7,991 results match your criteria Health affairs Project Hope[Journal]


The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care.

Health Aff (Millwood) 2019 Apr 24:101377hlthaff201805233. Epub 2019 Apr 24.

David C. Grabowski is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts.

As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care-including assisted living and independent living communities-has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Read More

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http://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05233
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http://dx.doi.org/10.1377/hlthaff.2018.05233DOI Listing
April 2019
2 Reads

Challenges For Middle-Income Elders In An Aging Society.

Authors:
John W Rowe

Health Aff (Millwood) 2019 Apr 24:101377hlthaff201900095. Epub 2019 Apr 24.

John W. Rowe ( ) is a professor in the Department of Health Policy and Management, Mailman School of Public Health, Columbia University, in New York City.

The United States is becoming an "aging society," in which the number of people older than age sixty exceeds the number of those younger than age fifteen. This transformation has major implications for many aspects of American life. The fundamental challenge relates to our core societal institutions-education, work and retirement, health care, housing, and the like-which were not designed to support a population with our future age distribution. Read More

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http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00095
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http://dx.doi.org/10.1377/hlthaff.2019.00095DOI Listing
April 2019
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What Can Be Done To Better Support Older Adults To Age Successfully In Their Homes And Communities?

Health Aff (Millwood) 2019 Apr 24:101377hlthaff201900203. Epub 2019 Apr 24.

Jennifer H. Molinsky is a senior research associate in the Joint Center for Housing Studies of Harvard University.

The rapid growth of the US population ages seventy-five and older in the coming years will increase the need for housing that accommodates mobility limitations and helps connect residents with supportive services and opportunities for socialization. While expanding the supply of housing with services such as those provided by independent and assisted living facilities is needed, so too are greater supports to allow older adults with disabilities to age successfully in their homes and communities. These include financial support for modifications to the home, the delivery of supportive services in the home by both family and paid caregivers, and the expansion of housing options in communities where older adults live. Read More

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http://dx.doi.org/10.1377/hlthaff.2019.00203DOI Listing

Adjusted Mortality Rates Are Lower For Medicare Advantage Than Traditional Medicare, But The Rates Converge Over Time.

Health Aff (Millwood) 2019 Apr;38(4):554-560

Bruce E. Landon is a professor in the Departments of Health Care Policy and of Medicine and a faculty member in the Center for Primary Care, all at Harvard Medical School.

Overall mortality rates, adjusted for age, sex, and Medicaid status, in Medicare Advantage have been below those in traditional Medicare for many years. Much attention has been paid to the resulting issue of favorable selection in Medicare Advantage. The common study design used to estimate causal effects of Medicare Advantage on utilization and outcomes compares new Medicare Advantage beneficiaries immediately before and after enrollment in Medicare Advantage with beneficiaries who choose to remain in traditional Medicare. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05390DOI Listing
April 2019
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Physicians, Medicare, And More.

Authors:
Alan R Weil

Health Aff (Millwood) 2019 Apr;38(4):519

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http://dx.doi.org/10.1377/hlthaff.2019.00368DOI Listing
April 2019
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An Education In Meeting Patients Where They Live.

Authors:
T R Goldman

Health Aff (Millwood) 2019 Apr;38(4):520-525

This article is part of a series on transforming health systems published with support from The Robert Wood Johnson Foundation. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt, and build upon this work, for commercial use, provided the original work is properly cited. See https://creativecommons.org/licenses/by/4.0/ . T. R. Goldman ( ) is a Washington, D.C.-based freelance journalist.

In Richmond, Virginia, an interprofessional group of health care students and faculty members is helping seniors solve problems early. Read More

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http://dx.doi.org/10.1377/hlthaff.2019.00225DOI Listing
April 2019
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Patient Safety As A Priority: The Authors Reply.

Health Aff (Millwood) 2019 Apr;38(4):693

Michael E. DeBakey VA Medical Center Houston, Texas.

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http://dx.doi.org/10.1377/hlthaff.2019.00163DOI Listing
April 2019
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Patient Safety And Other Priorities.

Health Aff (Millwood) 2019 Apr;38(4):693

Technion-Israel Institute of Technology Haifa, Israel.

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http://dx.doi.org/10.1377/hlthaff.2019.00121DOI Listing

Abuse-Deterrent OxyContin And Hepatitis C.

Authors:
Marcelo E Bigal

Health Aff (Millwood) 2019 Apr;38(4):696

Purdue Pharma Stamford, Connecticut.

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http://dx.doi.org/10.1377/hlthaff.2019.00187DOI Listing
April 2019
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US Spending On Health Care.

Health Aff (Millwood) 2019 Apr;38(4):695

University of Witwatersrand Johannesburg, South Africa.

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http://dx.doi.org/10.1377/hlthaff.2019.00044DOI Listing
April 2019
27 Reads

Effects Of Alternative Food Voucher Delivery Strategies On Nutrition Among Low-Income Adults.

Health Aff (Millwood) 2019 Apr;38(4):577-584

Hilary K. Seligman is an associate professor of medicine at UCSF.

Nutrition assistance programs are the subject of ongoing policy debates. Two proposals remain uninformed by existing evidence: whether restricting benefits to allow only fruit and vegetable purchases improves overall dietary intake, and whether more frequent distribution of benefits (weekly versus monthly) induces more fruit and vegetable consumption and less purchasing of calorie-dense foods. In a community-based trial, we randomly assigned participants to receive food vouchers that differed in what foods could be purchased (fruit and vegetables only or any foods) and in distribution schedule (in weekly or monthly installments, holding total monthly value constant). Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05405DOI Listing
April 2019
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Measuring The Lifetime Costs Of Serious Mental Illness And The Mitigating Effects Of Educational Attainment.

Health Aff (Millwood) 2019 Apr;38(4):652-659

Dana P. Goldman is the Leonard D. Schaeffer Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics in the Sol Price School of Public Policy and School of Pharmacy, USC.

Serious mental illness (SMI) is a disabling condition that develops early in life and imposes substantial economic burden. There is a growing belief that early intervention for SMI has lifelong benefits for patients. However, assessing the cost-effectiveness of early intervention efforts is hampered by a lack of evidence on the long-term benefits. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05246DOI Listing
April 2019
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Maryland's Experiment With Capitated Payments For Rural Hospitals: Large Reductions In Hospital-Based Care.

Health Aff (Millwood) 2019 Apr;38(4):594-603

Bernard Black is the Nicholas J. Chabraja Professor at the Pritzer School of Law and Kellogg School of Management, Northwestern University, in Evanston, Illinois.

In 2010 Maryland replaced fee-for-service payment for some rural hospitals with "global budgets" for hospital-provided services called Total Patient Revenue (TPR). A principal goal was to incentivize hospitals to manage resources efficiently. Using a difference-in-differences design, we compared eight TPR hospitals to seven similar non-TPR Maryland hospitals to estimate how TPR affected hospital-provided services. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05366DOI Listing

Medicare's Bundled Payments For Care Improvement Initiative Maintained Quality Of Care For Vulnerable Patients.

Health Aff (Millwood) 2019 Apr;38(4):561-568

Laura A. Dummit is a vice president of the Lewin Group.

The Bundled Payments for Care Improvement (BPCI) initiative established four models to test whether linking payments for an episode of care could reduce Medicare payments while maintaining or improving quality. Evaluations concluded that model 2, the largest, generally lowered payments without reducing quality for the average beneficiary, but these global results could mask adverse findings among vulnerable subpopulations. We analyzed changes in emergency department visits, unplanned hospital readmissions, and all-cause mortality within ninety days of hospital discharge among beneficiaries with one or more of three vulnerable characteristics-dementia, dual eligibility for Medicare and Medicaid, and recent institutional care-in 105,458 beneficiary episodes in the period October 2013-December 2016. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05146DOI Listing
April 2019
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Primary Care Physician Networks In Medicare Advantage.

Health Aff (Millwood) 2019 Apr;38(4):537-544

Austin Frakt is director of the Partnered Evidence-Based Policy Resource Center at the Veterans Affairs (VA) Boston Healthcare System; an associate professor in the Boston University School of Public Health; and an adjunct associate professor at the Harvard T. H. Chan School of Public Health, all in Boston.

Medicare Advantage (MA) plans often establish restrictive networks of covered providers. Some policy makers have raised concerns that networks may have become excessively restrictive over time, potentially interfering with patients' access to providers. Because of data limitations, little is known about the breadth of MA networks. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05501DOI Listing
April 2019
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Medication And Substance Abuse: The Authors Reply.

Health Aff (Millwood) 2019 Apr;38(4):695

Columbia University New York, New York.

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http://dx.doi.org/10.1377/hlthaff.2019.00168DOI Listing
April 2019
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Plan Choice And Affordability In The Individual And Small-Group Markets: Policy And Performance-Past And Present.

Health Aff (Millwood) 2019 Apr;38(4):675-683

Coleman Drake is an assistant professor in the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, in Pennsylvania.

The individual and small-group health insurance markets have experienced considerable changes since the passage of the Affordable Care Act in 2010, affecting access, choice, and affordability for enrollees in these markets. We examined how health plan access, choice, and affordability varied between the individual on-Marketplace, individual off-Marketplace, and small-group markets in 2018. We found relatively similar outcomes across the three markets with respect to deductibles and out-of-pocket spending maximums. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05401DOI Listing
April 2019
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The Affordable Care Act In The Heart Of The Opioid Crisis: Evidence From West Virginia.

Health Aff (Millwood) 2019 Apr;38(4):633-642

Colleen L. Barry is the Fred and Julie Soper Professor and chair of the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health.

West Virginia is at the epicenter of a national opioid crisis, with a 2016 fatal opioid overdose rate of 43.4 per 100,000 population-more than triple the US average. We used claims data for 2014-16 to examine trends in treatment for opioid use disorder (OUD) among people enrolled in the West Virginia Medicaid expansion program under the Affordable Care Act. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05049DOI Listing
April 2019
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Medical Cannabis And Pain: The Authors Reply.

Health Aff (Millwood) 2019 Apr;38(4):694

University of Michigan Ann Arbor, Michigan.

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http://dx.doi.org/10.1377/hlthaff.2019.00183DOI Listing
April 2019
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Knowledge Of Practicing Physicians About Their Legal Obligations When Caring For Patients With Disability.

Health Aff (Millwood) 2019 Apr;38(4):545-553

Lisa I. Iezzoni ( ) is a professor of medicine in the Department of Medicine, Harvard Medical School, and based at the Mongan Institute Health Policy Center, Massachusetts General Hospital.

Disability civil rights laws require equitable treatment of the approximately sixty-one million Americans with disability. However, federal reports and numerous research studies indicate that this diverse and growing population often experiences health care disparities. To examine one possible contributing factor, we interviewed practicing physicians to explore their knowledge of their obligations to accommodate patients with disability under federal civil rights law. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05060DOI Listing
April 2019
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US Spending On Health Care: The Authors Reply.

Health Aff (Millwood) 2019 Apr;38(4):696

American University of Armenia Yerevan, Armenia.

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http://dx.doi.org/10.1377/hlthaff.2019.00139DOI Listing

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities.

Health Aff (Millwood) 2019 Apr;38(4):528-536

Robert Burke is core investigator at the Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Affairs Medical Center, in Philadelphia, and an assistant professor of medicine in the Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania.

Although approximately one in five Medicare beneficiaries are discharged from hospital acute care to postacute care at skilled nursing facilities (SNFs), little is known about access to timely medical care for these patients after they are admitted to a SNF. Our analysis of 2,392,753 such discharges from hospitals under fee-for-service Medicare in the period January 2012-October 2014 indicated that first visits by a physician or advanced practitioner (a nurse practitioner or physician assistant) for initial medical assessment occurred within four days of SNF admission in 71.5 percent of the stays. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05458DOI Listing
April 2019
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Foundation Grants To Research And Improve Medicare.

Authors:

Health Aff (Millwood) 2019 Apr;38(4):689-690

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http://dx.doi.org/10.1377/hlthaff.2019.00255DOI Listing

Medication Treatment For Substance Abuse.

Authors:
Linda Rosenberg

Health Aff (Millwood) 2019 Apr;38(4):695

National Council for Behavioral Health Washington, D.C.

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http://dx.doi.org/10.1377/hlthaff.2019.00112DOI Listing

Behavioral And Other Chronic Conditions Among Adult Medicaid Enrollees: Implications For Work Requirements.

Health Aff (Millwood) 2019 Apr;38(4):660-667

Janet R. Cummings is an associate professor in the Department of Health Policy and Management, Rollins School of Public Health, Emory University, in Atlanta, Georgia.

Work requirements condition Medicaid eligibility on completing a specified number of hours of employment, work search, job training, or community service. Little is known about how behavioral health and other chronic health conditions intersect with employment status among Medicaid enrollees who may be subject to work requirements. Using data from the National Survey on Drug Use and Health for the period 2014-16, we found that people with behavioral health and other chronic health conditions were more likely to be enrolled in Medicaid and subject to work requirements than those without any identified health conditions. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05059DOI Listing
April 2019
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4.966 Impact Factor

The Present And Future Of Telehealth.

Authors:
Michael A Gomes

Health Aff (Millwood) 2019 Apr;38(4):693-694

ClearHealth Quality Institute Annapolis, Maryland.

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http://dx.doi.org/10.1377/hlthaff.2019.00210DOI Listing

Abuse-Deterrent Opioids: The Authors Reply.

Health Aff (Millwood) 2019 Apr;38(4):696

RAND Corporation Santa Monica, California.

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http://dx.doi.org/10.1377/hlthaff.2019.00212DOI Listing

Patient Readmission Rates For All Insurance Types After Implementation Of The Hospital Readmissions Reduction Program.

Health Aff (Millwood) 2019 Apr;38(4):585-593

Robert W. Yeh is the director of the Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center.

Since the implementation of the Hospital Readmissions Reduction Program (HRRP), readmissions have declined for Medicare patients with conditions targeted by the policy (acute myocardial infarction, heart failure, and pneumonia). To understand whether HRRP implementation was associated with a readmission decline for patients across all insurance types (Medicare, Medicaid, and private), we conducted a difference-in-differences analysis using information from the Nationwide Readmissions Database. We compared how quarterly readmissions for target conditions changed before (2010-12) and after (2012-14) HRRP implementation, using nontarget conditions as the control. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05412DOI Listing
April 2019
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The Role Of Social, Cognitive, And Functional Risk Factors In Medicare Spending For Dual And Nondual Enrollees.

Health Aff (Millwood) 2019 Apr;38(4):569-576

Karen E. Joynt Maddox is an assistant professor of medicine (cardiology) at the Washington University School of Medicine, in St. Louis.

The Centers for Medicare and Medicaid Services is increasingly focused on value-based payment programs, which tie payment to performance on quality and cost measures. In this context, there is rising concern that such programs systematically disadvantage providers that care for vulnerable populations, such as the poor, by holding the providers accountable for factors beyond their control that influence patient outcomes and utilization. In this nationally representative study of Medicare beneficiaries, we found that dually enrolled Medicare beneficiaries (those also enrolled in Medicaid) had strikingly higher levels of medical, functional, and cognitive comorbidities, as well as social needs, compared to their non-dually enrolled counterparts. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05032DOI Listing

My Struggle To Access Lifesaving Mental Health Care.

Authors:
Ashley R Clayton

Health Aff (Millwood) 2019 Apr;38(4):684-688

This essay is dedicated to my husband, Stephen Thomas, and to my dear friends Asha Evans and Linda Mayes-thank you for carrying me all the way through; to Juno Pinder, for championing this essay and endless patience and generosity; to my colleagues William Sledge, Phil Corlett, and Al Powers for helping me navigate this mess and incredible support along the way; to my nurses, especially Stephen Majoros and Herty Lawson, for caring for me with such love and kindness; and to Robert Ostroff, Gerard Sanacora, and Samuel Wilkinson, thank you for saving my life-all words fall short. Ashley R. Clayton ( ) is director of research and evaluation at the Center for Wellbeing of Women and Mothers in the Department of Psychiatry at the Yale School of Medicine, in New Haven, Connecticut.

A patient must overcome systemic hurdles to stay on the only effective treatment for her depression: ketamine. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05354DOI Listing
April 2019
2 Reads

Medical Cannabis And Chronic Pain.

Health Aff (Millwood) 2019 Apr;38(4):694

Wright State University Dayton, Ohio.

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http://dx.doi.org/10.1377/hlthaff.2019.00170DOI Listing
April 2019
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The Association Between Hospital Concentration And Insurance Premiums In ACA Marketplaces.

Health Aff (Millwood) 2019 Apr;38(4):668-674

Ashish K. Jha ( ) is dean of global strategy, K.T. Li Professor of Global Health, and director of the Harvard Global Health Institute at the Harvard T. H. Chan School of Public Health.

Keeping the Affordable Care Act's health insurance Marketplaces financially accessible is critically important to their viability. While the relationship between the number of insurers and Marketplace premiums has received widespread attention, the role of hospital market concentration on premiums has been understudied. We examined the relationship between hospital market concentration and Marketplace insurance premiums in the period 2014-17, the extent to which the number of insurers modified this relationship, and whether community-level characteristics were associated with varying levels of concentration. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05491DOI Listing
April 2019
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Multimorbidity And Health Outcomes In Older Adults In Ten European Health Systems, 2006-15.

Health Aff (Millwood) 2019 Apr;38(4):613-623

Maria Triassi is a professor of public health in the Department of Public Health, University Federico II. She and Christopher Millett acted equally as last author.

Despite the increase in awareness of chronic disease, little is known about whether multimorbidity-defined as two or more coexisting chronic conditions-has had a diminished impact on health in Europe in the past decade. We used multiple cross-sectional data from the Survey of Health, Ageing and Retirement in Europe to estimate changes in the prevalence of multimorbidity and in its association with health outcomes in ten European countries between 2006-07 and 2015. We found that the prevalence of multimorbidity rose from 38. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05273DOI Listing

News Media Reporting On Medication Treatment For Opioid Use Disorder Amid The Opioid Epidemic.

Health Aff (Millwood) 2019 Apr;38(4):643-651

Colleen L. Barry is the Fred and Julie Soper Professor and chair of the Department of Health Policy and Management and codirector of the Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health.

Medications such as methadone and buprenorphine are effective treatments for opioid use disorder (OUD), but levels of use remain low. Given the importance of the news media as a source of health information for the public and its role in shaping knowledge about these medications, we examined reporting on OUD medication treatment amid the opioid crisis. Analyzing news media reporting can provide insight into the public dialogue around this issue. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05075DOI Listing
April 2019
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Do Incentive Payments Reward The Wrong Providers? A Study Of Primary Care Reform In Ontario, Canada.

Health Aff (Millwood) 2019 Apr;38(4):624-632

Tara Kiran is the Fidani Chair in Improvement and Innovation and vice chair for quality and innovation in the Department of Family and Community Medicine, University of Toronto. She is also a clinician scientist in the Department of Family and Community Medicine at the University of Toronto and at St. Michael's Hospital in Toronto, and an embedded researcher at Health Quality Ontario.

Primary care payment reform in the US and elsewhere usually involves capitation, often combined with bonuses and incentives. In capitation systems, providing care within the practice group is needed to contain costs and ensure continuity of care, yet this is challenging in settings that allow patient choice in access to services. We used linked population-based administrative databases in Ontario, Canada, to examine a substantial payment called the "access bonus" designed to incentivize primary care access and to minimize primary care visits outside of capitation practices. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05272DOI Listing

When Is The Price Of A Drug Unjust? The Average Lifetime Earnings Standard.

Health Aff (Millwood) 2019 Apr;38(4):604-612

Ezekiel J. Emanuel ( ) is the Diane V. S. Levy and Robert M. Levy University Professor, chair of the Department of Medical Ethics and Health Policy, and vice provost for global initiatives, all at the University of Pennsylvania, in Philadelphia.

The majority of Americans believe that lowering drug prices should be the top health care priority for the federal government. Yet drug costs as a proportion of the country's medical expenditures have increased substantially in recent years. Because drugs are basic necessities, and because how much society should contribute toward providing basic necessities is a question of justice, policies regarding drug prices must fulfill principles of justice, not just economic efficiency. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05052DOI Listing

New Year Brings New ACA Developments.

Authors:
Katie Keith

Health Aff (Millwood) 2019 Apr 11;38(4):526-527. Epub 2019 Mar 11.

Katie Keith ( ) is a principal at Keith Policy Solutions, LLC, an appointed consumer representative to the National Association of Insurance Commissioners, and an adjunct professor at the Georgetown University Law Center. She is also a Health Affairs contributing editor. [Published online March 11, 2019.] Readers can find more detail and updates on health reform on Health Affairs Blog ( http://healthaffairs.org/blog/ ), where Keith publishes rapid-response "Following The ACA" posts.

A new year ushers in new Affordable Care Act regulations, court decisions, and hearings in the US House of Representatives. Read More

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http://dx.doi.org/10.1377/hlthaff.2019.00260DOI Listing

Consumer-Facing Data, Information, And Tools: Self-Management Of Health In The Digital Age.

Health Aff (Millwood) 2019 Mar;38(3):352-358

John M. Westfall is a senior scholar in family medicine at the Eugene S. Farley Jr. Health Policy Center, University of Colorado, in Aurora, and chair of family medicine and medical director for whole person care at the Santa Clara Valley Medical Center Health and Hospital System, in San Jose, California.

Consumers have greater access to data, information, and tools to support the management of their health than ever before. While the sheer quantity of these resources has increased exponentially over the past decade, the accuracy of consumer-facing resources is variable, and the value to the individual consumer remains uncertain. In general, the quality of these resources has improved, mostly because of improvements in web and mobile technologies and efforts to restructure health care delivery to be more patient centered. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05404DOI Listing
March 2019
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Engaging Beneficiaries In Medicaid Programs That Incentivize Health-Promoting Behaviors.

Health Aff (Millwood) 2019 Mar;38(3):431-439

Charlene A. Wong ( ) is an assistant professor of pediatrics and public policy, and faculty in the Duke-Margolis Center for Health Policy and the Duke Clinical Research Institute, all at Duke University in Durham.

Medicaid programs are increasingly adopting incentive programs to improve health behaviors among beneficiaries. There is limited evidence on what incentives are being offered to Medicaid beneficiaries, how programs are engaging beneficiaries, and how programs are evaluated. In 2017-18 we synthesized available information on these programs and interviewed eighty policy stakeholders to identify the rationale behind key program design decisions and stakeholders' recommendations for beneficiary engagement and program evaluation. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05427DOI Listing

Vulnerable And Less Vulnerable Women In High-Deductible Health Plans Experienced Delayed Breast Cancer Care.

Health Aff (Millwood) 2019 Mar;38(3):408-415

Dennis Ross-Degnan is an associate professor in the Department of Population Medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute.

The effects of high-deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, diagnosis, and chemotherapy among a group of women whose employers switched their insurance coverage from health plans with low deductibles ($500 or less) to plans with high deductibles ($1,000 or more) between 2004 and 2014. Primary subgroups of interest comprised 54,403 low-income and 76,776 high-income women continuously enrolled in low-deductible plans for a year and then up to four years in HDHPs. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05026DOI Listing
March 2019
2 Reads

Consumers' Perceptions And Choices Related To Three Value-Based Insurance Design Approaches.

Health Aff (Millwood) 2019 Mar;38(3):456-463

Patrick S. Romano is a professor of medicine and pediatrics at the UC Davis School of Medicine, in Sacramento.

The burden of rising health care costs is being shifted to consumers, and 30 percent of health care costs are attributed to wasteful spending on low- or no-value services. Value-based insurance design (VBID) is intended to encourage the use of high-value services or discourage the use of low-value services by aligning cost with quality. During the summer and fall of 2016, this mixed-methods study used focus groups and a quantitative analysis of survey data to explore consumer decision making in Northern California. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05048DOI Listing
March 2019
1 Read

Patient Harms: The Authors Reply.

Health Aff (Millwood) 2019 Mar;38(3):511

Michael E. DeBakey VA Medical Center Houston, Texas.

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http://dx.doi.org/10.1377/hlthaff.2019.00023DOI Listing
March 2019
4.966 Impact Factor

Americans' Growing Exposure To Clinician Quality Information: Insights And Implications.

Health Aff (Millwood) 2019 Mar;38(3):374-382

Jennifer Cerully is a behavioral and social scientist at the RAND Corporation in Pittsburgh.

For two decades, various initiatives have encouraged Americans to consider quality when choosing clinicians, both to enhance informed choice and to reduce disparities in access to high-quality providers. The literature portrays these efforts as largely ineffective. But this depiction overlooks two factors: the dramatic expansion since 2010 in the availability of patients' narratives about care and the growth of information seeking among consumers. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05006DOI Listing
March 2019
2 Reads

Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations.

Health Aff (Millwood) 2019 Mar;38(3):383-390

Christopher A. Longhurst is chief information officer and associate chief medical officer at UC San Diego Health, and a clinical professor of medicine and pediatrics at the UCSD School of Medicine.

Patients' journeys across the care continuum can be improved with patient-centered technology integrated into the care process. Misaligned financial incentives, change management challenges, and privacy concerns are some of the hurdles that have prevented health systems from deploying technology that engages patients along the care continuum. Despite these sociotechnical challenges, some health care organizations have developed innovative approaches to engaging patients. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05027DOI Listing

The Roles Of Assisters And Automated Decision Support Tools In Consumers' Marketplace Choices: Room For Improvement.

Health Aff (Millwood) 2019 Mar;38(3):473-481

Peter A. Ubel is the Madge and Dennis T. McLawhorn Professor of Business, Public Policy, and Medicine at Duke University.

Assisters provide in-person and phone-based support to help consumers narrow their plan options on the Affordable Care Act's health insurance Marketplaces. We elicited the perspectives of a national sample of thirty-two assisters from ten states on consumer plan selection and available Marketplace decision support tools (for example, total cost estimators and provider network look-up tools). Assisters identified several shortcomings that limited their use of decision support tools, such as nonspecific cost estimates and inaccurate provider network data. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05021DOI Listing
March 2019
3 Reads

Understanding What Information Is Valued By Research Participants, And Why.

Health Aff (Millwood) 2019 Mar;38(3):399-407

Paul A. Harris is director of the Office of Research Informatics in the Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center.

There is growing public demand that research participants receive all of their results, regardless of whether clinical action is indicated. Instead of the standard practice of returning only actionable results, we propose a reconceptualization called "return of value" to encompass the varied ways in which research participants value specific results and more general information they receive beyond actionable results. Our proposal is supported by a national survey of a diverse sample, which found that receiving research results would be valuable to most (78. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05046DOI Listing
March 2019
1 Read

Paying Patients To Switch: Impact Of A Rewards Program On Choice Of Providers, Prices, And Utilization.

Health Aff (Millwood) 2019 Mar;38(3):440-447

Ateev Mehrotra is an associate professor in the Department of Health Care Policy, Harvard Medical School.

Employers and insurers are experimenting with benefit strategies that encourage patients to switch to lower-price providers. One increasingly popular strategy is to financially reward patients who receive care from such providers. We evaluated the impact of a rewards program implemented in 2017 by twenty-nine employers with 269,875 eligible employees and dependents. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05068DOI Listing
March 2019
1 Read

Patient Engagement In Research: Early Findings From The Patient-Centered Outcomes Research Institute.

Health Aff (Millwood) 2019 Mar;38(3):359-367

Chinenye Ursla Anyanwu is an engagement officer in the Public and Patient Engagement program at PCORI.

Charged with ensuring that research produces useful evidence to inform health decisions, the Patient-Centered Outcomes Research Institute (PCORI) requires investigators to engage patients and other health care stakeholders, such as clinicians and payers, in the research process. Many PCORI studies result in articles published in peer-reviewed journals that detail research findings and engagement's role in research. To inform practices for engaging patients and others as research partners, we analyzed 126 articles that described engagement approaches and contributions to research. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05067DOI Listing
March 2019
4.966 Impact Factor

Barriers And Facilitators To Community-Based Participatory Mental Health Care Research For Racial And Ethnic Minorities.

Health Aff (Millwood) 2019 Mar;38(3):391-398

Benjamin Lê Cook is director of the Health Equity Research Lab, Cambridge Health Alliance, and an associate professor in the Department of Psychiatry, Harvard Medical School, in Boston.

People with serious mental illnesses, particularly members of racial and ethnic minority groups, are rarely included in prioritizing research topics or developing the tools and measures important for improving their care. Community-based participatory research holds promise toward reducing mental health disparities. However, initiating research partnerships with community stakeholders is challenging and does not always lead to sustainable community health improvements. Read More

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http://dx.doi.org/10.1377/hlthaff.2018.05040DOI Listing

Patient Portals And Disparities: The Authors Reply.

Health Aff (Millwood) 2019 Mar;38(3):510

University of Wisconsin-Milwaukee Milwaukee, Wisconsin.

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http://dx.doi.org/10.1377/hlthaff.2019.00083DOI Listing