“VBP [Value-Based Payment] was ushered in by the Affordable Care Act (ACA), but it is best understood as a rebranding of the larger managed care paradigm that took hold during the 1980s. Managed care delegates total-cost containment to insurance companies and large provider groups, tasking these private-sector “risk-bearing entities” to restrict spending. Spearheaded by health maintenance organizations, the rise of managed care promoted now-familiar utilization management tactics, such as prior authorization and narrow provider networks. It also promoted capitation or risk-based payments—what we call VBP today. Unlike FFS [fee-for-service], insurance companies would incentivize providers to manage utilization by making them … Read More
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“The COLONPREV trial—published online in The Lancet—is, therefore, a landmark study. It is the first randomised controlled trial to compare colorectal cancer deaths in people screened with the two most commonly used methods: colonoscopy and faecal immunochemical test (FIT), an antibody-based test for haemoglobin, indicative of blood in the stool. The study finds that invitation to biennial FIT-based screening is non-inferior to invitation to one-time colonoscopy in terms of colorectal cancer mortality at 10 years. These results build on the NordICC trial, published in The New England Journal of Medicine, which showed that invitation to colonoscopy reduced colorectal cancer risk … Read More
“The tobacco and ultra-processed food industries exemplify the detrimental effects of corporate influence on public health. For decades, tobacco companies lobbied aggressively against health regulations, contributing to millions of preventable deaths worldwide. Despite still causing more than 8 million tobacco-related deaths annually, the tobacco industry now claims through its public-relations campaigns and selective science that it focuses on “harm reduction”, particularly by selling new products such as e-cigarettes. These tactics allow the industry to argue that it deserves a seat at the policy table, all while shifting to new types of addictive and harmful products, targeting youth, and continuing to oppose tobacco … Read More
“We compared public-access naloxone strategies using more than 14 000 cases of opioid poisoning in Metro Vancouver over a 6-year period. We found that the 647 take-home naloxone sites were within a 3-minute walk to more than one-third of all opioid poisonings and had high coverage efficiency (Table 2) [the top five location categories for coverage efficiency were: government office, take-home naloxone site, convenience store, retail store and pharmacy]. In addition to existing operations that distribute take-home naloxone kits, which are likely taken elsewhere, take-home naloxone site locations appear generally well-aligned with where opioid poisonings occur, so they are also … Read More
“Despite the convenience and value of telehealth, many states have rolled back COVID-19 pandemic–era flexibilities and reimposed strict licensure requirements for telemedicine. Thus, as it was prepandemic, so it is again that a physician, duly licensed in their home state, is prohibited from consulting or following up with an out-of-state patient via video or phone unless they are also licensed in the patient’s state. Penalties for doing so without that license can amount to tens of thousands of dollars in fines and potential imprisonment. Despite growing pressure to respond to patient preferences and widespread evidence of the benefits of interstate … Read More
“An estimated 80% of physicians are now employed by hospitals, health systems, and corporations. Many factors have contributed to this shift away from independent practices, including rising administrative burdens, changing employment preferences, greater capital demands for health information technology, and favorable financial incentives (eg, site-differential payments). However, underappreciated among these factors is another important accelerant of corporate consolidation: the shift from fee-for-service to value-based payment models. [..] Evidence suggests that, on average, they [independent practices directly owned by clinicians] exhibit lower per-patient spending, fewer preventable admissions, and lower readmissions compared with their hospital-owned counterparts. [..] However, independent practices are often … Read More
“The basic benefits package of Medicare — replete with deductibles and coinsurance — long ago began falling short of the promise of financial protection as articulated by President Lyndon Johnson in 1965. In 2019, out-of-pocket spending in traditional Medicare averaged $7,053 among all seniors and $12,315 in the top decile, which was equal to 25% of seniors’ mean after-tax income and to 69% of retirees’ mean Social Security income. [..] Over time, Medicare Advantage has evolved into a conduit for financing coverage expansion that is arguably overdue. Enrollees enjoy substantially lower premiums for supplemental and prescription drug coverage than they … Read More
“Why would more screening in both Black and white Americans reduce the mortality disparity between the two groups? What’s more, cancer screening actually stands out for its lack of racial disparity. The proportion of Black and white women having mammograms has been virtually identical for the past three decades (in fact, Black women currently have the test at slightly higher rates). Yet deaths from breast cancer are about one-third higher in Black women. For the past two decades, a similar pattern has been seen in colorectal cancer screening — equal rates among Black and white Americans — yet colorectal cancer … Read More
“Landeiro and colleagues computed the economic burden of four diseases (cancer, coronary heart disease [CHD], dementia, and stroke) in England using consistent methodology and a broad definition of disease burden. This analysis is an important advance that will allow policy makers, researchers, and other stakeholders to assess the absolute and relative burden of these diseases in a meaningful way. The Global Burden of Disease also uses a consistent methodology for estimating the burden of many diseases across countries. However, its methodology focuses only on mortality and morbidity, which are evaluated comprehensively, but does not account for many other costs included … Read More
“As artificial intelligence (AI) tools become more consistently used in health care, federal agencies, health care facilities, medical societies, and other stakeholders are grappling with how to ensure they do not introduce unintended patient harm. [..] Regardless of approach, a well-designed one could improve safety, promote patient and health care professional confidence in AI use, and incentivize developers and users to focus on these important issues. Developing a testing and certification approach that is effective, rigorous, and rapid and that is a shared responsibility of both developers and users is necessary to meet the needs of multiple stakeholders. The Office … Read More