Medicaid Spending in Coordination-Only Dual-Eligible Special Needs Plans.

Importance: More than 4 million Medicare beneficiaries have enrolled in dual-eligible Special Needs Plans (D-SNPs), and coordination-only D-SNPs are common. Little is known about the impact of coordination-only D-SNPs on Medicaid-covered services and spending, including long-term services and supports, which are financed primarily by Medicaid.

Objective: To evaluate changes in Medicaid fee-for-service (FFS) spending before and after new enrollment in coordination-only D-SNPs vs new enrollment in non-D-SNP Medicare Advantage (MA) plans among community-living beneficiaries enrolled in both Medicare and North Carolina Medicaid.

Resumption Of Medicaid Eligibility Redeterminations: Little Change In Overall Insurance Coverage.

In anticipation of the end of the COVID-19 public health emergency, Congress ended the Medicaid continuous coverage requirement on March 31, 2023, allowing states to terminate coverage for ineligible people and resume eligibility determinations through a process known as unwinding. Although administrative data have documented substantial declines in Medicaid enrollment since April 2023, the impact on uninsurance is unknown. Using data from the Census Bureau's Household Pulse Survey, we estimated the early effect of Medicaid unwinding on insurance coverage among people ages 19-64.

Systemic treatments for advanced prostate cancer: relationship between health insurance plan and treatment costs.

Objectives: The high costs of cancer care can cause significant harm to patients and society. Prostate cancer, the leading nonskin malignancy in men, is responsible for the second-highest out-of-pocket (OOP) payments among all malignancies. Multiple first-line treatment options exist for metastatic castration-resistant prostate cancer (mCRPC); although their costs vary substantially, comparative effectiveness data are limited.

Long-Term Engagement of Patients With Advanced Cancer: Results From the EPAC Randomized Clinical Trial.

Importance: The long-term effect of interventions that assist patients with establishing their end-of-life care preferences among patients with cancer remain relatively unknown.

Objective: To evaluate the association of a long-term intervention of a lay health worker-led advance care planning intervention among patients with advanced stages of cancer with overall survival and end-of-life health care use and costs.

Design, Setting, And Participants: This follow-up study of the EPAC randomized clinical trial conducted between August 2013 and February 2015 used data from 9.

Changes in emergency department use associated with Medicaid expansion under the Affordable Care Act: A comparison of waiver and traditional expansion states.

Objective: To determine whether changes in emergency department use associated with Medicaid expansions differed between states undergoing waiver and traditional expansions.

Methods: Design: This study was a cross-sectional difference-in-difference and event studies of Medicaid Expansion among states that expanded during or after 2014. Setting: We used a nationally representative cross-sectional survey from all 50 United States and the District of Columbia from 2010 to 2016.

Association Between Cervical Cancer Screening Guidelines and Preterm Delivery Among Females Aged 18 to 24 Years.

Importance: Cervical cancer screening is associated with reduced cervical cancer mortality; however, clinical trials have also shown an association between excisional procedures for cervical neoplasia and an increased risk of preterm delivery (PTD). National screening guidelines must weigh adverse effects on birth outcomes against benefits of cancer prevention.

Objective: To ascertain the population-level association between the number of guideline-recommended cervical cancer screenings and downstream PTD risk among females aged 18 to 24 years.

Medication Payments by Insurers and Patients for the Treatment of Metastatic Castrate-Resistant Prostate Cancer.

Purpose: The implications of high prices for cancer drugs on health care costs and patients' financial burdens are a growing concern. Patients with metastatic castrate-resistant prostate cancer (mCRPC) are often candidates for multiple first-line systemic therapies with similar impacts on life expectancy. However, little is known about the gross and out-of-pocket (OOP) payments associated with each of these drugs for patients with employer-sponsored health insurance.

Employer-Sponsored Coverage Stabilized And Uninsurance Declined In The Second Year Of The COVID-19 Pandemic.

The health risks of COVID-19, combined with widespread economic instability in the US, spurred Congress to pass temporary measures to improve access to health insurance. Using data from the Household Pulse Survey, a high-frequency, population-based survey, we examined trends in health coverage during 2021 and early 2022 among nonelderly adults. We estimated that eight million people gained coverage during this period, primarily because of increases in Medicaid and other public coverage.

Analysis of Publicly Funded Reinsurance-Government Spending and Insurer Risk Exposure.

This analysis compares the design of section 1332 reinsurance policies across states based on their potential for reducing insurer risk exposure and likely level of government spending.

Trends in US Health Insurance Coverage During the COVID-19 Pandemic.

Importance: While most working-age adults in the US obtain health insurance through an employer, little is known about the implications of the massive pandemic-related job loss in March 2020 and subsequent rebound for rates of employer-sponsored coverage and uninsurance.

Objective: To determine how health insurance coverage changed during the COVID-19 pandemic.

Design Setting And Participants: Analysis of trends in insurance coverage based on repeated cross sections of the US Census Bureau's Household Pulse Survey data, using linear regression to adjust for respondent's demographic and socioeconomic characteristics and state of residence.

Association Between High-Deductible Health Plans and Hernia Acuity.

Importance: About half of people younger than 65 years with private insurance are enrolled in a high-deductible health plan (HDHP). While these plans entail substantially higher out-of-pocket costs for patients with chronic medical conditions who require ongoing care, their effect on patients undergoing surgery who require acute care is poorly understood. It is plausible that higher out-of-pocket costs may lead to delays in care and more complex surgical conditions.

Providing more balanced information on the harms and benefits of cervical cancer screening: A randomized survey among US and Norwegian women.

We aimed to identify how additional information about benefits and harms of cervical cancer (CC) screening impacted intention to participate in screening, what type of information on harms women preferred receiving, from whom, and whether it differed between two national healthcare settings. We conducted a survey that randomized screen-eligible women in the United States (n = 1084) and Norway (n = 1060) into four groups according to the timing of introducing additional information. We found that additional information did not significantly impact stated intentions-to-participate in screening or follow-up testing in either country; however, the proportion of Norwegian women stating uncertainty about seeking precancer treatment increased from 7.

Does Multispecialty Practice Enhance Physician Market Power?

In health care, vertical integration - common ownership of producers of complementary services - may have both pro- and anti-competitive effects. We use data on 40 million commercially-insured individuals from the Health Care Cost Institute to construct price indices for office visits to general-practice and specialist physicians for the years 2008-2012. Controlling for generalist market concentration, we find that generalists charge higher prices when they are integrated with specialists, and that the effect of integration is larger in more concentrated specialist markets.

The Role of Physician-Driven Device Preference in the Cost Variation of Common Interventional Radiology Procedures.

Purpose: To analyze the impact of physician-specific equipment preference on cost variation for procedures typically performed by interventional radiologists at a tertiary care academic hospital.

Materials And Methods: From October 2017 to October 2019, data on all expendable items used by 9 interventional radiologists for 11 common interventional radiology procedure categories were compiled from the hospital analytics system. This search yielded a final dataset of 44,654 items used in 2,121 procedures of 11 different categories.

Cataract Surgery Complexity and Surgical Complication Rates Among Medicare Beneficiaries With and Without Dementia.

Purpose: To evaluate cataract surgery complexity and complications among US Medicare beneficiaries with and without dementia.

Design: Retrospective claims-based cohort study.

Participants: A 20% representative sample of Medicare beneficiaries, 2006-2015.

ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study.

The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion.

Receipt of Eye Care Services among Medicare Beneficiaries with and without Dementia.

Purpose: To examine the relationship between dementia status and receipt of eye care among US Medicare beneficiaries.

Design: Retrospective, claims-based analysis.

Participants: A 20% representative sample of Medicare beneficiaries who received care between January 1, 2006, and December 31, 2015.

Online Consent Enables a Randomized, Controlled Trial Testing a Patient-Centered Online Decision-Aid for Medicare Beneficiaries to Meet Recruitment Goal in Short Time Frame.

Online consenting allows potential participants of research projects to deliberate their participation at their own pace and may be more cost-effective than conventional approaches. Yet, online consenting is not widespread in health services research due partly to concerns about security, confidentiality, and lack of established processes. We report our use of online consenting to successfully enroll over 1185 Medicare beneficiaries in a short 9-week time frame for a research study.

Association Between HEDIS Performance and Primary Care Physician Age, Group Affiliation, Training, and Participation in ACA Exchanges.

Background: There are a limited number of studies investigating the relationship between primary care physician (PCP) characteristics and the quality of care they deliver.

Objective: To examine the association between PCP performance and physician age, solo versus group affiliation, training, and participation in California's Affordable Care Act (ACA) exchange.

Design: Observational study of 2013-2014 data from Healthcare Effectiveness Data and Information Set (HEDIS) measures and select physician characteristics.

The effects of medicare advantage on opioid use.

Despite a vast literature on the determinants of prescription opioid use, the role of health insurance plans has received little attention. We study how the form of Medicare beneficiaries' drug coverage affects the volume of opioids they consume. We find that enrollment in Medicare Advantage, which integrates drug coverage with other medical benefits, significantly reduces beneficiaries' likelihood of filling an opioid prescription, as compared to enrollment in a stand-alone drug plan.

Comparative Usability Study of a Newly Created Patient-Centered Tool and Medicare.gov Plan Finder to Help Medicare Beneficiaries Choose Prescription Drug Plans.

Introduction: In response to reported difficulties in selecting a Medicare Part D prescription drug plan, we designed a patient-centered online Part D plan selection tool (CHOICE1.0) to simplify the selection process and to provide personalized, expert recommendations.

Methods: This ethnographic comparative usability study observed 44 patients using the first version of the tool during Medicare 2016 Open Enrollment.

Differences in Cataract Surgery Rates Based on Dementia Status.

Background: Cataract surgery substantially improves patient quality of life. Despite the rising prevalence of dementia in the US, little is known about use of cataract surgery among this group.

Objective: To evaluate the relationship between dementia status and cataract surgery.

Machine-Based Expert Recommendations And Insurance Choices Among Medicare Part D Enrollees.

Choosing a health insurance plan is difficult for many people, and patient-centered decision support may help consumers make these choices. We tested whether providing a patient-centered decision-support tool-with or without machine-based, personalized expert recommendations-influenced decision outcomes for Medicare Part D enrollees. We found that providing an online patient-centered decision-support tool increased older adults' satisfaction with the process of choosing a prescription drug plan and the amount of time they spent choosing a plan.