A Health Podyssey

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

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