Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, JAMA / 28.07.2020

MedicalResearch.com Interview with: Frank Wharam, MD, MPH Department of Population Medicine Harvard Medical School and Harvard Pilgrim Healthcare Institute Boston, MA 02215 MedicalResearch.com: What is the background for this study? Response:  There is substantial concern that high-deductible health plans increase people’s risk of major adverse health events such as heart attack and stroke. No studies have examined this question. This study examines the effects of a transition to a high-deductible health plan on the risk of major adverse cardiovascular outcomes (myocardial infarction and stroke). The study group included individuals with risk factors for cardiovascular disease who were continuously enrolled in low-deductible (<$500) health plans during a baseline year followed by up to 4 years in high-deductible (≥$1000) plans after an employer-mandated switch. The matched control group included individuals with the same risk factors who were contemporaneously enrolled in low-deductible plans.  We examined time to first major adverse cardiovascular event, defined as myocardial infarction or stroke.  (more…)
Author Interviews, Cost of Health Care, JAMA, Race/Ethnic Diversity / 24.06.2020

MedicalResearch.com Interview with: Megan B. Cole Brahim, PhD, MPH Assistant Professor | Dept. of Health Law, Policy, & Management Boston University School of Public Health Boston, MA MedicalResearch.com: What is the background for this study? Response: Enrollment in high deductible health plans (HDHPs)—which require patients to pay on the upwards of thousands of dollars in out-of-pocket costs before they can use their health insurance coverage for most services—has skyrocketed over the last decade. For cancer survivors in particular, this is really concerning, as patients may avoid or delay necessary health care services or important medications because they can’t afford their deductible. We know from previous work that HDHPs are associated with less use of health care, including less cancer screening and treatment. However, there has been very little work to assess how HDHPs may contribute to racial/ethnic disparities in care, and our study is the first known study to assess how HDHPs may contribute to racial/ethnic disparities in cancer survivors. To fill this gap, we used nationally representative survey data from 2013-2018 to assess how enrollment in high deductible health plans was associated with cost-related barriers to care among cancer survivors with private insurance, and how this relationship varied across racial/ethnic groups. (more…)
Author Interviews, Cost of Health Care, Diabetes, JAMA, Pediatrics / 01.06.2020

MedicalResearch.com Interview with: Kao-Ping Chua, M.D., Ph.D. Assistant Professor, Pediatrics, Medical School Susan B. Meister Child Health Evaluation and Research Center University of Michigan MedicalResearch.com: What is the background for this study? Response: Due to high and rising prices, insulin has become increasingly unaffordable for patients with type 1 diabetes who must pay out-of-pocket for this life-saving medication. Over the past 5 months, many states and insurers have taken steps to cap insulin out-of-pocket spending. For example, Cigna imposed a $25 monthly cap earlier this year. This week, the Centers for Medicare and Medicare Services announced a $35 monthly cap for many Medicare Part D beneficiaries. (more…)
Author Interviews, Cost of Health Care, Diabetes / 01.06.2020

MedicalResearch.com Interview with: Amir Meiri, MD MPH Atrius Health/Department of Population Medicine (DPM) | Delivery System Science Fellow HMS and HPHCI, DPM | General Internal Medicine Fellow Atrius Health Kenmore | Urgent Care Physician VA Boston Healthcare | Attending in Internal Medicine and Emergency Medicine  MedicalResearch.com: What is the background for this study? Response: There has been significant media reporting about rising insulin prices and the health impacts of those exorbitant prices. However, it was not clear how these insulin prices may impact out-of-pocket costs among commercially insured patients; though it is clear that those without insurance are affected per previous media reports. Our study examines the difference between insulin manufacturer-set prices and what patients actually pay, the out-of-pocket cost, in the context of the type of insurance patients have. (more…)
Author Interviews, Cost of Health Care, JAMA / 19.05.2020

MedicalResearch.com Interview with: James D. Chambers, PhD, MPharm, MSc Associate Professor of Medicine Tufts Medical Center Institute for Clinical Research and Health Policy Studies MedicalResearch.com: What is the background for this study? Response: We know that biosimilars have not had the same uptake in the US as they have had elsewhere. We know that this is in part due to reference product manufacturer tactics to delay biosimilar market entry and patent disputes. In this study we examined whether lack of preferred coverage by commercial health insurers may also play a role. (more…)
Author Interviews, Cost of Health Care, JAMA, Primary Care / 19.05.2020

MedicalResearch.com Interview with: Sara Martin, MD, MSc Santa Rosa Family Medicine Residency Program Santa Rosa, California MedicalResearch.com: What is the background for this study? Response: To improve access to comprehensive primary care, we need to understand how much is being spent on primary care. Until recently, the United States lacked any data-based estimate of primary care expenditure.  This study utilizes Medical Expenditure Panel Survey (MEPS)data from 2002 – 2016 to estimate the percentage of healthcare expenditures that was spent on primary care. Most discussions around health care expenditure in the U.S. focus on the fact that we spend more than any other country and do not have the corresponding outcomes to match that investment.  This paper focuses the conversation around the distribution of the expenditure. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, Race/Ethnic Diversity, Statins / 14.05.2020

MedicalResearch.com Interview with: Dr. Ankur Pandya, PhD Assistant Professor of Health Decision Science Department of Health Policy and Management Harvard T.H. Chan School of Public Health MedicalResearch.com: What is the background for this study? Response: The 2013 ACC-AHA cholesterol treatment guidelines greatly expanded statin medication eligibility for individuals between the ages of 40-75 years without known cardiovascular disease, and there was some concern that African Americans at "intermediate risk" per those guidelines could be (arguably) overtreated with statins. The 2018 ACC-AHA guidelines included coronary artery calcium assessment for individuals at intermediate cardiovascular disease risk; those with a "zero" calcium score and no other risk factors would now change the eligibility (from indicated statin to not indicated). (more…)
Asthma, AstraZeneca, Author Interviews, Cost of Health Care / 01.05.2020

MedicalResearch.com Interview with: Yen Chung, PharmD Payer Evidence Director US Medical Affairs, AstraZeneca MedicalResearch.com: What is the background for this study? Response: Among patients with persistent asthma, use of systemic corticosteroids (SCS) is typically reserved for treatment of asthma exacerbations and as a supplemental maintenance therapy for patients whose disease remains uncontrolled with maximum maintenance controller therapies. However, SCS therapy comes with known risks for acute and chronic complications. It is well established that patients with severe asthma are responsible for a disproportionate amount of the economic burden of asthma;  however, less clear is the extent to which systemic corticosteroids use and its consequences specifically contributes to the cost burden of asthma. The purpose of this study was to use administrative claims to follow asthma patients with and without SCS treatment for up to 3 years and compare their complication rates, health care resource utilization, and costs.  (more…)
Author Interviews, JAMA, Kidney Disease, Medicare / 10.04.2020

MedicalResearch.com Interview with: Lead and Senior coauthors contributing to this interview: Abby Hoffman, BA is a Pre-Doctoral Fellow in Population Health Sciences at Duke University and a PhD Candidate in Health Policy and Management University of North Carolina at Chapel Hill. Virginia Wang, PhD, MSPH is an Associate Professor in the Department of Population Health Sciences, Associate Director of the Center for Health Innovation and Outcomes Research, and Core Faculty in the Margolis Center for Health Policy at Duke University and Investigator at the Durham VA HSR&D Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT).   MedicalResearch.com: What is the background for this study? Response: It is well established that healthcare providers are sensitive to changes in price, though their behavioral response varies. Dialysis facilities are particularly responsive to changes in Medicare reimbursement. Many dialysis patients are eligible for Medicare regardless of age, but dialysis facilities generally receive significantly higher reimbursement from private insurers than from Medicare. In 2011, Medicare implemented a new prospective bundled payment for dialysis that was expected to decrease Medicare payment and reduce overall revenues flowing into facilities. Then the Affordable Care Act (ACA) rules against refusing to insure patients for preexisting conditions and the 2014 ACA Marketplace provided an additional avenue for patients to purchase private insurance. As a result of these policies, dialysis facilities had a strong motivation and opportunity to increase the share of patients with private insurance coverage. We were interested in understanding whether dialysis facilities were shifting their payer mix away from Medicare, possibly in response to these policy changes.  (more…)
Author Interviews, Cost of Health Care, JAMA, Opiods / 01.04.2020

MedicalResearch.com Interview with: Aparna Soni PhD, Assistant Professor Department of Public Administration and Policy School of Public Affairs American University Washington, DC MedicalResearch.com: What is the background for this study? Response: The United States is in the midst of an opioid epidemic. Opioids are responsible for nearly 50,000 deaths per year and present a substantial financial burden on hospitals. The rate of opioids-related hospital events has tripled since 2005. We are particularly concerned about rising hospitalizations because they may stem from a lack of access to treatment for individuals with opioid use disorder. Medication-assisted treatment is effective in treating opioid use disorder but can be unaffordable for people without health insurance. (more…)
Author Interviews, Cost of Health Care, Electronic Records / 20.03.2020

MedicalResearch.com Interview with: Rohit Bishnoi, M.D. Division of Hematology and Oncology Department of Medicine University of Florida Gainesville, FL MedicalResearch.com: What is the background for this study? Response: National Healthcare expenditure was $3.6 trillion in 2018 and 17.7% of Gross Domestic Product. Redundant laboratory testing is one part of this problem that is more pronounced in hospitalized patients as they are often seen by multiple physicians from the time of admission till discharge. This added burden on the US health care system leads to increased costs, decreased patient satisfaction, and unnecessary phlebotomy. It also leads to iatrogenic anemia over time and unnecessary transfusions. The Choosing Wisely initiative recommendation from the Society of Hospital Medicine, Society for the Advancement of Blood Management, and the Critical Care Societies Collaborative have recommended avoiding repetitive labs. As one of the physicians in the division of hospital medicine at the University of Florida (UF) Health Shands hospital, we encountered this problem frequently where a patient will get multiple HbA1c or lipid profiles or iron studies during the same hospital stay without any clear clinical indication. Most often these tests were ordered by different physicians seeing the same patient and not realizing that either the test has already been ordered or sometimes it is related to practice pattern of physicians. We often heard complaints about this from our nursing and laboratory staff and, most importantly by patients themselves. (more…)
Author Interviews, Cost of Health Care, JAMA, NIH, Social Issues / 12.03.2020

MedicalResearch.com Interview with: Dr. Adan Z. Becerra PhD Senior Epidemiologist for the  NIH Social and Scientific Systems Washington, District Of Columbia MedicalResearch.com: What is the background for this study? Response: Previous studies have shown that disparities in insurance coverage by immigration status exist in the United States such that immigrants compared to nonimmigrants are less likely to have insurance. However, most studies have been cross sectional with few studies investigating long term trajectories of insurance coverage over time. We addressed this gap in the literature by following a cohort of adults for 24 years from before until after reaching Medicare age-eligibility. (more…)
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Cost of Health Care, Geriatrics, JAMA, Medicare / 12.03.2020

MedicalResearch.com Interview with: Rishi K. Wadhera, MD Harvard Medical Faculty Physicians Cardiovasular Diseases Beth Israel Deaconess Medical Center  MedicalResearch.com: What is the background for this study? Response: In the U.S., income inequality has steadily increased over the last several decades. Given widening inequities, there has been significant concern about the health outcomes of older Americans who experience poverty, particularly because prior studies have shown a strong link between socioeconomic status and health. In this study, we evaluated how health outcomes for low-income older adults who are dually enrolled in both Medicare and Medicaid have changed since the early 2000’s, and whether disparities have narrowed or widened over time compared with more affluent older adults who are solely enrolled in Medicare (non-dually enrolled). (more…)
Author Interviews, Cost of Health Care / 10.03.2020

MedicalResearch.com Interview with: Olivier Wouters, Ph.D. Assistant Professor of Health Policy Department of Health Policy London School of Economics and Political Science London MedicalResearch.com: What is the background for this study? Response: Although both Democrats and Republicans consider lowering prescription drug prices a priority, lobbyists and campaign donors in the pharmaceutical industry may counteract efforts by federal and state governments to decrease these costs. In this study, I tracked every dollar spent by the pharmaceutical and health product industry on lobbying and campaign contributions in the US from 1999 to 2018. These data were obtained from the Center for Responsive Politics and the National Institute on Money in Politics—two non-profit, non-partisan US organizations.  (more…)
Author Interviews, Cost of Health Care, Infections / 07.03.2020

MedicalResearch.com Interview with: Dr. Steve Miller MD MBA Chief Clinical Officer Cigna MedicalResearch.com: What is the background for this study? Response: With diagnoses of coronavirus increasing, Cigna is committed to helping contain the virus, removing barriers to testing and treatment, and giving peace of mind to its clients and customers. (more…)
Author Interviews, Cost of Health Care, JAMA, Pharmaceutical Companies / 04.03.2020

MedicalResearch.com Interview with: Olivier Wouters, Ph.D. Assistant Professor of Health Policy Department of Health Policy (COW 2.06) London School of Economics and Political Science MedicalResearch.com: What is the background for this study? What are the main findings? Response: Drug companies often point to high research and development costs as justification for the rising prices of new medicines. Yet most prior analyses of research and development costs have been based on confidential data voluntarily supplied by drug companies to researchers with financial ties to the industry. Independent teams have not been able to verify those findings. (more…)
Author Interviews, Cost of Health Care, JAMA, University of Pittsburgh / 04.03.2020

MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy MedicalResearch.com: What is the background for this study? Response: Prior research found that list prices of drugs more than doubled in the last decade. However, because prior research was based on list prices, it did not account for manufacturer discounts, which have also increased in the past few years. We leveraged net pricing data from the investment firm SSR health to estimate increases in drug prices after accounting for discounts. (more…)
Author Interviews, Health Care Systems, Heart Disease, JAMA, Medicare / 24.02.2020

MedicalResearch.com Interview with: Rishi K. Wadhera, MD Beth Israel Deaconess Medical Center Harvard Medical Faculty Physicians MedicalResearch.com: What is the background for this study? Response: In recent years, the Centers for Medicare and Medicaid Services has implemented nationally mandated value-based programs to incentivize hospitals to deliver higher quality care. The Hospital Readmissions Reduction Program (HRRP), for example, has financially penalized hospitals over $2.5 billion to date for high 30-day readmission rates. In addition, the Value-Based Purchasing Program (VBP) rewards or penalizes hospitals based on their performance on multiple domains of care.  Both programs have focused on cardiovascular care. The evidence to date, however, suggests that these programs have not improved health outcomes, and there is growing concern that they may disproportionately penalize hospitals that care for sick and poor patients, rather than for poor quality care. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 22.02.2020

MedicalResearch.com Interview with: Collin Tebo BA Georgetown University School of Medicine Washington, DCCollin Tebo BA Georgetown University School of Medicine Washington, DC MedicalResearch.com: What is the background for this study? Response: The growing cost of pharmaceuticals is an issue of increasing concern in the United States where a large portion of the nation’s Gross Domestic Product is health care spending. During the past decade, visits to Emergency Departments (EDs) have increased considerably. Pharmaceutical drugs are utilized in the care of most patients who visit the ED therefore, rising drug prices are a concern for emergency medicine physicians, administrators, and patients throughout the US. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, University of Pennsylvania / 20.02.2020

MedicalResearch.com Interview with: Samuel Takvorian, MD, MS Instructor in the Division of Hematology and Oncology LDI Associate Professor University of Pennsylvania Perelman School of Medicine MedicalResearch.com: What is the background for this study? Response: The Affordable Care Act’s Medicaid expansions have been associated with improved access to care, affordability, and for certain surgical and medical conditions, health outcomes. However, studies have also suggested unintended consequences such as lengthened wait times, and there is continued debate about the overall impact of the expansions. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 19.02.2020

MedicalResearch.com Interview with: Jane M. Zhu, MD, MPP, MSHP Assistant Professor of Medicine Division of General Internal Medicine Oregon Health and Sciences University Penn LDI Adjunct Senior Fellow MedicalResearch.com: What is the background for this study? Response: In recent years, private equity firms have been rapidly entering the health care sector, including by purchasing physician medical groups. There’s a lot of interest in this trend but very little empirical research to understand its scope, characteristics, and effects. (more…)
Aging, Author Interviews, Cost of Health Care, JAMA, University of Michigan / 10.02.2020

MedicalResearch.com Interview with: Renuka Tipirneni, MD, MSc, FACP Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine Divisions of General Medicine and Hospital Medicine and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109 MedicalResearch.com: What is the background for this study? Response: While U.S. adults age 50-64 previously had more limited options for health insurance before Medicare at age 65, the Affordable Care Act expanded the number of options, including Marketplace plans (e.g., through HealthCare.gov) and Medicaid. This expanded set of options may complicate decisions about health insurance near retirement. In addition, several policy challenges to the Affordable Care Act may add uncertainty to the decision-making process. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 18.01.2020

MedicalResearch.com Interview with: Evan M. Graboyes, MD Surveillance and Health Services Research American Cancer Society, Atlanta, Georgia Department of Otolaryngology–Head & Neck Surgery Medical University of South Carolina, Charleston  MedicalResearch.com: What is the background for this study? Response: Prior studies have shown that Medication Expansions under the Patient Protection and Affordable Care Act (ACA) are associated with a decrease in uninsured individuals and increases in the percentage of nonelderly patients diagnosed with localized (stage I-II) cancer, primarily for cancers for which effective screening tests exist. Because no screening test exists for head and neck squamous cell carcinoma (HNSCC), access to care for physical examination and tissue-based biopsy- and thus health insurance coverage- are critical for the timely recognition of symptoms, early disease stage at diagnosis, and treatment initiation. However, the downstream association of changes in health insurance coverage following Medicaid expansion under the ACA with stage at diagnosis and time to treatment initiation, key metrics for access to care for HNSCC, remain unknown. (more…)
Accidents & Violence, Author Interviews, Cost of Health Care, Surgical Research / 17.01.2020

MedicalResearch.com Interview with: Juan P. Herrera-Escobar, MD, MPH Research Director, Long-term Outcomes in Trauma Center for Surgery and Public Health, Brigham and Women's Hospital Instructor in Surgery, Harvard Medical School MedicalResearch.com: What is the background for this study? Response: Firearm injuries are a pressing public health problem in the United States. Until now, most of the research on this problematic has focused on mortality, which of course is critical, but is only one piece of the story. For every person who dies from a firearm injury, three survive every year. As trauma systems continue to improve and save more lives every year, our attention should start shifting to the impact that firearm injuries have on survivors.  (more…)
Author Interviews, Cost of Health Care, Emergency Care, Neurology / 10.01.2020

MedicalResearch.com Interview with: Simon Borghs MSc RWE Strategy Lead of Neurology UCB:  Union Chimique Belge MedicalResearch.com: What is the background for this study? Response: Epilepsy is an episodic disease and so is associated with a more or less unpredictable occurrence of health care encounters. These encounters are costly and so reducing them, or their unpredictability, could be cost saving. The objective was to assess one half of this equation, that is the actual cost of those encounters to insurers. This could prompt insurers to consider addressing possible interventions in epilepsy to reduce the number of encounters (more…)
Author Interviews, Breast Cancer, Cost of Health Care, JAMA, Race/Ethnic Diversity / 09.01.2020

MedicalResearch.com Interview with: Naomi Y Ko, MD Director, Inpatient Medical Operations Assistant Professor of Medicine, Department of Medicine Boston University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background for this study is to help understand the association between risk of more advanced cancer in racial minorities and insurance.   (more…)
Author Interviews, Cost of Health Care, JAMA, Primary Care / 11.12.2019

MedicalResearch.com Interview with: Julie Reiff BA Researcher Health Care Cost Institute  MedicalResearch.com: What is the background for this study? Response: Prior studies have attempted to define primary care spending and quantify such spending. Using definitions from the Milbank Memorial Fund, we used Health Care Cost Institute data to calculate primary care utilization and spending among those age 0-64 with employer-sponsored insurance. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Rheumatology / 13.11.2019

MedicalResearch.com Interview with: Natalie McCormick, Ph.D. Post-Doctoral Research Fellow Clinical Epidemiology Program Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital Department of Medicine, Harvard Medical School Arthritis Research Canada  MedicalResearch.com: What is the background for this study? Response: Biologic disease-modifying anti-rheumatic drugs (bDMARDs) have improved the health and productivity of many people living with moderate-to-severe inflammatory rheumatic diseases. They are also among the highest-spend drugs in the USA, with substantial out-of-pocket costs that pose barriers to treatment initiation and adherence. To understand the drivers of ongoing bDMARD spending growth, and effective ways of containing costs, we analysed drug spending data for all bDMARD claims in Medicare Part D, Part B fee-for-service, and Medicaid over 2012 to 2016, isolating the impact of changes in drug prices from changes in utilisation.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Dermatology, JAMA, Rheumatology / 09.11.2019

MedicalResearch.com Interview with: Emily S. Ruiz, MD, MPH Director, High-Risk Skin Cancer Clinic, Dana Farber/Brigham and Women’s Cancer Center Assistant Professor, Harvard Medical School, Dermatology Brigham And Women's Faulkner Hospital  MedicalResearch.com: What is the background for this study? Response: Innovation in oncology has led to increased development and market entry of anticancer drugs. For example, from 2009 to 2013, the US FDA approved 51 oral and systemic anticancer drugs for 63 indications. Prices for anticancer drugs have risen faster than inflation over time, especially for older drugs, and prices in the US have largely been set by market forces rather than novelty or efficacy. Understanding the evolving cancer economic landscape requires consideration of annual and cumulative rates of change for key metrics, such as total spending, drug cost per beneficiary, out-of-pocket cost, and utilization. This study sought to weigh the proportional impacts of rising drug costs and utilization on increased Medicare Part D spending for a cohort of oral anticancer drug utilized from 2013-2017.  (more…)
Author Interviews, Cost of Health Care, JAMA / 01.11.2019

MedicalResearch.com Interview with: Rena M. Conti, PhD, Associate Professor Department of Markets, Public Policy and Law Questrom School of Business Boston University Boston, MA 02215 Co-Authors: Sayeh S. Nikpay, PhD Melinda B. Buntin, PhD Vanderbilt University School of Medicine MedicalResearch.com: What is the background for this study? Response: The federal 340B program provides deep discounts on the acquisition cost of prescription drugs for participating hospitals and places no limits on what hospitals charge patients and insurers.  Congress intended 340B profits generated from hospital participation to subsidize the provision of safety net care for patients residing in the community. This study is the first to estimate the size of profits hospitals participating in the 340B drug discount program collect from Medicare patients for the outpatient clinic administration of prescription drugs. (more…)