“no clear standard has emerged on how to implement social risk screening, nor how clinicians can or should use social risk information to adjust patient care or make referrals to community resources. Moreover, some have questioned the benefit of integrating social risk screening into primary care, raising concerns about the additional burden of adding more required data collection to already busy primary care practices and the limited resources available to address identified social risk factors. [..] relying solely on community-level data to understand the social context of an individual patient and/or to guide patient-level interventions poses a risk of ecological … Read More
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“US exceptionalism in maternity care is marked by the lack of midwives as primary providers. Out of 100 births, only 10 to 12 will be attended by a midwife – and 9 out of 10 of these midwives are white. Yet globally, most childbearing women are attended to by midwives, only turning to an obstetrician if serious complications arise. According to WHO and The Lancet, midwives could help avert roughly two-thirds of all maternal and newborn deaths, while providing 87% of all essential sexual, reproductive, and maternal health services. Midwifery is one of the most ancient of traditions and professions … Read More
“A Reuters review of deaths in more than 500 jails found that, from 2016 to 2018, those relying on one of the five leading jail healthcare contractors had higher death rates than facilities where medical services are run by government agencies. The analysis assessed deaths from illness and medical conditions, suicide, and the acute effects of drugs and alcohol. Jails with publicly managed medical services, usually run by the sheriff’s office or local health department, had an average of 12.8 deaths per 10,000 inmates in that time. Jails with healthcare provided by one of the five companies had an additional … Read More
“There is a growing concern that the current patchwork of state medical licensing rules could slow telehealth’s growth and impair the nation’s response to the next pandemic since most states will likely return to their pre-COVID rules as the crisis subsides, experts said. Delaware, Michigan, Wisconsin and Washington, D.C., ended their licensure flexibilities earlier this year. At the same time, Idaho is the only state with concrete plans to allow out-of-state physicians to practice in the state permanently. [..] But it could make sense for the federal government to take the lead on reforming medical licensing since telehealth and pandemic … Read More
“As the country reopens, it’s important to assess how we can be better prepared to stave off such enormous economic losses during the next wave or the next epidemic. In my view, a few key policy changes will be critical. First, expertise on pandemic-related policy and strategy should be located closer to the center of power. I believe that the type of pandemic-preparedness office (the Office of Pandemics and Emerging Threats) that now resides only in the Department of Health and Human Services (HHS) also needs to be reestablished as part of the National Security Council (NSC). [..] Since the … Read More
“In 2017, we find that helicopter air ambulance carriers owned by two private equity firms, who together make up 64% of the Medicare market, had a standardized average charge of $48,250 (7.2 times what Medicare would have paid). This is markedly higher than the $28,800 (4.3 times what Medicare would have paid) standardized average charge for the same service by air ambulance carriers that are not part of a private equity-owned or publicly-traded company. [..] one study found that nearly 80% of helicopter air ambulance transports for commercially-insured patients are out-of-network and that for half of these out-of-network transports, the … Read More
“Today, the Centers for Medicare & Medicaid Services (CMS) released a report showing the trend of lower premiums and increased issuer participation for HealthCare.gov will continue for 2021 year. The average premium for the second lowest cost silver plan (also called the benchmark plan) dropped by 2% for the 2021 coverage year and, when looking at states that are using HealthCare.gov in both 2020 and 2021, 22 more issuers will offer coverage in 2021, for a total of 181 issuers delivering more choice and competition for consumers. [..] Three years of declining average benchmark plan premiums combine to deliver an … Read More
“Managed care is the dominant method for financing and delivering services in the Medicaid program, with more than 71 million individuals (74% of all Medicaid beneficiaries) enrolled in a managed care plan in 2016. Under most managed care arrangements, state Medicaid programs negotiate a prepaid, capitated rate with a managed care plan to provide comprehensive services rather than directly reimbursing health care providers (eg, hospitals, physician groups, and clinics). By transferring financial risk to managed care plans, capitated payments increase predictability in costs for state Medicaid programs and provide an incentive for plans to reduce spending on hospitalization and emergency … Read More
“The Centers for Medicare & Medicaid Services recently announced a voluntary plan to cap out-of-pocket costs associated with insulin products in participating enhanced Part D plans. However, this model will not apply to other high-cost glucose-lowering medications such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. These classes are increasingly used as second-line agents for patients with type 2 diabetes despite only a modest effect on glycemic control (approximately 0.8% to 1%) because of mounting evidence of cardiovascular benefits. We sought to examine contemporary coverage and out-of-pocket costs for beneficiaries filling either an SGLT2 inhibitor … Read More
“we report the two largest insurers’ commercial market shares and Herfindahl-Hirschman Indices (HHIs) for 384 metropolitan statistical areas (MSAs), the 50 states and the District of Columbia. Among the key findings in this year’s update is that, based on the DOJ/FTC Horizontal Merger Guidelines, 74% of MSA-level markets were highly concentrated (HHI>2500). The average market was also highly concentrated, with an HHI of 3473. Other findings are that in 92% of MSA-level markets, at least one insurer had a commercial market share of 30% or greater, and in 48% of markets, a single insurer’s share was at least 50%. We … Read More