A Health Podyssey

Finding access to mental health services can be challenging in the United States.The explosion of the demand for services, the inadequate workforce to provide them, and payment levels and methods that don't always support the care people need all contribute to these challenges.There are also longstanding concerns around access to all types of care for people enrolled in Medicaid, primarily due to low payment rates for services.If you put those together, it's not surprising that access to mental health services for people on Medicaid poses particular challenges. And since Medicaid is the largest payer for mental health services and treatment in the United States, these are challenges that need to be addressed.Jane Zhu from Oregon Health and Science University joins A Health Podyssey to discuss access to mental health services for Medicaid enrollees.Zhu and colleagues published a paper in the July 2022 issue of Health Affairs assessing the prevalence of what they call "phantom providers" in Oregon Medicaid managed care networks. These are providers who are listed in network directories but not providing many services to Medicaid patients. They found that a large share of mental health providers listed in these network directories saw four or fewer Medicaid patients in 2018. The shares were largest for specialists and people authorized to prescribe medication.Order the July 2022 issue of Health Affairs for research on type 2 diabetes and more.Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Telemedicine burst onto the scene as the nation locked down at the start of the COVID-19 pandemic. Historically, telehealth, or telemedicine, was tightly restricted both by regulation and by payment policy.But in response to COVID-19's disruption of in-person care, all 50 states and Washington, DC issued temporary waivers that allowed clinicians to administer telehealth care to patients who live in a different state than their provider.Juan Andino from the University of Michigan joins A Health Podyssey to discuss how interstate telehealth use changed in the face of COVID-19.Andino and colleagues published a paper in the June 2022 issue of Health Affairs assessing the effect of waivers on interstate telehealth use among Medicare beneficiaries during the COVID-19 pandemic.They found that while the volume of interstate telehealth use increased in 2020, out of state telehealth use continued to make up only a small share of all outpatient visits and all telehealth visits. They also found some interesting patterns on how interstate telehealth has changed.Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and podcasts free for everyone.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

High prices are an enduring feature of the United States health care system. Traditional market forces haven't seemed to bring them down, which leads some to wonder if we need a new approach.Some may wonder, why not harness the purchasing behavior of consumers who provide downward cost pressure in pretty much every other sector of the economy?Enter the idea of high-deductible health plans - health insurance with a high deductible which presumably should make consumers more careful with their purchases. Sherry Glied from New York University joins A Health Podyssey to discuss the role of high deductible health plans in creating health market efficiencies.Glied and coauthors published a paper in the June 2022 issue of Health Affairs examining the evolution of high deductible plans and companion health savings accounts, which are tax-favored saving vehicles offered in conjunction with a high deductible plan.They found that these plans no longer serve their original purpose of encouraging cost consciousness and reducing spending. Instead, they provide regressive tax breaks disproportionally used by higher income people. Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Listen to Health Affairs Editor-in-Chief Alan Weil interview Andy Slavitt, co-founder of both United States of Care and Town Hall Ventures and former administrator of the Centers for Medicare and Medicaid Services.Andy is the host of the podcast In The Bubble with Andy Slavitt and recently published the book, "Preventable: The Inside Story of How Leadership Failures, Politics, and Selfishness Doomed the U.S. Coronavirus Response."Currently, more than 70 percent of our content is freely available — and we’d like to keep it that way. With your support, we can continue to keep our digital publication Forefront and Podcasts free for everyone.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The concepts that underlie hospice were introduced a few centuries ago but, the modern hospice movement began in London in 1967.In 1982 hospice was added as a Medicare benefit. Today, half of all Medicare decedents enroll in hospice, at a total cost of $20.9 billion to Medicare in 2019.Hospice has a strong evidence base for improving end-of-life experiences for the recipient and the recipient's family. But there's limited evidence regarding the effects of hospice for people with dementia.This is a critical knowledge gap given that one in three adults aged 85 and older has dementia.Krista Harrison from University of California San Francisco joins A Health Podyssey to discuss how well hospice works for people with dementia.Harrison and coauthors published a paper in the June 2022 issue of Health Affairs assessing the relationship between hospice enrollment and last month of life care quality for Medicare enrollees living with dementia.They found that hospice-enrolled people living with dementia had higher quality last month of life care than people who are not enrolled in hospice, with quality levels similar to people without dementia.Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Recently, there's been dramatic growth in the number of nurse practitioners (NPs) and physician assistants (PAs). The number of NPs has more than tripled in the last decade while the number of PAs has almost doubled.Yet, due to particular billing practices in Medicare, it can be difficult to know how care these clinicians are providing. That means there's a lot we don't know about access and quality related to this critical part of the health care workforce.Ateev Mehrotra from Harvard Medical School and Beth Israel Deaconess Medical Center joins A Health Podyssey to discuss how we bill for nurse practitioner and physician assistant services and the implications of those practices.Mehrotra and colleagues published a paper in the June 2022 issue of Health Affairs examining the prevalence of "indirect billing," where care provided by a PA or NP is billed under the supervising physician.They found about 11 million instances of Medicare indirect billing in 2010 and 30 million in 2018 and estimate that eliminating indirect billing would have saved Medicare more than $190 million.Order the June 2022 issue of Health Affairs for research on costs, care delivery, COVID-19, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The United States has the highest rate of incarceration of any country in the world.Health care for people in jails and prisons is rarely part of mainstream health care and health policy conversations. But people who are incarcerated have significant health needs and a legal right to medical treatment.In addition, with 10 million people released from jail every year, needs that aren't met while people are incarcerated re-emerge in the community.While the number of incarcerated people in the United States has started to decline, the share of the incarcerated population that's older has grown, placing additional strain on health system's that are already under a great deal of pressure.Dr. Rachael Bedard joins A Health Podyssey to discuss the health needs of older people in jail. Bedard and coauthors published a paper in the May 2022 issue of Health Affairs assessing the health and health needs of incarcerated older adults in New York City. They found that older incarcerated had greater health vulnerabilities than their younger counterparts. They are also more likely to suffer from serious mental and physical illnesses.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

When the Institute of Medicine defined health care quality, patient-centeredness was one of the five core dimensions. Yet as many have noted, the health system often seems to be more organized around the needs of providers than patients.This reality is particularly true when it comes to older Americans. An entire system of coverage and care has built up around institutional needs and institutional definitions - nursing homes, hospitals, assisted living centers, rehabilitation centers, and more.Christine Ritchie from Massachusetts General Hospital and Harvard Medical School joins A Health Podyssey to discuss what a reimagined health system truly designed around the needs of older patients could look like.Ritchie and coauthor Bruce Leff of Johns Hopkins University published a commentary in the May 2022 issue of Health Affairs describing the elements of a new home and community-based care ecosystem for older people.They argue for a system grounded in principles like respect for caregivers and medical and social integration.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

When medical offices shut down due to the COVID-19 pandemic and people were encouraged or required to avoid public spaces, there was a dramatic and rapid increase in the use of telemedicine. Telemedicine has the potential to open up access to care, particularly to people who are geographically isolated or have mobility limitations, but it can also exacerbate existing inequities given its relevance upon broadband internet access and other technologies.Caitlin Hicks from Johns Hopkins School of Medicine joins A Health Podyssey to discuss whether telemedicine expands or narrows care inequities.Hicks and colleagues published a paper in the May 2022 issue of Health Affairs examining the impact of Medicare's pandemic-era telemedicine coverage waiver on utilization by geographic area.They found that Medicare's telemedicine access expansion increased utilization overall and that those beneficiaries in areas of greater depravation, as measured by the Area Depravation Index, had greater odds of utilization than those who live in areas with more resources.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The health care sector has gone through various waves of consolidation with hospitals purchasing physician practices and hospitals, physicians, and health insurers merging with each other.We're in the midst of a wave of consolidation.Two years ago, Health Affairs published a paper that found more than half of US physicians and 72 percent of surveyed hospitals were affiliated with one of 637 health systems in 2018. More recently, some have estimated that the 10 largest health systems now control about a quarter of the health care market.Consolidation brings with it various opportunities for savings and efficiency but it also concentrates market power and creates opportunities to raise prices.Vilsa Curto from Harvard University joins A Health Podyssey to discuss the effects of consolidation and integration.Curto and colleagues published a paper in the May 2022 issue of Health Affairs assessing trends in vertical integration and joint contracting between physicians and hospitals in Massachusetts and exploring the affects on prices for physician services.They found notable price affects that varied according to system size and physician type.Order the May 2022 issue of Health Affairs for research on telemedicine, disparities, pharmaceuticals, and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts