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1.
Am Surg ; 86(3): 195-199, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-32223797

RESUMEN

Patients presenting with localized breast cancer have a five-year survival of 99 per cent, whereas survival falls to 27 per cent in advanced disease. This obviates the importance of early diagnosis and treatment. Our study evaluates the impact of Ohio's Medicaid expansion and the passage of the Affordable Care Act (ACA) on the stage at which Ohioans were diagnosed with breast cancer. Data were collected for 3056 patients presenting with breast cancer between 2006 and 2016 in the Dayton area. Patients were divided into groups based on cancer stage. The percentage of patients presenting with advanced disease (stage 3 or 4) was compared both before and after ACA implementation and Ohio Medicaid expansion. These results were also compared with statewide data maintained by the Ohio Department of Health. Compared with pre-ACA, the number of uninsured patients post-ACA was noted to fall 83 per cent, the number of patients presenting with Medicaid increased by five times, and the proportion of patients younger than 65 years presenting with breast cancer increased by approximately 7 per cent. These changes notwithstanding, no difference was identified in the percentage of patients presenting with advanced breast cancer before and after ACA implementation or Ohio Medicaid expansion (P = 0.56). Statewide data similarly demonstrated no change (P = 0.88). Improved insurance access had a smaller-than-anticipated impact on the stage at which Ohioans presented with breast cancer. As significant morbidity and mortality can be avoided by earlier presentation, additional research is appropriate to identify factors affecting patients' decision to seek breast cancer screening and care.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/economía , Costos de la Atención en Salud , Medicaid/economía , Evaluación de Resultado en la Atención de Salud , Adulto , Anciano , Neoplasias de la Mama/economía , Neoplasias de la Mama/mortalidad , Bases de Datos Factuales , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Cobertura del Seguro/estadística & datos numéricos , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Ohio , Patient Protection and Affordable Care Act , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia , Estados Unidos
2.
JAMA ; 323(9): 854-862, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125403

RESUMEN

Importance: Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade. Objective: To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts. Design, Setting, and Participants: Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US. Exposures: Calendar year. Main Outcomes and Measures: Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation. Results: From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices. Conclusions and Relevance: In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.


Asunto(s)
Costos de los Medicamentos/tendencias , Honorarios Farmacéuticos/tendencias , Costos y Análisis de Costo , Honorarios Farmacéuticos/legislación & jurisprudencia , Medicaid/economía , Estudios Retrospectivos , Estados Unidos
3.
BMJ ; 368: m40, 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32024637

RESUMEN

OBJECTIVE: To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN: Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING: United States. PARTICIPANTS: A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES: Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS: 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION: Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.


Asunto(s)
Financiación Personal/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Medicaid/legislación & jurisprudencia , Pobreza/economía , Pobreza/estadística & datos numéricos , Adulto , Costo de Enfermedad , Femenino , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/economía , Masculino , Medicaid/economía , Persona de Mediana Edad , Estados Unidos/epidemiología
5.
AIDS Educ Prev ; 32(1): 25-35, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32073307

RESUMEN

The objective of this study was to measure HIV screening rates and variables associated with screening among new enrollees in California's Low Income Health Program (LIHP). A logit model was used to estimate associations between HIV screening and enrollment, claims, and encounter data for enrollees. HIV prevalence among new LIHP enrollees was 1.2%xd. Among 42,550 new LIHP enrollees with no prior HIV diagnosis, only 27% received screening within 12 months of their first medical evaluation. A total of 350 new HIV diagnoses were identified (incidence rate of 0.8%), exceeding the 0.1% level at which the Centers for Disease Control and Prevention (CDC) recommends routine HIV screening. California reduced screening barriers by removing required written informed consent and pretest counseling; the Affordable Care Act (ACA) eliminated cost-sharing and enhanced access. Removing financial and administrative barriers to HIV screening is necessary, but may be insufficient to reach CDC's recommended screening targets.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Medicaid/estadística & datos numéricos , California/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Promoción de la Salud , Humanos , Masculino , Tamizaje Masivo/métodos , Medicaid/economía , Patient Protection and Affordable Care Act , Pobreza , Prevalencia , Estados Unidos
6.
MMWR Morb Mortal Wkly Rep ; 69(6): 155-160, 2020 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-32053583

RESUMEN

The prevalence of current cigarette smoking is approximately twice as high among adults enrolled in Medicaid (23.9%) as among privately insured adults (10.5%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Comprehensive, barrier-free, widely promoted coverage of these treatments increases use of cessation treatments and quit rates and is cost-effective (3). To monitor changes in state Medicaid cessation coverage for traditional Medicaid enrollees† over the past decade, the American Lung Association collected data on coverage of nine cessation treatments by state Medicaid programs during December 31, 2008-December 31, 2018: individual counseling, group counseling, and the seven FDA-approved cessation medications§; states that cover all nine of these treatments are considered to have comprehensive coverage. The American Lung Association also collected data on seven barriers to accessing covered treatments.¶ As of December 31, 2018, 15 states covered all nine cessation treatments for all enrollees, up from six states as of December 31, 2008. Of these 15 states, Kentucky and Missouri were the only ones to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers could reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (3-7).


Asunto(s)
Accesibilidad a los Servicios de Salud , Cobertura del Seguro/estadística & datos numéricos , Medicaid/economía , Cese del Uso de Tabaco , Adulto , Humanos , Fumar/epidemiología , Prevención del Hábito de Fumar , Estados Unidos/epidemiología
7.
Milbank Q ; 98(1): 106-130, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31967354

RESUMEN

Policy Points Large numbers of homeless adults gained Medicaid coverage under the Affordable Care Act, increasing policymaker interest in strategies to improve care and reduce avoidable hospital costs for homeless populations. Compared with nonhomeless adult Medicaid beneficiaries, homeless adult beneficiaries have higher levels of health care needs, due in part to mental health issues and substance use disorders. Homeless adults are also more likely to visit the emergency department or require inpatient admissions. Emergency care and inpatient admissions may sometimes be avoided when individuals have high-quality community-based care and healthful living conditions. Offering tenancy support services that help homeless adults achieve stable housing may therefore be a cost-effective strategy for improving the health of this vulnerable population while reducing spending on avoidable health care interventions. Medicaid beneficiaries with disabling health conditions and more extensive histories of homelessness experience the most potentially avoidable health care interventions and spending, with the greatest opportunity to offset the cost of offering tenancy support benefits. CONTEXT: Following Medicaid expansion under the Affordable Care Act, the number of homeless adults enrolled in Medicaid has increased. This has spurred interest in developing Medicaid-funded tenancy support services (TSS) for homeless populations as a way to reduce Medicaid spending on health care for these individuals. An emerging body of evidence suggests that such TSS can reduce avoidable health care spending. METHODS: Drawing on linked Homeless Management Information System and Medicaid claims and encounter data, this study describes the characteristics of homeless adults who could be eligible for Medicaid TSS in New Jersey and compares their Medicaid utilization and spending patterns to matched nonhomeless beneficiaries. FINDINGS: More than 8,400 adults in New Jersey were estimated to be eligible for Medicaid TSS benefits in 2016, including approximately 4,000 living in permanent supportive housing, 800 formally designated as chronically homeless according to federal guidelines, 1,300 who were likely eligible for the chronically homeless designation, and over 2,000 who were at risk of becoming chronically homeless. Homeless adults in our study were disproportionately between the ages of 30 and 64 years, male, and non-Hispanic blacks. The homeless adults we studied also tended to have very high burdens of mental health and substance use disorders, including opioid-related conditions. Medicaid spending for a homeless beneficiary who was potentially eligible for TSS was 10% ($1,362) to 27% ($5,727) more than spending for a nonhomeless Medicaid beneficiary matched on demographic and clinical characteristics. Hospital inpatient and emergency department utilization accounted for at least three-fourths of "excess" Medicaid spending among the homeless groups. CONCLUSIONS: A large group of high-need Medicaid beneficiaries could benefit from TSS, and Medicaid funding for TSS could reduce avoidable Medicaid utilization and spending.


Asunto(s)
Personas sin Hogar , Medicaid/economía , Adulto , Femenino , Política de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , New Jersey , Patient Protection and Affordable Care Act , Estados Unidos
8.
PLoS One ; 15(1): e0226942, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978084

RESUMEN

Few investigations have explored the potential impact of the Affordable Care Act on health disparity outcomes in states that chose to forgo Medicaid expansion. Filling this evidence gap is pressing as Congress grapples with controversial healthcare legislation that could phase out Medicaid expansion. Colorectal cancer (CRC) is a commonly diagnosed, preventable cancer in the US that disproportionately burdens African American men and has substantial potential to be impacted by improved healthcare insurance coverage. Our objective was to estimate the impact of the Affordable Care Act (increasing insurance through health exchanges alone or with Medicaid expansion) on colorectal cancer outcomes and economic costs among African American and White males in North Carolina (NC), a state that did not expand Medicaid. We used an individual-based simulation model to estimate the impact of ACA (increasing insurance through health exchanges alone or with Medicaid expansion) on three CRC outcomes (screening, stage-specific incidence, and deaths) and economic costs among African American and White males in NC who were age-eligible for screening (between ages 50 and 75) during the study period, years of 2013-2023. Health exchanges and Medicaid expansion improved simulated CRC outcomes overall, though the impact was more substantial among AAs. Relative to health exchanges alone, Medicaid expansion would prevent between 7.1 to 25.5 CRC cases and 4.1 to 16.4 per 100,000 CRC cases among AA and White males, respectively. Our findings suggest policies that expanding affordable, quality healthcare coverage could have a demonstrable, cost-saving impact while reducing cancer disparities.


Asunto(s)
Afroamericanos , Neoplasias Colorrectales/diagnóstico , Disparidades en Atención de Salud/tendencias , Medicaid/tendencias , Patient Protection and Affordable Care Act/tendencias , Anciano , Neoplasias Colorrectales/economía , Detección Precoz del Cáncer/economía , Detección Precoz del Cáncer/ética , Disparidades en Atención de Salud/economía , Humanos , Masculino , Medicaid/economía , Persona de Mediana Edad , North Carolina , Patient Protection and Affordable Care Act/economía , Factores Raciales/economía , Estados Unidos
9.
Plast Reconstr Surg ; 145(2): 333-339, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31985616

RESUMEN

BACKGROUND: Rates of autologous breast reconstruction are stagnant compared with prosthetic techniques. Insufficient physician payment for microsurgical autologous breast reconstruction is one possible explanation. The payment difference between governmental and commercial payers creates a natural experiment to evaluate its impact on method of reconstruction. This study assessed the influence of physician payment differences for microsurgical autologous breast reconstruction and implants by insurance type on the likelihood of undergoing microsurgical reconstruction. METHODS: The Massachusetts All-Payer Claims Database was queried for women undergoing immediate autologous or implant breast reconstruction from 2010 to 2014. Univariate analyses compared demographic and clinical characteristics between different reconstructive approaches. Logistic regression explored the relative impact of insurance type and physician payments on breast reconstruction modality. RESULTS: Of the women in this study, 82.7 percent had commercial and 17.3 percent had governmental insurance. Implants were performed in 80 percent of women, whereas 20 percent underwent microsurgical autologous reconstruction. Women with Medicaid versus commercial insurance were less likely to undergo microsurgical reconstruction (16.4 percent versus 20.3 percent; p = 0.063). Commercial insurance, older age, and obesity independently increased the odds of microsurgical reconstruction (p < 0.01). When comparing median physician payments, governmental payers reimbursed 78 percent and 63 percent less than commercial payers for microsurgical reconstruction ($1831 versus $8435) and implants ($1249 versus $3359, respectively). Stratified analysis demonstrated that as physician payment increased, the likelihood of undergoing microsurgical reconstruction increased, independent of insurance type (p < 0.001). CONCLUSIONS: Women with governmental insurance had lower odds of undergoing microsurgical autologous breast reconstruction compared with commercial payers. Regardless of payer, greater reimbursement for microsurgical reconstruction increased the likelihood of microsurgical reconstruction. Current microsurgical autologous breast reconstruction reimbursements may not be commensurate with physician effort when compared to prosthetic techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Asunto(s)
Reembolso de Seguro de Salud/economía , Mamoplastia/economía , Microcirugia/economía , Adulto , Implantación de Mama/economía , Implantación de Mama/estadística & datos numéricos , Implantes de Mama/economía , Implantes de Mama/estadística & datos numéricos , Neoplasias de la Mama/economía , Neoplasias de la Mama/cirugía , Femenino , Colgajos Tisulares Libres/economía , Humanos , Mamoplastia/estadística & datos numéricos , Massachusetts , Mastectomía/economía , Mastectomía/métodos , Medicaid/economía , Medicaid/estadística & datos numéricos , Microcirugia/estadística & datos numéricos , Microvasos , Persona de Mediana Edad , Reoperación/economía , Reoperación/estadística & datos numéricos , Trasplante Autólogo/economía , Estados Unidos
10.
Arthritis Care Res (Hoboken) ; 72(2): 208-215, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31562794

RESUMEN

OBJECTIVE: To examine the impact of the Affordable Care Act on preventable hospitalizations and associated charges for patients living with systemic lupus erythematosus, before and after Medicaid expansion. METHODS: A retrospective, quasi-experimental study, using an interrupted time series research design, was conducted to analyze data for 8 states from the Healthcare Cost and Utilization Project state inpatient databases. Lupus hospitalizations with a principal diagnosis of predetermined ambulatory-care sensitive (ACS) conditions were the unit of primary analysis. The primary outcome variable was access to care measured by preventable hospitalizations caused by an ACS condition. RESULTS: There were 204,150 lupus hospitalizations in the final analysis, with the majority (53.5%) of lupus hospitalizations in states that did not expand Medicaid. In unadjusted analysis, Medicaid expansion states had significantly lower odds of having preventable lupus hospitalizations (odds ratio [OR] 0.958); however, after adjusting for several covariates, Medicaid expansion states had increased odds of having preventable lupus hospitalizations (OR 1.302). Adjusted analysis showed that those individuals with increased age, public insurance (Medicare or Medicaid), no health insurance, rural residence, or low income had significantly higher odds of having a preventable lupus hospitalization. States that expanded Medicaid had $523 significantly more charges than states that did not expand Medicaid. Older age and rural residence were associated with significantly higher charges. CONCLUSION: Our findings suggest that while Medicaid expansion increased health insurance coverage, it did not address other issues related to access to care that could reduce the number of preventable hospitalizations.


Asunto(s)
Accesibilidad a los Servicios de Salud/tendencias , Precios de Hospital/tendencias , Hospitalización/tendencias , Lupus Eritematoso Sistémico/epidemiología , Medicaid/tendencias , Patient Protection and Affordable Care Act/tendencias , Adulto , Femenino , Accesibilidad a los Servicios de Salud/economía , Hospitalización/economía , Humanos , Análisis de Series de Tiempo Interrumpido/economía , Análisis de Series de Tiempo Interrumpido/tendencias , Lupus Eritematoso Sistémico/economía , Lupus Eritematoso Sistémico/terapia , Masculino , Medicaid/economía , Persona de Mediana Edad , Patient Protection and Affordable Care Act/economía , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto Joven
12.
Health Serv Res ; 54(6): 1203-1213, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31742687

RESUMEN

OBJECTIVE: To evaluate the impact of TEAM UP-an initiative that fully integrates behavioral health services into pediatric primary care in three Boston-area Community Health Centers (CHCs)-on health care utilization and costs. DATA SOURCES: 2014-2017 claims data on continuously enrolled children from a Massachusetts Medicaid managed care plan. STUDY DESIGN: We used a difference-in-difference approach with inverse probability of treatment weights to compare outcomes in children receiving primary care at TEAM UP CHCs versus comparison site CHCs, in the pre (2014-2016q2)- versus post (2016q3-2017)-intervention periods. Utilization outcomes included emergency department visits, inpatient admissions, primary care visits, and outpatient/professional visits (all cause and those with mental health (MH) diagnoses). Cost outcomes included total cost of care (inpatient, outpatient, professional, pharmacy). We further assessed differential effects by baseline MH diagnosis. PRINCIPAL FINDINGS: After 1.5 years, TEAM UP was associated with a relative increase in the rate of primary care visits (IRR = 1.15, 95% CI 1.04-1.27, or 115 additional visits/1000 patients/quarter), driven by children with a MH diagnosis at baseline. There was no significant change in avoidable health care utilization or cost. CONCLUSIONS: Expanding the TEAM UP behavioral health integration model to other sites has the potential to improve primary care engagement in low-income children with MH needs.


Asunto(s)
Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitales Pediátricos/economía , Medicaid/economía , Medicaid/estadística & datos numéricos , Servicios de Salud Mental/economía , Atención Primaria de Salud/economía , Adolescente , Boston , Niño , Preescolar , Prestación Integrada de Atención de Salud/estadística & datos numéricos , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Servicios de Salud Mental/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos
14.
Spine (Phila Pa 1976) ; 44(22): 1585-1590, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31568265

RESUMEN

STUDY DESIGN: Health Services Research. OBJECTIVE: The purpose of this study is to determine the variability of Medicaid (MCD) reimbursement for patients who require spine procedures, and to assess how this compares to regional Medicare (MCR) reimbursement as a marker of access to spine surgery. SUMMARY OF BACKGROUND DATA: The current health care environment includes two major forms of government reimbursement: MCD and MCR, which are regulated and funded by the state and federal government, respectively. METHODS: MCD reimbursement rates from each state were obtained for eight spine procedures, utilizing online web searches: anterior cervical decompression and fusion, posterior cervical decompression and fusion, posterior lumbar decompression, single-level posterior lumbar fusion, posterior fusion for deformity (less than six levels; six to 12 levels; 13+ levels), and lumbar microdiscectomy. Discrepancy in reimbursement for these procedures on a state-to-state basis, as well as overall differences in MCD versus MCR reimbursement, was determined. Procedures were examined to identify whether certain surgical interventions have greater discrepancy in reimbursement. RESULTS: The average MCD reimbursement was 78.4% of that for MCR. However, there was significant variation between states (38.8%-140% of MCR for the combined eight procedures). On average, New York, New Jersey, Florida, and Rhode Island provided MCD reimbursements <50% of MCR reimbursements in the region. In total, 20 and 42 states provided <75% and 100% of MCR reimbursements, respectively. Based upon relative reimbursement, MCD appears to value microdiscectomy (84.1% of MCR; P = 0.10) over other elective spine procedures. Microdiscectomy also had the most interstate variation in MCD reimbursement: 39.0% to 207.0% of MCR. CONCLUSION: Large disparities were found between MCR and MCD when comparing identical procedures. Further research is necessary to fully understand the effect of these significant differences. However, it is likely that these discrepancies lead to suboptimal access to necessary spine care. LEVEL OF EVIDENCE: 4.


Asunto(s)
Descompresión Quirúrgica , Reembolso de Seguro de Salud , Medicaid , Procedimientos Ortopédicos , Columna Vertebral/cirugía , Descompresión Quirúrgica/economía , Descompresión Quirúrgica/estadística & datos numéricos , Humanos , Reembolso de Seguro de Salud/economía , Reembolso de Seguro de Salud/estadística & datos numéricos , Medicaid/economía , Medicaid/estadística & datos numéricos , Procedimientos Ortopédicos/economía , Estados Unidos
15.
BMC Health Serv Res ; 19(1): 703, 2019 Oct 16.
Artículo en Inglés | MEDLINE | ID: mdl-31619229

RESUMEN

BACKGROUND: In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS: We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS: Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS: In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/economía , Medicaid/economía , Medicare/economía , Pautas de la Práctica en Medicina/economía , Fosfato de Sitagliptina/economía , Administración Oral , Anciano , Diabetes Mellitus Tipo 2/economía , Planes de Aranceles por Servicios , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Hipoglucemiantes/administración & dosificación , Masculino , Persona de Mediana Edad , Pennsylvania , Fosfato de Sitagliptina/administración & dosificación , Estados Unidos
17.
N C Med J ; 80(5): 292-295, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31471512

RESUMEN

The success of Medicaid transformation in North Carolina depends on participating health plans' ability to bring about better value to deliver on the Triple Aim of health care. Blue Cross and Blue Shield of North Carolina, working in collaboration with Amerigroup Partnership Plan, LLC, is making value-based care a cornerstone of its approach to serving the state's Medicaid population.


Asunto(s)
Medicaid/economía , Medicaid/organización & administración , Planes de Seguros y Protección Cruz Azul , Ahorro de Costo , Humanos , North Carolina , Estados Unidos
18.
N C Med J ; 80(5): 312-316, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31471518

RESUMEN

North Carolina's move to Medicaid managed care is part of the larger move to value-based care nationally. Keys to value-based care guide how practices and health systems can navigate the new payment model. The experience of North Carolina's Area Health Education Centers with primary care practices that work on value-based care can serve as an important case study.


Asunto(s)
Programas Controlados de Atención en Salud/organización & administración , Medicaid/organización & administración , Logro , Humanos , Programas Controlados de Atención en Salud/economía , Medicaid/economía , North Carolina , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Estados Unidos
19.
Tex Med ; 115(8): 23, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31369139

RESUMEN

Medicine didn't get everything it needed from lawmakers for Medicaid, including TMA's biggest and boldest ask of the 2019 session. Still, progress TMA achieved on managed care reform and other facets of Medicaid will advance physicians' efforts to care for the most vulnerable Texans.


Asunto(s)
Reforma de la Atención de Salud , Programas Controlados de Atención en Salud , Medicaid/organización & administración , Humanos , Medicaid/economía , Planes Estatales de Salud , Texas , Estados Unidos
20.
Surgery ; 166(5): 793-799, 2019 11.
Artículo en Inglés | MEDLINE | ID: mdl-31405578

RESUMEN

BACKGROUND: Studies using national data sets have suggested that insurance type drives a disparity in the care of emergency surgery patients. Large databases lack the granularity that smaller, single-institution series may provide. The goal of this study is to identify factors that may account for differences in care between Medicaid and non-Medicaid enrollees with appendicitis in central Massachusetts. METHODS: All adult patients with acute appendicitis in an academic medical center between 2010 and 2018 were included. Sociodemographic and clinical characteristics were compared according to Medicaid enrollment status. Analyses were performed to assess differences in the frequency of operative treatment, time to surgery, length of stay, and rates of readmission. RESULTS: The sample included 1,257 patients, 10.7% of whom (n = 135) were enrolled in Medicaid. The proportions of patients presenting with perforated appendicitis (28.9% vs 31.2%, P = .857) and undergoing laparoscopic appendectomy (96.3% vs 90.7%, P = .081) were similar between the 2 groups, as were length of stay (20 hours 30 minutes versus 22 hours 38 minutes, P = .109) and readmission rates (17.8% vs 14.5%, P = .683). Medicaid enrollees did experience somewhat greater time to surgery (6 hours 47 minutes versus 4 hours 49 minutes, P < .001). CONCLUSION: Despite anticipated differences in population, the treatment of appendicitis was similar between Medicaid and non-Medicaid enrollees. Medicaid enrollees experienced greater time to surgery; however, further studies are needed to explain this disparity in care.


Asunto(s)
Apendicectomía/estadística & datos numéricos , Apendicitis/cirugía , Disparidades en Atención de Salud/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Adulto , Apendicectomía/economía , Apendicitis/economía , Femenino , Disparidades en Atención de Salud/economía , Humanos , Laparoscopía/economía , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Massachusetts , Medicaid/economía , Persona de Mediana Edad , Estudios Retrospectivos , Factores Socioeconómicos , Tiempo de Tratamiento , Estados Unidos , Adulto Joven
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