Health affairs scholar最新文献

The United States faces a worsening maternal health crisis, with mortality rates far exceeding those of peer nations and persistent inequities for Black, Indigenous, and rural women. Medicaid finances over 40% of U.S. births, yet fiscal pressure, heightened scrutiny of program spending, and political resistance to benefit expansion constrain states' ability to adopt new maternal health interventions. In this environment, outcome-indexed public-private partnerships (PPPs) offer a pragmatic pathway to advance maternal health equity while tying expenditures to measurable value. This paper examines the promise and limitations of emerging FemTech innovations such as virtual doula care, remote patient monitoring, and AI-enabled risk-assessment-and the structural barriers that impede their adoption in Medicaid. We argue that innovation failures reflect misaligned incentives rather than lack of technological potential. To address this gap, we propose a coordinated policy framework that aligns the Advanced Research Projects Agency for Health (ARPA-H), the Centers for Medicare & Medicaid Services (CMS) Transforming Maternal Health Model and Medicaid Section 1115 waivers across the innovation lifecycle. This approach enables disciplined experimentation, independent evaluation, and scalable deployment of equity-focused technologies within Medicaid, safeguarding maternal health gains under constrained fiscal conditions.

Introduction: Workplace violence (WPV) against health care workers is a longstanding challenge that impacts the well-being of workers and patients. State legislative efforts to address WPV against health care workers have accelerated in recent years, particularly following the COVID-19 pandemic.

Methods: This study conducted a review of WPV-related enacted laws in health care settings across all 50 states over the last 10 years.

Results: As of June 2024, 48 states had enacted at least 1 WPV law, and some states have enacted 2 or more laws. State laws were categorized into 3 types: penalties, prevention, and remediation. Forty-five states had laws that penalize perpetrators of WPV, 27 enacted prevention laws, and 23 had remediation laws. Ten states had laws combining penalties with either prevention or remediation, 17 states had laws covering all 3 categories, while 3 states had only prevention and remediation laws.

Conclusion: Understanding variation in state WPV laws is important to future efforts to evaluate the efficacy of different legislative approaches. This study provides a landscape for federal and state government to understand legislative trends, and can inform health systems on strategies that can be used to prevent and address WPV.

Introduction: Originally introduced in Health Affairs in 2013, Standardized Clinical Assessment and Management Plans (SCAMPs) are clinician-developed, modifiable care pathways designed to reduce unwarranted variation and optimize resource use while preserving professional judgment. Unlike traditional clinical practice guidelines that prescribe "best" practice, SCAMPs begin with consensus-based "sound" practice and emphasize iterative learning from real-world deviations and outcomes. Initially developed for conditions with limited evidence, SCAMPs have since expanded across a wide range of diagnoses and care settings.

Methods: We conducted a structured historical review of more than 40 peer-reviewed publications describing SCAMPs development, implementation, evaluation, and iterative refinement. The review synthesizes reported experiences across clinical domains, settings, and study designs, and is intended as a descriptive, perspective-oriented assessment rather than a formal systematic review.

Results: Published SCAMPs reports describe broad deployment across diverse conditions and institutions, with recurrent findings of reduced practice variation, changes in resource utilization, iterative pathway refinement, and high reported adherence among participating clinicians. The literature also reflects important limitations, including heterogeneity of study designs, limited evaluation of harms, equity, patient-reported outcomes, and implementation burden, and likely underrepresentation of unsuccessful implementations. Early reliance on paper-based workflows constrained scalability and consistency of use.

Conclusion: This perspective synthesizes the published SCAMPs experience, highlighting reported benefits alongside implementation conditions, risks, and limitations. SCAMPs are best understood as a clinician-led methodology whose value is conditional on governance, analytic capacity, patient safety oversight, and attention to equity. Emerging informatics standards and artificial intelligence tools may enhance scalability and learning, but require careful governance to avoid amplifying bias or harm.

[This corrects the article DOI: 10.1093/haschl/qxaf100.].

Introduction: Healthcare and behavioral health professionals employed by local, state, and federal governments are essential to maintaining public health infrastructure, ensuring access to care, and responding to emergencies. Despite their importance, limited research has examined how recent policy, budgetary, and labor market changes are influencing their employment stability and retention within government sectors.

Methods: This study used longitudinal data from the Current Population Survey (2015-2025) to examine employment transitions among government-employed healthcare and behavioral health workers. We estimated the predicted probabilities of (1) transitions from government to non-governmental employment and (2) full exits from the labor force.

Results: Historically, federal healthcare and behavioral health workers had the lowest exit rates from government employment, but their probability of leaving government employment rose sharply in 2024-2025, converging with state and local levels (8%). Healthcare workers were consistently more likely than behavioral health workers to transition out of government roles, though both groups experienced higher exit rates in 2024-2025. Federal employees also exhibited a modest increase in labor force exits, from 2.5%-3% to 3.8% in 2024-2025.

Conclusion: These trends suggest increasing instability in the government-employed health workforce.

Introduction: Significant declines in therapy provision in skilled nursing facilities (SNFs) followed the 2019 implementation of Medicare's Patient-Driven Payment Model (PDPM) and the onset of the COVID-19 pandemic, raising concerns about effects on patient outcomes.

Methods: Using Medicare fee-for-service claims and SNF assessment data from January 2018 through September 2021, we analyzed 3.5 million post-hospital SNF stays to assess whether changes in therapy volumes mediated changes in successful community discharge and 30-day hospital readmissions.

Results: Average total physical, occupational, and speech therapy minutes per day declined from 122.2 before PDPM to 96.5 immediately after implementation and to 87.7 during the pandemic. Adjusted probabilities of successful community discharge rose modestly after PDPM but fell during COVID-19, while readmissions declined initially and then increased. Mediation analyses showed that reductions in therapy volumes were strongly associated with the declines in community discharge and increases in readmissions. These findings persisted for patients with dementia and moderate levels of functional impairment at admission; declining therapy volumes were associated with the observed worsening of discharge outcomes after PDPM implementation and during the pandemic.

Conclusions: Results highlight therapy provision as a key modifiable policy target for improving post-acute outcomes and reducing rehospitalizations among older adults in SNFs.

Introduction: In the midst of sweeping federal and state policy changes that will significantly impact Medicaid, effectively integrating community feedback into Medicaid policymaking will require identifying what Medicaid beneficiaries want and need to be healthy. We aimed to identify North Carolina community leaders' and community members' wants, needs, and experiences with Medicaid.

Methods: This qualitative study collected data using semi-structured interviews with 4 leaders of community-based organizations (CBOs), and 6 focus groups with 37 community members held across North Carolina between April and August 2024.

Results: A rapid qualitative analysis yielded 6 themes related to barriers and facilitators to overall health and well-being: (1) Challenges Applying for and Accessing Medicaid Services, (2) Addressing Health-Related Social Needs, (3) Accessing High-Quality Providers & Services, (4) Experiencing Stigma, Bias and Discrimination in Clinical Settings, (5) Promoting Coordination, Co-Location to Help with System Navigation, and (6) Enhancing Medicaid Engagement with Communities.

Conclusion: CBO leaders and community members communicated actionable insights that amplify important perspectives often not incorporated in Medicaid policymaking. As Medicaid agencies contend with implementing broad structural changes to their benefits and programs, it will be critical to tailor future reforms to address community feedback and maintain the health and well-being of beneficiaries.

Peer review is inefficient, biased, and often ineffective. However, its importance in maintaining research integrity, at a time when the public has less faith in science, is clear, since journals are the principal conduit for communicating the results of research to the scientific community and the public. Given that the number of published manuscripts in the biomedical sciences now exceeds 3 million per year it is no longer possible for human editorial and peer review alone to ensure integrity. New approaches are needed, including the use of artificial intelligence (AI) to assist in editorial and peer review.