A Health Podyssey

Almost all commercial insurance plans have cost-sharing provisions where patients help pay for their health care services. Annual deductibles — which patients have to meet before insurance pays anything at all — and co-payments — where the patient pays either a fixed amount for or a share of the cost of each service received — are common examples.Cost-sharing generally reduces the health insurance premium by simply shifting a share of the costs to enrollees. But it also affects utilization because having to pay for a share of the care can deter people from getting it.How cost-sharing actually works in practice is the subject of this episode's A Health Podyssey.Stacie Dusetzina from Vanderbilt University School of Medicine and Michal Horný from Emory University published a paper in the February 2021 edition of Health Affairs that analyzes the out-of-pocket spending patterns for commercially-insured individuals. They focused on the timing for when expenses are incurred.  The unique analysis points to some distorting of the provisions of a typical health insurance plan. In particular, they found that although most commercially-insured people had several health care encounters throughout the year, their out-of-pocket spending was mostly concentrated within short time intervals.Listen to Health Affairs Editor-in-Chief Alan Weil interview Stacie Dusetzina and Michal Horný on out-of-pocket health care spending.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Lowering prescription drug prices continues to be a hot topic. Spending on biologic products, which includes most vaccines and gene therapies, was estimated at $125 billion in the United States in 2018, representing about a quarter of total pharmaceutical spending.Biosimilars, follow-on products to biologic drugs with essentially the same molecular composition to produce comparable clinical effects, are viewed by many as a way to promote competition and bring down drug prices. But the biosimilar market is young, with half of the 10 key product classes seeing marketing entry in 2018 or later. Understanding the evolving market for biosimilars is the topic of this episode of A Health Podyssey.Ariel Dora Stern, associate professor at Harvard Business School and a faculty affiliate of the Harvard-MIT Center for Regulatory Science, and coauthors published a paper in the June 2021 issue of Health Affairs examining how quickly biosimilars and follow-on products gained market share and the subsequent trajectory of drug prices.Listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Stern on what biosimilars are and how the pharmaceutical market is evolving in response to their market entry. This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Pre-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, Editor-in-Chief Alan Weil welcomed Elizabeth "Liz" Fowler, the new deputy administrator of the Centers for Medicare and Medicaid Services and director of its Center for Medicare and Medicaid Innovation to an in-depth discussion of Biden administration's plans and priorities for health care.The interview was conducted on June 3, 2021.As chief health council to then-Senate Finance Committee Chair Max Baucus (D-MT) at the time of the passage of the Affordable Care Act, Liz Fowler was a major force in crafting and shepherding the landmark legislation through the Senate. Later, as a vice president at The Commonwealth Fund, she was a contributor to Health Affairs’ 2020 special issue marking the 10-year anniversary of the signing of the Affordable Care Act: The ACA At 10. In her current post, Dr. Fowler will play a key role setting priorities for the future of the ACA, insurance exchanges, Medicaid expansion, and a host of other issues critical to the quality, accessibility, and affordability of American health care. Policy Spotlight features conversations with influential health policy experts in Washington, DC, and beyond. Interested in learning who is next as a speaker? 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

Rates of burnout among primary care physicians is a growing concern in the health care workforce. Major shifts in the practice environment — from truncated office visits and growing documentation requirements to practice consolidation — have changed physicians' sense of efficacy and autonomy, both of which are important factors in work satisfaction. The COVID-19 pandemic has heightened these concerns as many physicians have been working long hours while experiencing supply shortages and facing significant health risks themselves.Samuel Edwards, assistant professor of medicine at the Oregon Health and Science University, joins Health Affairs Editor-in-Chief Alan Weil on A Health Podyssey to discuss his new research published in the June 2021 issue of Health Affairs investigating burnout in primary care practices.They describe the characteristics of practices where clinical and nonclinical staff both report an absence of burnout and compare them to practices where burnout rates are high.Listen to Alan Weil and Samuel Edwards discuss physician burnout, its prevalence in primary care practices, and the implications of their research on the practice of medicine.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota. Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Skilled nursing care is an important Medicare benefit but it also accounts for significant spending.In Medicare, cost sharing applies to patients' care in skilled nursing facilities after the twentieth day of residence. This prompts a spike in discharges from facilities at that time. But does cutting short these skilled nursing facility stays at day 20 negatively impact patient health?J. Michael McWilliams, a researcher from Harvard Medical School and Brigham and Women's Hospital, and coauthors aimed to answer this question in a paper they published in the May 2021 issue of Health Affairs. They studied the extent to which skilled nursing facility discharges accelerated by Medicare cost sharing are safe.McWilliams and coauthors found no clear evidence that those who are discharged face increased risk of death, hospitalization for fall-related injuries, or all-cause hospitalizations.On this episode of A Health Podyssey, J. Michael McWilliams joins Health Affairs Editor-in-Chief Alan Weil to discuss this research and his perspective on the future of health care financing.Pre-order the July 2021 Health Affairs issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

The HITECH Act, part of the broad American Recovery and Reinvestment Act of 2009, ushered in major changes for health care's information and informatics landscape. The legislation may best be known for "meaningful use" requirements attached to hospital and/or physician funding to support the adoption of electronic health records (EHRs).The law also greatly boosted health information exchanges, or networks that share clinical information across different health care settings.On today's episode of A Health Podyssey, Dr. Julia Adler-Milstein, director of the Center for Clinical Informatics and Improvement Research at the University of California San Francisco, joins Health Affairs Editor-in-Chief Alan Weil to discuss a survey of health information exchange organizations she and colleagues published in the May 2021 issue of Health Affairs. The survey reveals a level of maturity in the field of health information exchange, but a few critical issues continue to threaten the ability to achieve the potential and promise of EHRs. Listen to Alan Weil interview Julia Adler-Milstein on the evolution of health information exchange organizations, TEFCA, and health data governance.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

"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