A Health Podyssey

"I think we need to step back first before we even ask the policy question and ask this simple question, is it okay in the United States to die of cancer simply because you don't have health insurance?" - Dr. Gerard SilvestriCancer is a leading cause of death in the United States. Although there have been declines in cancer deaths in recent years, improvements have not been equally distributed across the population.The risk of cancer increases with age and nearly a quarter of all new cancers diagnosed each year in the US occur among those aged 55 to 64 years old. At age 65, most Americans gain Medicare coverage, creating a ready comparison of cancer outcomes between those just below age 65 — who may have private insurance, Medicaid, or are uninsured — and those above 65 who are on Medicare.The relationship between insurance coverage and cancer outcomes is the subject of this episode of A Health Podyssey.  Dr. Gerard Silvestri, a professor of thoracic oncology at the Medical University of South Carolina, joins the program to discuss a paper he and co-authors published in the May 2021 issue of Health Affairs wherein they found significantly worse survival rates for uninsured patients ages 60 to 64 in comparison to Medicare beneficiaries.Listen to Alan Weil interview Gerard Silvestri on cancer outcomes among Medicare beneficiaries and their younger, uninsured counterparts.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Many think of pharmacies primarily as places to get prescription medications, but pharmacists are highly trained clinicals who offer other important health care services. Pharmacies are a valuable health care resource, and access to pharmacies may be an overlooked contributor to health inequities. Individuals who live in pharmacy deserts aren't able to easily obtain prescription medications or essential health care services. While the overall number of pharmacies in the US has increased gradually in recent years, research shows inequitable distribution of pharmacy and pharmacy closures.  On today's episode of A Health Podyssey, Jenny Guadamuz from the University of Southern California School of Pharmacy joins Health Affairs Editor-in-Chief Alan Weil to discuss her research published in the May 2021 edition of Health Affairs. Guadamuz and colleagues investigated the accessibility of pharmacies by neighborhood racial and ethnic composition in large US cities from 2007 to 2015. They found fewer pharmacies and more pharmacy closures located in predominantly black and Hispanic/Latino neighborhoods when compared with other neighborhoods. Listen to Health Affairs Editor-in-Chief Alan Weil interview Jenny Guadamuz discuss this foundational research on pharmacy access and how policies can encourage pharmacies to operate in pharmacy deserts.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

To say the role of private equity investment in the health care system is growing would be an understatement. In 2018, the valuation of private equity deals in the US health care sector surpassed $100 billion, a 20-fold increase from 2000 when it was less than $5 billion. Now, many are concerned that the incentive structures built into private equity financing have exacerbated trends such as surprise medical billing and contribute to increasing health care prices.Despite the increased presence of private equity in health care, there's been little systematic examination of its scope and its effect on health care access and spending.Published in the May 2021 edition of Health Affairs, Dr. Anaeze Offodile II from the University of Texas MD Anderson Cancer Center and colleagues reviewed private equity acquisitions of hospitals from 2003 to 2017. They found that private equity acquisitions occurred mostly in the Mid-Atlantic and Southern US regions and were more likely to be for-profit hospitals in urban areas. In addition, they found that private equity-acquired hospitals also had higher charge-to-cost ratios and operating margins. Listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Anaeze Offodile II to discuss this foundational piece of research on the role of private equity investments in health care.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

A central tenant of the move to value-based payment in health care is that quality can be measured and high quality providers should be rewarded for their excellence. But efforts to define and measure quality of care can run into challenges.It's considered benign to take certain types of risk factors, such as disease severity, into account when measuring quality of care. But accounting for social risk factors, like poverty or housing instability, is a lot more controversial.It's also the subject of today's A Health Podyssey. In an April 2021 paper as part of Health Affairs' Policy Insights series, David Nerenz, director emeritus of the Center for Health Policy and Health Services Research at the Henry Ford Health System, and colleagues reviewed the arguments surrounding social risk factors and their inclusion in quality metrics. They concluded that "social risk adjustment should be the default option," and that is can be an important tool for promoting health equity.Listen to Health Affairs Editor-in-Chief Alan Weil interview David Nerenz on social risk factors, his research, and what it means for hospitals to take responsibility for social determinants of health.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The Affordable Care Act (ACA) has been the law of the land in the U.S. for 11 years and helped more than 20 million Americans gain health coverage. Still, some are losing it, even at times when they arguably need it most. There are demonstrated health benefits for the mother and baby to having insurance before and during pregnancy and after giving birth. But a patchwork of programs leaves care gaps for this population. Typically, Medicaid only covers eligible pregnant women until they’re 60 days postpartum. The ACA allowed states that expanded Medicaid to offer longer coverage protections for eligible pregnant women. How big of a step was that, and what remains to be done? That's the topic of today's A Health Podyssey.  Dr. Emily Johnston from the Health Policy Center at the Urban Institute joins Health Affairs Editor-in-Chief Alan Weil to discuss a new paper she published in the April 2021 edition of Health Affairs. Weil and Johnston talk about her research, which shows Medicaid expansion helped close many — but not all — gaps in coverage for pregnant women, as well as what the American Rescue Plan might mean for postpartum uninsurance.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The number of urgent care centers grew significantly in the last decade, thanks in part by private equity investments. They seek to lower health costs and be cheaper than the ER by conveniently providing on-demand care for easily treatable conditions. But, when looking at the economics, urgent care clinics may increase net health care spending.In a new research article published in the April 2021 edition of Health Affairs, Dr. Ari Friedman, assistant professor of emergency medicine, medical ethics, and health policy at the University of Pennsylvania, and colleagues studied the impact on urgent care centers on emergency department (ED) visits.Their research found that although the entry of urgent care deterred lower-acuity ED visits, the impact was small. They estimate that 37 additional urgent care visits were associated with a reduction of a single lower-acuity ED visit. In addition, each $1,600 lower-acuity emergency department visit prevented was offset by a $6,000 increase in urgent care center costs. On this episode of A Health Podyssey, Ari Friedman joins Health Affairs Editor-in-Chief Alan Weil to discuss his research on the cost of urgent care centers and what it might tell us about patient utilization patterns. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The Affordable Care Act requires all private health insurance to fully cover birth control. According to new research published in the April 2021 edition of Health Affairs, this contraception mandate led to increased use of long-acting reversible contraceptives (LARCs) among women enrolled in high-deductible health plans. LARCs, such as IUDs, previously had high one-time, out-of-pocket expenses.This is a positive development for women, according to Dr. Nora Becker, the lead researcher and an assistant professor at the University of Michigan. "LARCs are the best contraceptive methods available so having access to LARCs is really important for patients," she says on today's episode of A Health Podyssey.  Becker argues that the benefits of contraception go beyond health: Women with access to contraception earn more money and have better professional outcomes.  Listen to Health Affairs Editor-in-Chief Alan Weil interview Becker about her research on how the Affordable Care Act impacted the cost of long-acting reversible contraceptives, the role that behavioral economics plays when people choose a health plan, and what it all means for society. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Nursing homes are challenging places to work. As David Grabowski, a professor of health care policy at Harvard Medical School, notes in today's episode of A Health Podyssey, "we knew the nursing home system was broken before the COVID-19 pandemic."Grabowski recently co-authored two papers in the March 2021 edition of Health Affairs on the topic of nursing home staffing using a new Medicare data set (Payroll Based Journal) that spanned 2017-2019 and is a game changer for measuring quality. One article noted that Medicare's new patient-driven payment model resulted in reductions in therapy staffing in skilled nursing facilities. A second found that mean annual nursing staff turnover rate was an eye-popping 128 percent.  Post-pandemic, the implications of a nursing home's high staffing turnover rate is clear: it could lead to health and safety risks for residents.David Grabowski joins Health Affairs Editor-in-Chief Alan Weil on today's episode to discuss his research, its implications, and why nursing home staff relationships with residents matter. He also delves into the complex ownership structures and the need for greater transparency and accountability in nursing homes. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Medical training has historically focused almost exclusively on the skills and actions of individual physicians. Increasingly, clinical training is incorporating an understanding of how team-based care affects patient outcomes.For patients with chronic disease such as diabetes, hypertension and high cholesterol, can teams provide better care? Maximilian Pany and Lucy Chen, both MD-PhD candidates in health policy at Harvard Medical School, and coauthors recently published research on that very question in the March 2021 edition of Health Affairs. They found that provider teams outperformed solo providers in managing chronic diseases.Both Maximilian Pany and Lucy Chen join Alan Weil on A Health Podyssey to discuss their research, team-based care, and how team composition and scope-of-practice fit into their findings.  Listen to find out more.  Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The COVID-19 pandemic has prompted an increase in telehealth utilization. Since that growth, researchers have made calls to ensure that telehealth's subsequent growth does not exacerbate disparities in care. Evidence of the “digital divide,” or differences in the technology or skills needed to access telehealth care, is widely documented. Race, age, geography, health coverage, and more can all impact how and if one adopts and uses telehealth services. English language proficiency is one factor closely connected to telemedicine use, even before the COVID-19 pandemic began. Jorge Rodriguez, an instructor of medicine at Brigham and Women's Hospital and Harvard Medical School, and colleagues recently published research in the March 2021 edition of Health Affairs on telehealth use among patients with limited English proficiency using data from 2015-2018. They found that patients with limited English proficiency had lower rates of telehealth use when compared to proficient English speakers and argue that policy makers must focus on limited English proficiency as an important factor to promote telehealth equity and mitigate the digital divide. On this episode of A Health Podyssey, Alan Weil interviews Jorge Rodriguez on telehealth utilization for patients with limited English proficiency, the digital divide, and how technology equity feeds into health equity initiatives.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher