Pub Date : 2025-01-03DOI: 10.1001/jamahealthforum.2024.4692
Renuka Tipirneni, Wendy Furst, Dominic A Ruggiero, Dianne C Singer, Erica Solway, Erin Beathard, Syama R Patel, Andrei R Stefanescu, Jeffrey T Kullgren, John Z Ayanian, Eric T Roberts
Importance: Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.
Objective: To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.
Design, setting, and participants: A cross-sectional national survey of community-dwelling US adults aged 65 years or older with incomes less than or equal to 100% of the federal poverty level, via internet and telephone, was conducted from January 23 through February 19, 2024. Participants were recruited from NORC probability-based and 2 additional national nonprobability panels.
Main outcomes and measures: Weighted percentage values for respondent awareness of Medicaid redeterminations, experiences navigating reenrollment, and cost-related barriers to accessing care.
Results: Of 843 respondents, most were female (62.9%), aged 65 to 74 years (62.3%), and had completed up to high school education (72.3%). Overall, 16.1% (95% CI, 12.4%-19.9%) had heard a lot and 34.6% (95% CI, 28.9%-40.4%) a little about states returning to Medicaid renewals; 49.0% (95% CI, 43.0%-55.0%) heard nothing at all. A total of 45.1% completed a Medicaid renewal, 37.0% did not complete a renewal, and 17.7% did not know about renewal requirements. A total of 87.7% maintained Medicaid, 5.9% lost Medicaid but got it back, and 5.5% lost Medicaid and did not get it back. In the last 6 months, 7.7% reported delaying or forgoing care due to cost. Delayed or forgone care was more common among those who lost Medicaid and did not get it back (18.4%) and those who lost Medicaid but got it back (30.6%) compared with those who maintained Medicaid (5.5%). Cost-related barriers were more common for dental (25.1%) and home health services (18.5%), which are frequently covered by Medicaid.
Conclusions and relevance: The findings highlight a need to address informational gaps and navigational barriers related to Medicaid unwinding among older adults with dual eligibility for Medicare and Medicaid. Addressing these gaps may help to avoid Medicaid losses that contribute to difficulties accessing care.
{"title":"Medicaid Unwinding Experiences in Dual-Eligible Older Adults.","authors":"Renuka Tipirneni, Wendy Furst, Dominic A Ruggiero, Dianne C Singer, Erica Solway, Erin Beathard, Syama R Patel, Andrei R Stefanescu, Jeffrey T Kullgren, John Z Ayanian, Eric T Roberts","doi":"10.1001/jamahealthforum.2024.4692","DOIUrl":"10.1001/jamahealthforum.2024.4692","url":null,"abstract":"<p><strong>Importance: </strong>Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.</p><p><strong>Objective: </strong>To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.</p><p><strong>Design, setting, and participants: </strong>A cross-sectional national survey of community-dwelling US adults aged 65 years or older with incomes less than or equal to 100% of the federal poverty level, via internet and telephone, was conducted from January 23 through February 19, 2024. Participants were recruited from NORC probability-based and 2 additional national nonprobability panels.</p><p><strong>Main outcomes and measures: </strong>Weighted percentage values for respondent awareness of Medicaid redeterminations, experiences navigating reenrollment, and cost-related barriers to accessing care.</p><p><strong>Results: </strong>Of 843 respondents, most were female (62.9%), aged 65 to 74 years (62.3%), and had completed up to high school education (72.3%). Overall, 16.1% (95% CI, 12.4%-19.9%) had heard a lot and 34.6% (95% CI, 28.9%-40.4%) a little about states returning to Medicaid renewals; 49.0% (95% CI, 43.0%-55.0%) heard nothing at all. A total of 45.1% completed a Medicaid renewal, 37.0% did not complete a renewal, and 17.7% did not know about renewal requirements. A total of 87.7% maintained Medicaid, 5.9% lost Medicaid but got it back, and 5.5% lost Medicaid and did not get it back. In the last 6 months, 7.7% reported delaying or forgoing care due to cost. Delayed or forgone care was more common among those who lost Medicaid and did not get it back (18.4%) and those who lost Medicaid but got it back (30.6%) compared with those who maintained Medicaid (5.5%). Cost-related barriers were more common for dental (25.1%) and home health services (18.5%), which are frequently covered by Medicaid.</p><p><strong>Conclusions and relevance: </strong>The findings highlight a need to address informational gaps and navigational barriers related to Medicaid unwinding among older adults with dual eligibility for Medicare and Medicaid. Addressing these gaps may help to avoid Medicaid losses that contribute to difficulties accessing care.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e244692"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-03DOI: 10.1001/jamahealthforum.2024.5031
Kevin B Johnson, Ivor B Horn, Eric Horvitz
{"title":"Pursuing Equity With Artificial Intelligence in Health Care.","authors":"Kevin B Johnson, Ivor B Horn, Eric Horvitz","doi":"10.1001/jamahealthforum.2024.5031","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.5031","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"6 1","pages":"e245031"},"PeriodicalIF":9.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4944
John Z Ayanian
{"title":"Reflections on the First 5 Years of JAMA Health Forum.","authors":"John Z Ayanian","doi":"10.1001/jamahealthforum.2024.4944","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2024.4944","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244944"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4436
Ming Tai-Seale, Michael Cheung, Florin Vaida, Bernice Ruo, Amanda Walker, Rebecca L Rosen, Michael Hogarth, Kimberly A Fisher, Sonal Singh, Robert A Yood, Lawrence Garber, Cassandra Saphirak, Martina Li, Albert S Chan, Edward E Yu, Gene Kallenberg, Christopher A Longhurst, Marlene Millen, Cheryl D Stults, Kathleen M Mazor
<p><strong>Importance: </strong>Despite various attempts to improve patient-clinician communication, there has been limited head-to-head comparison of these efforts.</p><p><strong>Objective: </strong>To assess whether clinician coaching (mobile application or in-person) is more effective than reminder posters in examination rooms and whether mobile app use is noninferior to in-person coaching.</p><p><strong>Design, setting, and participants: </strong>A cluster randomized clinical trial with 3 arms. A total of 21 primary care clinics participated in 3 health systems in the US; participants were patients and primary care clinicians with clinic visits between August 28, 2019, and December 31, 2021. Data were analyzed from August 4, 2022, to November 10, 2024. Data analysis was based on intention to treat.</p><p><strong>Interventions: </strong>In-person coaching of clinicians with standardized patient instructor training (high-touch), mobile application-based coaching (high-tech), and posters placed in examination rooms encouraging shared decision-making (AskShareKnow [ASK]). Before visits, patients in the high-touch and high-tech groups were prompted to inform their clinicians of the most important matter for discussion using online check-in.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a patient engagement measure (CollaboRATE) of patient perceptions of communication and shared decision-making during the visit. Difference-in-differences mixed-effect regression with random intercepts for primary care clinician were used for analyses. Secondary outcomes included the net promoter score (patient's likelihood of recommending this clinician to others) and patient's confidence in managing their health.</p><p><strong>Results: </strong>Participants included 4852 patients with a median age of 54 years (IQR, 39-66 years); 63.6% were women. A total of 114 clinicians (median age range, 40-59 years; 48 were women [42.1%]) participated. The 3 interventions did not differ significantly in probability of CollaboRATE top score (marginal difference, high-tech vs ASK, -0.021; 95% CI, -0.073 to 0.030; high-touch vs ASK, -0.018, 95% CI, -0.069 to 0.033; high-tech vs high-touch, -0.003, 95% CI, -0.057 to 0.052; P = .14). Patients in the high-tech group were less likely to recommend their clinician to others than patients in the high-touch group (difference in marginal probability, -0.056; 95% CI, -0.118 to 0.019; P = .04). After 3 months, patients in the high-tech group had a significantly lower score than patients in the high-touch group (mean difference, -0.176; 95% CI, -0.341 to -0.011; P = .04) in confidence in managing their health.</p><p><strong>Conclusions and relevance: </strong>This cluster randomized clinical trial found no evidence of intervention effects, although there were differences across systems. Some secondary outcomes suggested positive effect of clinicians receiving in-person coaching. Alternative outcome measures of pat
{"title":"Patient-Clinician Communication Interventions Across Multiple Primary Care Sites: A Cluster Randomized Clinical Trial.","authors":"Ming Tai-Seale, Michael Cheung, Florin Vaida, Bernice Ruo, Amanda Walker, Rebecca L Rosen, Michael Hogarth, Kimberly A Fisher, Sonal Singh, Robert A Yood, Lawrence Garber, Cassandra Saphirak, Martina Li, Albert S Chan, Edward E Yu, Gene Kallenberg, Christopher A Longhurst, Marlene Millen, Cheryl D Stults, Kathleen M Mazor","doi":"10.1001/jamahealthforum.2024.4436","DOIUrl":"10.1001/jamahealthforum.2024.4436","url":null,"abstract":"<p><strong>Importance: </strong>Despite various attempts to improve patient-clinician communication, there has been limited head-to-head comparison of these efforts.</p><p><strong>Objective: </strong>To assess whether clinician coaching (mobile application or in-person) is more effective than reminder posters in examination rooms and whether mobile app use is noninferior to in-person coaching.</p><p><strong>Design, setting, and participants: </strong>A cluster randomized clinical trial with 3 arms. A total of 21 primary care clinics participated in 3 health systems in the US; participants were patients and primary care clinicians with clinic visits between August 28, 2019, and December 31, 2021. Data were analyzed from August 4, 2022, to November 10, 2024. Data analysis was based on intention to treat.</p><p><strong>Interventions: </strong>In-person coaching of clinicians with standardized patient instructor training (high-touch), mobile application-based coaching (high-tech), and posters placed in examination rooms encouraging shared decision-making (AskShareKnow [ASK]). Before visits, patients in the high-touch and high-tech groups were prompted to inform their clinicians of the most important matter for discussion using online check-in.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was a patient engagement measure (CollaboRATE) of patient perceptions of communication and shared decision-making during the visit. Difference-in-differences mixed-effect regression with random intercepts for primary care clinician were used for analyses. Secondary outcomes included the net promoter score (patient's likelihood of recommending this clinician to others) and patient's confidence in managing their health.</p><p><strong>Results: </strong>Participants included 4852 patients with a median age of 54 years (IQR, 39-66 years); 63.6% were women. A total of 114 clinicians (median age range, 40-59 years; 48 were women [42.1%]) participated. The 3 interventions did not differ significantly in probability of CollaboRATE top score (marginal difference, high-tech vs ASK, -0.021; 95% CI, -0.073 to 0.030; high-touch vs ASK, -0.018, 95% CI, -0.069 to 0.033; high-tech vs high-touch, -0.003, 95% CI, -0.057 to 0.052; P = .14). Patients in the high-tech group were less likely to recommend their clinician to others than patients in the high-touch group (difference in marginal probability, -0.056; 95% CI, -0.118 to 0.019; P = .04). After 3 months, patients in the high-tech group had a significantly lower score than patients in the high-touch group (mean difference, -0.176; 95% CI, -0.341 to -0.011; P = .04) in confidence in managing their health.</p><p><strong>Conclusions and relevance: </strong>This cluster randomized clinical trial found no evidence of intervention effects, although there were differences across systems. Some secondary outcomes suggested positive effect of clinicians receiving in-person coaching. Alternative outcome measures of pat","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244436"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4312
Laura G Burke, Yanlei Ma, Jessica Phelan, Ellen Latsko, Austin B Frakt, Steven D Pizer, Jose F Figueroa
{"title":"Cost Shifting for Emergency Care of Veterans With Medicare After MISSION Act Implementation.","authors":"Laura G Burke, Yanlei Ma, Jessica Phelan, Ellen Latsko, Austin B Frakt, Steven D Pizer, Jose F Figueroa","doi":"10.1001/jamahealthforum.2024.4312","DOIUrl":"10.1001/jamahealthforum.2024.4312","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244312"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4319
Kenneth W Kizer, Said Ibrahim
{"title":"Medicare to Veterans Affairs Cost Shifting-A Challenging Conundrum.","authors":"Kenneth W Kizer, Said Ibrahim","doi":"10.1001/jamahealthforum.2024.4319","DOIUrl":"10.1001/jamahealthforum.2024.4319","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244319"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.5090
{"title":"Error in Introduction and Figure 1.","authors":"","doi":"10.1001/jamahealthforum.2024.5090","DOIUrl":"10.1001/jamahealthforum.2024.5090","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e245090"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4019
Steffani R Bailey, Nathalie Huguet, Hilary A Tindle
{"title":"The Oregon Medicaid Guideline on Smoking Abstinence Prior to Elective Surgery.","authors":"Steffani R Bailey, Nathalie Huguet, Hilary A Tindle","doi":"10.1001/jamahealthforum.2024.4019","DOIUrl":"10.1001/jamahealthforum.2024.4019","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244019"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11816830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-06DOI: 10.1001/jamahealthforum.2024.4365
Tami L Mark, Benjamin D Huber
Importance: Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.
Objective: To determine the rate of drug overdose among Medicaid beneficiaries.
Design, setting, and participants: In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.
Exposure: Participation in the Medicaid program.
Main outcome: Death of a drug overdose.
Results: In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.
Conclusions and relevance: The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.
{"title":"Drug Overdose Deaths Among Medicaid Beneficiaries.","authors":"Tami L Mark, Benjamin D Huber","doi":"10.1001/jamahealthforum.2024.4365","DOIUrl":"10.1001/jamahealthforum.2024.4365","url":null,"abstract":"<p><strong>Importance: </strong>Medicaid programs have expanded coverage of substance use disorder treatment and undertaken many other initiatives to reduce drug overdoses among beneficiaries. However, to date, no information has been published that tracks overdose deaths among the Medicaid population.</p><p><strong>Objective: </strong>To determine the rate of drug overdose among Medicaid beneficiaries.</p><p><strong>Design, setting, and participants: </strong>In this cross-sectional study, US Centers for Medicare & Medicaid Services data from 2016 to 2020 that linked enrollment and demographic data from all Medicaid beneficiaries in the US with the US Centers for Disease Control and Prevention National Death Index were used to determine the rate of drug overdose death among Medicaid beneficiaries. The Medicaid population rates were compared with those of the total US population, overall and by age and sex.</p><p><strong>Exposure: </strong>Participation in the Medicaid program.</p><p><strong>Main outcome: </strong>Death of a drug overdose.</p><p><strong>Results: </strong>In 2020, the drug overdose death rate among Medicaid beneficiaries was 54.6 per 100 000, a rate that was twice as high as the drug overdose rate among all US residents (27.9 per 100 000). In 2020, Medicaid beneficiaries comprised 25.0% of the US population but 48% of all overdose deaths (44 277 of 91 783). For each age and sex group older than 15 years, overdose deaths were higher for the Medicaid population than for the US population, with the greatest difference occurring among adults ages 45 to 64 years. From 2016 to 2020, Medicaid overdose deaths increased by 54%.</p><p><strong>Conclusions and relevance: </strong>The results of this study suggest that more research is needed to understand why Medicaid beneficiaries have higher rates of drug overdoses than all US residents. Additionally, research is needed to understand how best to prevent overdoses among Medicaid beneficiaries. The federal government should support these efforts by routinely linking Medicaid claims and enrollment data to death records.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"5 12","pages":"e244365"},"PeriodicalIF":9.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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