Health affairs scholar最新文献_第9页

Comparing HEDIS Performance of Dual Eligible Special Needs Plans to Other Coverage Types for Dually Eligible People 比较双合格特殊需求计划与其他双合格人群保险类型的 HEDIS 业绩

Health affairs scholar Pub Date : 2024-03-20 DOI: 10.1093/haschl/qxae036

Amelia M Haviland, Megan Mathews, Steven C. Martino, Yvette Overton, Jacob W Dembosky, Jessica Maksut, Marc N. Elliott

{"title":"Comparing HEDIS Performance of Dual Eligible Special Needs Plans to Other Coverage Types for Dually Eligible People","authors":"Amelia M Haviland, Megan Mathews, Steven C. Martino, Yvette Overton, Jacob W Dembosky, Jessica Maksut, Marc N. Elliott","doi":"10.1093/haschl/qxae036","DOIUrl":"https://doi.org/10.1093/haschl/qxae036","url":null,"abstract":"\u0000 People eligible for both Medicare and Medicaid coverage (“dually eligible individuals”) have lower levels of income and assets and often higher health care needs and costs than those eligible for Medicare but not Medicaid coverage. Their three most common Medicare coverage options are: Medicare Advantage (MA) Dual Eligible Special Needs Plans(D-SNP), non-D-SNP MA plans, and fee-for-service (FFS) Medicare with a stand-alone prescription drug plan. No prior study has examined clinical quality of care for dually eligible individuals across these three coverage types. To fill that void, we used logistic regression to compare these coverage types on six HEDIS measures of clinical quality of care that were available for both MA and FFS (constructed from claims files).\u0000 D-SNP and non-D-SNP MA plans significantly outperformed FFS for all six measures for dually eligible individuals, by approximately 5 percentage points for two measures and by 18-34 percentage points for the other four measures. For the four measures with the greatest advantage over FFS, performance was 3-8 percentage points higher in D-SNP than in non-D-SNP MA plans.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140227769","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}

引用次数: 0

Re-evaluation of the methodology for estimating the U.S. specialty physician workforce 重新评估美国专科医生队伍的估算方法

Health affairs scholar Pub Date : 2024-03-19 DOI: 10.1093/haschl/qxae033

W. S. Black-Schaffer, David J Gross, Z. Nouri, Aidan DeLisle, Michael Dill, Jason Y Park, James M Crawford, Michael B Cohen, Rebecca L Johnson, Donald S Karcher, Thomas M Wheeler, Stanley J Robboy

{"title":"Re-evaluation of the methodology for estimating the U.S. specialty physician workforce","authors":"W. S. Black-Schaffer, David J Gross, Z. Nouri, Aidan DeLisle, Michael Dill, Jason Y Park, James M Crawford, Michael B Cohen, Rebecca L Johnson, Donald S Karcher, Thomas M Wheeler, Stanley J Robboy","doi":"10.1093/haschl/qxae033","DOIUrl":"https://doi.org/10.1093/haschl/qxae033","url":null,"abstract":"\u0000 Increasing pursuit of subspecialized training has quietly revolutionized physician training, but the potential impact on physician workforce estimates has not previously been recognized. The Physicians Specialty Data Reports of the Association of American Medical Colleges, derived from specialty designations in the American Medical Association Physician Professional Data (PDP), are the reference source for US physician workforce estimates; by 2020 the report for pathologists is an undercount of 39% when compared to the PDP. Most of the difference was due to omission of pathology subspecialty designations. The rest resulted from reliance on only the first of the AMA Physician Professional Data’s two specialty data fields. Placement of specialty designation in these two fields is sensitive to sequence of training and is thus affected by multiple or intercalated (between years of residency training) fellowships. Both these phenomena have become progressively more common and are not unique to pathology. Our findings demonstrate the need to update definitions and methodology underlying estimates of the US physician workforce for pathology and suggest a like need in other specialties affected by similar trends.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140229821","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}

引用次数: 0

Domestic violence: prevention past due. 家庭暴力：预防逾期。

Health affairs scholar Pub Date : 2024-03-19 eCollection Date: 2024-04-01 DOI: 10.1093/haschl/qxae034

Debbie I Chang

引用次数: 0

Locations and characteristics of pharmacy deserts in the United States: A geospatial study 美国药房沙漠的位置和特征：地理空间研究

Health affairs scholar Pub Date : 2024-03-16 DOI: 10.1093/haschl/qxae035

R. Wittenauer, P. Shah, J. Bacci, Andy Stergachis

{"title":"Locations and characteristics of pharmacy deserts in the United States: A geospatial study","authors":"R. Wittenauer, P. Shah, J. Bacci, Andy Stergachis","doi":"10.1093/haschl/qxae035","DOIUrl":"https://doi.org/10.1093/haschl/qxae035","url":null,"abstract":"\u0000 Pharmacies are important healthcare access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US States and DC. We also compared sociodemographic characteristics of pharmacy desert vs. non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the US live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who: have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible healthcare setting in the US, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to healthcare. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140237200","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}

引用次数: 0

The Highest Cost Medicaid Enrollees with Sickle Cell Disease Had Annual Health Care Expenditures Nearing $200 000 费用最高的镰状细胞病医疗补助计划参保者每年的医疗支出接近 200 000 美元

Health affairs scholar Pub Date : 2024-03-11 DOI: 10.1093/haschl/qxae029

Junelle Speller, Sarah Rayel, Kristen Hayashi, Michaela Kirby, Dianne Munevar, A. Hartzman, Kevin Dietz

引用次数: 0

Unmet need for mental health care is common across insurance market segments in the United States. 在美国，未得到满足的心理健康护理需求在各个保险细分市场都很普遍。

Health affairs scholar Pub Date : 2024-03-08 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae032

Mark K Meiselbach, Catherine K Ettman, Karen Shen, Brian C Castrucci, Sandro Galea

{"title":"Unmet need for mental health care is common across insurance market segments in the United States.","authors":"Mark K Meiselbach, Catherine K Ettman, Karen Shen, Brian C Castrucci, Sandro Galea","doi":"10.1093/haschl/qxae032","DOIUrl":"https://doi.org/10.1093/haschl/qxae032","url":null,"abstract":"A substantial proportion of individuals with depression in the United States do not receive treatment. While access challenges for mental health care have been documented, few recent estimates of unmet mental health needs across insurance market segments exist. Using nationally representative survey data with participant-reported depression symptom severity and mental health care use collected in Spring 2023, we assessed access to mental health care among individuals with similar levels of depression symptom severity with commercial, Medicare, Medicaid, and no insurance. Among individuals who reported symptoms consistent with moderately severe to severe depression, 37.8% did not have a diagnosis for depression (41.0%, 28.1%, 33.6%, and 56.3% with commercial, Medicare, Medicaid, and no insurance), 51.9% did not see a mental health specialist (49.7%, 51.7%, 44.9%, and 91.8%), and 32.4% avoided mental health care due to affordability in the past 12 months (30.2%, 34.0%, 21.1%, and 54.8%). There was substantial unmet need for mental health treatment in all insurance market segments, but especially among individuals without insurance.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961464","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

Oncologic Drug Repository Programs in the United States: A Review and Comparison 美国的肿瘤药物储存库计划：回顾与比较

Health affairs scholar Pub Date : 2024-03-06 DOI: 10.1093/haschl/qxae031

Natalie K Heater, S. Kircher, Christine Weldon, J. Trosman, Al Benson

引用次数: 0

Access to perinatal doula services in Medicaid: a case analysis of 2 states. 在医疗补助中获得围产期陪护服务：对两个州的案例分析。

Health affairs scholar Pub Date : 2024-03-04 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae023

Cara B Safon, Lois McCloskey, Maria Guadalupe Estela, Sarah H Gordon, Megan B Cole, Jack Clark

{"title":"Access to perinatal doula services in Medicaid: a case analysis of 2 states.","authors":"Cara B Safon, Lois McCloskey, Maria Guadalupe Estela, Sarah H Gordon, Megan B Cole, Jack Clark","doi":"10.1093/haschl/qxae023","DOIUrl":"https://doi.org/10.1093/haschl/qxae023","url":null,"abstract":"Doula services support maternal and child health, but few Medicaid programs reimburse for them. Through qualitative interviews with key policy informants (n = 20), this study explored facilitators and barriers to Medicaid reimbursement through perceptions of doula-related policies in 2 states: Oregon, where doula care is reimbursed, and Massachusetts, where reimbursement is pending. Five themes characterize the inclusion of doula services in Medicaid. In Theme 1, stakeholders recognized an imperative to expand access to doula services. Subsequent themes represent complications in accomplishing that imperative. In Theme 2, perceptions that doula services were not valued by health care providers resulted in conflict between doulas and the health care system. In Theme 3, complex billing processes created friction and impeded reimbursement. In Theme 4, internal conflict presented barriers to policymaking. In Theme 5, structural fragmentation between state government and doula communities was prominent in Massachusetts, presenting tensions during policymaking. Informants reported on problems demanding resolution to establish equitable and robust doula care policies. Medicaid coverage of doula services requires ongoing collaboration with doulas, providers, and health care advocates.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10986220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961356","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: Prescription drug monitoring program use by opioid prescribers: a cross-sectional study. 更正：阿片类药物处方者使用处方药监控计划的情况：一项横断面研究。

Health affairs scholar Pub Date : 2024-03-04 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae006

引用次数: 0

Surprise billing in intensive care unit (ICU) hospitalizations. 重症监护室（ICU）住院的突击收费。

Health affairs scholar Pub Date : 2024-02-27 eCollection Date: 2024-03-01 DOI: 10.1093/haschl/qxae025

Sneha Kannan, Zirui Song

{"title":"Surprise billing in intensive care unit (ICU) hospitalizations.","authors":"Sneha Kannan, Zirui Song","doi":"10.1093/haschl/qxae025","DOIUrl":"10.1093/haschl/qxae025","url":null,"abstract":"Intensive care unit (ICU) care is expensive for patients and providers, and utilization and spending on ICU resources have increased. The No Surprises Act, passed in 2022, specifically prohibits balance billing by ICU specialists (intensivists) for emergency and most non-emergency care. The potential economic impact of this remains unclear, given few data exist on the magnitude of balance billing in the ICU. Using the MarketScan Commercial (IBM) database, we studied hospitalizations in which ICU care was provided (\"ICU hospitalizations\") between 2010 and 2019. Hospitalizations were characterized as fully in-network, fully out-of-network, or \"mixed\" (contained both in- and out-of-network services). The share of \"mixed\" hospitalizations among all ICU hospitalizations rose from 26% to 33% over the study period. Over half of these mixed hospitalizations contained out-of-network services specifically delivered within the ICU. Total hospitalization spending averaged $81 047, with ICU spending averaging $15 799. On average, 11% of ICU spending within these hospitalizations was out-of-network. Patients were plausibly balance-billed in approximately one-third of ICU hospitalizations, for thousands of dollars per hospitalization. Given that the No Surprises Act prevents this type of balance billing, the portended revenue loss may lead to changes in provider negotiations with insurers concerning network status and prices, which could affect the care patients receive.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10932732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140133606","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