Inequities in availability and access to adult vaccinations represent significant gaps in the U.S. public health infrastructure. Adults in racial and ethnic minority groups are less likely to receive routinely recommended vaccinations due to systemic barriers, distribution inequities, and lack of trust in vaccines; similar disparities were seen during early COVID-19 vaccination efforts. However, a deliberate focus on reducing disparities can yield progress. National data show narrowing of racial and ethnic adult COVID-19 vaccination coverage disparities over time, highlighting the value of the equity-focused community-level interventions implemented during the pandemic. This paper describes CDC’s efforts during the COVID-19 pandemic to address racial and ethnic disparities in adult immunization, and how lessons learned may be applied post-pandemic. Progress made is likely to be lost without sustained support for adult vaccination at national, state, and community levels.
{"title":"Increasing Equity in Adult Immunization through Community-Level Action","authors":"Ram Koppaka, Melinda Wharton, Megan C Lindley, Jitinder Kohli, Julie Morita","doi":"10.1093/haschl/qxad071","DOIUrl":"https://doi.org/10.1093/haschl/qxad071","url":null,"abstract":"\u0000 Inequities in availability and access to adult vaccinations represent significant gaps in the U.S. public health infrastructure. Adults in racial and ethnic minority groups are less likely to receive routinely recommended vaccinations due to systemic barriers, distribution inequities, and lack of trust in vaccines; similar disparities were seen during early COVID-19 vaccination efforts. However, a deliberate focus on reducing disparities can yield progress. National data show narrowing of racial and ethnic adult COVID-19 vaccination coverage disparities over time, highlighting the value of the equity-focused community-level interventions implemented during the pandemic. This paper describes CDC’s efforts during the COVID-19 pandemic to address racial and ethnic disparities in adult immunization, and how lessons learned may be applied post-pandemic. Progress made is likely to be lost without sustained support for adult vaccination at national, state, and community levels.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138588063","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}
New data from the Social Security Administration suggests there were 260,000 excess deaths in the United States among current or former disability beneficiaries during the first 22 months of the COVID-19 pandemic. These beneficiaries accounted for 26 percent of all excess deaths in the US during this period. The pattern of deaths among disabled beneficiaries corresponds closely with known milestones in the pandemic’s history. Disabled beneficiaries in New York, particularly those residing in institutions, had extremely elevated mortality with the onset of the pandemic in the spring of 2020. Across all regions in the US, mortality among disability beneficiaries increased sharply with the onset of the winter of 2020-2021 and with the emergence of the Delta and Omicron variants in 2021. Elevated mortality was observed for persons with intellectual, mental, and physical impairments. Future public information campaigns about vaccines and other measures may be more successful if they include specific efforts to directly target disability beneficiaries. In addition, clinical trials and other research should consider including disabled persons as specific study groups as the severity of their underlying health impairments is likely comparable to that of persons of advanced age.
{"title":"The Mortality Experience of Disabled Persons in the United States During the COVID-19 Pandemic","authors":"David A Weaver","doi":"10.1093/haschl/qxad082","DOIUrl":"https://doi.org/10.1093/haschl/qxad082","url":null,"abstract":"\u0000 New data from the Social Security Administration suggests there were 260,000 excess deaths in the United States among current or former disability beneficiaries during the first 22 months of the COVID-19 pandemic. These beneficiaries accounted for 26 percent of all excess deaths in the US during this period. The pattern of deaths among disabled beneficiaries corresponds closely with known milestones in the pandemic’s history. Disabled beneficiaries in New York, particularly those residing in institutions, had extremely elevated mortality with the onset of the pandemic in the spring of 2020. Across all regions in the US, mortality among disability beneficiaries increased sharply with the onset of the winter of 2020-2021 and with the emergence of the Delta and Omicron variants in 2021. Elevated mortality was observed for persons with intellectual, mental, and physical impairments. Future public information campaigns about vaccines and other measures may be more successful if they include specific efforts to directly target disability beneficiaries. In addition, clinical trials and other research should consider including disabled persons as specific study groups as the severity of their underlying health impairments is likely comparable to that of persons of advanced age.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138586457","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}
Tim McDonald, Arindam Debbarma, Christopher Whaley, Rachel Reid, Bryan Dowd
Primary care clinics are a frequent focus of policy initiatives to improve the value of healthcare, yet it is unclear whether they have the ability or incentive to take on the additional tasks that these initiatives ask of them. This paper reports on a qualitative study assessing barriers clinic leaders face to reducing cost within a tiered cost-sharing commercial health insurance benefit design that gives both consumers and clinics a strong incentive to reduce cost. We conducted semi-structured interviews of clinical and operational leaders at a diverse set of 12 Minnesota primary care clinics and identified six barriers: Insufficient information on drivers of cost; clinics controlling a portion of spending; patient preference for higher cost specialists; administrative challenges; limited resources; and misalignment of incentives. We discuss approaches to reducing these barriers and opportunities to implement them.
{"title":"Barriers Primary Care Clinic Leaders Face to Improving Value in a Consumer Choice Health Plan Design","authors":"Tim McDonald, Arindam Debbarma, Christopher Whaley, Rachel Reid, Bryan Dowd","doi":"10.1093/haschl/qxad065","DOIUrl":"https://doi.org/10.1093/haschl/qxad065","url":null,"abstract":"\u0000 Primary care clinics are a frequent focus of policy initiatives to improve the value of healthcare, yet it is unclear whether they have the ability or incentive to take on the additional tasks that these initiatives ask of them. This paper reports on a qualitative study assessing barriers clinic leaders face to reducing cost within a tiered cost-sharing commercial health insurance benefit design that gives both consumers and clinics a strong incentive to reduce cost. We conducted semi-structured interviews of clinical and operational leaders at a diverse set of 12 Minnesota primary care clinics and identified six barriers: Insufficient information on drivers of cost; clinics controlling a portion of spending; patient preference for higher cost specialists; administrative challenges; limited resources; and misalignment of incentives. We discuss approaches to reducing these barriers and opportunities to implement them.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138593655","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}
Scott S. Lee, Benjamin French, Francis Balucan, Michael D McCann, Eduard E Vasilevskis
High utilization by a minority of patients accounts for a large share of healthcare costs, but the dynamics of this utilization remain poorly understood. We sought to characterize longitudinal trajectories of hospitalization among adult patients at an academic medical center from 2017 to 2023. Among 3,404 patients meeting eligibility criteria, following an initial “rising-risk” period of three hospitalizations in six months, growth mixture modeling discerned four clusters of subsequent hospitalization trajectories: no further utilization, low chronic utilization, persistently high utilization with a slow rate of increase, and persistently high utilization with a fast rate of increase. Baseline factors associated with higher-order hospitalization trajectories included: admission to a non-surgical service, full code status, ICU-level care, opioid administration, discharge home, and comorbid cardiovascular disease, end-stage kidney or liver disease, or cancer. Characterizing hospitalization trajectories and their correlates in this manner lays groundwork for early identification of those most likely to become high-need, high-cost patients.
{"title":"Characterizing Hospitalization Trajectories in the High-Need, High-Cost Population using Electronic Health Record Data","authors":"Scott S. Lee, Benjamin French, Francis Balucan, Michael D McCann, Eduard E Vasilevskis","doi":"10.1093/haschl/qxad077","DOIUrl":"https://doi.org/10.1093/haschl/qxad077","url":null,"abstract":"\u0000 High utilization by a minority of patients accounts for a large share of healthcare costs, but the dynamics of this utilization remain poorly understood. We sought to characterize longitudinal trajectories of hospitalization among adult patients at an academic medical center from 2017 to 2023. Among 3,404 patients meeting eligibility criteria, following an initial “rising-risk” period of three hospitalizations in six months, growth mixture modeling discerned four clusters of subsequent hospitalization trajectories: no further utilization, low chronic utilization, persistently high utilization with a slow rate of increase, and persistently high utilization with a fast rate of increase. Baseline factors associated with higher-order hospitalization trajectories included: admission to a non-surgical service, full code status, ICU-level care, opioid administration, discharge home, and comorbid cardiovascular disease, end-stage kidney or liver disease, or cancer. Characterizing hospitalization trajectories and their correlates in this manner lays groundwork for early identification of those most likely to become high-need, high-cost patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138595054","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}
Linda Diem Tran, Liam Rose, Ken Suzuki, Tracy Urech, Anita Vashi
Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We employed a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs (VA) enrollees. Analyzing over one million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared to those with access to the standard medical advice line (38% vs. 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand to a virtual provider can effectively decrease ED visits.
{"title":"Medical Advice Lines Offering On-Demand Access to Providers Reduced Emergency Department Visits","authors":"Linda Diem Tran, Liam Rose, Ken Suzuki, Tracy Urech, Anita Vashi","doi":"10.1093/haschl/qxad079","DOIUrl":"https://doi.org/10.1093/haschl/qxad079","url":null,"abstract":"\u0000 Instant access to clinicians through virtual care is designed to allow patients to receive care they need while avoiding high-cost visits in acute care settings. This study investigates the effect of offering patients the option to instantly connect with emergency care providers instead of being referred to the emergency department (ED) following calls to a medical advice line. We employed a staggered rollout design to assess the effects of implementing this program on key outcomes among Veterans Affairs (VA) enrollees. Analyzing over one million calls from 2019 to 2022, we found that access to a provider reduced the proportion of patients who subsequently visited the ED compared to those with access to the standard medical advice line (38% vs. 36%). There was no significant difference observed in subsequent inpatient admissions or 30-day mortality. We found that a majority of callers (65%) achieved issue resolution or were directed to lower acuity settings for further evaluation. Although substantial direct cost savings were not evident, our findings demonstrate that on-demand to a virtual provider can effectively decrease ED visits.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594673","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}
Samantha J. Harris, Ezra Golberstein, Johanna Catherine Maclean, Bradley D Stein, S. Ettner, Brendan Saloner
State policymakers have long sought to improve access to mental health and substance use disorder (MH/SUD) treatment through insurance market reforms. Examining decisions made by innovative policymakers (“policy entrepreneurs”) can inform the potential scope and limits of legislative reform. Beginning in 2022, New Mexico became the first state to eliminate cost-sharing for MH/SUD treatment in private insurance plans subject to state regulation. Based on key informant interviews (N = 30), this study recounts the law’s passage and intended impact. Key facilitators to the law’s passage included receptive leadership, legislative champions with medical and insurance backgrounds, the use of local research evidence, advocate testimony, support from health industry figures, the severity of mental health and substance use disorders, and increased attention to MH/SUD during the COVID-19 pandemic. Findings have important implications for states considering similar laws to improve access to MH/SUD treatment.
{"title":"How Policymakers Innovate Around Behavioral Health: Adoption of the New Mexico “No Behavioral Health Cost-sharing” Law","authors":"Samantha J. Harris, Ezra Golberstein, Johanna Catherine Maclean, Bradley D Stein, S. Ettner, Brendan Saloner","doi":"10.1093/haschl/qxad081","DOIUrl":"https://doi.org/10.1093/haschl/qxad081","url":null,"abstract":"\u0000 State policymakers have long sought to improve access to mental health and substance use disorder (MH/SUD) treatment through insurance market reforms. Examining decisions made by innovative policymakers (“policy entrepreneurs”) can inform the potential scope and limits of legislative reform. Beginning in 2022, New Mexico became the first state to eliminate cost-sharing for MH/SUD treatment in private insurance plans subject to state regulation. Based on key informant interviews (N = 30), this study recounts the law’s passage and intended impact. Key facilitators to the law’s passage included receptive leadership, legislative champions with medical and insurance backgrounds, the use of local research evidence, advocate testimony, support from health industry figures, the severity of mental health and substance use disorders, and increased attention to MH/SUD during the COVID-19 pandemic. Findings have important implications for states considering similar laws to improve access to MH/SUD treatment.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138597695","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}
Berkeley Franz, Ashlyn Burns, Kristin Kueffner, Meeta Bhardwaj, Valerie A Yeager, Simone Singh, Neeraj Puro, Cory E. Cronin
Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) of identified SDOH as a top-five health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients while the remaining 56% of programs addressed SDOH at the community-level. Hospitals that were major teaching organizations, those in the Western region of the US, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.
{"title":"A National Overview of Nonprofit Hospital Community Benefit Programs to Address the Social Determinants of Health","authors":"Berkeley Franz, Ashlyn Burns, Kristin Kueffner, Meeta Bhardwaj, Valerie A Yeager, Simone Singh, Neeraj Puro, Cory E. Cronin","doi":"10.1093/haschl/qxad078","DOIUrl":"https://doi.org/10.1093/haschl/qxad078","url":null,"abstract":"\u0000 Decades of research have solidified the crucial role that social determinants of health (SDOH) play in shaping health outcomes, yet strategies to address these upstream factors remain elusive. The aim of this study was to understand the extent to which US nonprofit hospitals invest in SDOH at either the community or individual patient level and to provide examples of programs in each area. We analyzed data from a national dataset of 613 hospital community health needs assessments and corresponding implementation strategies. Among sample hospitals, 69.3% (n = 373) of identified SDOH as a top-five health need in their community and 60.6% (n = 326) reported investments in SDOH. Of hospitals with investments in SDOH, 44% of programs addressed health-related social needs of individual patients while the remaining 56% of programs addressed SDOH at the community-level. Hospitals that were major teaching organizations, those in the Western region of the US, and hospitals in counties with more severe housing problems had greater odds of investing in SDOH at the community level. Although many nonprofit hospitals have integrated SDOH-related activities into their community benefit work, stronger policies are necessary to encourage greater investments at the community-level that move beyond the needs of individual patients.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138594236","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}
Bryant Shuey, Fang Zhang, Edward Rosen, Brian Goh, Nicolas K. Trad, J. Wharam, Hefei Wen
Post-operative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day limit law that occurred before other statewide or plan-wide policies took affect and used commercial insurance claims from 2014-2017 to study its association with post-operative opioid prescriptions greater than 7-days duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14,097 commercially insured opioid-naïve adults aged 18 and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23-percentage point absolute reduction (95% CI 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI 55.36% to 11.19%) in the percentage of initial fills greater than 7-days in the Massachusetts relative to the control group. Seven-day limit laws may be an important state level tool to mitigate longer duration prescribing to high-risk post-operative populations.
骨科术后患者是接受长时间大剂量阿片类药物处方的高危人群。在这一高危群体中，缺乏对全国各地为应对阿片类药物过量流行而颁布的州阿片类药物持续时间限制法律的严格评估。我们利用马萨诸塞州在其他全州或计划范围内的政策生效之前早期实施的2016年7天限制法律，并使用2014-2017年的商业保险索赔来研究其与马萨诸塞州骨科患者中超过7天的术后阿片类药物处方的关系相对于新罕布什尔州对照组。我们的样本包括14,097名商业保险opioid-naïve年龄在18岁及以上的成年人接受选择性整形手术。我们发现，与对照组相比，马萨诸塞州7天的限制与马萨诸塞州超过7天的初始填充百分比的立即绝对减少4.23个百分点(95% CI 8.12至0.33个百分点)和33.27%的相对减少(95% CI 55.36%至11.19%)相关。7天限制法可能是一个重要的州一级工具，以减少对高风险术后人群的长期处方。
{"title":"Massachusetts’ Opioid Limit Law Associated with a Reduction in Post-Operative Opioid Duration Among Orthopedic Patients","authors":"Bryant Shuey, Fang Zhang, Edward Rosen, Brian Goh, Nicolas K. Trad, J. Wharam, Hefei Wen","doi":"10.1093/haschl/qxad068","DOIUrl":"https://doi.org/10.1093/haschl/qxad068","url":null,"abstract":"\u0000 Post-operative orthopedic patients are a high-risk group for receiving long-duration, large-dosage opioid prescriptions. Rigorous evaluation of state opioid duration limit laws, enacted throughout the country in response to the opioid overdose epidemic, is lacking among this high-risk group. We took advantage of Massachusetts’ early implementation of a 2016 7-day limit law that occurred before other statewide or plan-wide policies took affect and used commercial insurance claims from 2014-2017 to study its association with post-operative opioid prescriptions greater than 7-days duration among Massachusetts orthopedic patients relative to a New Hampshire control group. Our sample included 14,097 commercially insured opioid-naïve adults aged 18 and older undergoing elective orthopedic procedures. We found that the Massachusetts 7-day limit was associated with an immediate 4.23-percentage point absolute reduction (95% CI 8.12 to 0.33 percentage points) and a 33.27% relative reduction (95% CI 55.36% to 11.19%) in the percentage of initial fills greater than 7-days in the Massachusetts relative to the control group. Seven-day limit laws may be an important state level tool to mitigate longer duration prescribing to high-risk post-operative populations.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138604230","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}
On June 8th, 2023, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Making Care Primary (MCP) model, its latest attempt to transform primary care delivery for a value-based care payment system. The MCP is a decade-long multi-payer partnership with a voluntary risk-adjusted payment model for primary care organizations. It provides financial support for organizations to develop and implement a value-based care infrastructure and prospective payments per beneficiary for the delivery of primary care. The MCP consists of 3 tracks, ranging from lump sum infrastructure payments to a fully prospective payment model with one-sided risk. In turn, physicians need to meet a set criteria such as quality outcomes, health-related social needs (HRSN) screening and referral, and high-touch chronic care management.1 While MCP is a well-planned effort, it is likely to suffer from some of the same pitfalls as prior CMS attempts to revolutionize primary care and may therefore exert unintended effects on market consolidation.
2023年6月8日，美国医疗保险和医疗补助创新中心(CMMI)宣布了“初级医疗服务”(Making Care Primary, MCP)模式，这是该机构将初级医疗服务转变为基于价值的医疗支付系统的最新尝试。MCP是一个长达十年的多付款人伙伴关系，为初级保健组织提供自愿风险调整支付模式。它为各组织提供财政支持，以发展和实施基于价值的保健基础设施，并为提供初级保健的每个受益人提供预期付款。MCP包括3个方面，从一次性基础设施支付到具有单方面风险的完全前瞻性支付模式。反过来，医生需要满足一套标准，如质量结果，健康相关的社会需求(HRSN)筛查和转诊，以及高接触慢性护理管理虽然MCP是一个精心策划的努力，但它可能会遭受一些同样的陷阱，因为之前的CMS试图彻底改变初级保健，因此可能会对市场整合产生意想不到的影响。
{"title":"Making Care Primary: Medicare’s Latest Attempt at Value-Based Primary Care","authors":"Wasan M. Kumar, Bob Kocher, Eli Y Adashi","doi":"10.1093/haschl/qxad072","DOIUrl":"https://doi.org/10.1093/haschl/qxad072","url":null,"abstract":"\u0000 On June 8th, 2023, the Centers for Medicare and Medicaid Innovation (CMMI) announced the Making Care Primary (MCP) model, its latest attempt to transform primary care delivery for a value-based care payment system. The MCP is a decade-long multi-payer partnership with a voluntary risk-adjusted payment model for primary care organizations. It provides financial support for organizations to develop and implement a value-based care infrastructure and prospective payments per beneficiary for the delivery of primary care. The MCP consists of 3 tracks, ranging from lump sum infrastructure payments to a fully prospective payment model with one-sided risk. In turn, physicians need to meet a set criteria such as quality outcomes, health-related social needs (HRSN) screening and referral, and high-touch chronic care management.1 While MCP is a well-planned effort, it is likely to suffer from some of the same pitfalls as prior CMS attempts to revolutionize primary care and may therefore exert unintended effects on market consolidation.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138601900","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}
Biosimilars have the potential to greatly reduce U.S. spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drugs. Our analysis focused on six reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Lastly, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare carrier claims. Reference biologics greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilars generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars’ direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.
{"title":"Biosimilars Engage in Low Levels of Direct-to-Physician Marketing Relative to Reference Biologics","authors":"Megan Hyland, Colleen Carey","doi":"10.1093/haschl/qxad069","DOIUrl":"https://doi.org/10.1093/haschl/qxad069","url":null,"abstract":"\u0000 Biosimilars have the potential to greatly reduce U.S. spending on biologic drugs, but uptake of these competitor products varies. We used Open Payments data from 2014 to 2022 to proxy for direct-to-physician marketing and compared levels of activity between biologic and biosimilar drugs. Our analysis focused on six reference biologics that recently faced competition in the years immediately before and after the launch of the first biosimilar. We used Medicare Part B dosage units to measure market penetration of biosimilars and its relationship with biosimilar marketing activity. Lastly, we conducted a sensitivity test, comparing payments for primarily office- or hospital-based physicians, using affiliations constructed from Medicare carrier claims. Reference biologics greatly reduced the amount of direct-to-physician marketing in the post-launch period. Biosimilars generally engaged in low levels of activity relative to the historic performance of reference biologics. These trends were consistent across office- and hospital-based physicians. The intensity of biosimilars’ direct-to-physician marketing also had no apparent relationship with achieved market penetration. Our findings demonstrate that persistently high market shares of reference biologics cannot be explained by ongoing direct-to-physician marketing activities. At the same time, while such activities could educate physicians or induce switching, biosimilar entrants engaged in little direct-to-physician marketing.","PeriodicalId":94025,"journal":{"name":"Health affairs scholar","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603551","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}
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