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…)
Author Interviews, Cost of Health Care, Emergency Care / 24.10.2019

MedicalResearch.com Interview with: Murtaza Akhter, MD Assistant Professor Department of Emergency Medicine University of Arizona College of Medicine Phoenix MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent years have brought a significant increase in emergency department visits, and therefore also a boon in openings of freestanding emergency departments (FrEDs). However, it is has been unclear whether the opening of FrEDs reduces healthcare costs. Our study showed that in increase in FrEDs was associated with an increase in spending per Blue Cross Blue Shield enrollee. (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 22.10.2019

MedicalResearch.com Interview with: David S Buck, MD, MPH Associate Dean of Community Health Professor, Clinical Sciences University of Houston - College of Medicine Houston, TX 77204  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: High-Needs, High-Cost (HNHC) patients account for 5% of the general population and cost 50% of the healthcare spending. In Harris County, one patient alone costed $439,600 in a year when he visited multiple medical, social and behavioral agencies for care. This was a result of siloed systems working independently of each other leading to inefficient care for the patient. By providing coordinated care, using patient-centered goals and values, we are able to better engage and provide a holistic approach to patient care.  This paper introduces a novel ‘values-based’ intervention mechanism for the HNHC patients, in addition to a coordinated care management approach, through a single record system. The findings indicate an improved daily functioning of the HNHC patients over 4 months, improved relationship between the providers and the patients and moderate well-being scores. (more…)
Author Interviews, Cost of Health Care, Health Care Systems, JAMA / 08.10.2019

MedicalResearch.com Interview with: William Shrank, MD, MSHS Chief Medical Officer Humana  MedicalResearch.com: What is the background for this study? Response: Health care waste is a serious problem in the system and the rising and uncontrolled costs of healthcare remain one of the top political and social issues in the U.S. We thought that sufficient time had passed since the 2012 groundbreaking analysis that was developed by Donald M. Berwick, MD, MPP and Andrew D. Hackbarth, MPhil, that first characterized waste in the US health system.  (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Diabetes, JAMA / 02.10.2019

MedicalResearch.com Interview with: Andrew Sumarsono, MD UT Southwestern Medical Center MedicalResearch.com: What is the background for this study?   Response: There are currently 12 types of medications used to treat type 2 diabetes. With approximately 30 million adults living with diabetes in the United States, the rising cost of insulin has raised concerns about the affordability of diabetes care. We evaluated trends in total spending and number of prescriptions of all diabetes therapies among Medicare Part D beneficiaries between 2012 and 2017. (more…)
Author Interviews, BMC, Cost of Health Care, Diabetes, Yale / 28.09.2019

MedicalResearch.com Interview with: Phoebe Tran Doctoral Student Department of Chronic Disease Epidemiology Yale School of MedicinePhoebe Tran Doctoral Student Department of Chronic Disease Epidemiology Yale School of Medicine  MedicalResearch.com: What is the background for this study? Response: As the prevalence of diabetes risk factors such as obesity, high blood pressure, high cholesterol, and physical inactivity are considerably higher in US individuals residing in rural areas compared to their urban counterparts, rural residents face increased risk of developing diabetes. Diabetes screening is a useful tool that can be used to identify people with newly developed type 2 diabetes and offer them early treatment. In this study, we examined whether there are differences in diabetes screening levels between rural and urban areas across the US using nationally representative survey data from 2011, 2013, 2015, and 2017.   (more…)
Author Interviews, Cost of Health Care, Diabetes, Diabetes Care, JAMA / 23.09.2019

MedicalResearch.com Interview with: Rebecca Myerson, PhD Assistant Professor, Population Health Sciences School of Medicine and Public Health University of Wisconsin, Madison MedicalResearch.com: What is the background for this study? Response: Many people with diabetes are undiagnosed, and those who are diagnosed often are untreated and uncontrolled. Increasing access to health insurance for patients with health care needs was a goal of the Affordable Care Act. We analyzed information from 11 years of the National Health and Nutrition Examination Survey, which gathers data that are nationally representative of the civilian population. The biennial survey includes biomarkers, including HbA1c, a measure of blood-sugar control. Using the NHANES data allowed the researchers to identify those with undiagnosed diabetes. (more…)
Author Interviews, Cost of Health Care, JAMA, University of Pittsburgh / 23.09.2019

MedicalResearch.com Interview with: Coleman Drake, PhD Assistant Professor, Department of Health Policy and Management Affiliate faculty member Center for Pharmaceutical Policy and Prescribing University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Every year, the Centers for Medicare and Medicaid Services puts out of notice of proposed changes to the rules governing the Health Insurance Marketplaces created by the Affordable Care Act (e.g., healthcare.gov). The most recent notice for 2020 (issued in 2019) considered eliminating automatic reenrollment for Marketplace enrollees. On the one hand, requiring that enrollees actively select a health plan to stay insured is a good thing because it forces them to consider their options – we know that people make better health plan choices when they consider their choices. On the other hand, creating an administrative barrier to staying insured could cause some people to become uninsured. Since 3.4 million Marketplace enrollees used automatic enrollment in 2019, eliminating it might cause a spike in the uninsured rate. (more…)
ASCO, Author Interviews, Cancer Research, Cost of Health Care, End of Life Care / 17.09.2019

MedicalResearch.com Interview with: Richy Agajanian, M.D. Chief Medical Officer and Senior Regional Director The Oncology Institute of HopeRichy Agajanian, M.D. Chief Medical Officer and Senior Regional Director The Oncology Institute of Hope and Innovation MedicalResearch.com: What is the background for this study? Response: Cancer patients and their families face status-quo treatment protocols and reimbursement models which often result in confusion and unnecessary pain and suffering in the final weeks or months of life while also causing enormous financial burden. To help combat these issues, The Oncology Institute, in collaboration with the Stanford University School of Medicine and CareMore Health, released the study, Enhancing community capacity to deliver value-based cancer care at the end-of-life. This study evaluated the effect of using lay health workers (LHWs), who are non-physician members of the community who have received specialized training to support patient care and navigation, on end-of-life cancer care outcomes, quality and cost.  (more…)
Author Interviews, Cost of Health Care, Health Care Systems / 06.09.2019

MedicalResearch.com Interview with: Vivian Ho, PhD The James A. Baker III Institute Chair in Health Economics Director of the Center for Health and Biosciences Rice's Baker Institute for Public Policy MedicalResearch.com: What is the background for this study? Response: In 2003, approximately 29% of U.S. hospitals employed physicians, a number that rose to 42% by 2012. The share of physician practices owned by hospitals rose from 14% in 2012 to 29% in 2016. Economists refer to these relationships between hospitals and physicians as vertical integration, because they represent hospitals exerting more control over physicians as an essential part of inpatient care. As hospitals gain more control over physicians, they may incentivize delivery of more services but not necessarily higher quality care. When we launched this study, we hypothesized that tighter integration of physicians with hospitals would improve care coordination. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare / 06.09.2019

MedicalResearch.com Interview with: Md Momotazur Rahman PhD Associate Professor of Health Services, Policy and Practice Margot Schwartz MPH Doctoral program Brown University MedicalResearch.com: What is the background for this study? Response: Although one third of Medicare beneficiaries are currently enrolled in Medicare Advantage (MA), it is difficult to assess the quality of healthcare providers that serve MA beneficiaries, or to compare them to providers that serve Traditional Medicare (TM) beneficiaries. While Medicare Advantage plans are required to cover the same minimum healthcare services as TM, MA beneficiaries receive care from their plan’s network of preferred providers, while TM beneficiaries may select any Medicare-certified provider. The objective of this study is to compare the quality of Home health Agencies (HHAs) that serve Medicare Advantage and TM beneficiaries. Approximately 3.5 million Medicare beneficiaries receive home health care annually.   (more…)
Author Interviews, Cost of Health Care, JAMA, Medical Imaging, UCSF / 05.09.2019

MedicalResearch.com Interview with: Rebecca Smith-Bindman, MD Professor, Department of Radiology and Biomedical Imaging, Epidemiology and Biostatistics Philip R. Lee Institute for Health Policy Studies University of California, San Francisco MedicalResearch.com: What is the background for this study? Response: Medical imaging increased rapidly from 2000 to 2006. The rise in imaging can be attributed to improvements in technical aspects of imaging, strong physician and patient demand, and strong financial incentives. While imaging contributes to accurate disease diagnosis and improved treatment, imaging can also increase costs and patient harms, such as incidental findings, overdiagnosis, anxiety, and radiation exposure associated with increased risk of cancer. Potential overuse of diagnostic testing has been addressed by the American Board of Internal Medicine Foundation’s Choosing Wisely Campaign and initiatives by payers to reduce imaging through payment reductions, but there remains uncertainty in the impact of these initiatives on imaging rates.The objective of our study was to evaluate recent trends in medical imaging. Our study assessed imaging from 2000 through 2016 among individuals enrolled in diverse U.S. integrated healthcare systems and among individuals residing in Ontario, Canada and assessed changes in medical imaging utilization over time by country, health system, and patient demographic factors. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Medicare / 28.08.2019

MedicalResearch.com Interview with: Jose F. Figueroa, MD, MPH Instructor , Harvard Medical School, Department of Medicine Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? Response: Hospitalizations related to ambulatory-care sensitive conditions are widely considered a key measure of access to high-quality ambulatory care. It is included as a quality measure in many national value-based care programs. To date, we do not really know whether rates of these avoidable hospitalizations are meaningfully improving for Medicare beneficiaries over time. (more…)
Author Interviews, Cost of Health Care, Medicare / 14.08.2019

MedicalResearch.com Interview with: ABT-AssociatesMatthew Trombley, Ph.D. Associate/Scientist Abt Associates  MedicalResearch.com: What is the background for this study?   Response: CMS developed the Accountable Care Organization (ACO) Investment Model (AIM) as part of the Medicare Shared Savings Program (MSSP) to encourage the growth of ACOs in rural and underserved areas.  The goal of our study was to see if AIM ACOs could successfully decrease Medicare spending in these areas. (more…)