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Advance care planning is a term used to describe when a person prepares for future management of serious or terminal illness, including developing an advance care directive or what is sometimes is called a living will.

Beginning in January of 2016, Medicare made it possible for certain clinicians to bill for their work for patients to develop advance care plans.

Despite the new billing option, uptake has been quite slow.

In health care, we often use financial incentives to motivate behavior change. You might have expected that simply creating a payment option for advance care planning would make it happen.

Keren Ladin from Tufts University joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the reasons Medicare's payment policy has not led to the greater pursuit of advance care planning.

Ladin and coauthors published a paper in the January 2022 issue of Health Affairs examining the limited use of advance care planning billing codes among clinicians. Their qualitative study revealed a number of potential explanations for low use that can help us  understand why a seemingly simple payment change doesn't automatically yield a desired result.

Barriers to use of the advance care planning billing codes include institutional practices, concerns about the effects on patients and more.

If you enjoy this interview, order the January 2022 Health Affairs issue.

Pre-order the February 2022 Racism and Health issue.

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"Let us hope that this is a one in a hundred years pandemic. We don't want to build our health care system to operate at all times as if tomorrow will be COVID." - Sherry Glied

On December 15, Health Affairs published ahead-of-print, “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic,” the annual national health expenditures article prepared by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary. Always one of Health Affairs’ most-read articles, this year’s provides the first official report on spending that reflects the effects of COVID-19. 

During a live Lunch and Learn event, a discussion was held on the findings with economists Sherry Glied from the Robert F. Wagner Graduate School of Public Service at New York University and Craig Garthwaite from Northwestern University’s Kellogg School of Management. 

The event was held on January 5, 2022.

Listen to Health Affairs Senior Editor Laura Tollen interview Sherry Glied and Craig Garthwaite about what's behind the numbers regarding the latest national health care spending report, long COVID, health care spending reform, which hospitals gained the most during the pandemic, delayed care, and more. 

Lunch and Learn events hosts top researchers and analysts on timely topics and initiatives impacting health policy. Interested in attending future events? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events.

If you enjoy this interview, order the January 2022 Health Affairs issue.

Pre-order the February 2022 Racism and Health issue.

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When you think of the health care workforce, nurses and physicians are probably the first professions which come to mind.

But there are actually more personal care aides in the US than physicians. Together with home health aides and nursing assistants, personal care aides comprise one-fifth of the US health care workforce. These workers provide essential supports to people who face limitations in basic activities such as eating, bathing, and moving around.

As the US population ages, the demand for home health and personal care aides is projected to increase by nearly 1.2 million additional jobs by 2030.

Esther Friedman from the University of Michigan joins A Health Podyssey to discuss the changing size in employment in the personal care workforce.

Friedman and colleagues published a paper in the December 2021 edition of Health Affairs investigating state level changes in the nursing home and home care workforce between 2009 and 2020. While almost all states experienced an increase in the overall size of their home care workforce, most saw a decrease in their nursing home workforce relative to the number of people who need these services.

If you enjoy this interview, order the December 2021 Health Affairs issue.

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The availability of pharmacist-administered vaccination has grown in recent decades. Proximity to a pharmacy has found to be predictive of vaccine use.

In Florida, Publix grocery stores were the first retail pharmacies to provide COVID-19 vaccinations to eligible members of the public. For more than a month after the initial rollout, Publix remained the sole retail pharmacy authorized to administer COVID-19 vaccines.

Grocery stores seem like a natural place to reach a large share of the population, but grocery stores are not located evenly throughout communities.

Jennifer Attonito, an instructor of health administration from Florida Atlantic University, joins A Health Podyssey to discuss disparities in access to COVID-19 vaccines during the initial vaccine rollout in Florida.

Attonito and co-authors published a paper in the December 2021 issue of Health Affairs that analyzed the locations of Publix stores in Florida. They found that the Publix locations don't always line up with where the needs are greatest.

Listen to Health Affairs Editor-in-Chief Alan Weil interview Jennifer Attonito on her research, its implications in the context of broader vaccine disparities, and health equity.

If you enjoyed this interview, order the December 2021 Health Affairs issue.

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This episode originally aired on November 10, 2020.

The U.S. health policy community recognizes that fee-for-service models incentivize physicians and health systems to perform more tasks than may be needed. And, these models can contribute to industry fragmentation as organizations chase revenue.

But is fee-for-service really the smoking gun when it comes to the high levels of U.S. health care spending?

The answer is, unsurprisingly, complicated.

To discuss, Health Affairs Editor-in-Chief Alan Weil interviews Dr. Michael K. Gusmano, professor at the Rutgers School of Public Health and research scholar at The Hastings Center, to examine how physician payments are set in France, Germany, and Japan. These countries all employ fee-for-service models but pay less than the U.S. when it comes to health spending.

What can the U.S. learn from these countries? Is policy importation even possible?

Alan Weil and Dr. Gusmano explore these questions and more on A Health Podyssey.

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Medical advances have enabled many people to be cared for appropriately in an outpatient setting rather than being admitted to a hospital.

Yet, since Medicare payment rates are generally lower for outpatient visits than inpatient hospital stays, hospitals have a financial incentive to admit patients.

Observing what were believed to be inappropriate admissions, in 2013 Medicare adopted the "two-midnight rule" stating that hospitals would only be paid inpatient rates if the patient was expected to stay in the hospital over two nights. The rule was controversial, but data show that it changed hospital visit behavior.

The two-midnight rule is part of a larger effort to ensure appropriate payments within Medicare.

Sabrina Poon from the Vanderbilt University Medical Center joins A Health Podyssey to discuss the effects of the rule and whether or not it obtained its objective.

Poon and colleagues published a paper in the November 2021 issue of Health Affairs investigating how the two-midnight rule affected inpatient admissions and outpatient observation stays.

They conclude that the shift from inpatient to observation stays is directly associated with adoption of the rule, the change occurred quickly after the rule was implemented, and it had different affects for patients with more chronic conditions.

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When we launched A Health Podyssey in 2020, our goal was to take listeners beyond the research published in Health Affairs.

For A Health Podyssey's one-year anniversary, we wanted to take listeners on an Excursion and speak with someone who epitomizes so much of what brings professionals into the fields of health policy and health services.
  
Ashish Jha from the Brown University School of Public Health is a widely published researcher whose public voice arises from a combination of deep expertise and a unique ability to explain complex concepts in an accessible language. Over the course of the COVID-19 pandemic, Jha's insights on the virus have helped many navigate thorny, complicated public health issues.

Jha's most recent publication in Health Affairs was a commentary article where he and coauthors discussed adding a climate lens to health policy discussion in the U.S. Before joining Brown University, he was at the Harvard T. H. Chan School of Public Health.

Today, Ashish Jha joins Health Affairs' Editor-in-Chief Alan Weil to discuss what he's learned from the COVID-19 pandemic, the bright spots he sees for health care payment reform, and how he uses social media.

This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.

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With about 700 pregnancy-related deaths every year, the United States has the worst maternal mortality rates among developed countries.

One response to this crisis has been the creation of state and local maternal mortality review committees (MMRCs), which are multidisciplinary committees that examine the context in which maternal deaths occur.

The October 2021 issue of Health Affairs is focused on the topic of perinatal mental health. MMRC reports provide a treasure trove of information that can help us understand the role perinatal mental health plays in maternal mortality and what it might take to achieve better results.

Susanna Trost, an Oak Ridge Institute for Science and Education Fellow at the Centers for Disease Control and Prevention, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss addressing perinatal mental health as a factor in maternal mortality.

Trost and co-authors published a paper in the October 2021 issue of Health Affairs analyzing data from 14 state and local MMRCs regarding pregnancy-related maternal death. Studying these determinations from 2008 to 2017, they identified the characteristics of, and factors contributing to, pregnancy-related deaths caused by mental health conditions, including substance use disorder.

They found that mental health conditions are the underlying cause of nearly one-in-nine pregnancy-related deaths, all of which were considered preventable by MMRCs.

This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Postpartum depression is a common condition among people who give birth. Within four weeks of childbirth, 13% of women experience postpartum depression with as many as 19% of women affected three months postpartum.

Mothers who experienced postpartum depression are more likely to experience impaired mother-infant bonding, which has been linked to increased risk for infant maltreatment and socio-emotional behavior and cognitive problems.

Now, acute stress during pregnancy can increase the risk of postpartum depression. The current global COVID-19 pandemic represents a stressor that may have significant repercussions for postpartum depression risk and mother-child relationship development.

Sara Kornfield, assistant professor of psychiatry at the University of Pennsylvania, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the relationship between COVID-19, postpartum depression, and mother-infant bonding.

Kornfield and coauthors recently published a paper in the October 2021 issue of Health Affairs - which is dedicated to the topic of perinatal mental health - about mental health and resilience among women who were pregnant during the early lockdown phase of the COVID-19 pandemic. Their analysis suggests prenatal depression is an important risk factor that predicts postpartum depression and uniquely contributes to impaired mother-infant bonding.  

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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Systems of oppression like racism, sexism, and classism lead to poor health outcomes. These factors are a source of poor mental health and have particular implications for pregnant and birthing people.

Black women who face multiple axes of oppression experience higher rates of maternal mental health conditions than the population as a whole. Yet maternal mental health issues among black women are under reported and often under addressed.

Isabel Morgan, director of the Birth Equity Research Scholars Program at the National Birth Equity Collaborative, joins A Health Podyssey to discuss the effects of structural racism on black birthing people's mental health and how we can do better.

Morgan and coauthors published a paper in the October 2021 issue of Health Affairs - which is dedicated to the topic of perinatal mental health - describing what they call pathways to equitable and anti-racist maternal mental health care. Through interviews with black maternal and infant mental health individuals, they identify five key pathways.

Listen to Health Affairs Editor-in-Chief Alan Weil discuss those pathways with Isabel Morgan and other opportunities to improve maternal mental health issues among black women.

If you like this interview, order the October Perinatal Mental Health Theme Issue.

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