Twelve-Month Contraceptive Supply Policies and Medicaid Contraceptive Dispensing.

Importance: Nineteen states have passed legislation requiring insurers to cover the dispensation of a 12-month supply of short-acting, hormonal contraception.

Objective: To determine whether 12-month contraceptive supply policies were associated with an increase in the receipt of 12-month or longer supply of contraception.

Design, Setting, And Participants: This retrospective cohort study included data from all female Medicaid enrollees aged 18 to 44 years who used short-acting hormonal contraception (ie, pill, patch, or ring) from 2016 to 2020.

Decomposition analysis of racial and ethnic differences in receipt of immediate postpartum, long-acting, reversible, and permanent contraception.

Objectives: This study aimed to determine the factors contributing to racial and ethnic disparities in the use of immediate postpartum, long-acting reversible contraception (IPP LARC) and permanent contraception among Medicaid recipients.

Study Design: We conducted a cross-sectional study using 3 years of national Medicaid claims data to examine the rates of IPP LARC use alone and a composite measure of postpartum permanent contraception and IPP LARC within 7 days of delivery by race and ethnicity. We used a Blinder-Oaxaca model to quantify the extent to which medical complexity, age, rurality, mode of delivery, and year explained differences in outcomes among different minoritized groups in comparison to non-Hispanic White women.

The association of federal Medicaid abortion funding restrictions with adverse obstetric outcomes among United States Medicaid recipients.

Objective: We examine the association of the Hyde Amendment with obstetrical outcomes in a national Medicaid population.

Study Design: We conducted a national study of Medicaid-funded abortions to determine the association of restrictions on adolescent, preterm, low-birth weight, and short interpregnancy interval births using administrative data.

Results: States that restricted coverage for abortion had a higher median rate of adolescent (10.

Geographic Variation In Effective Contraceptive Use Among Medicaid Recipients In 2018.

Medicaid is the largest payer for publicly funded contraception, serving millions of women across the United States. However, relatively little is known about the extent to which effective contraceptive services vary geographically for Medicaid recipients. This study used national Medicaid claims to assess county-level variation in rates of provision of the most or moderately effective methods of contraception and provision of long-acting reversible contraception (LARC) across forty states and Washington, D.

Catholic sole community hospitals are associated with decreased receipt of postpartum permanent contraception among Medicaid recipients.

Objectives: To examine the association of Catholic hospitals with receipt of postpartum tubal ligation and long acting, reversible contraception among Medicaid recipients.

Study Design: We conducted a retrospective cohort study of live births from January 1, 2016 to October 31, 2016 to female Medicaid beneficiaries in the United States between ages 21 and 44. Our main exposure was the presence of a Catholic-affiliated sole community hospital, and our primary outcome was highly effective postpartum contraception.

Hospital Characteristics Associated With Heterogeneity in Institutional Postacute Care Spending Reductions Under the Comprehensive Care for Joint Replacement Model.

Importance: Prior research concluded that institutional postacute care spending decreased under the Comprehensive Care for Joint Replacement (CJR) model. Less is known about how changes in institutional postacute care spending varied across different types of hospitals.

Objective: To measure hospital-level heterogeneity in the association of the CJR model with changes in institutional postacute care spending and to identify hospital characteristics associated with this variation.

Association of Medicare bundled payment model with joint replacement care for people with dementia.

Background: We examined whether the Comprehensive Care for Joint Replacement (CJR) model was associated with changes in the receipt of joint replacement among people with Alzheimer's disease and related dementias (ADRD) as well as spending, health service use, and postsurgical outcomes among people with ADRD who underwent a joint replacement surgery.

Methods: Retrospective cohort study using 2013-2017 Medicare claims and Minimum Data Set. We used a difference-in-differences analysis to compare people with ADRD residing in CJR-participating treatment areas versus nonparticipating control areas on the receipt of joint replacement, episode spending during the index hospitalization and subsequent 90-day post-discharge period, discharges to an institutional post-acute care setting, and readmissions within 90 days of hospital discharge.

Postpartum Contraceptive Use Among US Medicaid Recipients.

This cohort study uses national Medicaid claims data to assess US state variation in effective contraceptive use 60 days post partum.

The Spillover Effect of the Medicare Mandatory Bundled Payment Program on Joint Replacement Outcomes: Analysis of Patients with Commercial Insurance and Medicare Advantage.

Background: To improve the value and efficiency of care among traditional Medicare enrollees, the Centers for Medicare & Medicaid Services has implemented alternative payment models designed to control health-care spending and improve quality. These models may affect care beyond traditional Medicare enrollees, "spilling over" into other populations. Established in April 2016, the Medicare mandatory bundled payment program, called the Comprehensive Care for Joint Replacement (CJR) model, holds hospitals accountable for spending and quality of care for traditional Medicare joint-replacement patients during care episodes that span from the index hospitalization to 90 days post-discharge.

Association of rural location and long acting reversible contraceptive use among Oregon Medicaid recipients.

Objective: To evaluate whether the use of long-acting, reversible contraception (LARC) is equitably accessible to Medicaid recipients in rural and urban areas. We also determined whether women's health specialists' availability was associated with the type of LARC used.

Study Design: We used claims data for 242,057 adult women who were continuously enrolled in Oregon Medicaid for at least one year and at risk of pregnancy from January 1, 2015, through December 31, 2017 to assess the association between LARC utilization and (1) rurality and (2) provider supply.

Association of Medicare Mandatory Bundled Payment Program With the Receipt of Elective Hip and Knee Replacement in White, Black, and Hispanic Beneficiaries.

Importance: The Comprehensive Care for Joint Replacement (CJR) model was designed to reduce the cost and improve the quality of hip or knee replacement among Medicare beneficiaries. Yet whether this model may exacerbate existing racial/ethnic disparities in access to the surgery is unclear.

Objective: To examine the association of the CJR model with the receipt of elective hip or knee replacement across White, Black, and Hispanic Medicare beneficiaries.

Association of Medicare Mandatory Bundled Payment System for Hip and Knee Joint Replacement With Racial/Ethnic Difference in Joint Replacement Care.

Importance: There are marked racial/ethnic differences in hip and knee joint replacement care as well as concerns that value-based payments may exacerbate existing racial/ethnic disparities in care.

Objective: To examine changes in joint replacement care associated with Medicare's Comprehensive Care for Joint Replacement (CJR) model among White, Black, and Hispanic patients.

Design, Setting, And Participants: Retrospective cohort study of Medicare claims from 2013 through 2017 among White, Black, and Hispanic patients undergoing joint replacement in 67 treatment (selected for CJR participation) and 103 control metropolitan statistical areas.

Association of Implementing an Incentive Metric in the Oregon Medicaid Program With Effective Contraceptive Use.

Importance: Reducing unintended pregnancy is a national public health priority. Incentive metrics are increasingly used by health systems to improve health outcomes and reduce costs, but limited data exist on the association of incentive metrics with contraceptive use.

Objective: To evaluate whether an association exists between implementing an incentive metric and effective contraceptive use within the Oregon Medicaid program.

Accuracy of Hospital Discharge Codes in Medicare Claims for Knee and Hip Replacement Patients.

Background: Despite the importance of the hospital discharge destination field ("discharge code" hereafter) for research and payment reform, its accuracy is not well established.

Objectives: The aim of this study was to examine the accuracy of discharge codes in Medicare claims.

Data Sources: 2012-2015 Medicare claims of knee and hip replacement patients.

Association of the Mandatory Medicare Bundled Payment With Joint Replacement Outcomes in Hospitals With Disadvantaged Patients.

Importance: Medicare's Comprehensive Care for Joint Replacement (CJR) model rewards or penalizes hospitals on the basis of meeting spending benchmarks that do not account for patients' preexisting social and medical complexity or high expenses associated with serving disadvantaged populations such as dual-eligible patients (ie, those enrolled in both Medicare and Medicaid). The CJR model may have different implications for hospitals serving a high percentage of dual-eligible patients (termed high-dual) and hospitals serving a low percentage of dual-eligible patients (termed low-dual).

Objective: To examine changes associated with the CJR model among high-dual or low-dual hospitals in 2016 to 2017.

Access to Primary, Mental Health, and Specialty Care: a Comparison of Medicaid and Commercially Insured Populations in Oregon.

Objective: To describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon.

Design: Cross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology).

Participants: 420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015.

Level of Reconciliation Payments by Safety-Net Hospital Status Under the First Year of the Comprehensive Care for Joint Replacement Program.

This study uses data from the Comprehensive Care for Joint Replacement program to assess the level of Medicare reconciliation payments and examine these levels by hospital size and teaching hospital status to understand hospital performance.

Provider reasons for discontinuing long-term opioid therapy following aberrant urine drug tests differ based on the type of substance identified.

Objective: Urine drug testing (UDT) is increasingly performed as a means of identifying aberrant behavior that may be grounds for discontinuation of long-term opioid therapy (LTOT). Little is known, however, about the ways in which positive UDT results may differentially inform decisions to discontinue LTOT based on the type of substance for which the UDT screened positive. The aim of this study was to examine the likelihood of clinician-initiated discontinuation of LTOT attributed to positive UDT results across three discrete categories of substances: (1) cannabis, (2) alcohol or illicit substances (excluding cannabis), and (3) controlled prescription medications that were not prescribed.

Changes in pain intensity after discontinuation of long-term opioid therapy for chronic noncancer pain.

Little is known about changes in pain intensity that may occur after discontinuation of long-term opioid therapy (LTOT). The objective of this study was to characterize pain intensity after opioid discontinuation over 12 months. This retrospective U.

Clinician Referrals for Non-opioid Pain Care Following Discontinuation of Long-term Opioid Therapy Differ Based on Reasons for Discontinuation.

Background: Little is known about pain care offered to patients discontinued from long-term opioid therapy (LTOT) by their prescriber due to aberrant behaviors versus other reasons.

Objective: This study aimed to compare rates of non-opioid analgesic pharmacotherapy initiation and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons.

Design: The design included retrospective manual electronic health record review and administrative data abstraction.

Oregon's Emphasis On Equity Shows Signs Of Early Success For Black And American Indian Medicaid Enrollees.

In 2012 Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for the CCOs, implementing a multipronged approach that included strategic planning, community health workers, and Regional Health Equity Coalitions. We used claims-based measures of utilization, access, and quality to assess baseline disparities and test for changes over time.