Author Interviews, Cost of Health Care, JAMA / 18.07.2019

MedicalResearch.com Interview with: [caption id="attachment_50263" align="alignleft" width="140"]Jim Stimpson, PhD Professor, Associate Dean for Academic Affairs  Health Management and Policy Drexel Dornsife School of Public Health Dr. Stimpson[/caption] Jim Stimpson, PhD Professor, Associate Dean for Academic Affairs Health Management and Policy Drexel Dornsife School of Public Health  MedicalResearch.com: What is the background for this study? Response: We have limited information on the impact of the ACA on persons with a disability, even though nearly 1 in 5 persons in the US has a physical or mental disability. Prior to the ACA, persons with a disability had complications accessing health insurance for a variety of reasons including lower likelihood of employer-based coverage, reduced access to private insurance due to pre-existing conditions, and income-restrictions for Medicaid coverage that are on average below the poverty threshold across the country.
ASCO, Author Interviews, Cancer Research, Cost of Health Care, Race/Ethnic Diversity / 06.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49644" align="alignleft" width="161"]Blythe J.S. Adamson, PhD, MPH Senior Quantitative Scientist Flatiron Health Dr. Adamson[/caption] Blythe J.S. Adamson, PhD, MPH Senior Quantitative Scientist Flatiron Health MedicalResearch.com: What is the background for this study? Response: Racial disparities in access and outcomes have been documented across the full trajectory of cancer-related care. This includes access to prevention and screening, to early diagnosis, treatment, survival and other health outcomes. While these disparities have been well documented, finding mechanisms to reduce disparities is more challenging. One potential mechanism to reduce treatment disparities is to improve access to insurance coverage. The Affordable Care Act (ACA), passed in March 2010, included as its overall goals the improvement in healthcare quality and access, and enhancing equity in treatment and outcomes. The ACA allowed states to expand Medicaid to poor and near-poor adults, and this was implemented by many states starting in 2014. In addition, the ACA established private insurance marketplaces with income-based premium subsidies and limits on out-of-pocket spending for qualifying low-income enrollees. Prior research has demonstrated that ACA Medicaid expansions are associated with increased coverage and improved overall access for cancer survivors; and for newly diagnosed patients, the ACA was associated with increased coverage and shifts to earlier stage diagnosis for some cancers. To our knowledge, no research has yet demonstrated that the ACA coverage expansions affected the process of cancer care, specific cancer treatments received or specific treatment outcomes, let alone whether disparities were reduced.  In this study we looked at the time from advanced/metastatic diagnosis to start of systemic treatment for black vs. white patients and based on whether they were diagnosed at a time and in a state that had vs. had not implemented Medicaid expansion. Our study hypothesis was that Medicaid expansion reduced disparity in timely treatment of black patients compared to white patients with advanced cancer. We defined timely treatment as start of systemic therapy within 30 days of advanced/metastatic diagnosis. This is a retrospective observational study, not a randomized controlled trial. In other words, we selected a cohort of patients diagnosed with advanced or metastatic cancers over time and observed whether they received timely treatment. The Flatiron Health EHR-derived database was the principal data source for this research. Flatiron contributing practices include 280 cancer community based clinics and academic hospital outpatient settings (~800 sites of care) representing more than 2.2 million patients with cancer in the United States. Practices are located in 40 states. To produce the database, Flatiron extracted data from structured fields, including demographics, and recorded medication orders and administrations. Flatiron also abstracted unstructured data, using technology assisted review by highly trained clinicians. Abstracted data include diagnosis date, stage, and prescribed oral anticancer medications. The database used for research purposes was de-identified. We also used data from the Kaiser Family Foundation which has tracked Medicaid implementation policies for over twenty years, and the US Bureau of Labor Statistics from which we pulled state-year unemployment rates.
Author Interviews, Cost of Health Care, JAMA, Mental Health Research / 06.06.2019

MedicalResearch.com Interview with: [caption id="attachment_48428" align="alignleft" width="200"]Hefei Wen, PhDAssistant Professor, Department of Health Management & PolicyUniversity of Kentucky College of Public Health Dr. Wen[/caption] 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? Response: Medicaid is the principal payer of behavioral health services in the U.S. and expected to play an increasing role in financing behavioral health services following Medicaid expansions under the ACA.
Author Interviews, JAMA, OBGYNE, Pediatrics, Race/Ethnic Diversity / 24.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48728" align="alignleft" width="123"]Clare Brown, PhDHealth Systems and Services ResearchUniversity of Arkansas for Medical Sciences Dr. Brown[/caption] Clare Brown, PhD Health Systems and Services Research University of Arkansas for Medical Sciences [caption id="attachment_48727" align="alignleft" width="125"]J. Mick Tilford, PhD, Professor and ChairDepartment of Health Policy and ManagementFay W. Boozman College of Public HealthUniversity of Arkansas for Medical Science Dr. Tilford[/caption] J. Mick Tilford, PhD, Professor and Chair Department of Health Policy and Management Fay W. Boozman College of Public Health University of Arkansas for Medical Science   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Prematurity and low birthweight are associated with increased risk of infant mortality as well as increased risk of chronic conditions throughout infancy and into adulthood. Non-Hispanic black infants are twice as likely to be born low birthweight (13.9% vs 7.0%) and 1.5 times as likely to be born prematurely (13.9% vs 9.1%) compared to non-Hispanic white infants. Under the Affordable Care Act (ACA), states may expand Medicaid to adults with household income levels at or below 138% of the federal poverty level, thus extending coverage to childless adults and improving continuity. Insurance gain may ultimately improve maternal health, increased use and earlier initiation of prenatal care services, and improved access to pregnancy planning resources. Our study aimed to evaluate whether there were changes in rates of low birthweight and preterm birth outcomes among states that expanded Medicaid versus states that did not expand Medicaid.
Author Interviews / 11.12.2018

MedicalResearch.comInterview with:
Lisa M. Lines, PhD, MPH
University ofMassachusetts Medical School
Worcester
RTI International,Waltham, MA

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

Response: The problem of potentially avoidable emergency department (ED) visits has been linked to barriers in access to high-quality, timely primary care. In Massachusetts ,about half of all ED visits were considered potentially avoidable, or primary-care sensitive (PCS), in the mid-2000s. Indeed, improving access to primary care was a prime motive for the state’s – and the nation’s – first universal coverage health insurance program in 2006. Now, the state has the highest coverage rate in the country.

We used Massachusetts All-Payer Claims Data to study characteristics of insured Massachusetts residents associated with primary-care sensitive ED use and compared such use among people under age 65 with public (Medicaid[MassHealth]) versus private insurance. We studied more than 2.2 million individuals in 2011-12; about 40% had public insurance in 2011, and the rest had private insurance. Our PCS ED measure included nonurgent, urgent but primary care treatable, and urgent but potentially avoidable ED visits.

We found that primary-care sensitive ED use was more than 4 times higher among the publicly insured (public insurees: 36.5 PCS ED visits per 100 person-years; private insurees: 9.0). After adjusting for a range of potential confounders, such as the vastly different morbidity burden of the two groups, public insurance in2011 was associated with about 150% more primary-care sensitive ED use. We also found that 70% of people with public insurance had at least 1 primary care visit, compared with 80% of those with private insurance. The public group also had fewer visits to their PCP of record, even though nearly all of them had an officially designated PCP.

Author Interviews, Cancer Research, Cost of Health Care, ENT, HPV, JAMA, Surgical Research / 18.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44611" align="alignleft" width="133"]Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City  Dr. Cannon[/caption] Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: The Patient Protection and Affordable Care Act (ACA) is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care. This legislation is commonly debated and objective data is needed to evaluate its impact.  As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.  Main findings below:     MedicalResearch.com: What should readers take away from your report? Response: This population-based study found an increase in the percentage of patients enrolled in Medicaid and private insurance and a large decrease in the rates of uninsured patients after implementation of the Patient Protection and Affordable Care Act (ACA).  This change was only seen in states that adopted the Medicaid expansion in 2014. The decrease in the rate of uninsured patients was significant, 6.2% before versus 3.0% after. Patients who were uninsured prior to the Patient Protection and Affordable Care Act had poorer survival outcomes.
Author Interviews, Cost of Health Care, JAMA, Pediatrics / 19.07.2018

MedicalResearch.com Interview with: [caption id="attachment_43292" align="alignleft" width="142"]Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland Dr. Hudson[/caption] Julie L. Hudson, PhD Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality Rockville, Maryland MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Since 2013, public coverage has increased not only among low-income adults newly eligible for Medicaid but also among children and adults who were previously eligible for Medicaid or the Children’s Health Insurance Program (CHIP). Recent research has shown that growth in public coverage varied by state-level policy choices. In this paper we study the growth in public coverage (Medicaid/CHIP) for three population samples living in Medicaid Expansion states between 2013 and 2015: previously eligible children, previously eligible parents, and newly eligible parents by state-level marketplace policies (Note: eligibility refers to eligible for Medicaid/CHIP, eligibility for marketplace subsidized coverage). All marketplaces are required to assess each applicants’ eligibility for both the marketplace and for Medicaid/CHIP. States running state-based marketplaces are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage (Medicaid or CHIP), but states using federally-facilitated marketplaces can opt to require their marketplace to forward these cases to state Medicaid/CHIP authorities for final eligibility determination and enrollment. We study the impact of marketplace policies on public coverage by observing changes in the probability Medicaid-/CHIP-eligible children and parents are enrolled in public coverage across three marketplace structures: state-based marketplaces that are required to enroll Medicaid-/CHIP-eligible applicants directly into public coverage, federally-facilitated marketplaces in states that enroll Medicaid-/CHIP-eligible applicants directly into public coverage, and federally-facilitated marketplaces with no authority to enroll Medicaid-/CHIP-eligible applicants into public coverage. Supporting the existing literature, we find that public coverage grew between 2013-2015 for all three of our samples of Medicaid-/CHIP-eligible children and parents living in Medicaid expansion states. However, we show that growth in public coverage was smallest in expansion states that adopted a federally-facilitated marketplace and gave no authority to the marketplace to enroll Medicaid-/CHIP-eligible applicants directly into public coverage. Additionally, once we account for enrollment authority, we found no differences in growth of public coverage for eligible children and parents living in expansion states that adopted a state-based marketplace versus those in states that adopted a federally-facilitated marketplaces with the authority to directly enroll Medicaid-/CHIP-eligible applicants
Author Interviews, Heart Disease, JACC, Outcomes & Safety, Surgical Research, University of Michigan / 12.04.2018

MedicalResearch.com Interview with: [caption id="attachment_41141" align="alignleft" width="149"]Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan Dr. Likosky[/caption] Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions. Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion. 
Author Interviews, OBGYNE, Pediatrics, Race/Ethnic Diversity / 20.01.2018

MedicalResearch.com Interview with: [caption id="attachment_39409" align="alignleft" width="200"]Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS) Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University Miami Fl  Dr. Bhatt[/caption] Chintan Bhatt  MBBS, MPH    (HE/HIM/HIS) Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health and Social Work, Florida International University Miami Fl  MedicalResearch.com: What is the background for this study? Response: Women and children are disproportionately affected by the uncertainty around medical health insurance rising in the United States. The Patient Protection and Affordable Care Act was implemented on Jan 1st, 2014, since then the uninsured rate decreased considerably, especially in women aged 18 to 64 years. ACA revised and expanded Medicaid eligibility. Under the law, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. Because of the large proportion of maternal, infant, and child health care and preventive services funded by Medicaid. The purpose of our study was to examine the potential effect of Medicaid expansion on infant mortality rates by comparing infant mortality rate trends in states and Washington D.C. by Medicaid expansion acceptance or decline.
Author Interviews, Cost of Health Care / 26.04.2017

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.
Author Interviews, Cost of Health Care, Primary Care / 28.02.2017

MedicalResearch.com Interview with: [caption id="attachment_32467" align="alignleft" width="192"]Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania Dr. Molly Candon[/caption] Molly Candon, PhD Fellow Leonard Davis Institute of Health Economics, The Wharton School Center for Mental Health Policy and Services Research, Perelman School of Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Primary care practices are less likely to schedule appointments with Medicaid patients compared to the privately insured, largely due to lower reimbursement rates for providers. Given the gap in access, concerns have been raised that Medicaid enrollees may struggle to translate their coverage into care. Despite the substantial increase in demand for care resulting from provisions in the Affordable Care Act (ACA), our 10-state audit study recently published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016, while appointment availability for patients with private coverage did not change. Over the same time period, both Medicaid patients and the privately insured experienced slight increases in wait times.
Author Interviews, Colon Cancer, Cost of Health Care, Medicare / 23.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31434" align="alignleft" width="200"]Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia Dr. Nengliang Yao[/caption] Nengliang “Aaron” Yao PhD Assistant professor Department of Public Health Sciences University of Virginia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ACA made several changes in Medicare that could increase the use of cancer screening and thus lead to more early cancer diagnoses. This includes waiving patient cost-sharing for screening, waiving patient cost-sharing for one wellness visit per year, and paying bonuses to physicians for doing more work in a primary care setting. We studied how effective those changes were in facilitating more early diagnoses of breast and colorectal cancers. We found that the changes had no effect on early breast cancer diagnoses (likely because costs and other access barriers for mammograms were already low), but increased the number of early colorectal cancer diagnoses by 8 percent.
Author Interviews, Cost of Health Care, NEJM / 08.01.2017

MedicalResearch.com Interview with: [caption id="attachment_31066" align="alignleft" width="142"]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[/caption] 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.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Primary Care / 09.12.2016

MedicalResearch.com Interview with: [caption id="attachment_30342" align="alignleft" width="200"]Dr. Ateev Mehrotra Associate professor, Department of Health Care Policy Harvard Medical School and a  hospitalist at Beth Israel Deaconess Medical Center Boston, Massachusetts Dr. Ateev Mehrotra[/caption] Dr. Ateev Mehrotra MD Associate professor, Department of Health Care Policy Harvard Medical School and a hospitalist at Beth Israel Deaconess Medical Center Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: More people in the US are using price transparency websites to shop for care. Some have wondered whether using the information on these websites to choose a doctor will help them actually save money. A relatively small difference in price for visits on the website translated into hundreds of dollars.
Author Interviews, Cost of Health Care, Hospital Readmissions / 10.10.2016

MedicalResearch.com Interview with: [caption id="attachment_28723" align="alignleft" width="182"]Kathleen Carey, Ph.D. Professor, Department of Health Law, Policy and Management School of Public Health Boston University Boston MA  02118 Dr. Kathleen Carey[/caption] Kathleen Carey, Ph.D. Professor, Department of Health Law, Policy and Management School of Public Health Boston University Boston MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: The ACA’s Hospital Readmissions Reduction Program (HRRP) imposes Medicare reimbursement penalties on hospitals with readmission rates for certain conditions if they exceed national averages. A number of observers have expressed serious concern over the program’s impact on safety-net hospitals, which serve a high proportion of low income patients who are more likely to be readmitted – often for reasons outside hospital control. Many have argued that the HRRP should adjust for socio-economic status. However, Medicare does not want to lower the standard of quality for these hospitals.
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 08.08.2016

MedicalResearch.com Interview with: [caption id="attachment_24380" align="alignleft" width="123"]Benjamin D. Sommers, MD, PhD Assistant Professor of Health Policy & Economics Harvard T. H. Chan School of Public Health / Brigham & Women's Hospital Boston, MA 02115 Dr. Benjamin D. Sommers[/caption] Benjamin D. Sommers, M.D., Ph.D Assistant Professor of Health Policy & Economics Department of Health Policy & Management Harvard T.H. Chan School of Public Health Assistant Professor of Medicine Division of General Medicine & Primary Care Brigham & Women’s Hospital / Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than half of states have expanded Medicaid under the Affordable Care Act, and several states have taken alternative approaches, such as using federal Medicaid funds to purchase private insurance for low-income adults. Our study looks at the effects of these two different approaches - vs. not expanding at all - in three southern states (Kentucky Arkansas, and Texas). What we find is that expanding coverage, whether by Medicaid (Kentucky) or private insurance (Arkansas), leads to significant improvements in access to care, preventive care, quality of care, and self-reported health for low-income adults compared to not expanding (Texas). The benefits of the coverage expansion also took a while to become evident - the first year of expansion (2014) showed some of these changes, but they become much more apparent in the second year (2015).
Author Interviews, Health Care Systems / 20.06.2016

MedicalResearch.com Interview with: [caption id="attachment_25305" align="alignleft" width="108"]Renuka Tipirneni, MD, MSc Clinical Lecturer in Internal Medicine University of Michigan Department of Internal Medicine, Division of General Medicine North Campus Research Complex, Bldg 16, Rm 472C Ann Arbor, MI Dr. Renuka Tipirneni[/caption] Renuka Tipirneni, MD, MSc Clinical Lecturer in Internal Medicine University of Michigan Department of Internal Medicine, Division of General Medicine North Campus Research Complex, Bldg 16, Rm 472C Ann Arbor, MI MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tipirneni: One year after Medicaid expansion in Michigan, 600,000 individuals had enrolled in the program and there was concern that new enrollees would crowd doctor’s offices and new patients would not be able to get an appointment. We found that the opposite occurred – primary care appointment availability for new Medicaid patients increased. This study builds on a previous study looking at what happened in the first four months after Medicaid expansion. In the earlier study, we found that appointment availability for new Medicaid patients had increased in the first few months after expansion. Even though the number of enrollees in the Medicaid expansion program doubled since then, the new study found that appointment availability remained increased for new Medicaid patients one year after expansion.