Health affairs scholar最新文献_第3页

How AI will redefine care delivery: the rise of the generalist-specialist. 人工智能将如何重新定义医疗服务：通才型专家的崛起。

IF 2.7

Health affairs scholar Pub Date : 2026-03-26 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag075

Bob Kocher, Siobhan Nolan-Mangini, Robert M Wachter

{"title":"How AI will redefine care delivery: the rise of the generalist-specialist.","authors":"Bob Kocher, Siobhan Nolan-Mangini, Robert M Wachter","doi":"10.1093/haschl/qxag075","DOIUrl":"https://doi.org/10.1093/haschl/qxag075","url":null,"abstract":"Artificial intelligence is transforming healthcare beyond efficiency gains, presenting an opportunity to fundamentally reorganize the clinical workforce. This paper proposes the \"Generalist-Specialist\" model, arguing that AI's capacity to scale specialist-level knowledge challenges the historical \"cognitive necessity\" for narrow specialty definitions. By democratizing clinical expertise, AI-augmented clinicians could manage the full constellation of patients' chronic and complex conditions within broader, disease-based domains (eg, cardiometabolic, infectious and inflammatory) rather than organ-specific specialties. This shift promises fewer handoffs, better coordination, and unlocked specialty capacity for patients who need it most. Economically, consolidating care under fewer clinicians makes value-based and bundled payments more feasible, though under fee-for-service, without countervailing payment reform, it risks increasing total utilization. Realizing this vision requires evolving medical education to incorporate AI, reforming malpractice standards to accept AI-guided evidence-based care, modernizing credentialing frameworks, and strategically repositioning Academic Medical Centers toward ultra-complex care or seamless generalist-specialist hubs. The greatest impact of AI in healthcare may not be doing the same things more efficiently, but enabling an entirely new class of clinicians organized around disease biology and patient need. Realizing this potential will require navigating formidable non-technical barriers, including incumbent interests, legacy payment models, and patient safety and liability standards.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag075"},"PeriodicalIF":2.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679711","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

Comparing health care utilization after hospital discharge in Medicaid managed care versus fee-for-service. 比较医疗补助管理医疗和按服务收费的出院后医疗保健利用情况。

IF 2.7

Health affairs scholar Pub Date : 2026-03-26 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag073

Anna M Morenz, Joseph H Joo, Yixin Tang, Yujia Jin, Sanaa Alam, Danielle S Browne, Joshua M Liao

{"title":"Comparing health care utilization after hospital discharge in Medicaid managed care versus fee-for-service.","authors":"Anna M Morenz, Joseph H Joo, Yixin Tang, Yujia Jin, Sanaa Alam, Danielle S Browne, Joshua M Liao","doi":"10.1093/haschl/qxag073","DOIUrl":"https://doi.org/10.1093/haschl/qxag073","url":null,"abstract":"Background: Although managed care organizations (MCOs) insure the majority of Medicaid beneficiaries, contemporary and nationwide data comparing postdischarge utilization between MCOs and Medicaid fee-for-service (FFS) beneficiaries are lacking.Methods: We conducted a cross-sectional study of 1.65 million hospital discharges among Medicaid-only beneficiaries between 2015-2019 and 2021-2022. Multivariable logistic regression, adjusted for patient and utilization characteristics, estimated average marginal effects of MCO vs FFS enrollment on 30-day emergency department (ED) visits, observation stays, readmissions, and follow-up visits between MCO vs FFS beneficiaries. Analyses were stratified by ages 18-49 years and 50+ years.Results: Among young adults, MCO vs FFS enrollment was associated with a lower probability of ED visits (average marginal effect [AME]: -1.2 percentage points [pp]) and a higher probability of follow-up visits (AME: 10.6 pp). Among older adults, MCO enrollment was also associated with a lower probability of ED visits (AME: -2.2 pp) and a higher probability of follow-up visits (AME: 20.4 pp), but a higher readmission risk (AME: 1.6 pp).Conclusion: Associations between Medicaid managed care and greater follow-up and lower ED visits signal effective care coordination, while greater readmission risk for older adults is concerning. This finding may reflect barriers to care continuity and recommended post-acute care in managed care, meriting further investigation to inform solutions.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag073"},"PeriodicalIF":2.7,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13070724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694495","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

Telehealth and the work behavior of mental health clinicians. 远程医疗与心理健康临床医生的工作行为。

IF 2.7

Health affairs scholar Pub Date : 2026-03-25 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag070

Sooyeon Song, Steven D Pizer, Christine A Yee

{"title":"Telehealth and the work behavior of mental health clinicians.","authors":"Sooyeon Song, Steven D Pizer, Christine A Yee","doi":"10.1093/haschl/qxag070","DOIUrl":"https://doi.org/10.1093/haschl/qxag070","url":null,"abstract":"Introduction: Telehealth delivers more than half of mental health care in the United States amid persistent mental health workforce shortages. However, little is known about how telehealth relates to clinicians' work behavior, specifically their visits per clinic day and probability of turnover.Methods: We examined mental health clinicians working at the Veterans Health Administration who collectively delivered 26 million visits. We regressed clinicians' monthly visit volume (supply), number of clinic days worked (input), visits per clinic day (throughput), and probability of turnover (retention) on the proportion of their mental health visits delivered via video. We used variation in broadband availability as an instrumental variable for video visit use.Results: A 10 percentage-point higher proportion of video visits was associated with no significant difference in total visits, 0.9 fewer clinic days per month (8.5% of the sample mean), 0.5 more visits per clinic day (6.2% of the sample mean), and a 0.4 percentage-point lower probability of monthly turnover (46% of the sample mean). Among psychologists and social workers, higher video share was associated with more visits per clinic day and fewer clinic days, whereas psychiatrists showed fewer visits per clinic day.Conclusion: Telehealth may shape clinicians' work behavior, including visits per clinic day, allocation of clinic days, and retention.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag070"},"PeriodicalIF":2.7,"publicationDate":"2026-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792856","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

Homelessness, justice involvement, and publicly funded substance use treatment after Medicaid expansion. 无家可归，司法介入，以及医疗补助扩张后公共资助的药物滥用治疗。

IF 2.7

Health affairs scholar Pub Date : 2026-03-24 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag069

Suparna Das, Kerry Green

{"title":"Homelessness, justice involvement, and publicly funded substance use treatment after Medicaid expansion.","authors":"Suparna Das, Kerry Green","doi":"10.1093/haschl/qxag069","DOIUrl":"https://doi.org/10.1093/haschl/qxag069","url":null,"abstract":"Introduction: People experiencing homelessness (PEH) and individuals referred through the criminal-justice (CJ) system face high rates of substance use disorders (SUD) and persistent barriers to treatment. Although Medicaid expansion increased insurance coverage among low-income adults with SUD, it remains unclear how these reforms affected entry into publicly funded treatment for individuals experiencing both homelessness and justice involvement.Methods: We analyzed 32.9 million specialty SUD treatment admissions reported to the Treatment Episode Data Set-Admissions (TEDS) from 2006 to 2023. Multinomial logistic regression estimated demographic, socioeconomic, clinical, and insurance correlates across pathways. Comparative interrupted time series (CITS) models with state and year fixed effects assessed changes in admissions involving PEH-CJ following Medicaid expansion.Results: Of all admissions, PEH-CJ admissions showed the highest levels of socioeconomic instability, repeated treatment episodes, and stimulant involvement. Multinomial models identified elevated relative risk among American Indian/Alaska Native, Black, unemployed individuals, those with low educational attainment, and prior treatment episodes. CITS analyses showed no significant post-expansion change in PEH-CJ admission probability.Conclusion: Medicaid expansion did not alter reliance on publicly funded safety-net treatment for PEH-CJ. Continued dependence on the SUPTRS-BG highlights the need to align Medicaid reforms with strengthened safety-net financing and cross-sector support.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 4","pages":"qxag069"},"PeriodicalIF":2.7,"publicationDate":"2026-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13122626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147792710","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

Assessing access to cardiologists and endocrinologists in the Texas ACA market. 评估在德州ACA市场获得心脏病专家和内分泌专家的机会。

IF 2.7

Health affairs scholar Pub Date : 2026-03-21 eCollection Date: 2026-04-01 DOI: 10.1093/haschl/qxag068

Simon F Haeder, Yuqin Lou, Wendy Xu

引用次数: 0

Patterns and implications of 2025 NIH-F31 grant terminations for the predoctoral training pipeline. 2025年NIH-F31终止博士前培训的模式和影响。

IF 2.7

Health affairs scholar Pub Date : 2026-03-18 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag065

Jahn Jaramillo, Audrey Harkness

{"title":"Patterns and implications of 2025 NIH-F31 grant terminations for the predoctoral training pipeline.","authors":"Jahn Jaramillo, Audrey Harkness","doi":"10.1093/haschl/qxag065","DOIUrl":"10.1093/haschl/qxag065","url":null,"abstract":"Introduction: In 2025, the National Institutes of Health (NIH) terminated student grants across the Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship mechanisms, including both general F31 and F31-Diversity awards, disrupting a critical training pipeline marked by inequities. Since the terminations, the status of many grants has shifted amid an evolving landscape of freezes, appeals, and reinstatements, leading to prolonged uncertainty for predoctoral trainees.Methods: In this article, we analyzed from publicly available data the scope and geographical distribution of terminated F31 (general and diversity) awards from 2025 and considered the implications of these terminations on trainees. We queried publicly available data from Grant Witness (November 16, 2025, to December 18, 2025), a website that monitors grant terminations across various US government agencies, such as NIH.Results: We found that 405 F31 grants were affected by the 2025 terminations; of these, 136 were general F31s, and 269 were F31-Diversity awards. States in the South and Midwest were disproportionately represented among the terminations of diversity-promoting F31s.Conclusion: Federal agencies and academic institutions may consider implementing safeguards, including protections against midyear grant terminations and emergency bridge funding to protect trainees during periods of political and funding instability.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 3","pages":"qxag065"},"PeriodicalIF":2.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032874/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577282","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

Will AI-written and AI-reviewed preprints from aiXiv be bibliometrically accepted? 来自aiXiv的人工智能撰写和人工智能评审的预印本在文献计量学上是否被接受？

IF 2.7

Health affairs scholar Pub Date : 2026-03-18 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag064

Jaime A Teixeira da Silva

引用次数: 0

ICER's launch price and access report: 5 key takeaways and 5 questions we should all be asking. ICER的发布价格和访问报告：我们都应该问的5个关键要点和5个问题。

IF 2.7

Health affairs scholar Pub Date : 2026-03-16 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag057

Foluso Agboola, Sarah K Emond

引用次数: 0

What are the true medical concerns facing unsheltered homeless adults? 无家可归的成年人面临的真正的医疗问题是什么？

IF 2.7

Health affairs scholar Pub Date : 2026-03-16 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag062

Randall Kuhn, Jessie Chien, Evan Michael Shannon, Sonali Saluja, Giovanni Righi, Mohammad Damra, Coley M King, Lillian Gelberg, Benjamin F Henwood

{"title":"What are the true medical concerns facing unsheltered homeless adults?","authors":"Randall Kuhn, Jessie Chien, Evan Michael Shannon, Sonali Saluja, Giovanni Righi, Mohammad Damra, Coley M King, Lillian Gelberg, Benjamin F Henwood","doi":"10.1093/haschl/qxag062","DOIUrl":"10.1093/haschl/qxag062","url":null,"abstract":"Introduction: Estimates of behavioral and physical health conditions among unsheltered populations are often used to guide policy initiatives for healthcare and housing, yet robust, disease-specific prevalence estimates remain limited. We address this gap by leveraging multiple data sources to generate more reliable estimates of specific disease conditions for unsheltered adults.Methods: We triangulate data from three sources in Los Angeles County, which has the largest unsheltered population in the US: a probability-based survey of adults experiencing homelessness (n = 898), and electronic health records from two field-based medical providers (n = 1683; n = 527). We report univariate estimates by source and summarize across sources.Results: Across sources, median prevalence was 40% for mental health conditions (range: 40%-61%) and 33% for substance use conditions (range: 31%-43%). Post-traumatic stress disorder and major depression were the most common mental health conditions (median 22%), and stimulant use disorder was the most common substance use condition (median 17%). Physical health conditions were more common than both mental health and substance use conditions overall (median 57%; range: 49%-73%).Conclusion: These findings underscore that housing and health care are complementary components of care and support, integrating field-based medical services with permanent housing investments.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 3","pages":"qxag062"},"PeriodicalIF":2.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147576437","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 calls to action: leveraging the 2-1-1 system to intervene on food insecurity. 从呼吁到行动：利用2-1-1系统干预粮食不安全问题。

IF 2.7

Health affairs scholar Pub Date : 2026-03-14 eCollection Date: 2026-03-01 DOI: 10.1093/haschl/qxag063

Nasser Sharareh, Gloria Castaneda, Rachel Dalrymple, Cassandra Wambach, Ben Brintz, Sara E Simonsen, Olutobi A Sanuade, Hanna Hedges, Fernando A Wilson, Rachel Hess, Jorie Butler, Andrea S Wallace

{"title":"From calls to action: leveraging the 2-1-1 system to intervene on food insecurity.","authors":"Nasser Sharareh, Gloria Castaneda, Rachel Dalrymple, Cassandra Wambach, Ben Brintz, Sara E Simonsen, Olutobi A Sanuade, Hanna Hedges, Fernando A Wilson, Rachel Hess, Jorie Butler, Andrea S Wallace","doi":"10.1093/haschl/qxag063","DOIUrl":"10.1093/haschl/qxag063","url":null,"abstract":"Introduction: The 2-1-1 system is a nationwide social service provider that connects callers with unmet needs to appropriate community resources. Every year, over two million Americans experiencing food insecurity (FI) seek help from 2-1-1. Yet, little is known about the FI experiences among 2-1-1 callers seeking food-related support, specifically, who they are, the circumstances that lead them to contact 2-1-1, and the strategies they believe could help reduce FI.Methods: To address this gap, we interviewed 30 food-related callers (20 in English and 10 in Spanish) to the Utah 2-1-1 system between November 2024 and January 2025.Results: Thematic analysis revealed three primary reasons for seeking food-related help from 2-1-1: (1) ineligibility for federal nutrition and financial assistance programs; (2) facing non-income-related barriers to accessing food; and (3) experiencing unexpected life events. Callers suggested strengthening and adapting federal nutrition assistance programs, improving emergency food provision systems, and enhancing informational support.Conclusion: Based on these insights, we provide suggestions on how to leverage the 2-1-1 system to intervene on FI.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"4 3","pages":"qxag063"},"PeriodicalIF":2.7,"publicationDate":"2026-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13032864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577306","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