Health affairs scholar最新文献

Introduction: While surveys suggest that many Medicaid enrollees mistakenly report that they do not have Medicaid coverage, little is known about this population. Enrollment misreporting could be associated with poorer access if enrollees delay or avoid needed care because they incorrectly believe they cannot afford it.

Methods: We exploited the COVID-19 Medicaid continuous coverage provision to identify sociodemographic and health characteristics of enrollees who initially reported Medicaid but subsequently misreported their coverage, and to characterize their patterns of health care access, utilization, and spending.

Results: We found that 11.5% of enrollees misreported their coverage, belonging to 2 distinct groups: those who reported being uninsured, and those who reported other coverage. Compared to enrollees who accurately reported having Medicaid, enrollees who reported uninsurance experienced more cost-related barriers to care, lower utilization, and $1682 less in average annual health expenditures.

Conclusion: These findings suggest that health care behaviors follow perceptions of Medicaid enrollment status. Because coverage confusion may impair access to needed services, addressing the needs of this group will require policy and programmatic strategies to ensure that enrolled individuals can benefit from their Medicaid coverage.

Introduction: The intensity of diagnostic coding in Medicare Advantage (MA) relative to Original Medicare (OM) plays an important role in Medicare's fiscal costs due to its impact on risk adjustment payments. In this article, we provide new estimates of coding differentials that differ from other prominent estimates and incorporate recent policy changes.

Methods: CMS staff recalculated payment year 2022 national average enrollment-weighted risk scores for MA and OM using the newly implemented v28 risk adjustment model and a demographic-only risk adjustment model. Following the demographic estimate of coding intensity methodology, we estimate the difference in risk scores due to differences in health status between MA and OM.

Results: Using a comparable methodology as other widely cited research, we estimate 1.5%-2.0% of "uncorrected" coding in MA relative to OM in 2022 after accounting for statutorily mandated payment adjustments and recent changes to the MA risk adjustment model.

Conclusion: Compared with alternative estimates of roughly 10%, our lower estimated uncorrected coding in MA suggests that prior policy actions may have affected federal spending in MA. These findings can help inform discussion of the overall fiscal balance between MA and OM.

Introduction: Despite the association of meth/amphetamine use with risk for unintentional injury and interpersonal violence, screening for meth/amphetamine use among injured patients is not required at US trauma centers.

Methods: Using data from the American College of Surgeons Trauma Quality Programs dataset, we examined the prevalence of meth/amphetamine positivity on urine drug screen and its association with clinical outcomes at 873 trauma centers.

Results: Of 4.5 million adult trauma patients, 1.5 million (33%) received a urine drug screen, of which 11% were positive for meth/amphetamines. Rates of positivity increased from 9% in 2017 to 12% in 2022. Prevalence among those screened varied widely across trauma centers (interquartile range 4%-16%). Patients who screened positive for meth/amphetamine presented with more severe injuries and required longer hospitalizations.

Conclusion: Our findings indicate that meth/amphetamine use is common among trauma patients, with a prevalence several times higher than national averages. For this population, improved screening and intervention for meth/amphetamine use disorder at US trauma centers may represent an opportunity to prevent reinjury and improve the health of patients and their communities.

In this piece, we provide context for new estimates of coding intensity in Medicare advantage (MA) and highlight how researchers can build on them to inform ongoing policy debates. In particular, we identify opportunities to study how insurer responses may affect the intended goals of the Center for Medicare and Medicaid Services's (CMS) recently introduced risk adjustment model, as well as how potential changes in insurer payments may influence plan design.

Persons with disabilities experience significant health inequities globally, driven in part by the lack of disability-disaggregated data in national health surveillance systems. In Korea, despite having a well-established administrative infrastructure-most notably the Korean National Disability Registration System-disability-inclusive health data remain limited. The National Health Information Database, which links administrative and health insurance data, offers a rare example of integrated data enabling individual-level analysis by disability status, type, and severity. However, the absence of a legal mandate and limited policy recognition of disability inclusion have hindered the widespread use of disability identifiers across key national health datasets. Korea's experience illustrates both the potential and the limitations of relying solely on administrative definitions, which often fail to reflect the broader spectrum of disability outlined in international frameworks such as the International Classification of Functioning, Disability and Health. To advance equity in health systems, countries must integrate disability into population-based data using standardized, functional definitions. This commentary emphasizes the need for both technical integration and a conceptual shift in how disability is defined, measured, and operationalized in health data systems.

Introduction: The Centers for Medicare and Medicaid Services has made screening for health-related social needs (HRSNs) mandatory since 2024. Patients screening positive for HRSN food insecurity (FI) are connected with Supplemental Nutrition Services using 1115 Demonstration waivers. With a shift in funding, Massachusetts adopted a more stringent FI-level screening protocol (very low food security [VLFS]). To date, there is no screening tool that identifies VLFS alone; thus, we developed a sensitive, specific, and valid screen to determine risk for VLFS.

Methods: Sensitivity, specificity, and positive- and negative-predictive values were used to test combinations of questions compared with the USDA Household Food Security Survey Module using the 2022 Current Population Survey.

Results: The best VLFS screen was, "In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?" (yes/no). The screen was highly sensitive, specific, and valid for detecting VLFS risk in US households with and without children (sensitivity, 92.2% and 97.2%; specificity, 96.2% and 97.4%, respectively), and with diverse populations.

Conclusion: The VLFS screen is recommended for use by states adopting a more stringent FI-level screening protocol.

Despite substantial progress, many serious diseases continue to lack safe and effective therapies. Building on a recent National Academies consensus study report that offers several recommendations to better align investments in therapeutic development with unmet needs, in this commentary, we focus on the Food and Drug Administration's role in advancing this goal. Historically, FDA has encouraged investment where market incentives fall short, undertaken efforts to address broad scientific challenges, and administered programs to expedite development and review of drugs targeting unmet needs. Under the second Trump administration, FDA has launched several initiatives that continue these key themes, although some have been controversial, primarily due to concerns about resource sufficiency and the potential for political interference. Regarding other domains addressed by the National Academies report, FDA has recently given mixed signals on its commitment to upholding rigorous approval standards; paid limited attention to noted gaps, including improving rigorous postmarket evidence generation and validating the surrogate markers often used to support product approval; and failed to ensure adequate financial and human resources to support the agency's critical work. Engagement with the National Academies report's recommendations can help ensure that FDA continues to advance progress toward addressing unmet medical needs.

There have been notable improvements in patient safety in recent years; however, significant challenges remain in reducing the incidence of preventable patient harm. Supporting patient safety efforts is increasingly important given increasing complexity of care and changing health needs, especially with aging populations. Emerging technologies and capabilities open new possibilities to address longstanding patient safety problems. For example, predictive analytics to support provider decision-making, increased patient interest in engagement in their care, and artificial intelligence provide opportunities to further reduce harm. Many of these examples support a more proactive approach to patient safety by focusing on anticipating, predicting, and preventing patient harm; however, implementation is essential to avoid unintended consequences. Additionally, health care organizations oftentimes cannot accomplish this work on their own and strategic partnerships are crucial for continued improvement. This paper proposes a strategic focus for health care leaders as they build comprehensive plans to prevent harm from adverse events. Drawing on international case examples from the Future of Health Community, it outlines actionable approaches to partnerships that can be adapted and implemented across diverse health care organizations.

Objective: Doula support improves maternal health outcomes. States have increasingly included doula services as a covered benefit under Medicaid. We evaluated the implementation of Virginia's Medicaid doula policy and identified lessons to improve access and utilization.

Methods: This mixed-methods study used administrative data (Medicaid claims data from January 2022-December 2024 and state-certified doula registry data) and qualitative interviews with 9 doula Medicaid providers to understand the barriers and facilitators to doula care among Medicaid beneficiaries in Virginia.

Results: At the time of the study, there were 130 state-certified doula Medicaid providers in Virginia, but fewer than half billed Medicaid for services, most commonly billing for postpartum care. Additionally, utilization of doula services among beneficiaries was low (less than 1%) from 2022 to 2024. Geographic disparities showed limited doula availability in some high-need areas. Five policy lessons emerged.

Conclusion: State Medicaid programs can strengthen doula policy implementation, and in turn strengthen the doula workforce and expand access to doula care for Medicaid beneficiaries, by revising reimbursement rates and structure to better reflect the scope of doula services, recruiting doulas in underserved areas, providing technical assistance for enrollment and billing, expanding outreach to beneficiaries, and engaging a range of doulas in policy discussions.

Introduction: About 2.7 million U.S. households face an eviction filing each year. The effect of eviction policy on substance use disorder (SUD) treatment is uncertain.

Methods: We used IQVIA all-payer claims, Jan 2020-Dec 2021, in a difference-in-differences design. Phase 1 compared states where moratoria expired March-August 2020 with states that kept protections. Phase 2 examined the August 2021 end of the federal moratorium, contrasting states with ongoing state moratoria vs none. The population was people with a mental health or SUD diagnosis. Outcomes were state-week counts of unique patients with outpatient SUD visits, inpatient SUD stays, medications for opioid or alcohol use disorder, and opioid use disorder (OUD)-specific outpatient and inpatient care.

Results: Ending moratoria was associated with more patients receiving outpatient SUD care: +3.3% (95% CI -0.5% to 7.2%; P = 0.09) in Phase 1 and +4.9% (95% CI 1.8% to 8.0%; P = 0.002) in Phase 2. We observed no change in inpatient SUD care. In Phase 2, medication treatment increased by 2.5% (95% CI 0.3% to 4.7%; P = 0.03). OUD-specific results were similar.

Conclusion: The return of eviction risk coincided with greater use of clinic-based SUD services but not hospital care. Housing policy may shift where and how people seek SUD treatment.