standardized data on ownership and organization to address key policy issues related to competition, antitrust, and quality impacts.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 10","pages":"qxaf181"},"PeriodicalIF":2.7,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12508799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145282440","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}

引用次数: 0

Management of low back pain among Medicaid beneficiaries: modalities, patterns, and perspectives across states. 医疗补助受益人中腰痛的管理：各州的模式、模式和观点。

IF 2.7

Health affairs scholar Pub Date : 2025-09-08 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf180

Kayla N Tormohlen, Christie Lee Luo, Anam Ahsan, Brian C Coleman, Patience M Dow, William C Becker, Tamara Haegerich, Emma E McGinty

{"title":"Management of low back pain among Medicaid beneficiaries: modalities, patterns, and perspectives across states.","authors":"Kayla N Tormohlen, Christie Lee Luo, Anam Ahsan, Brian C Coleman, Patience M Dow, William C Becker, Tamara Haegerich, Emma E McGinty","doi":"10.1093/haschl/qxaf180","DOIUrl":"10.1093/haschl/qxaf180","url":null,"abstract":"Introduction: Low back pain is the leading cause of disability worldwide and Medicaid beneficiaries are disproportionally impacted. No studies have comprehensively examined patterns of treatment among Medicaid beneficiaries with low back pain.Methods: We quantitatively described modalities of treatment and low-value care received following a low back pain diagnosis among Medicaid beneficiaries across the United States. We then qualitatively explored factors that influence treatment patterns by interviewing chronic pain experts.Results: On average, 39.6% of patients received a prescription opioid in the 12 months following diagnosis and 41.2% received conservative therapies-noninvasive, nonpharmacological methods including physical, manual, or psychological therapies. Prescription nonopioid analgesic medications were the most common modality received first (57.8%) and across the 12 months following diagnosis (74.1%). On average, 8.9% of patients received high-dose, long-term opioid therapy (>120 morphine milligram equivalents/d for ≥90 days) and 31.7% received early imaging; both indicators for low-value care. Chronic pain experts highlighted challenges related to Medicaid coverage for conservative therapies, limited access to pain specialists, and social and economic factors influencing treatment access and utilization.Conclusion: Barriers, including Medicaid coverage limitations, provider access challenges, and economic factors, likely impact patterns of low back pain treatment among individuals enrolled in Medicaid.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf180"},"PeriodicalIF":2.7,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208264","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}

引用次数: 0

Decomposing Medicare total, Part D, and Part B drug payments among people with Alzheimer's disease and related diseases. 分解老年痴呆症和相关疾病患者的医疗保险总额、D部分和B部分药物支付。

IF 2.7

Health affairs scholar Pub Date : 2025-09-05 eCollection Date: 2025-09-01 DOI: 10.1093/haschl/qxaf179

Jie Chen, Seyeon Jang

{"title":"Decomposing Medicare total, Part D, and Part B drug payments among people with Alzheimer's disease and related diseases.","authors":"Jie Chen, Seyeon Jang","doi":"10.1093/haschl/qxaf179","DOIUrl":"10.1093/haschl/qxaf179","url":null,"abstract":"Introduction: This study aims to examine the extent to which health status, socioeconomic characteristics, and access to needed medications contribute to differences in total Medicare costs and drug spending among beneficiaries with and without Alzheimer's disease and related dementias (ADRD).Methods: We used Medicare fee-for-service (FFS) claims data from 2018, 2019, 2021, and 2022, linked with the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, to examine factors associated with total Medicare spending, Part D drug spending, and Part B drug costs. Decomposition analysis was conducted to quantify the contribution of individual characteristics to observed cost differences by ADRD status.Results: Our model explained 48% of the total Medicare spending difference and 80% of the Part D drug cost gap between beneficiaries with and without ADRD. Depression, heart disease, self-reported poor health, and functional limitations were major contributors to total spending differences. Dual eligibility was a primary driver of higher Part D costs. However, the model did not adequately explain differences in Part B drug costs.Conclusion: These findings underscore the need for targeted interventions in mental health, cardiovascular care, and pharmaceutical policy. Further research is needed to better understand unmeasured drivers of Medicare spending, especially physician-administered drug costs under Part B, among beneficiaries with ADRD.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 9","pages":"qxaf179"},"PeriodicalIF":2.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208168","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}

引用次数: 0