A Health Podyssey

Recent reports suggest about six-tenths of a percent of the United States population, or 1.4 million people, identify as transgender. Transgender individuals are people whose personal and gender identity are different from the gender they were thought to be at birth. Good information about the health status of this group has been hard to come by although research is growing. Some data come from Medicare, which is useful but not representative of the population as a whole.Landon Hughes, a doctoral candidate at the University of Michigan, joins A Health Podyssey to discuss a paper he and coauthors published in the September issue of Health Affairs describing the morbidity of privately-insured, transgender individuals as compared to cisgender people, or those whose personal identity and gender corresponds with their birth sex.Using insurance claims data from 2001 to 2019, Hughes and colleagues report that transgender people were at an overall greater risk for morbidity than their cisgender counterparts across a broad range of conditions.If you like this interview, order the September issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The US government reports that the total spending on hospital care in 2019 was almost $1.2 trillion. High and highly variable hospital prices have been in the news recently in part due to new information made available under the price transparency rules implemented by the Trump administration.Competitive markets are supposed to constrain prices, but in much of the US, there's little competition among hospitals and consolidation throughout the healthcare sector has contributed to that consolidation. The result is a number of proposals to regulate health care prices in general and for hospital prices in particular. Leemore Dafny from the Harvard Business School and Harvard Kennedy School joins Health Affairs Editor-in-Chief Alan Weil to discuss her latest research on hospital prices and market concentration. Dafny and colleagues published a paper in the September 2021 issue of Health Affairs analyzing hospital prices and relating them to market concentration. The authors found the relationship isn't as straightforward as one might expect — but the findings still have major implications for any consideration of regulating hospital prices. If you like this interview, order the September issue of Health Affairs.Pre-order the October Perinatal Mental Health Theme Issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The quality-adjusted life-year (QALY) combines the expected effects on longevity and the expected effects on quality-of-life into a single standard measure. QALYs are often used as part of cost effectiveness analysis, particularly when analyzing the effectiveness of drugs.QALY as a measurement has received a lot of criticism. It's been criticized in concept or in the specifics of how it's defined or used. This criticism often forms the basis for opposition to price negotiations or any limitations on access to a particular drug. This kind of criticism can make it difficult to reach a consensus on processes that might yield negotiated or regulated drug prices.Leah Rand, a postdoctoral fellow at Harvard Medical School and Brigham and Women’s Hospital, joins A Health Podyssey to talk about QALY, its criticism, and how to respond to that criticism.Rand and coauthor Aaron Kesselheim published in the September 2021 issue of Health Affairs a systematic literature review of critiques of QALYs and their relevance to drug health technology assessments. They identify three main categories of ethical and practical critiques of QALYS, including methodological concerns, criticisms of neutrality, and potential discrimination. Rand and Kesselheim conclude that understanding and addressing criticism of the QALY is essential for the move to value-based pricing.Listen as Health Affairs Editor-in-Chief Alan Weil interviews Leah Rand on the pros and cons of the Quality Adjusted Life Year measurement in health policy.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

If you're a regular listener of A Health Podyssey, you know that most episodes revolve around a particular study published in Health Affairs. Every once in awhile, a person's experience as it relates to health care warrants an excursion from the constraints of discussing a single study. For those, we want to offer listeners a broader conversation.Welcome to A Health Podyssey Excursion.  Dr. Julian Harris is the CEO of ConcertoCare, a provider of integrated care for seniors living at home. His career touches both the public and private sectors.Before joining ConcertoCare in 2021, Harris served as President of Care Allies, a group of Cigna-affiliated population health management and home-based primary care companies. Prior to Cigna, Dr. Harris served as an adviser to Google Ventures (GV) with a focus on tech-enabled health care services.In the public sector, Harris led the health care team in the White House Office of Management of Budget (OMB). As the federal government's Chief Health Care Finance Official, he had oversight of more than $1 trillion in spending in Medicare, Medicaid and a myriad other programs. He also previously served as the chief executive of the $11 billion Massachusetts Medicaid program.Listen to Health Affairs Editor-in-Chief Alan Weil trace Julian Harris' career and discuss how his varied experiences have shaped his perspectives on health and health care. The two discuss social determinants of health, the connection between unmet social needs and health care costs, how COVID-19 affected health equity, why the Program of All-inclusive Care for the Elderly (PACE) is special and more.Come along on an excursion to hear from the top minds in health policy and health care industry on A Health Podyssey.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

While estimates vary, spending on prescription drugs in the United States exceeds $500 billion per year. This makes drug prices a perennial health policy topic.In this context, payers and manufacturers are in a constant battle. Manufacturers seek to expand their market while payers attempt to use their leverage to negotiate lower drug prices. Often, patients and clinicians are caught in the middle and left to navigate increasingly complex pharmaceutical insurance benefit design, tiered formularies, drug rebates, and drug coupon programs.On today's A Health Podyssey, Scott Howell, chief strategy officer of US pharmaceuticals at Novartis Pharmaceuticals, joins Health Affairs Editor-in-Chief Alan Weil to discuss how much the United States health system spends on drug utilization management.Howell and co-authors published a paper in the August 2021 issue of Health Affairs exploring the growing burden of drug utilization management and seeking to quantify its financial cost. They found combined costs shared among payers, manufacturers, physicians, and patients totaling almost a hundred billion dollars per year.Order the August 2021 issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

As part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Chiquita Brooks-LaSure, the new Administrator of the Centers for Medicare and Medicaid Services (CMS) at the US Department of Health and Human Services for a one-on-one discussion about her priorities at CMS, where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Brooks-LaSure has decades of experience in the federal government, Capitol Hill, and the private sector. In March 2020, Ms. Brooks-LaSure was the lead author on Building On The Gains Of The ACA: Federal Proposals To Improve Coverage And Affordability in Health Affairs' thematic issue on “The Affordable Care Act Turns 10.” The interview was conducted on August 12, 2021.The discussion covered a number of topics, including how the unfinished work of the Affordable Care Act (ACA) is an important effort to address health equity, access to coverage, person-centered care, maternal health, Section 1115 Medicaid waivers, the future of value-based payments, social determinants of health, behavioral health and telehealth.Brooks-LaSure co-authored and published a post, titled "Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years," on the Health Affairs Blog on the same day as the event.Policy Spotlights feature conversations with influential health policy experts in Washington, DC, and beyond. 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. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

In our multi-payer health care system, the pharmaceutical market involves the complex interplay of manufacturers, insurers, prescribers, and patients. Each seeks to protect its own interest, which can be counterproductive for overall system efficiency.The United States also has a high rate of generic drug use, which is considered a success story as the introduction of generics can rapidly and dramatically reduce drug prices. But we've had much less success with biosimilars, the generic equivalent of high-cost biologic drugs.James Robinson from the University of California, Berkeley School of Public Health joins A Health Podyssey to discuss pharmaceuticals, how they're priced, and how competition in the United States compares to other countries.Robinson is a contributing editor to Health Affairs and the co-author of two papers published in the August 2021 issue. In one, Robinson and coauthor Quentin Jarrion analyze prices for three drugs and 11 competing biosimilars in France's single payer health system. They find the launch of biosimilars in France is associated with price reductions for the originator drug and the similar drug. In the second paper, Robinson and coauthors investigated the economic burden of drug utilization management on payers, manufacturers, physicians, and patients. They report that all stakeholders would benefit from a de-escalation of utilization management, which could lower drug prices and increase patient access.Order the August 2021 issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Migrants on their way to another country and people seeking asylum are often overlooked in health policy. During the COVID-19 pandemic as immigration and asylum processes stalled, thousands of people were stranded at Mexico's northern border. With limited health care and sometimes crowded and unsanitary living conditions, COVID posed a significant risk.How Mexico's response to COVID-19 took into account the particular needs of in-transit migrants and asylum seekers is the topic of today's episode of A Health Podyssey. Ietza Bojorquez-Chapela from the College of the Northern Border and Cesar Infante from the National Institute of Public Health join Health Affairs Editor-in-Chief Alan Weil to discuss their research they and co-authors published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.In the issue, the authors examine COVID-19 health policy documents issued by Mexican federal, state, and municipal authorities. Exploring these documents — which were prepared between January and September of 2020 —they found that only seven out of 80 publicly available documents explicitly mentioned the health care needs of in-transit migrants and asylum seekers.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Children born in the United States are born US citizens. Some of these children are born to immigrant parents who returned to their country of origin, either voluntarily or because they were deported.In 2015, more than half a million US citizen children lived in Mexico having returned with their parents. These children may face language and school adjustments, stressful living arrangements and economic and heath challenges. Fewer than half of them report holding Mexican citizenship, complicating their access to health and social services.The well-being of US citizen children living in Mexico is the topic of today's A Health Podyssey. Sharon Borja, an assistant professor from the University of Houston, joins the program to discuss research she and colleagues published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.In the issue, Borja and colleagues investigated health insurance coverage among US citizen migrant children living in Mexico. They found that about half of US citizen migrant children living in Mexico had limited, inadequate health insurance, which is a barrier to receiving necessary health care services.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

BONUS EPISODEAs part of Policy Spotlight, a new virtual event series from Health Affairs, The Commonwealth Fund President David Blumenthal welcomed Micky Tripathi, the national coordinator for health information technology (IT), to an in-depth discussion of Biden administration's plans and priorities for health care data.The interview was conducted on July 1, 2021.At the Department of Health and Human Services, Micky Tripathi leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. Guest host David Blumenthal held the same post during the Obama administration from 2009 to 2011.The discussion covered a number of topics, including information blocking, interoperability, Biden's equity project, social determinants of health data, artificial intelligence, data privacy, and much more.Policy Spotlights feature conversations with influential health policy experts in Washington, DC, and beyond. 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. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts