A Health Podyssey

More than 40 percent of Medicare enrollees are enrolled in Medicare Advantage (MA) plans, privately-sponsored health plans that provide Medicare benefits often along with other benefits not included in the standard Medicare package such as eye exams, hearing aids, and dental coverage.Medicare Advantage is growing rapidly. On the current trajectory, it's likely that the majority of Medicare enrollees will be in MA plans within a year or two.Since MA plans are paid on a capitated basis, insurers have a financial incentive to control health care costs. Recently, much attention has been focused on how addressing social needs can yield health benefits, which save MA plans money.In order to address those needs, health plans need to know the social needs of their enrollees.Brian Powers from Humana joins A Health Podyssey to discuss understanding the unmet social needs of Medicare enrollees.Powers and colleagues published a paper in the April 2022 issue of Health Affairs assessing the health related social needs of enrollees in Humana's MA plans. They found significant needs including financial strain, food and utility insecurity, poor housing quality, and unreliable transportation. These needs were distributed unevenly across enrollees by race, socioeconomic status, and sex.If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Vaccine requirements have been much in the news lately tied to the COVID-19 pandemic, but disputes over requiring vaccines have been with us for decades.How to balance respecting individual autonomy with protecting public health is not a new issue. It's played out in particular force when it comes to children.All states have vaccine requirements for children as they enter school and those requirements are often pretty widely known. Less well known are those requirements related to child care, which can affect children long before they reach school age.Alexandra Bhatti from Merck joins A Health Podyssey to discuss vaccine requirements for child care in the United States.Bhatti and coauthors published a paper in the April 2022 issue of Health Affairs assessing child care vaccination requirements in the United States. They found considerable variation across the 50 states and Washington, DC.While all jurisdictions require children up through age five to meet certain requirements to attend school or child care programs, the states are uneven in their breadth, enforcement, and implementation of these requirements.If you enjoy this interview, order the April 2022 issue of Health Affairs for research on access to care, hospitals and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.March 23 marked the 12th anniversary of the passage of the Affordable Care Act (ACA).This landmark legislation expanded health care access to millions of Americans and accelerated changes in how we organize and pay for health care. Having survived numerous legal challenges and strong political opposition by some, it continues to be the centerpiece of domestic health policy.If you want to understand the evolution of the Affordable Care Act from enactment to today, there's no one better to learn from than Katie Keith of the Georgetown University Law Center.Keith is a regular contributor to Health Affairs' Following The ACA Forefront article series and the recently launched Health Reform newsletter. Most recently, she's written about the No Surprises Act rules, the Department of Health & Human Services response to anti-trans youth policies, delay of the Sunset Rule, and much more.Today on A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil and Katie Keith dive into the latest ACA news and explore the law's successes, shortcomings, and unfinished work.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.The United States is facing a drug affordability crisis. Even as we celebrate scientific discovery, the health benefits of drugs are limited due to barriers of affordability, often even for people with health insurance. The RAND Corporation reports that on average drug prices in the United States are more than two and a half times those in 32 other nations studied. The disparities are even wider when we focus just on brand name drugs.Drug pricing is the subject of seemingly perennial debates. One side focuses on access barriers due to high prices while the other side argues that lower prices threaten future innovation. Stacie Dusetzina from Vanderbilt University Medical Center joins A Health Podyssey to talk about the complex world of drug pricing.She and colleagues published a paper in the April 2022 issue of Health Affairs examining the degree to which people with Medicare prescription drug benefits use the drugs that are prescribed to them.In the paper, the authors found non-initiation rates among some beneficiaries of greater than 50 percent for certain treatments.If you enjoy this interview, order the April 2022 Health Affairs issue to get research on access to care, hospitals and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Cancer diagnosis has changed radically in the era of precision medicine. New techniques like multi-cancer early-detection screening tests can detect up to 50 types of cancer from a single blood draw.We generally think of early detection, especially of cancer, as an unambiguously good thing. Given that, you might assume and expect that insurers would readily pay for it. But it turns out the considerations regarding insurance coverage for these screening tests are quite complex.As is often the case, advances in medical technology have accelerated beyond certain policies that were put in place when cancer diagnosis and treatment were very different.Kathryn Phillips from the University of California San Francisco joins A Health Podyssey to discuss how we can gain the advantages of better cancer screening technologies as they emerge.Phillips and coauthors published a paper in the March 2022 edition of Health Affairs examining payment considerations for multi-cancer screening tests. They outline clinical and economic considerations that will have to adjust to meet the new reality.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Limited access to transportation is well established as a barrier to people obtaining health care services. If it's hard to get to the doctor, you're less likely to go and that means delays getting needed care, poorer management of chronic conditions, and more use of the emergency room.While health insurance typically covers emergency transportation, say for an ambulance, coverage of non-emergency transportation to get you to a doctor's visit is less common. Medicaid, which serves people with low incomes, has covered this type of transportation for decades, but it's become increasingly clear that plenty of people with incomes above the Medicaid eligibility threshold face significant transportation barriers.Thus, some insurers and health systems have begun to offer a non-emergency transportation benefit as well.Seth Berkowitz from the University of North Carolina School of Medicine joins A Health Podyssey to discuss the effect of providing a transportation benefit.Berkowitz and colleagues published a paper in the March 2022 issue of Health Affairs assessing the effects of a non-medical transportation benefit offered to members of a Medicare accountable care organization.Enrollees had very positive reactions to the program, but it was also associated with more outpatient visits per person per year and thousands of dollars more in outpatient spending.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

There's a tremendous amount of consolidation going on in the health care sector. A lot of the research about consolidation focuses on the economics. But, one of the primary arguments people make for bringing disparate parts of the health system together is that it enables clinical integration.Patients, they say, should get better care if the clinicians are talking to each other and sharing information, which is easier to do if clinicians are a part of the same health care system.It turns out that studying clinical integration is hard. How do you define it? How do you measure it or having the desired effect?Hector Rodriguez from University of California Berkeley School of Public Health joins A Health Podyssey to discuss health care consolidation.Rodriguez and colleagues published a paper in the March 2022 issue of Health Affairs examining the relationship between physician practice capabilities and service metrics, like quality, utilization, and spending.They found that physician practices with robust capabilities, as defined by technology and innovation, management, culture, and patient-centered care, spent less on Medicare fee-for-service beneficiaries than those practice locations with less robust capabilities and they delivered similar quality care.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Out of about 5,000 community hospitals in the United States, almost 3,000 are nonprofit. More than a thousand are investor-owned, also called for-profit. The balance are owned by state or local governments.Nonprofit hospitals, like all nonprofit organizations, must have a charitable mission and for hospitals that mission is generally expressed as providing charity care and various benefits to the community.In exchange, nonprofit hospitals are exempt from various taxes, they can receive tax-deductible charitable donations and they may have access to tax-exempt bonds.There's a longstanding debate regarding whether nonprofit hospitals deserve the benefits they receive and whether nonprofit hospitals really behave all that differently from investor-owned hospitals.Jill Horwitz from the UCLA School of Law joins A Health Podyssey to discuss the similarities and differences in hospital behavior based upon ownership.Horwitz and Austin Nichols published a paper in the March issue of Health Affairs exploring the relationship between urban hospitals ownership type and which service lines they offer. They found that for-profits, nonprofits, and government-owned hospitals are all more likely to offer a service if its profitable but for-profit hospitals are overall more responsive to service profitability than nonprofits.If you enjoy this interview, order the March 2022 Health Affairs issue to get research on hospitals, health equity, care delivery and more.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Racism is a social phenomenon. Even though the medical research community has historically relied heavily on racism that treated Black bodies as property that could be experimented upon, clinical medicine has actually been pretty slow to accept racism as a legitimate topic of examination.Health services, with its ties to the social sciences, has been somewhat more accepting of the notion that racism is a topic worthy of scholarly inquiry. However, direct discourse about racism has been limited.Despite the squeamishness of mainstream institutions when it comes to talking about racism, a significant and robust body of research has arisen, demonstrating a direct link between racism and health.Ruth Enid Zambrana from the University of Maryland joins A Health Podyssey to discuss the rich intellectual history of scholarship on racism and health.Zambrana and coauthor David Williams published a paper in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health, tracing the scholarly origins of the understanding of racism as a social determinant of health.If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

There are more than 22 million people of Asian descent living in the United States. In the aggregate, Asian Americans have mostly better economic and health outcomes than other groups, including White Americans.Yet within the broad category of Asian Americans, there are dozens of subgroups often with quite different health outcomes and lived experiences. This within-group heterogeneity is often lost, buried under the so-called model minority myth, which is used to deny attention to unmet needs among Asian Americans and to denigrate the experience of other minority groups such of those of Black and Hispanic Americans.One subset of the larger Asian American population is people whose history traces to the Philippines. The relationship between the United States and the Philippines is unique and this history and present day status affect the health of Filipino Americans.Melanie Sabado-Liwag from California State University, Los Angeles joins A Health Podyssey to discuss the paper she and coauthors published in the February 2022 issue of Health Affairs, an issue devoted entirely to the topic of racism and health. They wrote about the ongoing impact of colonialism and racism on the health inequities faced by Filipino Americans.Sabado-Liwag and coauthors note that despite Filipino Americans high educational attainment and high employment rates, they still face significant health disparities. If you enjoy this interview, order the February 2022 Health Affairs Racism & Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts