Medicaid Patients May Not Have Access to IVIG for Autoimmune Blistering Diseases

MedicalResearch.com Interview with:
Kyle T. Amber, MD

Department of Dermatology
UC Irvine Health
Irvine, CA 92697-2400 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of IVIg has been shown in randomized controlled trials to be safe and highly effective in the treatment of both pemphigus and bullous pemphigoid. Despite its efficacy, its cost remains a deterrent to its use. Cost studies in the United States point towards IVIg being an overall cost-saving therapy in the treatment of  Autoimmune Blistering Diseases when compared to traditional immunosuppressive treatment due to the decrease in associated infections, complications, and hospitalizations.

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Patients With Social Risks Are More Expensive and Require Greater Medicaid Resources

MedicalResearch.com Interview with:

Dr-arlene-S-Ash.jpg

Dr. Ash

Arlene S. Ash, PhD
Department of Quantitative Health Sciences
University of Massachusetts Medical School
Worcester 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score.

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State ACA Expansions Linked To Large Increase In Prescription Drugs Paid For By Medicaid

MedicalResearch.com Interview with:
Benjamin D. Sommers, MD, PhD
Associate Professor of Health Policy & Economics
Harvard T. H. Chan School of Public Health / Brigham & Women’s Hospital
Boston, MA 02115 and
Kosali Simon PhD
School of Public and Environmental Affairs
Indiana University
Bloomington, IN

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prescription drugs are considered a high value form of medical care, and can be especially difficult for the uninsured to access. The Affordable Care Act’s Medicaid expansion represents an unprecedented expansion of insurance to low-income non-disabled adults, and our study is the first to examine the effects on prescription utilization in detail.

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Buprenorphine Prescriptions for Opioid Use Disorder Rise With Medicaid Expansion

MedicalResearch.com Interview with:

Hefei Wen, PhD Assistant Professor, Department of Health Management & Policy University of Kentucky College of Public Health

Dr.Hefei Wen

Hefei Wen, PhD
Assistant Professor, Department of Health Management & Policy
University of Kentucky College of Public Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Buprenorphine has been proven effective in treating opioid use disorder. However, the high cost of buprenorphine and the limited prescribing capacity may restrict access to this effective medication-assisted treatment (MAT) for opioid use disorder.

We found a 70% increase in Medicaid-covered buprenorphine prescriptions and a 50% increase in buprenorphine spending associated with the implementation of Medicaid expansions in 26 states during 2014. Physician prescribing capacity was also associated with increased buprenorphine prescriptions and spending.

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Economic Effects of Medicaid Expansion in Michigan

MedicalResearch.com Interview with:

John Z. Ayanian, MD, MPP</strong> Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan

Dr. John Z. Ayanian

John Z. Ayanian, MD, MPP
Director of the Institute for Healthcare Policy and Innovation and
Alice Hamilton Professor of Medicine
University of Michigan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014.

Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded.

Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding.

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Association Between the 2014 Medicaid Expansion and US Hospital Finances Under Obamacare

MedicalResearch.com Interview with:

Fredric Blavin, PhD The Urban Institute Washington, DC

Dr. Fredric Blavin

Fredric Blavin, PhD
The Urban Institute
Washington, DC 

MedicalResearch.com: What is the background for this study?

Response: The Affordable Care Act expanded Medicaid eligibility to millions of low-income adults. However, the US Supreme Court struck down the mandatory expansion of Medicaid and ruled that each state could choose whether to expand this entitlement program. This choice could affect the financial health of hospitals by decreasing patient volumes and unreimbursed expenses attributable to uninsured patients while increasing revenue from newly covered patients. The impact of Medicaid expansion on hospital profits remains uncertain, particularly for hospitals that receive generous subsidies from state or local governments for providing uncompensated care. 

This analysis focused on the association between Medicaid expansion in 2014 and hospital finances by assessing differences between hospitals in states that expanded Medicaid and those in states that did not expand Medicaid.

MedicalResearch.com: What are the main findings?

Response:  Overall, the 2014 expansion of Medicaid was associated with a decline of $2.8 million in average annual uncompensated care costs per hospital and an increase of $3.2 million in average annual Medicaid revenue per hospital. Medicaid expansion was also significantly associated with improved excess margins (1.1 percentage points) but not with improved operating margins. The estimated associations were also larger in states with high uninsurance rates prior to the implementation of the Affordable Care Act

MedicalResearch.com: What should readers take away from your report?

Response: Hospitals in states that implemented the Medicaid expansion saw significant increases in Medicaid revenue, decreases in uncompensated care costs, and improvements in profit margins, compared with hospitals in states that did not expand Medicaid.

However, the estimates based on profit margin models were less precise and less robust than the other findings. This is not surprising, given the various factors that can influence the overall profitability of hospitals.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further study is needed to assess the long-term implications of the Medicaid expansion on hospitals’ overall finances. For example, the Affordable Care Act is expected to substantially reduce Medicaid Disproportionate Share Hospital payments in fiscal year 2018; these payments provide additional funding to help cover uncompensated care in qualifying hospitals that serve a large number of Medicaid and uninsured patients. The proposed reductions were developed to help offset some of the federal costs associated with Medicaid expansion, with the expectation that costs would be replaced with Medicaid revenues from newly eligible beneficiaries. However, states that have chosen not to expand Medicaid will experience cuts in this funding source without the offsetting benefit of an influx of new Medicaid patients. This could widen the financial gap between hospitals in states with Medicaid expansion and those in states without expansion. 

MedicalResearch.com: Is there anything else you would like to add?

Response: For states still considering Medicaid expansion, these findings offer evidence that expansion may be associated with improvements in hospitals’ payer mix and overall financial outlook. However, changes in financial outcomes for hospitals in any given state will likely depend on a host of factors, such as the state’s pre-ACA income and coverage distribution, Medicaid eligibility thresholds, Medicaid reimbursement levels, and subsidies paid to hospitals providing uncompensated care. States should take these factors into account when making their Medicaid expansion decision.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Association Between the 2014 Medicaid Expansion and US Hospital Finances
JAMA. 2016;316(14):1475-1483. doi:10.1001/jama.2016.14765
Fredric Blavin, PhD

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

 

Some Medicaid Programs Offer Peer-Review For Pediatric Atypical Antipsychotic Medications

Dr. Julie Magno Zito, PhD University of Maryland, Baltimore, MD 21201MedicalResearch.com Interview with:
Dr. Julie Magno Zito, PhD

University of Maryland, Baltimore, MD 21201

MedicalResearch: What is the background for this study?

Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.

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Study Finds Medicaid Improves Depression But Not Physical Health

Peter Muennig, MD, MPH Columbia University Mailman School of Public Health NYC 10032MedicalResearch.com Interview with:
Peter Muennig, MD, MPH
Columbia University
Mailman School of Public Health
NYC 10032

Medical Research: What is the background for this study? What are the main findings?

Dr. Muennig: The Oregon Health Insurance Experiment (OHIE) is one of just two experimental investigations of the health benefits of medical insurance. The first was the Rand Health Insurance Experiment, which was conducted over 3 decades ago. The OHIE randomly assigned participants to receive Medicaid or their usual care. It found that Medicaid protected families from financial ruin caused by medical illness, that it reduced depression, and that it increased preventive screening tests. However, it produced no medical benefits with respect to high blood pressure, diabetes, or high cholesterol. Medicaid opponents suggested that this meant that we should get rid of Medicaid because Medicaid does not improve physical health. But Medicaid proponents suggested that too few participants enrolled to detect a benefit, and, regardless of the study’s flaws, reduced depression, financial protections, and improved screening were reason enough to continue.

We found that the Medicaid opponents were right. Medicaid actually didn’t produce any meaningful benefits with respect to blood pressure, diabetes, or cholesterol. But we also found that the Medicaid proponents were right. It’s impacts on depression alone rendered it cost-effective even if one does not account for the benefits of financial protections or medical screening.
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Medical Students Have Mixed Knowledge and Expectations of ACA

MedicalResearch.com Interview with:
Tyler Winkelman, M.D.
Internal Medicine and Pediatrics – PGY 4
University of Minnesota

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Winkelman: Future physicians will practice after key provisions of the Affordable Care Act (ACA) have been enacted.  Whether medical students support or understand the legislation or are willing to engage in its implementation or modification as part of their professional obligation is unknown.  We surveyed medical students at 8 U.S. medical schools to assess their views and knowledge of the ACA (RR=52%).  We found that the majority of students support the ACA and indicate a professional obligation to assist with its implementation. There are, however, gaps in knowledge with regards to Medicaid expansion and insurance plans available within the health exchanges.  Students anticipating a surgical or procedural specialty, compared to those anticipating a medical specialty, were less likely to support the ACA, less likely to indicate a professional obligation to implement the ACA, and more likely to have negative expectation of the ACA.  Moderates, liberals, and those with above average knowledge scores were more likely to support the ACA and indicate a professional obligation to assist with its implementation.
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Program Aims To Ensure Atypical Antipsychotics Used Appropriately in Children

Julie M. Zito, PhD Professor of Pharmacy and Psychiatry Department of Pharmaceutical Health Services Research University of Maryland School of Pharmacy Baltimore, MD 21201MedicalResearch.com Interview with:
Julie M. Zito, PhD
Professor of Pharmacy and Psychiatry
Department of Pharmaceutical Health Services Research
University of Maryland School of Pharmacy
Baltimore, MD 21201

MedicalResearch: What is the background for this study?

Dr. Zito: Atypical antipsychotic (AAP) use in children and adolescents has grown substantially in the past decade, largely for behavioral (non-psychotic) conditions. Poor and foster care children with Medicaid-insurance are particularly affected. This ‘off-label’ usage has insufficient evidence of benefits regarding improved functioning (i.e. appropriate behavior and performance, socially and academically) while the little evidence that accrues tends to emphasize ‘symptoms’, i.e. less acting out. Recent evidence shows that youth treated with Atypical antipsychotics are at risk of serious cardiometabolic adverse events including diabetes emerging after atypical antipsychotics are ‘on board’.

MedicalResearch: What are the main findings?

Dr. Zito: The continued expansion in Atypical antipsychotics use for behavioral conditions, particularly in poor and foster care youth prompted several government reports asking states to implement oversight programs. In our survey of state Medicaid agencies, we identified programs implementing a new and promising approach to increase the likelihood that these medications are used appropriately. These ‘peer review’ programs have been launched in 15 of the 31 prior authorization state Medicaid programs. There is a distinct advantage in having a qualified peer review, on a case-by-case basis, of the rationale for use of an atypical antipsychotic in a condition or age group that is ‘off-label’ according to the FDA product information label.

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