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.

When the Institute of Medicine defined health care quality, patient-centeredness was one of the five core dimensions. Yet as many have noted, the health system often seems to be more organized around the needs of providers than patients.

This reality is particularly true when it comes to older Americans. An entire system of coverage and care has built up around institutional needs and institutional definitions - nursing homes, hospitals, assisted living centers, rehabilitation centers, and more.

Christine Ritchie from Massachusetts General Hospital and Harvard Medical School joins A Health Podyssey to discuss what a reimagined health system truly designed around the needs of older patients could look like.

Ritchie and coauthor Bruce Leff of Johns Hopkins University published a commentary in the May 2022 issue of Health Affairs describing the elements of a new home and community-based care ecosystem for older people.

They argue for a system grounded in principles like respect for caregivers and medical and social integration.

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

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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.

When medical offices shut down due to the COVID-19 pandemic and people were encouraged or required to avoid public spaces, there was a dramatic and rapid increase in the use of telemedicine. 

Telemedicine has the potential to open up access to care, particularly to people who are geographically isolated or have mobility limitations, but it can also exacerbate existing inequities given its relevance upon broadband internet access and other technologies.

Caitlin Hicks from Johns Hopkins School of Medicine joins A Health Podyssey to discuss whether telemedicine expands or narrows care inequities.

Hicks and colleagues published a paper in the May 2022 issue of Health Affairs examining the impact of Medicare's pandemic-era telemedicine coverage waiver on utilization by geographic area.

They found that Medicare's telemedicine access expansion increased utilization overall and that those beneficiaries in areas of greater depravation, as measured by the Area Depravation Index, had greater odds of utilization than those who live in areas with more resources.

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

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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 health care sector has gone through various waves of consolidation with hospitals purchasing physician practices and hospitals, physicians, and health insurers merging with each other.

We're in the midst of a wave of consolidation.

Two years ago, Health Affairs published a paper that found more than half of US physicians and 72 percent of surveyed hospitals were affiliated with one of 637 health systems in 2018. More recently, some have estimated that the 10 largest health systems now control about a quarter of the health care market.

Consolidation brings with it various opportunities for savings and efficiency but it also concentrates market power and creates opportunities to raise prices.

Vilsa Curto from Harvard University joins A Health Podyssey to discuss the effects of consolidation and integration.

Curto and colleagues published a paper in the May 2022 issue of Health Affairs assessing trends in vertical integration and joint contracting between physicians and hospitals in Massachusetts and exploring the affects on prices for physician services.

They found notable price affects that varied according to system size and physician type.

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

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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.

More than 40 percent of Medicare enrollees are enrolled in Medicare Advantage (MA) plans, privately-sponsored health plans that provide Medicare benefits often along with other benefits not included in the standard Medicare package such as eye exams, hearing aids, and dental coverage.

Medicare Advantage is growing rapidly. On the current trajectory, it's likely that the majority of Medicare enrollees will be in MA plans within a year or two.

Since MA plans are paid on a capitated basis, insurers have a financial incentive to control health care costs. Recently, much attention has been focused on how addressing social needs can yield health benefits, which save MA plans money.

In order to address those needs, health plans need to know the social needs of their enrollees.

Brian Powers from Humana joins A Health Podyssey to discuss understanding the unmet social needs of Medicare enrollees.

Powers and colleagues published a paper in the April 2022 issue of Health Affairs assessing the health related social needs of enrollees in Humana's MA plans. They found significant needs including financial strain, food and utility insecurity, poor housing quality, and unreliable transportation. These needs were distributed unevenly across enrollees by race, socioeconomic status, and sex.

If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals and more.

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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.

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.

Vaccine requirements have been much in the news lately tied to the COVID-19 pandemic, but disputes over requiring vaccines have been with us for decades.

How to balance respecting individual autonomy with protecting public health is not a new issue. It's played out in particular force when it comes to children.

All states have vaccine requirements for children as they enter school and those requirements are often pretty widely known. Less well known are those requirements related to child care, which can affect children long before they reach school age.

Alexandra Bhatti from Merck joins A Health Podyssey to discuss vaccine requirements for child care in the United States.

Bhatti and coauthors published a paper in the April 2022 issue of Health Affairs assessing child care vaccination requirements in the United States. They found considerable variation across the 50 states and Washington, DC.

While all jurisdictions require children up through age five to meet certain requirements to attend school or child care programs, the states are uneven in their breadth, enforcement, and implementation of these requirements.

If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals 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.

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.

March 23 marked the 12th anniversary of the passage of the Affordable Care Act (ACA).

This landmark legislation expanded health care access to millions of Americans and accelerated changes in how we organize and pay for health care. Having survived numerous legal challenges and strong political opposition by some, it continues to be the centerpiece of domestic health policy.

If you want to understand the evolution of the Affordable Care Act from enactment to today, there's no one better to learn from than Katie Keith of the Georgetown University Law Center.

Keith is a regular contributor to Health Affairs' Following The ACA Forefront article series and the recently launched Health Reform newsletter. Most recently, she's written about the No Surprises Act rules, the Department of Health & Human Services response to anti-trans youth policies, delay of the Sunset Rule, and much more.

Today on A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil and Katie Keith dive into the latest ACA news and explore the law's successes, shortcomings, and unfinished work.

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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.

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.

The United States is facing a drug affordability crisis. 

Even as we celebrate scientific discovery, the health benefits of drugs are limited due to barriers of affordability, often even for people with health insurance. The RAND Corporation reports that on average drug prices in the United States are more than two and a half times those in 32 other nations studied. The disparities are even wider when we focus just on brand name drugs.

Drug pricing is the subject of seemingly perennial debates. One side focuses on access barriers due to high prices while the other side argues that lower prices threaten future innovation. 

Stacie Dusetzina from Vanderbilt University Medical Center joins A Health Podyssey to talk about the complex world of drug pricing.

She and colleagues published a paper in the April 2022 issue of Health Affairs examining the degree to which people with Medicare prescription drug benefits use the drugs that are prescribed to them.

In the paper, the authors found non-initiation rates among some beneficiaries of greater than 50 percent for certain treatments.

If you enjoy this interview, order the April 2022 Health Affairs issue to get research on access to care, hospitals 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.

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.

Cancer diagnosis has changed radically in the era of precision medicine. New techniques like multi-cancer early-detection screening tests can detect up to 50 types of cancer from a single blood draw.

We generally think of early detection, especially of cancer, as an unambiguously good thing. Given that, you might assume and expect that insurers would readily pay for it. But it turns out the considerations regarding insurance coverage for these screening tests are quite complex.

As is often the case, advances in medical technology have accelerated beyond certain policies that were put in place when cancer diagnosis and treatment were very different.

Kathryn Phillips from the University of California San Francisco joins A Health Podyssey to discuss how we can gain the advantages of better cancer screening technologies as they emerge.

Phillips and coauthors published a paper in the March 2022 edition of Health Affairs examining payment considerations for multi-cancer screening tests. They outline clinical and economic considerations that will have to adjust to meet the new reality.

If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.

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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.

Limited access to transportation is well established as a barrier to people obtaining health care services. If it's hard to get to the doctor, you're less likely to go and that means delays getting needed care, poorer management of chronic conditions, and more use of the emergency room.

While health insurance typically covers emergency transportation, say for an ambulance, coverage of non-emergency transportation to get you to a doctor's visit is less common. Medicaid, which serves people with low incomes, has covered this type of transportation for decades, but it's become increasingly clear that plenty of people with incomes above the Medicaid eligibility threshold face significant transportation barriers.

Thus, some insurers and health systems have begun to offer a non-emergency transportation benefit as well.

Seth Berkowitz from the University of North Carolina School of Medicine joins A Health Podyssey to discuss the effect of providing a transportation benefit.

Berkowitz and colleagues published a paper in the March 2022 issue of Health Affairs assessing the effects of a non-medical transportation benefit offered to members of a Medicare accountable care organization.

Enrollees had very positive reactions to the program, but it was also associated with more outpatient visits per person per year and thousands of dollars more in outpatient spending.

If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.

Listen to Health Affairs Pathways.

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's a tremendous amount of consolidation going on in the health care sector. A lot of the research about consolidation focuses on the economics. But, one of the primary arguments people make for bringing disparate parts of the health system together is that it enables clinical integration.

Patients, they say, should get better care if the clinicians are talking to each other and sharing information, which is easier to do if clinicians are a part of the same health care system.

It turns out that studying clinical integration is hard. How do you define it? How do you measure it or having the desired effect?

Hector Rodriguez from University of California Berkeley School of Public Health joins A Health Podyssey to discuss health care consolidation.

Rodriguez and colleagues published a paper in the March 2022 issue of Health Affairs examining the relationship between physician practice capabilities and service metrics, like quality, utilization, and spending.

They found that physician practices with robust capabilities, as defined by technology and innovation, management, culture, and patient-centered care, spent less on Medicare fee-for-service beneficiaries than those practice locations with less robust capabilities and they delivered similar quality care.

If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.

Listen to Health Affairs Pathways.

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

Subscribe to Semafor Healthcare for free.