A Health Podyssey

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

Bundled payments have long been an experiment in the Medicare program to help reduce health care spending. The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services broad authority to test bundled payments, or paying providers for episodes of care instead of for each service provided. Research has found savings associated with participating in the Bundled Payment for Care Improvement (BPCI) initiative. While there have been encouraging results, Medicare has experienced net losses under BPCI when taking reconciliation payments into account. However, some alternative payment models have seen significant savings. There's still much to learn as the new iteration of BPCI — BCPI Advanced — continues. For example, Christopher Whaley, a policy researcher at the RAND Corporation, and coauthors recently published research in the March 2021 issue as part of the Health Affairs Considering Health Spending series. They found a bundled payment program developed by Carrum Health for orthopedic and surgical procedures in a commercially-insured population led to significant price reductions of more than 10%, or more than $4,000 per procedure, with employers capturing approximately 85% of the savings. In this episode of A Health Podyssey, listen to Alan Weil interview Christopher Whaley on bundled payments, the promise of direct payments in the commercial market, and whether alternative payments can become a mainstream payment model.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The COVID-19 pandemic caused an enormous wave of disruption to the U.S. economy, leading the unemployment rate to rise to a record high of 14.7% in April 2020. While unemployment has since improved — the unemployment rate in January 2021 was 6.3% — America has yet to reach the employment levels it held before the pandemic.In response to so many out of work, the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March 2020 expanded eligibility for unemployment benefits. Within that legislative package, the Federal Pandemic Unemployment Compensation (FPUC) increased the amount of money people could receive through such programs. FPUC expired for the first time in July 2020, leading to insurance beneficiaries receiving smaller benefits.Employment and job security is a known social determinant of health and the relationship to suddenly losing a job and a person's health isn't yet widely understood. To study the how FPUC may have affected unmet health-related social needs, Seth Berkowitz from the University of North Carolina at Chapel Hill and Sanjay Basu from Harvard Medical School examined these needs and mental health among unemployment insurance beneficiaries before and after the initial expiration of FPUC.Published in the March 2021 edition of Health Affairs, Berkowitz and Basu's research found that the initial FPUC expiration was associated with a 10-percentage-point increase in risk for self-reported missed housing payments. In addition, risk for food insufficiency as well as depression and anxiety symptoms increased among households receiving unemployment insurance benefits.Seth Berkowitz joins Editor-in-Chief Alan Weil on A Health Podyssey to discuss his research, the potential health impact of unemployment insurance, the changing nature of work in the U.S., and how direct payments programs — such as universal basic income — could compliment social safety nets.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

There's no doubt that the COVID-19 pandemic spurred an increase in telemedicine use. As Americans were reluctant to venture out of their homes in the pandemic's early months, both public and private payers were quick to change telehealth reimbursement policies as admissions plummeted.According to new research published in the February edition of Health Affairs, 30.1% of all outpatient visits were provided via telemedicine from January 2020 to June 2020. The weekly number of telemedicine visits rose by a 23-fold increase during the same time period. Prior to 2020, telehealth hadn't yet become a mainstream avenue of care despite the technology being in place for at least a decade. As COVID-19 vaccines are deployed and mutations spread, a question remains whether telemedicine will finally become a popular care delivery option.On this episode of A Health Podyssey, Alan Weil interviews Dr. Michael Barnett, from the T.H. Chan School of Public Health, and Dr. Sadiq Patel, from Harvard Medical School, on their research published in Health Affairs, how specialty care providers are adopting telemedicine, the speed of their research, and where the telemedicine field may be heading. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

"Quite honestly, it is not easy to be a nerd on the reservation." - Dr. Donald WarnePathways are not predetermined in life. But, without readily available role models to point to, it can be difficult for young people to know what options may be available as they advance toward adulthood.Currently, there's a shortage of health care providers for Indigenous populations, which have been linked to limited access to care and higher rates of chronic health conditions. As native physicians are more likely than non-native physicians to serve these populations, increasing the number of native physicians is a critical strategy for improving access for this population.At the University of North Dakota, role-modeling is a key component to increase interest and build the next generation of American Indian physicians. Currently, American Indian or Alaskan native students make up about 1% of medical school students nationwide. At the University of North Dakota's medical school, 1 in 10 students came from Indigenous background, the highest ratio in the country.Since 1973, the Indians Into Medicine program has graduated over 250 American Indian and Alaskan Native physicians. It's a growing presence in the health profession and the subject of a Leading to Health article published in the February 2021 edition of Health Affairs. On A Health Podyssey, Alan Weil speaks with Dr. Donald Warne, a professor and director of the Indians Into Medicine program at the University of North Dakota and a member of the Oglala Lakota tribe, to discuss the shortage of health care providers for American Indians and Indigenous populations and how the program helps create an interest in medicine at an early age for American Indians. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher