Addressing Serious Illness Care in Medicare Advantage

“we believe the quality bonus program (QBP), which offers incentives for providing high-quality care in Medicare Advantage, needs critical review and strengthening to improve accountability — steps that will be particularly important to support enrollees with serious illness. The foundation of the QBP is a five-star rating system in which plans are scored on the basis of claims-based performance measures and patient surveys. [..] A decade after the QBP’s implementation in 2012, however, concerns about its accuracy in measuring quality and its ability to drive quality improvement have been persistently documented in academic research and MedPAC reports. The inaccurate reflection … Read More

Structural Racism and Long-term Disparities in Youth Exposure to Firearm Violence

“Exposure to firearm violence is associated with lasting consequences for youth and their loved ones. Indirect exposure (eg, witnessing violence) and direct exposure (eg, surviving an assault) can influence mental and physical health outcomes over the life course. In a subset of individuals, exposure is associated with the future enactment of firearm violence, feeding cycles of firearm violence at the community level. [..] At the same time, efforts must directly target the systemic inequities that concentrate firearm violence exposure among Black and Hispanic youth. Racial and ethnic disparities in these outcomes are profound and longstanding. In the study by Lanfear … Read More

The Problem with Planned Parenthood

“For fifty years, Roe protected providers from legal risks like the ones taken on by the Jane Collective, an underground network of women in Chicago. Collective members arranged more than eleven thousand illegal abortions in the late nineteen-sixties and early seventies, until a team of detectives raided their makeshift clinic and charged them with multiple counts of “conspiracy to commit abortion.” (Just before their cases went to trial, the Supreme Court legalized abortion.) Arguably, providers face greater legal dangers now than they did before Roe. Carole Joffe, a sociologist who has written about the history of abortion, told me that … Read More

How Emergency Department Use in Ontario Can Help Determine the Right Dose of Telehealth

“Commensurate with the rise in telehealth has been a proliferation in publications assessing the cost, experience, efficiency, safety, and unintended consequences of telehealth. Many publications aim to answer the “Goldilocks question”: what is the right amount of telehealth that optimizes its benefits while minimizing potential problems? The right dose of telehealth needs to balance (1) concerns by payers and policy makers that it will increase cost and cause unintended consequences (eg, misdiagnosis or duplicative care) and (2) the desire of its proponents who want to allow clinicians to use it as they see fit, with few restrictions. [..] To date, … Read More

How to battle superbugs with viruses that “eat” them

As antibiotic resistance spreads, bacteriophages could help avert a crisis “Antibiotics are vital to modern medicine. [..] Life expectancy would drop by a third if they did not exist. But after decades of overuse their powers are fading. Some bacteria have evolved resistance, creating a growing army of “superbugs” against which there is no effective treatment. Antimicrobial resistance is expected to kill 10m people a year by 2050, up from around 1m in 2019. [..] Microbiologists have known for decades that disease-causing bacteria can suffer from illnesses of their own. They are susceptible to attack by bacteriophages (“phages” for short): … Read More

The risk of losing health insurance in the United States is large, and remained so after the Affordable Care Act

“Abstract: Health insurance coverage in the United States is highly uncertain. In the post-Affordable Care Act (ACA), pre-COVID United States, we estimate that while 12.5% of individuals under 65 are uninsured at a point in time, twice as many—one in four—are uninsured at some point over a 2-y period. Moreover, the risk of losing insurance remained virtually unchanged with the introduction of the landmark ACA. Risk of insurance loss is particularly high for those with health insurance through Medicaid or private exchanges; they have a 20% chance of losing coverage at some point over a 2-y period, compared to 8.5% … Read More

Patients Lose Access to Free Medicines Amid Spat Between Drugmakers, Health Plans

“Johnson & Johnson, Pfizer and other pharmaceutical companies are scaling back programs that cover the copayments of patients or provide free drugs. The programs have been costing drugmakers billions of dollars a year and have been increasing as health plans seeking to control their own spending have tried to take advantage of the assistance. [..] A spokesman for the trade group America’s Health Insurance Plans said pharmaceutical companies were trying to sidestep cost-control efforts by encouraging patients to take expensive drugs through copay assistance. “The problem isn’t health insurance providers, it’s the price of prescription drugs,” the spokesman said. [..] Health insurers and employers … Read More

Why Americans Feel More Pain

“Tens of millions of Americans are suffering pain. But chronic pain is not just a result of car accidents and workplace injuries but is also linked to troubled childhoods, loneliness, job insecurity and a hundred other pressures on working families. [..] [..] cluster of tightly woven problems that hold back our people and our country: childhood trauma, educational failure, addiction, mental health issues, homelessness, loneliness, family breakdown, unemployment — and, we increasingly recognize, physical pain. “People’s lives are coming apart, and this leads to huge increases in physical pain,” said Angus Deaton, a Nobel Prize winner in economics who with … Read More

Washington passes law requiring consent before companies collect health data

“A new Washington state law will require companies to receive a user’s explicit consent before they can collect, share, or sell their health data. Washington Governor Jay Inslee signed the My Health, My Data bill into law on Thursday, giving users the right to withdraw consent at any time and have their data deleted. The law should help shield users’ health data from the companies and organizations not included under the HIPAA Privacy Rule, which prevents certain medical providers from disclosing “individually identifiable” health information without consent. The HIPAA Privacy Rule doesn’t cover many of the health apps and sites that collect medical data, … Read More

Medicaid Expansion Won’t Stop Rural Hospital Closures

“Since 2014, dozens of hospitals have closed in states that haven’t expanded Medicaid. Yet their stated reasons almost always have nothing to do with Medicaid expansion. Damage from natural disasters, declining business and fraud, among many other factors, have caused hospitals to close. Only four hospitals in non-expansion states directly attributed their closures to a lack of Medicaid expansion. Two of them later were alleged to have engaged in wide-scale fraud and financial mismanagement, casting doubt on their earlier statements. Even more telling is what happened in the nearly 40 states that did expand Medicaid before the start of this … Read More