A Health Podyssey

The February 2022 issue of Health Affairs focuses entirely on racism and health. It includes papers that trace the long history of racism to present day policies and practices that are the reasons for large and sustained health disparities.Racism and bias come in many forms and given the social stigma associated with them, they can be difficult to study. When a study comes along that provides new empirical data on bias, it makes a major contribution to our understanding of this important topic.One such study in the February issue from Michael Sun, a medical student from the University of Chicago, and colleagues is the focus of today's A Health Podyssey.Sun and coauthors studied bias in how patients are characterized by clinicians through the history and physical notes entered into a patient's electronic health record, or EHR. When a patient is admitted as an inpatient or an outpatient, the notes document the patient's reason for seeking medical care and summarize the patient's medical, family, and social history. The notes can also describe the plan to address the patient's medical problems. But what if the way the patient is characterized in these notes is distorted by clinician bias? Sun and colleagues examined racial bias in EHRs and found that Black patients had over 2.5 times the odds of having negative descriptors in their medical records when compared to white patients.If you enjoy this interview, order the February 2022 Health Affairs Racism and Health theme issue.Listen to Health Affairs Pathways.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The COVID-19 pandemic has made the relationship among research, policy, and public health strikingly clear. People who may have given little thought to health policy and research began following the latest study results to guide their own behavior and push governments and businesses to make decisions that reflect a combination of science and their own values and risk tolerance.Health journals like Health Affairs responded by accelerating editorial processes and publishing free content to meet growing consumer demand. The new environment affected health services researchers as well as placed a new emphasis on timeliness and attention to issues affecting the public.In this context, George Wehby from the University of Iowa College of Public Health joins Health Affairs Editor-in-Chief Alan Weil for a new A Health Podyssey Excursion.Wehby co-authored the most read Health Affairs article in 2020. In that paper, Wehby and coauthor Wei Lyu showed the value of state-level mask mandates in the early phase of the COVID-19 pandemic.More recently in January 2022, Wehby and colleagues published two more papers in Health Affairs, one related to children's educational attainment and the other on racial and ethnic disparities in dental service use among lower income adults receiving Medicaid.Join Alan Weil and George Wehby as they discuss these topics and how health services research has changed in recent years. If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Precision medicine is built on a platform of big data, or large data bases that permit analysis of correlations among environmental and personal factors, treatments, and health outcomes.Data bases that once included only paper records now include tissue samples, air and water samples, and more. There's vast potential for significant advances in health care from precision medicine.But existing large data bases tend to be drawn almost entirely from European and Asian populations, limiting the reach of the benefits of precision medicine. Since big data analytics are often hidden from the patient (and sometimes even the clinician), non-representative data also contributes to mistrust in a health care system that has a long history of excluding certain people.Kayte Spector-Bagdady from the Center for Bioethics and Social Sciences in Medicine from the University of Michigan Medical School joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the representativeness of data banks and what to do about it.Spector-Bagdady and coauthors published a paper in the December 2021 issue of Health Affairs examining the lack of racial and ethnic diversity in data bank recruitment and enrollment at Michigan Medicine, a major academic medical center.They found failures of representation were in part due to recruitment practices and in part due to the disproportionate rate at which black, Asian, and Hispanic patients declined enrollment when offered, relative to non-Hispanic white patients.If you enjoy this interview, order the December 2021 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Advance care planning is a term used to describe when a person prepares for future management of serious or terminal illness, including developing an advance care directive or what is sometimes is called a living will.Beginning in January of 2016, Medicare made it possible for certain clinicians to bill for their work for patients to develop advance care plans.Despite the new billing option, uptake has been quite slow.In health care, we often use financial incentives to motivate behavior change. You might have expected that simply creating a payment option for advance care planning would make it happen.Keren Ladin from Tufts University joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss the reasons Medicare's payment policy has not led to the greater pursuit of advance care planning.Ladin and coauthors published a paper in the January 2022 issue of Health Affairs examining the limited use of advance care planning billing codes among clinicians. Their qualitative study revealed a number of potential explanations for low use that can help us  understand why a seemingly simple payment change doesn't automatically yield a desired result.Barriers to use of the advance care planning billing codes include institutional practices, concerns about the effects on patients and more.If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

"Let us hope that this is a one in a hundred years pandemic. We don't want to build our health care system to operate at all times as if tomorrow will be COVID." - Sherry GliedOn December 15, Health Affairs published ahead-of-print, “National Health Care Spending In 2020: Growth Driven By Federal Spending In Response To The COVID-19 Pandemic,” the annual national health expenditures article prepared by the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary. Always one of Health Affairs’ most-read articles, this year’s provides the first official report on spending that reflects the effects of COVID-19. During a live Lunch and Learn event, a discussion was held on the findings with economists Sherry Glied from the Robert F. Wagner Graduate School of Public Service at New York University and Craig Garthwaite from Northwestern University’s Kellogg School of Management. The event was held on January 5, 2022.Listen to Health Affairs Senior Editor Laura Tollen interview Sherry Glied and Craig Garthwaite about what's behind the numbers regarding the latest national health care spending report, long COVID, health care spending reform, which hospitals gained the most during the pandemic, delayed care, and more. Lunch and Learn events hosts top researchers and analysts on timely topics and initiatives impacting health policy. Interested in attending future events? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. If you enjoy this interview, order the January 2022 Health Affairs issue.Pre-order the February 2022 Racism and Health issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

When you think of the health care workforce, nurses and physicians are probably the first professions which come to mind.But there are actually more personal care aides in the US than physicians. Together with home health aides and nursing assistants, personal care aides comprise one-fifth of the US health care workforce. These workers provide essential supports to people who face limitations in basic activities such as eating, bathing, and moving around.As the US population ages, the demand for home health and personal care aides is projected to increase by nearly 1.2 million additional jobs by 2030.Esther Friedman from the University of Michigan joins A Health Podyssey to discuss the changing size in employment in the personal care workforce.Friedman and colleagues published a paper in the December 2021 edition of Health Affairs investigating state level changes in the nursing home and home care workforce between 2009 and 2020. While almost all states experienced an increase in the overall size of their home care workforce, most saw a decrease in their nursing home workforce relative to the number of people who need these services.If you enjoy this interview, order the December 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The availability of pharmacist-administered vaccination has grown in recent decades. Proximity to a pharmacy has found to be predictive of vaccine use. In Florida, Publix grocery stores were the first retail pharmacies to provide COVID-19 vaccinations to eligible members of the public. For more than a month after the initial rollout, Publix remained the sole retail pharmacy authorized to administer COVID-19 vaccines.Grocery stores seem like a natural place to reach a large share of the population, but grocery stores are not located evenly throughout communities.Jennifer Attonito, an instructor of health administration from Florida Atlantic University, joins A Health Podyssey to discuss disparities in access to COVID-19 vaccines during the initial vaccine rollout in Florida.Attonito and co-authors published a paper in the December 2021 issue of Health Affairs that analyzed the locations of Publix stores in Florida. They found that the Publix locations don't always line up with where the needs are greatest.Listen to Health Affairs Editor-in-Chief Alan Weil interview Jennifer Attonito on her research, its implications in the context of broader vaccine disparities, and health equity.If you enjoyed this interview, order the December 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

This episode originally aired on November 10, 2020.The U.S. health policy community recognizes that fee-for-service models incentivize physicians and health systems to perform more tasks than may be needed. And, these models can contribute to industry fragmentation as organizations chase revenue.But is fee-for-service really the smoking gun when it comes to the high levels of U.S. health care spending?The answer is, unsurprisingly, complicated. To discuss, Health Affairs Editor-in-Chief Alan Weil interviews Dr. Michael K. Gusmano, professor at the Rutgers School of Public Health and research scholar at The Hastings Center, to examine how physician payments are set in France, Germany, and Japan. These countries all employ fee-for-service models but pay less than the U.S. when it comes to health spending.What can the U.S. learn from these countries? Is policy importation even possible?Alan Weil and Dr. Gusmano explore these questions and more on A Health Podyssey.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Medical advances have enabled many people to be cared for appropriately in an outpatient setting rather than being admitted to a hospital.Yet, since Medicare payment rates are generally lower for outpatient visits than inpatient hospital stays, hospitals have a financial incentive to admit patients. Observing what were believed to be inappropriate admissions, in 2013 Medicare adopted the "two-midnight rule" stating that hospitals would only be paid inpatient rates if the patient was expected to stay in the hospital over two nights. The rule was controversial, but data show that it changed hospital visit behavior.The two-midnight rule is part of a larger effort to ensure appropriate payments within Medicare.Sabrina Poon from the Vanderbilt University Medical Center joins A Health Podyssey to discuss the effects of the rule and whether or not it obtained its objective.Poon and colleagues published a paper in the November 2021 issue of Health Affairs investigating how the two-midnight rule affected inpatient admissions and outpatient observation stays. They conclude that the shift from inpatient to observation stays is directly associated with adoption of the rule, the change occurred quickly after the rule was implemented, and it had different affects for patients with more chronic conditions.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

When we launched A Health Podyssey in 2020, our goal was to take listeners beyond the research published in Health Affairs.For A Health Podyssey's one-year anniversary, we wanted to take listeners on an Excursion and speak with someone who epitomizes so much of what brings professionals into the fields of health policy and health services.   Ashish Jha from the Brown University School of Public Health is a widely published researcher whose public voice arises from a combination of deep expertise and a unique ability to explain complex concepts in an accessible language. Over the course of the COVID-19 pandemic, Jha's insights on the virus have helped many navigate thorny, complicated public health issues.Jha's most recent publication in Health Affairs was a commentary article where he and coauthors discussed adding a climate lens to health policy discussion in the U.S. Before joining Brown University, he was at the Harvard T. H. Chan School of Public Health. Today, Ashish Jha joins Health Affairs' Editor-in-Chief Alan Weil to discuss what he's learned from the COVID-19 pandemic, the bright spots he sees for health care payment reform, and how he uses social media.This episode is sponsored by the University of Pennsylvania's Master of Health Care Innovation.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts