A Health Podyssey

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Paid sick leave is a benefit many of us take as a given, but almost one-quarter of workers in the United States don't get any paid sick leave at all.

That puts the employee in a very difficult position - reluctant to not go to work even when sick because they can't afford to lose their wages. Other high-income countries mandate sick leave and in 2012 Connecticut became the first state to adopt a sick leave mandate.

Fifteen other states and the District of Columbia have followed suit.

It might not be surprising to learn that paid sick leave mandates reduce the likelihood of people going to work when they're sick. But do these mandates affect the use of emergency room?

Yanlei Ma from the Harvard Pilgrim Health Care Institute joins A Health Podyssey to discusses the relationship between state paid sick leave mandates and emergency department use.

Ma and coauthors published a paper in the August 2022 edition of Health Affairs examining the effect of state-level mandatory sick leave policies on emergency department visits. Listen to learn about the relationship they found.

Order the August 2022 issue of Health Affairs for research on spending, payments, and more.

Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

In the United States we have multiple commercial health insurers, each with their own rules regarding filing and documenting claims for payment.

Medicare and Medicaid have their own rules and both of those programs rely heavily on insurers who impose their own rules. All this adds up to is significant burden on health care providers who rely upon staff and technology to navigate this complex system.

While there are various estimates, all told administrative costs account for at least a few hundred billion dollars of health care spending each year. This figure is much lower in other countries.

Barak Richman from Duke University joins A Health Podyssey to discuss how insurance-related health spending in the United States compares to that in other countries.

Richman and coauthors published a paper in the August issue of Health Affairs comparing administrative spending in five countries with spending in the United States. In the paper, they provide insights for reasons for the differences.

Order the August 2022 issue of Health Affairs.

Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

There are currently an estimated 37.3 Americans living with diabetes, more than a 40 percent increase from a decade ago. Thus, it isn't surprising that efforts to measure and improve the quality of health care focuses a significant amount of attention on diabetes.

Major health care quality datasets all include a number of measures related to the quality of diabetes care. Given the continuing growth in the burden of diabetes, it's appropriate to ask the question: What are we actually getting from measuring the quality of diabetes care as we do it today?

Rozalina McCoy from Mayo Clinic joins A Health Podyssey today to discuss just that very topic.

McCoy and coauthors published a paper in the July 2022 issue of Health Affairs examining diabetes quality measures in the US since the mid-1990s. They recommend some pretty significant changes in how we measure and report on the quality of diabetes care.

McCoy's research was part of a six-paper cluster of research on type 2 diabetes, all of which were published in the July 2022 issue of Health Affairs.

Order the July 2022 issue of Health Affairs for research on type 2 diabetes and more.

Currently, more than 70 percent of our content is freely available - and we'd like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Finding access to mental health services can be challenging in the United States.

The explosion of the demand for services, the inadequate workforce to provide them, and payment levels and methods that don't always support the care people need all contribute to these challenges.

There are also longstanding concerns around access to all types of care for people enrolled in Medicaid, primarily due to low payment rates for services.

If you put those together, it's not surprising that access to mental health services for people on Medicaid poses particular challenges. And since Medicaid is the largest payer for mental health services and treatment in the United States, these are challenges that need to be addressed.

Jane Zhu from Oregon Health and Science University joins A Health Podyssey to discuss access to mental health services for Medicaid enrollees.

Zhu and colleagues published a paper in the July 2022 issue of Health Affairs assessing the prevalence of what they call "phantom providers" in Oregon Medicaid managed care networks. 

These are providers who are listed in network directories but not providing many services to Medicaid patients. They found that a large share of mental health providers listed in these network directories saw four or fewer Medicaid patients in 2018. The shares were largest for specialists and people authorized to prescribe medication.

Order the July 2022 issue of Health Affairs for research on type 2 diabetes and more.

Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Telemedicine burst onto the scene as the nation locked down at the start of the COVID-19 pandemic. Historically, telehealth, or telemedicine, was tightly restricted both by regulation and by payment policy.

But in response to COVID-19's disruption of in-person care, all 50 states and Washington, DC issued temporary waivers that allowed clinicians to administer telehealth care to patients who live in a different state than their provider.

Juan Andino from the University of Michigan joins A Health Podyssey to discuss how interstate telehealth use changed in the face of COVID-19.

Andino and colleagues published a paper in the June 2022 issue of Health Affairs assessing the effect of waivers on interstate telehealth use among Medicare beneficiaries during the COVID-19 pandemic.

They found that while the volume of interstate telehealth use increased in 2020, out of state telehealth use continued to make up only a small share of all outpatient visits and all telehealth visits. They also found some interesting patterns on how interstate telehealth has changed.

Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.

Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

High prices are an enduring feature of the United States health care system. Traditional market forces haven't seemed to bring them down, which leads some to wonder if we need a new approach.

Some may wonder, why not harness the purchasing behavior of consumers who provide downward cost pressure in pretty much every other sector of the economy?

Enter the idea of high-deductible health plans - health insurance with a high deductible which presumably should make consumers more careful with their purchases. 

Sherry Glied from New York University joins A Health Podyssey to discuss the role of high deductible health plans in creating health market efficiencies.

Glied and coauthors published a paper in the June 2022 issue of Health Affairs examining the evolution of high deductible plans and companion health savings accounts, which are tax-favored saving vehicles offered in conjunction with a high deductible plan.

They found that these plans no longer serve their original purpose of encouraging cost consciousness and reducing spending. Instead, they provide regressive tax breaks disproportionally used by higher income people.

Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Listen to Health Affairs Editor-in-Chief Alan Weil interview Andy Slavitt, co-founder of both United States of Care and Town Hall Ventures and former administrator of the Centers for Medicare and Medicaid Services.

Andy is the host of the podcast In The Bubble with Andy Slavitt and recently published the book, "Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response."

Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and Podcasts free for everyone.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

The concepts that underlie hospice were introduced a few centuries ago but, the modern hospice movement began in London in 1967.

In 1982 hospice was added as a Medicare benefit. Today, half of all Medicare decedents enroll in hospice, at a total cost of $20.9 billion to Medicare in 2019.

Hospice has a strong evidence base for improving end-of-life experiences for the recipient and the recipient's family. But there's limited evidence regarding the effects of hospice for people with dementia.

This is a critical knowledge gap given that one in three adults aged 85 and older has dementia.

Krista Harrison from University of California San Francisco joins A Health Podyssey to discuss how well hospice works for people with dementia.

Harrison and coauthors published a paper in the June 2022 issue of Health Affairs assessing the relationship between hospice enrollment and last month of life care quality for Medicare enrollees living with dementia.

They found that hospice-enrolled people living with dementia had higher quality last month of life care than people who are not enrolled in hospice, with quality levels similar to people without dementia.

Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

Recently, there's been dramatic growth in the number of nurse practitioners (NPs) and physician assistants (PAs). The number of NPs has more than tripled in the last decade while the number of PAs has almost doubled.

Yet, due to particular billing practices in Medicare, it can be difficult to know how care these clinicians are providing. That means there's a lot we don't know about access and quality related to this critical part of the health care workforce.

Ateev Mehrotra from Harvard Medical School and Beth Israel Deaconess Medical Center joins A Health Podyssey to discuss how we bill for nurse practitioner and physician assistant services and the implications of those practices.

Mehrotra and colleagues published a paper in the June 2022 issue of Health Affairs examining the prevalence of "indirect billing," where care provided by a PA or NP is billed under the supervising physician.

They found about 11 million instances of Medicare indirect billing in 2010 and 30 million in 2018 and estimate that eliminating indirect billing would have saved Medicare more than $190 million.

Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.

This episode is brought to you by Semafor Healthcare.

Delivered weekly from David Lim, Semafor Healthcare connects the dots between decisions in government, business, and technology to reveal how they impact the future of healthcare. Each edition will provide the analysis you need to understand and stay ahead of a rapidly changing landscape. Subscribe for free.

The United States has the highest rate of incarceration of any country in the world.

Health care for people in jails and prisons is rarely part of mainstream health care and health policy conversations. But people who are incarcerated have significant health needs and a legal right to medical treatment.

In addition, with 10 million people released from jail every year, needs that aren't met while people are incarcerated re-emerge in the community.

While the number of incarcerated people in the United States has started to decline, the share of the incarcerated population that's older has grown, placing additional strain on health system's that are already under a great deal of pressure.

Dr. Rachael Bedard joins A Health Podyssey to discuss the health needs of older people in jail. 

Bedard and coauthors published a paper in the May 2022 issue of Health Affairs assessing the health and health needs of incarcerated older adults in New York City. They found that older incarcerated had greater health vulnerabilities than their younger counterparts. They are also more likely to suffer from serious mental and physical illnesses.

Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.

Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Subscribe to Semafor Healthcare for free.