Beyond demonstrations: implementing a primary care hybrid payment model in Medicare.

The National Academies of Sciences, Engineering, and Medicine's (NASEM's) 2021 report on primary care called for a hybrid payment approach-a mix of fee-for-service and population-based payment-with performance accountability to strike the proper balance for desired practice transformation and to support primary care's important and expanding role. The NASEM report also proposed substantial increases to primary care payment and reforms to the Medicare Physician Fee Schedule. This paper addresses pragmatic ways to implement these recommendations, describing and proposing solutions to the main implementation challenges.

Assessing the difference in racial and ethnic disparities in access to and use of care between Traditional Medicare and Medicare Advantage.

Objective: Test whether racial-ethnic disparities in the access and use of care differ between Traditional Medicare (TM) and Medicare Advantage (MA).

Data Source: Secondary data from the 2015-2018 Medicare Current Beneficiary Survey (MCBS).

Study Design: Measure Black-White and Hispanic-White disparities in access to care and use of preventive services within TM, within MA, and assess the difference-in-disparities between the two programs with and without controls for factors that could influence enrollment, access, and use.

How did the Affordable Care Act Medicaid Expansion Affect Coverage and Access to Care for Low-Income Parents Who Were Eligible for Medicaid Before the Law Was Passed?

We use the National Health Interview Survey from 2010 to 2017 and a difference-in-differences approach to assess the impact of the Affordable Care Cct (ACA) Medicaid expansion on coverage and access to care for a subset of low-income parents who were already eligible for Medicaid when the ACA was passed. Any gains in coverage would typically be expected to improve access to and affordability of care, but there were concerns that by increasing the total population with coverage and thereby straining provider capacity, that the ACA would reduce access to care for individuals who were already eligible for Medicaid prior to the passage of the law. We found that the expansion reduced uninsurance among previously eligible parents by 12.

The impact of civil conflict on infant and child malnutrition, Nigeria, 2013.

The new millennium brought renewed attention to improving the health of women and children. In this same period, direct deaths from conflicts have declined worldwide, but civilian deaths associated with conflicts have increased. Nigeria is among the most conflict-prone countries in Sub-Saharan Africa, especially recently with the Boko Haram insurgency in the north.

Changes in primary care access at community health centers between 2012/2013 and 2016.

Objective: To compare access at community health centers (CHCs) vs private offices (non-CHCs) under the Affordable Care Act.

Data Source: Ten state primary care audit conducted in 2012/2013 and 2016.

Study Design: CHCs and non-CHCs were called.

Potential Medicaid cost savings from maternity care based at a freestanding birth center.

Objectives: Medicaid pays for about half the births in the United States, at very high cost. Compared to usual obstetrical care, care by midwives at a birth center could reduce costs to the Medicaid program. This study draws on information from a previous study of the outcomes of birth center care to determine whether such care reduces Medicaid costs for low income women.

Forecasting the use of electronic health records: an expert opinion approach.

Background: To promote the widespread adoption and use of electronic health records (EHRs), in 2011, CMS started making Medicare and Medicaid incentive payments to providers who demonstrate that they are "meaningful users" of certified EHR systems.

Data And Methods: This paper combines an expert opinion method, a modified Delphi technique, with a technological diffusion framework to create a forecast of the percent of office-based physicians who will become adopters and "meaningful users" of health information technology from 2012 to 2019. The panel consisted of 18 experts from industry, academia, and government who are knowledgeable about the adoption and use of EHRs in office-based settings and are recognized as opinion leaders in their respective professions.

A decade of health care access declines for adults holds implications for changes in the Affordable Care Act.

The pending Supreme Court decision on the Affordable Care Act and the fall presidential election raise concerns about what would happen if the insurance expansion promised by the landmark health reform law were to be curtailed. This paper's analysis of national survey estimates found that access to health care and use of health services for adults ages 19-64--the primary targets of the Affordable Care Act--deteriorated between 2000 and 2010, particularly among those who were uninsured. More than half of uninsured US adults did not see a doctor in 2010, and only slightly more than a quarter of these adults were seen by a dentist.

Among dual eligibles, identifying the highest-cost individuals could help in crafting more targeted and effective responses.

The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nation's most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles.

The 2007-09 recession and health insurance coverage.

Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007-09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance.

Low-income uninsured children with special health care needs: why aren't they enrolled in public health insurance programs?

Objective: We examined potential barriers to enrollment in public programs among low-income children with special health care needs who are uninsured. Barriers considered include parents not knowing about the Medicaid and State Children's Health Insurance programs, not believing that their child is eligible for public coverage, not perceiving the enrollment processes as easy, and not wanting to enroll their child in a public program.

Methodology: The source of data is the 2001 National Survey of Children With Special Health Care Needs.