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.

Nursing homes are challenging places to work. As David Grabowski, a professor of health care policy at Harvard Medical School, notes in today's episode of A Health Podyssey, "we knew the nursing home system was broken before the COVID-19 pandemic."

Grabowski recently co-authored two papers in the March 2021 edition of Health Affairs on the topic of nursing home staffing using a new Medicare data set (Payroll Based Journal) that spanned 2017-2019 and is a game changer for measuring quality. One article noted that Medicare's new patient-driven payment model resulted in reductions in therapy staffing in skilled nursing facilities. A second found that mean annual nursing staff turnover rate was an eye-popping 128 percent. 

Post-pandemic, the implications of a nursing home's high staffing turnover rate is clear: it could lead to health and safety risks for residents.

David Grabowski joins Health Affairs Editor-in-Chief Alan Weil on today's episode to discuss his research, its implications, and why nursing home staff relationships with residents matter. He also delves into the complex ownership structures and the need for greater transparency and accountability in nursing homes.

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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.

Medical training has historically focused almost exclusively on the skills and actions of individual physicians. Increasingly, clinical training is incorporating an understanding of how team-based care affects patient outcomes.

For patients with chronic disease such as diabetes, hypertension and high cholesterol, can teams provide better care?

Maximilian Pany and Lucy Chen, both MD-PhD candidates in health policy at Harvard Medical School, and coauthors recently published research on that very question in the March 2021 edition of Health Affairs. They found that provider teams outperformed solo providers in managing chronic diseases.

Both Maximilian Pany and Lucy Chen join Alan Weil on A Health Podyssey to discuss their research, team-based care, and how team composition and scope-of-practice fit into their findings. 

Listen to find out more. 

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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 COVID-19 pandemic has prompted an increase in telehealth utilization. Since that growth, researchers have made calls to ensure that telehealth's subsequent growth does not exacerbate disparities in care.

Evidence of the “digital divide,” or differences in the technology or skills needed to access telehealth care, is widely documented. Race, age, geography, health coverage, and more can all impact how and if one adopts and uses telehealth services. English language proficiency is one factor closely connected to telemedicine use, even before the COVID-19 pandemic began.

Jorge Rodriguez, an instructor of medicine at Brigham and Women's Hospital and Harvard Medical School, and colleagues recently published research in the March 2021 edition of Health Affairs on telehealth use among patients with limited English proficiency using data from 2015-2018. They found that patients with limited English proficiency had lower rates of telehealth use when compared to proficient English speakers and argue that policy makers must focus on limited English proficiency as an important factor to promote telehealth equity and mitigate the digital divide.

On this episode of A Health Podyssey, Alan Weil interviews Jorge Rodriguez on telehealth utilization for patients with limited English proficiency, the digital divide, and how technology equity feeds into health equity initiatives.

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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.

Bundled payments have long been an experiment in the Medicare program to help reduce health care spending. The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services broad authority to test bundled payments, or paying providers for episodes of care instead of for each service provided.

Research has found savings associated with participating in the Bundled Payment for Care Improvement (BPCI) initiative. While there have been encouraging results, Medicare has experienced net losses under BPCI when taking reconciliation payments into account.

However, some alternative payment models have seen significant savings. There's still much to learn as the new iteration of BPCI — BCPI Advanced — continues.

For example, Christopher Whaley, a policy researcher at the RAND Corporation, and coauthors recently published research in the March 2021 issue as part of the Health Affairs Considering Health Spending series. They found a bundled payment program developed by Carrum Health for orthopedic and surgical procedures in a commercially-insured population led to significant price reductions of more than 10%, or more than $4,000 per procedure, with employers capturing approximately 85% of the savings.

In this episode of A Health Podyssey, listen to Alan Weil interview Christopher Whaley on bundled payments, the promise of direct payments in the commercial market, and whether alternative payments can become a mainstream payment model.

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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 COVID-19 pandemic caused an enormous wave of disruption to the U.S. economy, leading the unemployment rate to rise to a record high of 14.7% in April 2020.

While unemployment has since improved — the unemployment rate in January 2021 was 6.3% — America has yet to reach the employment levels it held before the pandemic.

In response to so many out of work, the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March 2020 expanded eligibility for unemployment benefits. Within that legislative package, the Federal Pandemic Unemployment Compensation (FPUC) increased the amount of money people could receive through such programs.

FPUC expired for the first time in July 2020, leading to insurance beneficiaries receiving smaller benefits.

Employment and job security is a known social determinant of health and the relationship to suddenly losing a job and a person's health isn't yet widely understood. To study the how FPUC may have affected unmet health-related social needs, Seth Berkowitz from the University of North Carolina at Chapel Hill and Sanjay Basu from Harvard Medical School examined these needs and mental health among unemployment insurance beneficiaries before and after the initial expiration of FPUC.

Published in the March 2021 edition of Health Affairs, Berkowitz and Basu's research found that the initial FPUC expiration was associated with a 10-percentage-point increase in risk for self-reported missed housing payments. In addition, risk for food insufficiency as well as depression and anxiety symptoms increased among households receiving unemployment insurance benefits.

Seth Berkowitz joins Editor-in-Chief Alan Weil on A Health Podyssey to discuss his research, the potential health impact of unemployment insurance, the changing nature of work in the U.S., and how direct payments programs — such as universal basic income — could compliment social safety nets.

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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 no doubt that the COVID-19 pandemic spurred an increase in telemedicine use. As Americans were reluctant to venture out of their homes in the pandemic's early months, both public and private payers were quick to change telehealth reimbursement policies as admissions plummeted.

According to new research published in the February edition of Health Affairs, 30.1% of all outpatient visits were provided via telemedicine from January 2020 to June 2020. The weekly number of telemedicine visits rose by a 23-fold increase during the same time period.

Prior to 2020, telehealth hadn't yet become a mainstream avenue of care despite the technology being in place for at least a decade. As COVID-19 vaccines are deployed and mutations spread, a question remains whether telemedicine will finally become a popular care delivery option.

On this episode of A Health Podyssey, Alan Weil interviews Dr. Michael Barnett, from the T.H. Chan School of Public Health, and Dr. Sadiq Patel, from Harvard Medical School, on their research published in Health Affairs, how specialty care providers are adopting telemedicine, the speed of their research, and where the telemedicine field may be heading.

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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.

"Quite honestly, it is not easy to be a nerd on the reservation." - Dr. Donald Warne

Pathways are not predetermined in life. But, without readily available role models to point to, it can be difficult for young people to know what options may be available as they advance toward adulthood.

Currently, there's a shortage of health care providers for Indigenous populations, which have been linked to limited access to care and higher rates of chronic health conditions. As native physicians are more likely than non-native physicians to serve these populations, increasing the number of native physicians is a critical strategy for improving access for this population.

At the University of North Dakota, role-modeling is a key component to increase interest and build the next generation of American Indian physicians. Currently, American Indian or Alaskan native students make up about 1% of medical school students nationwide. At the University of North Dakota's medical school, 1 in 10 students came from Indigenous background, the highest ratio in the country.

Since 1973, the Indians Into Medicine program has graduated over 250 American Indian and Alaskan Native physicians. It's a growing presence in the health profession and the subject of a Leading to Health article published in the February 2021 edition of Health Affairs.

On A Health Podyssey, Alan Weil speaks with Dr. Donald Warne, a professor and director of the Indians Into Medicine program at the University of North Dakota and a member of the Oglala Lakota tribe, to discuss the shortage of health care providers for American Indians and Indigenous populations and how the program helps create an interest in medicine at an early age for American Indians.

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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 February 2021 edition, Health Affairs presented a collection of papers from the National Academy of Medicine (NAM) for their Vital Directions for Health and Health Care project.

While originally established in 2016, NAM reassessed its priorities and found a vastly different health care landscape in 2020. Not only had the COVID-19 pandemic ripped through the health care ecosystem nationwide, but issues regarding maternal health, mental health, and elder care surfaced as pressing concerns. And, as always, health costs and financing was flagged for appraisal.

But, as Dr. Victor Dzau, president of the National Academy of Medicine, and colleagues note in their opening commentary, health equity was present throughout every priority.

The collection of commentaries from NAM sets forth health and health care priorities for 2021 and the new Biden administration. Vital Directions for Health and Health Care: Priorities For 2021 identifies the overarching theme of this series as the clear and urgent obligation for the US to turn its full attention to the growing problem of health inequities and to the structural racism that perpetuates health disparities.

On this episode of A Health Podyssey, listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Victor Dzau on the new Vital Directions publication, why health equity is fundamental for shaping health system reform, and how converging science disciplines will shape the field of health and medicine.

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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 opioid epidemic has ravaged American life.

It has claimed more than 750,000 lives as a result of a drug overdose since 1999. In 2018 alone, more than 2 million people had an opioid use disorder and more than 800,000 people used heroin.

To alleviate these deaths of despair and get people the treatment they need, many individuals are looking to short-term residential facilities for substance use treatment programs, commonly referred to as rehabilitation, or rehab.

But, as a paper in the 2021 February issue of Health Affairs notes, recruitment practices and cost of care at these facilities can raise concerns. The authors found most programs required up-front payments, with for-profit programs charging more than twice as much as nonprofits.

Listen to Alan Weil interview Tamara Beetham, a PhD student in health policy and management at the Yale School of Medicine and lead author of the paper.

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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.

Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That's certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.

As Gaffney and co-authors note in their paper, "focusing only on the impact of health care reform on government expenditures is short-sighted." On the supply side, there's a natural limit to doctor and nurses' time as well as the number of hospital beds in a given facility.

Their analysis suggest that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.

On this episode of A Health Podyssey, Alan Weil and Adam Gaffney take listeners through health reform economics 101 before sharing the implications of the paper, ultimately questioning whether health reform is too focused on a demand-side framework.

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