The January issue of Health Affairs featured several studies authored by AcademyHealth members. Members contributed research to a wide range of pressing issues including substance use and treatment, payment and costs, Medicare, and health policy implications.
Substance Use and Treatment
In light of the current opioid epidemic, researchers from Johns Hopkins and Columbia University proposed expanding the use of medication treatment like buprenorphine and naltrexone. They found that medication treatment (MT) was effective and becoming widespread. However, there is still a large unmet need for MT, which could be remedied by state and federal grants. A similar study was conducted by researchers at the University of Kentucky, in collaboration with Janet Cummings, PhD, an AcademyHealth member from Emory University. Looking at trends in buprenorphine prescriptions, they found that office-based physician visits involving these prescriptions have increased significantly during the last 10 years, and even non-psychiatric physicians have started to prescribe buprenorphine.
AcademyHealth member Katherine Hempstead, PhD, a senior policy advisor at the Robert Wood Johnson Foundation, worked with a Rutgers professor to examine trends in intentional and unintentional opioid overdoses. Their research found a tenuous link between the two, inviting further study on the issue.
Payment and Costs
A study from Tufts Medical Center and the University of Michigan analyzed incentives for lung cancer screenings. Providing incentives was found to be extremely effective, especially when specifically targeted to high-risk patients. Other researchers looked at pricing trends. A University of Pittsburgh professor and AcademyHealth member, Inmaculada Hernandez, PharmD, PhD, FACC, in collaboration with other members, studied rising drug costs. Their study found that while specialty drug prices rose in competition with new products, generic drug prices mainly rose because of inflation. And as way of reimbursing dementia care, another study suggested an alternative payment method that reimburses collective care.
A study from the University of Pennsylvania led by AcademyHealth member Joshua Liao, M.D., M.Sc., examined the effects of a 2016 Medicare policy. The 2016 policy created the mandatory Comprehensive Care for Joint Replacement Program, which paid clinicians a fixed amount for hip and knee replacements. Researchers found that the program was broadly implemented across health centers in similar ways and could be scaled up, however, some targeted approaches might be needed. Another policy was implemented in 2010, establishing the Hospital Readmissions Reduction Program (HRRP), which penalized hospitals with high readmission rates for certain conditions. However, the efficacy of these programs has been overstated, according to a new study which readjusted for other factors.
Looking into the accessibility of Medicare services, Amber Willink, PhD, and colleagues at the Johns Hopkins Bloomberg School of Public Health, studied access to hearing care services. They found that while patients can easily purchase low-cost hearing aids, having access to hearing care services is more important and should also be covered by Medicare. A Harvard Medical School group also researched how to target high-cost Medicare patients. By creating a profile of high-cost patients, healthcare providers can be more strategic about how to reach them and provide care, which has health care policy implications as well.
AcademyHealth member Naomi Zwede, PhD, along with the codirector of the Center on Poverty and Social Policy at Columbia University, studied the antipoverty effects of Medicaid. In the study, they found that Medicaid expansion caused a significant reduction of the poverty rate. Other research looked at healthcare spending in the U.S., finding that spending increases were effective, but a disease-specific approach was needed. Vicki Fung, PhD, and Catherine Liang from the Mongan Institute Health Policy Center at Massachusetts General Hospital, researched the potential effects of eliminating the individual mandate in California. Working with AcademyHealth members across the country, they found that eliminating the mandate would not have a significant effect on the California market. However, it would reduce coverage for historically underinsured groups.
Other research focused on a variety of issues relevant to health policy. AcademyHealth member Robin Clark, PhD, a professor at the University of Massachusetts Medical School, worked with his colleagues to study how homelessness contributes to pregnancy complications. Due to shelter use, injury risks, inconsistant health care, and other factors, homeless women faced higher rates of complications. To mitigate these issues, researchers recommended health policy that focuses on reducing homelessness and preventing health issues. Another California study found that frequent emergency department use is connected to higher mortality rates. And an article published by Jonathan Mayer, PhD, from the University of Washington, shared his experience with pain treatment, calling for better education and treatment for pain in healthcare.
January’s Health Affairs issue featured relevant and timely research on a broad range of topics from AcademyHealth members. Congratulations to all the members who contributed to these studies and helped advance industry knowledge on these important issues.