Health affairs scholar最新文献_第8页

Telehealth payment parity and outpatient service utilization: evidence from privately insured workers. 远程医疗支付平价和门诊服务利用：来自私人保险工人的证据。

Health affairs scholar Pub Date : 2025-04-01 DOI: 10.1093/haschl/qxaf068

Zhang Zhang, M Kate Bundorf, Qing Gong, Christopher M Shea, Donna Gilleskie, Sean Y Sylvia

{"title":"Telehealth payment parity and outpatient service utilization: evidence from privately insured workers.","authors":"Zhang Zhang, M Kate Bundorf, Qing Gong, Christopher M Shea, Donna Gilleskie, Sean Y Sylvia","doi":"10.1093/haschl/qxaf068","DOIUrl":"10.1093/haschl/qxaf068","url":null,"abstract":"Telehealth was catalyzed by the COVID-19 pandemic and has become a new norm in healthcare. In response to the pandemic, some states passed telehealth payment parity legislation, mandating equal payment rates for telehealth and in-person services. We evaluated the relationship between telehealth payment parity and health service utilization, focusing on insured workers in commercial insurance plans. Using the Merative Commercial Claims and Encounters database from 2019 to 2021, we leverage variation in the timing of policy changes across states using a difference-in-difference approach. Payment parity was significantly associated with increased telehealth visits and total outpatient visits but without a notable rise in in-person visits. Furthermore, payment parity was pronounced in increasing telehealth utilization within self-funded large employer plans, while not significantly associated with telehealth visits among fully insured small employer plans. Our findings underscore the important role of payment parity in increasing telehealth service utilization by incentivizing providers. Future policies should support the sustainable integration of telehealth services, shifting from solely focusing on equal payment rates to adopting value-based reimbursement models that improve equitable healthcare access for all employees in commercial insurance.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf068"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12013821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050516","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

Unequal enforcement, unequal inference: rethinking how we define policy exposures. 不平等的执行，不平等的推断：重新思考我们如何定义政策风险。

Health affairs scholar Pub Date : 2025-03-28 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf063

Simone Wien, Ariana N Mora, Michael R Kramer

引用次数: 0

Increasing commercial coverage of doula services: perspectives from health plans and large employers in California. 增加助产师服务的商业覆盖率：来自加州健康计划和大雇主的观点。

Health affairs scholar Pub Date : 2025-03-26 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf065

Ashley Nguyen, Mounika Parimi, Kendy Yaneth Mendoza, Anu Manchikanti Gómez, Cassondra Marshall

{"title":"Increasing commercial coverage of doula services: perspectives from health plans and large employers in California.","authors":"Ashley Nguyen, Mounika Parimi, Kendy Yaneth Mendoza, Anu Manchikanti Gómez, Cassondra Marshall","doi":"10.1093/haschl/qxaf065","DOIUrl":"https://doi.org/10.1093/haschl/qxaf065","url":null,"abstract":"Although Medicaid coverage of doula services has expanded since 2014, commercial coverage remains nascent. Little is known about what motivates private payers to cover doula support. Through qualitative interviews with staff members (n = 11) from health plans and employers that operate in California, we aimed to identify factors that could influence commercial coverage of doula services. In our first theme, we describe how a health plan or employer's commitment to birth equity can serve as a catalyst for commercial coverage of doula services. Second, participants noted that when considering new benefits, payers would review evidence related to doula support and weigh cost. The third theme centers on how consumer demand could impact a health plan or employer's appetite for adding a commercial doula benefit. The final theme highlights the operational considerations health plans and employers are contemplating, such as how to prioritize populations that could most benefit from doula support. Our findings suggest that the decision to cover doula support largely hinges on payer priorities. However, we found that health plans and employers interested in advancing birth equity were compelled by evidence supporting doula care, suggesting there may be opportunities to increase commercial coverage of doula services.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf065"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000861","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

Utilization and quality among Medicare Advantage beneficiaries with high vs low access to telehealth. 医疗保险优势受益人的利用和质量与高与低获得远程医疗。

Health affairs scholar Pub Date : 2025-03-26 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf064

Jiani Yu, Lawrence P Casalino, Hye-Young Jung, Derek Lake, Manyao Zhang, Reekarl Pierre, Dhruv Khullar

{"title":"Utilization and quality among Medicare Advantage beneficiaries with high vs low access to telehealth.","authors":"Jiani Yu, Lawrence P Casalino, Hye-Young Jung, Derek Lake, Manyao Zhang, Reekarl Pierre, Dhruv Khullar","doi":"10.1093/haschl/qxaf064","DOIUrl":"https://doi.org/10.1093/haschl/qxaf064","url":null,"abstract":"Access to telehealth care has increased markedly in recent years, especially for patients in the Medicare Advantage (MA) program. Given the unique features of MA, such as capitated payment and provider networks, understanding the impact of telehealth availability on quality, costs, and utilization is important for informing coverage and payment decisions. We compared quality and utilization outcomes among MA beneficiaries with varying access to telehealth, using MA encounter data from a 20% national random sample of enrollees from 2019 to 2021. We found that high-telehealth access was associated with a 13.4% decrease in in-person evaluation and management (E&M) visits, relative to the period prior to the pandemic onset. Given that this decrease was offset by increases in telehealth E&M visits, there was no change in total E&M visits. High-telehealth access was also associated with a 4.8% decrease in total emergency department (ED) visits, but no differences in preventable ED visits, total hospital admissions, or ambulatory care-sensitive admissions. Increases in telehealth-delivered E&M visits among MA beneficiaries with high-telehealth access offset decreases in in-person-delivered E&M visits. These findings may help clinicians and policymakers contextualize the relationship between broader access to telehealth for MA enrollees and various types of health care utilization.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf064"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061571","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

Substantial variation among Medicare beneficiaries in the impact from 2025 Part D out of pocket spending caps. 2025年D部分自付支出上限对医疗保险受益人影响的实质性变化。

Health affairs scholar Pub Date : 2025-03-24 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf059

Debra M Lederman, Alexander L Olssen, Mark V Pauly

{"title":"Substantial variation among Medicare beneficiaries in the impact from 2025 Part D out of pocket spending caps.","authors":"Debra M Lederman, Alexander L Olssen, Mark V Pauly","doi":"10.1093/haschl/qxaf059","DOIUrl":"https://doi.org/10.1093/haschl/qxaf059","url":null,"abstract":"In 2025, Medicare Part D introduced an annual $2000 limit on beneficiary out-of-pocket (OOP) costs under the Inflation Reduction Act. The objective of this research is to analyze the variability of OOP costs for beneficiaries with high total drug spending to understand who would benefit from the OOP cap. Using Part D data from 2022, we examine OOP costs for 2 samples of beneficiaries with high total drug spending: those with annual drug spending exceeding $6560 (who would have more than $2000 in OOP under the standard-benefit) and those in the top 1% of annual drug spending. We find that 64.72% and 37.84% of beneficiaries in each respective sample did not have OOP costs that would reach the annual cap. There is large variation in OOP costs even among beneficiaries who all have very high annual total drug spending, and reductions in patient liability from third-party payors appears to be an important reason for this variation. The introduction of OOP drug spending caps will result in substantial variation in the change in OOP spending for high-spending Medicare beneficiaries.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 4","pages":"qxaf059"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046529","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

Utilization and patient experiences of telehealth among Medicaid expansion enrollees. 医疗补助扩大登记人员远程医疗的利用和患者经验。

Health affairs scholar Pub Date : 2025-03-21 eCollection Date: 2025-05-01 DOI: 10.1093/haschl/qxaf060

Terrence Liu, Nicholas Box, Matthias Kirch, Denise Anthony, John Z Ayanian, Minal R Patel, Sarah J Clark, Susan D Goold

{"title":"Utilization and patient experiences of telehealth among Medicaid expansion enrollees.","authors":"Terrence Liu, Nicholas Box, Matthias Kirch, Denise Anthony, John Z Ayanian, Minal R Patel, Sarah J Clark, Susan D Goold","doi":"10.1093/haschl/qxaf060","DOIUrl":"https://doi.org/10.1093/haschl/qxaf060","url":null,"abstract":"Telehealth can promote access to health care, especially among individuals enrolled in Medicaid. However, we currently lack data on patient experiences of telehealth from low-income individuals. Using data collected in 2021 and 2022 from a statewide survey of enrollees in the Heathy Michigan Plan, Michigan's Medicaid expansion program, we conducted an analysis to study patients' experiences of using telehealth. Approximately one-third of enrollees reported a telehealth visit within the past year. Individuals reporting barriers to primary care were more likely to have had a telehealth visit compared with those reporting no barriers to primary care. Among those who had a telehealth visit, most individuals reported that telehealth provided care they could not or would not otherwise receive (63.3%; 95% CI: 58.9%-67.5%) and were satisfied with telehealth adequately addressing their health concerns (92.1%; 95% CI: 89.4%-94.1%). Our findings that telehealth was largely accepted among Medicaid enrollees can help inform policy that shapes its future implementation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 5","pages":"qxaf060"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039630","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

Use of real-world evidence in the Medicare Drug Price Negotiation Program: A checklist for the Centers for Medicare and Medicaid Services and manufacturers. 在医疗保险药品价格谈判计划中使用真实证据：医疗保险和医疗补助服务中心和制造商的清单。

Health affairs scholar Pub Date : 2025-03-21 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf030

Sean R Tunis, Jason Shafrin, Kyi-Sin Than, Melanie D Whittington, Richard J Willke, Murtuza Bharmal

{"title":"Use of real-world evidence in the Medicare Drug Price Negotiation Program: A checklist for the Centers for Medicare and Medicaid Services and manufacturers.","authors":"Sean R Tunis, Jason Shafrin, Kyi-Sin Than, Melanie D Whittington, Richard J Willke, Murtuza Bharmal","doi":"10.1093/haschl/qxaf030","DOIUrl":"10.1093/haschl/qxaf030","url":null,"abstract":"Under the Inflation Reduction Act's (IRA's) - Medicare Drug Price Negotiation Program, the Centers for Medicare & Medicaid Services' (CMS's) \"maximum fair price\" must be informed by evidence on factors such as therapeutic advance of the selected drug compared with its alternative, comparative effectiveness across clinical and patient-reported outcomes, the impact on specific populations, and the ability to address unmet medical needs. This paper describes how real-world evidence could improve CMS decision-making and creates a best practices checklist to help CMS evaluate the quality of any manufacturer-submitted evidence. The checklist was developed in four steps: (i) identification of the IRA requirements for determining the maximum fair price through a review of official guidance from CMS, (ii) assessment of provisions that could be supported by real-world evidence (RWE) in addition to clinical trial evidence, (iii) literature review on existing best-practice guidelines relevant to RWE, and (iv) consolidation of these RWE guidelines into a checklist through a series of web conference discussions among experts. The checklist aims to improve the quality of the information available to CMS during the drug price negotiation process.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":"3 3","pages":"qxaf030"},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694948","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

Correction to: Medicaid-covered health care visits during the postpartum year: Variation by enrollee characteristics and state. 更正：产后一年医疗补助覆盖的医疗保健访问：参保者特征和州的变化。

Health affairs scholar Pub Date : 2025-03-21 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf055

引用次数: 0

Trends in providers participating in Medicare oncology value-based care models. 医疗服务提供者参与医疗肿瘤学价值护理模式的趋势。

Health affairs scholar Pub Date : 2025-03-20 eCollection Date: 2025-04-01 DOI: 10.1093/haschl/qxaf058

Arthur S Hong, Sofia Babool, Lesi He, Ethan A Halm

引用次数: 0

Correction to: What happens behind closed doors? Investigating care practices in nursing home and assisted living memory care units. 更正：关起门来发生了什么？调查养老院和辅助生活记忆护理单位的护理实践。

Health affairs scholar Pub Date : 2025-03-19 eCollection Date: 2025-03-01 DOI: 10.1093/haschl/qxaf053

引用次数: 0