Aaron E. Carroll's Blog, page 15

HSR Special Issue Call for Abstracts: Social Care and the US Health Care Sector

Cross-posted from the HSR website.

Sponsored by: Robert Wood Johnson Foundation
Submission deadline for abstracts: Wednesday January 3, 2024

Health Services Research (HSR) is partnering with the Social Interventions Research and Evaluation Network (SIREN), a research and research translation center at the University of California San Francisco focused on social care, on a special issue on the health care sector’s practices and opportunities for identifying and addressing social care needs.

The guest editor in chief for the special issue will be HSR Senior Associate Editor Margarita Alegria, PhD, Disparities Research Unit, Massachusetts General Hospital, the Mongan Institute, and Harvard Medical School, working with guest editor HSR Editorial Board member Carrie Fry, assistant professor in the Department of Health Policy at Vanderbilt University School of Medicine, and Danielle Hessler Jones, PhD, Laura M. Gottlieb, MD, MPH, Emilia De Marchis, MD, MAS, and Yuri Cartier, MPH, from SIREN; and Rebekah Angove, PhD, from the Patient Advocate Foundation (PAF).

For this issue, social care means how health care institutions and health care-partnered institutions (e.g., community-based organizations or social service organizations partnering with health care) identify and address patient- and population-level social assets, risks or needs (e.g., related to food, housing, transportation, and other needs). It also includes how they use that understanding to improve patient health, for example, improving access to resources that address the identified needs and tailoring medical care based on those needs.

Social Care and the US Health Care Sector will include original research and perspective articles on the implementation and effectiveness of health care policies and practices associated with collecting and applying information as well as addressing patient-level socioeconomic adversity (sometimes referred to as social risks, social needs, or health-related social needs, e.g., food, housing, or transportation insecurity).

We are interested in quantitative, qualitative, or mixed-methods research studies. We also welcome manuscripts that explain what is needed to improve bridges between social care and health care organizations. We will not consider submissions describing associations between social determinants of health and health outcomes unless they also assess interventions related to policy or practice.

Of particular interest for this special issue is research that explores:

Benefits/drawbacks of different approaches to social risk/needs data collection for use in health care or social service organizations partnering with health care;The health and cost impact of social care interventions in health care or social service organizations partnering with health care (not limited to navigation programs), including impacts on racial and ethnic populations or other health inequities (e.g., related to language, culture, health literacy, gender identity and sexuality, immigration status);Facilitators and barriers of different implementation approaches of social care in health, health care, or social service organizations partnering with health care;Impact and comparative impacts of different social care health policy approaches;Community-led/partnered social care programs and research strategies;Novel research methods for assessing the impacts of social care policies, programs, or interventions partnering with health care or social service organizations partnering with health care.

The deadline for initial submission of abstracts is Wednesday January 3, 2024. Abstracts may not exceed 300 words and must be formatted as indicated in Section 2.4.2.2 of the HSR Author Instructions (keywords not necessary).

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include: (1) quality, rigor, and originality; (2) relevance to the special issue theme; and (3) clarity of writing and presentation. PAF Experts by Experience will contribute to reviewing abstracts for this special issue to ensure the selected manuscripts adequately reflect patients’ experience.

Authors of abstracts that most closely match the criteria will be invited to submit full manuscripts. Invited manuscripts must follow the Author Instructions and undergo the same HSR peer review process as regular manuscripts. However, due to the strict timeline for publishing the special issue, the process may be shorter. Authors must be prompt in returning revisions. Invited articles will be published online on acceptance. Some accepted articles might not be selected for the special issue but will be published in a regular issue.

The expected publication date for the special issue is September 2025. To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “Social Care and the US Health care Sector” in the email subject line.

Key dates for authors
Submission deadline for abstracts: Wednesday 3 January 2024
Full manuscript invitation: Monday 18 March 2024
Full manuscript deadline: Monday 17 June 2024
Final notification of all accepted manuscripts: June 2025
Special issue publication date: September 2025, but articles may be posted earlier

Questions? Please email Kelly Teagle at hsr@aha.org.

The post HSR Special Issue Call for Abstracts: Social Care and the US Health Care Sector first appeared on The Incidental Economist.

Misinformation About Health Is Nothing New

Misinformation. A recent and major problem facing us all, and one that is pervasive in many realms including medicine and healthcare, which are, of course, favorite realms around here. But is all this stuff recent? Is misinformation a new phenomenon in the world of medicine and health, or does it have a history?

The answer to that, thanks in part to funding from the National Institute for Healthcare Management, is the topic of this week’s Healthcare Triage.

 



The post Misinformation About Health Is Nothing New first appeared on The Incidental Economist.

The Potential for SHIPs to Combat Medicare Misinformation and Deceptive Marketing

With Medicare’s Annual Election Period (also known as Open Enrollment) beginning on October 15th, over 65 million adults across the United States will have until December 7th to decide whether they plan to renew or change their Medicare coverage. Beneficiaries choose between Traditional Medicare (TM) and a variety of Medicare Advantage (MA) plans and prescription drug coverage. For this enrollment cycle, it is estimated that the average beneficiary will have over 40 plans to choose from, leading to complexity. For those who are dually eligible for both Medicare and Medicaid benefits, there is an even greater number of options for them to consider, especially if they live in areas where integrated options such as dual-eligible special needs plans and Medicare-Medicaid plans are available. As the US population continues to age and the number of Medicare enrollees grow, it is important to understand how beneficiaries make their coverage decisions and ensure they are protected from any misinformation in the process.

Though already complex, the plan selection process for older adults is further complicated by the deceptive marketing tactics that brokers, agents, and third-party marketing organizations (TPMOs) have employed in recent years. In a recent study, the Commonwealth Fund identified how some of these practices are driven by the financial incentives associated with enrolling beneficiaries in particular MA plans. Between robocalls and misleading television advertisements, many beneficiaries across the country have found themselves enrolled in MA plans they did not intend to enroll in, or that did not cover services or in-network providers that they were initially marketed. In a sweeping review of Medicare Open Enrollment-related television ads, Kaiser Family Foundation found that the majority of Open Enrollment-related advertisements last year promoted the Medicare logo and privately-operated hotlines, misleading beneficiaries into believing these were government sponsored ads and helplines.

Acknowledging the growing concerns and complaints among beneficiaries, the Centers for Medicare and Medicaid Services (CMS) announced that starting in 2024, Medicare-related television ads must be approved in advance of airing and cannot contain plan names or Medicare logos and images that misrepresent their organization or agency. Additional consumer protections included in the 2024 MA and Part D Final Rule will hold brokers, agents, and other TPMOs to higher standards of providing transparent, quality information. These activities include monitoring TPMO behavior, regulating how and when they market to beneficiaries, ensuring brokers review the full list of options and choices available to a beneficiary, and going through a detailed, standardized set of pre-enrollment questions. There is also an increased effort in getting beneficiaries to use some of the federally funded tools and resources available to assist in their coverage decisions.

Some of these tools include the Medicare.gov website, the CMS Medicare Plan Compare tool, and a 1-800-MEDICARE hotline to help inform beneficiaries about their benefits. However, a study by Hernandez et al. revealed that very few Medicare beneficiaries utilized these tools and often felt more comfortable discussing their options in-person with brokers or family members and friends, even though these sources may be biased or potentially inaccurate.  Additionally, it is important to recognize that navigating these tools requires some degree of health literacy and technological proficiency, which may disproportionately affect those who are low-income, have lower levels of education, or are non-native English speakers.

The State Health Insurance Assistance Program (SHIP), however, is a free and unbiased resource for Medicare counseling that few beneficiaries are aware of. In 1990, the federal government implemented SHIPs to help support Medicare beneficiaries with free, one-to-one health insurance counseling and education within their communities. It is currently run by the Administration for Community Living (ACL). The ACL administers grants to states, who in turn provide funding to community-level subgrantees to maintain various networks of full-time, part-time, and/or volunteer counselors. The latest available data suggests that SHIPs provided assistance to 2.7 million Medicare beneficiaries from April 2018 through March 2019—just 4.5% of the eligible Medicare population.

While some states had greater success, serving over 10% of their eligible population, others were only able to reach as few as 2%. A 2018 evaluation of California’s SHIP, called HICAP (Health Insurance Counseling & Advocacy Program), highlighted the strengths of this community-based counseling system. HICAP reported high rates of engagement, citing their ability to deliver uniquely tailored counseling to beneficiaries in their native languages and through in-person or hybrid settings depending on the beneficiary’s condition or preferences. Moreover, strong marketing efforts via Spanish radio shows and mailing postcards were particularly effective in reaching “hard-to-locate” populations. However, the program did experience challenges given the variation in operations across locations, citing concerns over the recruitment, training and retention of volunteers and paid staff.

In recognition of SHIP’s potential to provide an unbiased alternative to brokers and combat misinformation, CMS finalized a requirement in the 2024 MA and Part D rule that TPMOs are to provide a disclaimer citing SHIP as an option for beneficiaries to obtain additional help (42 CFR § 422.2267(e )(41)).But despite SHIP’s promise, some beneficiary advocates have worried that the multi-tiered, volunteer, and part-time driven delivery model that characterizes most SHIPs leads to access and quality gaps. This is especially a concern among vulnerable beneficiaries who may live in low-income neighborhoods, have disabilities, or limited English proficiency. Given their historically low utilization rates and limited visibility, others have expressed concern that SHIPs may be ill-equipped to handle an increased demand for services in the coming year, due to more Medicare beneficiaries being advised of their existence through TPMO disclaimers. With the limited evidence about SHIP’s performance and outreach nationally, given the diffuse nature of the program, it will be important to understand some of the barriers and facilitators they face to delivering timely and accurate Medicare counseling.

The free and unbiased nature of the SHIP program presents a promising alternative to helping beneficiaries navigate complex plan choices for Open Enrollment. As MA enrollment increases and as plan choices become more complex, the SHIP program should be monitored for potential inequities in access to and quality of services based on area income. For more information about your state’s SHIP program and to find a local Medicare counselor, please visit https://www.shiphelp.org/.

Research for this piece was supported by Arnold Ventures & The Commonwealth Fund

The post The Potential for SHIPs to Combat Medicare Misinformation and Deceptive Marketing first appeared on The Incidental Economist.

Monthly caps as a matter of affordability and equity

While the United States celebrates a record-low uninsured rate (8.3%) due to pandemic-related policies, a lurking issue remains: nearly 25% of working-age adults remain underinsured.

As part of a series with Health Affairs, Paul Shafer, David M. Anderson, Michal Horný, and Stacie B. Dusetzina discuss the potential impact of switching from annual to monthly cost sharing caps on insurance affordability. Monthly caps take what have historically been annual limits, like deductibles and out-of-pocket maximums, and turn it into a single, more manageable amount that represents the maximum that enrollees would be responsible for out-of-pocket each month.

From the piece:

“Monthly caps  are a simple and intuitive way to internalize that annual cost-sharing limits have become decoupled from what most Americans can afford , not serving as an incentive to shop for care but instead as a significant barrier to use of any care. Whether a person has a one-time event—such as a car accident—or chronic needs, monthly caps may reduce the financial strain associated with receiving care as well as help those who need to switch plans mid-year…”

Read the whole piece for details here!

Research for this piece was supported by Arnold Ventures.

The post Monthly caps as a matter of affordability and equity first appeared on The Incidental Economist.

What is the Inflation Reduction Act and What Does it do for Medicare?

Despite a frenzy of coverage about the Biden-Harris Administration’s Inflation Reduction Act (IRA) and its impact on drug pricing, you may be wondering what the law even does.

The IRA, signed into law in August 2022, is a landmark piece of legislation that paves the way for significant changes to Medicare drug pricing. This post serves as a primer on what the law does and how its impact will be felt by Medicare beneficiaries and others.

Medicare Drug Price Negotiation Program

What is it?

The biggest part of the IRA is the new Medicare Drug Price Negotiation Program. This program allows the federal government to negotiate prescription drug prices with manufacturers. It will have a big impact on older adults and disabled Americans, giving them better, more affordable access to common treatments.

In particular, the program addresses Medicare Part B and Part D drugs. Part D drugs are ones that you would typically get at a pharmacy for conditions like high blood pressure or diabetes. Part B drugs are infusion therapies for cancer or other conditions, provided in an outpatient hospital setting or in your home by a medical professional. (It’s worth noting that Part B drugs won’t be eligible for negotiation until 2028.)

The new IRA drug negotiation program is a stepwise program in which the federal government will select a growing list of drugs each year for negotiation, with their new prices taking effect two years later. The Biden-Harris Administration released the first ten Part D drugs eligible for negotiation in August 2023. Negotiation will begin in 2024, with new prices going live in 2026.

How are drugs selected?

Any drug is eligible for negotiation unless it is disqualified for a reason delineated in the law. For example, drugs are ineligible if they have not been FDA-approved for at least 9-13 years (depending on the type), have a generic or biosimilar version, or have an orphan designation.

The ten drugs selected for the first round of negotiations make up the largest total gross expenditures annually for Medicare, and include treatments for diabetes, heart disease, and rheumatoid arthritis. These drugs accounted for $50.5 billion in Medicare Part D spending, or about 20% of all Part D spending, from June 2022 to May 2023 and patients paid $3.4 billion out-of-pocket for them during the same period.

How does negotiation happen?

Once the federal government releases the list of drugs eligible for negotiation, manufacturers have exactly one month to respond with their decision to participate in the negotiation process or not.

If manufacturers choose to participate, they and the public may submit data and commentary to be considered. Then, Medicare and manufacturers will engage in up to three negotiation meetings to determine a final new price. Should manufacturers choose not to participate, they can either keep their drug in the Medicare and Medicaid markets at a heavily taxed rate, starting at 65% of product sales and increasing quarterly to a maximum of 95% of sales, or withdraw it completely.

What else does the IRA do for drug prices?

While the Medicare Drug Price Negotiation Program has received the majority of the media attention, the IRA includes additional stipulations to help make drugs more affordable.

For example, the IRA caps insulin for Medicare beneficiaries at $35 per monthly supply. If the IRA had already been active, Medicare beneficiaries with diabetes would’ve saved $734 million for Part D-covered insulin and $27 million in Part B-covered insulin in 2020 alone.

The IRA also caps total out-of-pocket spending for Part D medications at $2,000 per year per beneficiary. Estimates show a potential $7.4 billion in annual savings for roughly 18.7 million beneficiaries as a result.

Lastly, the IRA imposes heavy rebates, refunds to the government, on manufacturers who raise drug prices past the annual rate of inflation. This limit on manufacturers’ ability to hike prices will help patients continue to afford treatments. Patients will pay lower out-of-pocket costs on drugs that have historically had runaway prices.

Takeaway

The IRA does a number of things to address the ever-increasing cost of drugs. Most importantly, it gives the government the power to negotiate with manufacturers over drug prices for the first time since Medicare Part D was created in 2006. This alone has the potential to prescription drugs more accessible for millions of Americans. However, the IRA doesn’t fully address Medicare Part B in its implementation, which may be a focus for the Biden-Harris Administration moving forward and will be explored in an upcoming post in this series.

The post What is the Inflation Reduction Act and What Does it do for Medicare? first appeared on The Incidental Economist.

Studies Show New Weight Loss Medications are the Real Deal, plus some data on what happens when we stop taking them

Back in 2021 we did an episode on Semaglutide, the then-recently-approved drug for weight loss that was originally approved for Type 2 diabetes. Since that episode another paper has come out on what happens to weight when the drug is discontinued, and another on Mounjaro, a drug approved for Type 2 diabetes. Let’s take a look.

 



The post Studies Show New Weight Loss Medications are the Real Deal, plus some data on what happens when we stop taking them first appeared on The Incidental Economist.

Climate Change and Our Food Supply

Recently, in our adventures on climate change and health, we covered the critical issue of how our water supply is impacted by a warming planet. And that is a perfect segue into something equally important: The impact of climate change on food security.

 

The post Climate Change and Our Food Supply first appeared on The Incidental Economist.

A Research Gap in Crisis Pregnancy Center Patient Outcomes

This summer, Ohio more than doubled its annual funding for crisis pregnancy centers (CPCs). In California, two bills that would have limited their reach stalled in the state legislature. The recent uptick in state and federal funding for CPCs has had me questioning what the mental and physical health implications are for those who use them.

While the outcomes associated with unwanted pregnancy are well documented in literature, there is a research gap on the impacts of seeking care at a CPC on a patient’s health. This article covers what is already known about CPCs and why researchers should examine this further.

What are CPCs?
CPCs are nonprofit organizations that provide anti-choice pregnancy counseling and prenatal services. The majority of centers are affiliated with the largest pro-life organizations in the United States: Heartbeat International, Care Net, and The National Institute of Family and Life Advocates.

CPCs describe themselves as faith-based and community-based nonprofits that provide personalized and life-affirming services to empower women to welcome their children into the world. Their goal is to improve maternal health outcomes and to promote well-being of women and families.

While some centers have obtained licenses to offer medical services (e.g., ultrasounds, testing for sexually transmitted infections), 84% do not have a physician on staff and a quarter of centers do not have a registered nurse. But these unlicensed centers, run by volunteers, give out free pregnancy tests, offer parenting classes, and provide material assistance such as maternity clothing, diapers and more.

Many CPCs mislead patients into thinking they offer comprehensive reproductive health services, including contraception, abortion care, and/or abortion referrals. Many lie about what they offer in their advertisements; some even dress their staff in scrubs or alter the office environment to mimic a doctor’s office.

The ultimate goal of these tactics is to delay access to time sensitive services, such as abortion, with the hope that patients will ultimately carry their pregnancies to term. As such, CPCs are often located near abortion clinics, to steer pregnant folks away from neighboring services.

How prevalent are CPCs?
There are over 2,500 CPCs nationwide, which is triple the number of abortion clinics. That figure is continually growing, based on a live directory created by a research team at the University of Georgia School of Public Health.

The Associated Press reported that there has also been a significant increase in annual investment nationwide for CPCs in the last decade, from $17 million/year in 2013 up to $89 million/year in 2023.

Who do CPCs serve?
CPCs disproportionately serve pregnant women who are young, low income, and have limited education. These women are often drawn in by the free health services advertised on billboards, public transportation, and high school bulletin boards.

What is known on the impact of CPCs care on patient health?
There have only been a few qualitative accounts detailing patient experience at CPCs.

One study found that women often felt like “bad people” for considering an abortion. The women further explained that once their interest in pursuing an abortion was disclosed, CPC staff changed their behavior toward them and began devaluing them.

Another report shared that women felt traumatized by the deception they experienced at CPCs. For example, some were distressed after counselors warned them of a fake “post-abortion syndrome” that can cause suicidal thoughts and depression.

Similarly, a short documentary by Vice News revealed hidden camera footage of patient distress when CPCs counselors shared false information about abortions causing long-term psychological damage and infertility.

Although there is minimal research quantifying their impact, one study found that nearly 30% of respondents who considered abortion were significantly less likely to have an abortion after visiting a center compared to those who had not visited one.

How do CPCs impact public health?
According to the Society for Adolescent Health and Medicine and the North American Society for Pediatric and Adolescent Gynecology, CPCs pose risks to vulnerable women by not adhering to medical and ethical practice standards (e.g., informed consent, patient autonomy).

While these centers are not bound to these principles since they’re not medical practices, their influence may play a role in the number of unintended births and second-trimester abortions that arise.

Consequences of unintended births include pregnant folks being more likely to avoid prenatal care, use tobacco and alcohol during pregnancy, deliver pre-term, avoid breast feeding, suffer from postpartum depression and deliver infants with low birth weight and negative mental health outcomes.

What’s more, second-trimester abortions are more expensive, harder to access, and come with higher mortality and post-surgery complication rates for the parent.

What should we do about it?
Since most CPCs are not medical clinics and do not charge for their services, they are not regulated and are exempt from laws that apply to commercial enterprises. Protected by the First Amendment as well, CPCs have been successfully winning most legal challenges.

However, some states (e.g., Connecticut, Illinois) now have laws to hold CPCs accountable and maximize protections against fraud. Cities around the nation are working to pass similar local ordinances requiring transparency on what services CPCs do and do not offer.

This clarification is crucial for patients when choosing reproductive care and a vital next step until more research is gathered on the suspected health impacts of receiving care at a CPC.

The post A Research Gap in Crisis Pregnancy Center Patient Outcomes first appeared on The Incidental Economist.

Robert Kennedy, Jr. Is Wrong About Vaccine Testing

RFK Jr. is claiming that scientists do not test vaccines with placebo-controlled trials, specifically against a saline placebo, and that all he’s asking for is that they are tested this way, as all other medicines are. On its face alone, that probably sounds like a reasonable argument. I, too, would like vaccines to be tested in randomized controlled trials – and thankfully, THEY ARE.

 



The post Robert Kennedy, Jr. Is Wrong About Vaccine Testing first appeared on The Incidental Economist.

Climate Change and Safe Drinking Water

In our last climate episode we took a look at how climate change affects the spread of infectious disease. Unfortunately, that isn’t the end of our discussion of disease on a warming planet. Waterborne diseases are already a serious public health threat. As climate change continues and increases intense rainfall, periods of drought, and temperatures, our struggle with waterborne diseases is going to increase, too.

 



The post Climate Change and Safe Drinking Water first appeared on The Incidental Economist.