Health Affairs

Active pharmaceutical ingredients (APIs) are a critical input for manufacturing pharmaceuticals. However, production is highly centralized and vulnerable to supply shocks. Melissa Barber of Yale University and her team of coauthors @global-health-centre examine the effects of the COVID-19 pandemic on prices and export volume for APIs exported from India during the COVID-19 pandemic. The researchers find that the COVID-19 pandemic resulted in an 80 percent decrease in the volume of APIs for key essential medicines exported from India, while API prices did not change significantly. Read the full study: https://bit.ly/4d2i6uo

Robert Berenson of the Urban Institute and Kevin Hayes outline ways to fix the Medicare Physician Fee Schedule and ultimately improve value-based payment efforts. The authors conclude that the “Centers for Medicare and Medicaid Services (CMS) should correct misvalued services and establish a hybrid payment for primary care that blends fee-for-service and population-based payment.” They also recommend that “Congress alter the thirty-five-year-old statutory basis for setting Medicare fees to allow CMS to explicitly consider policy priorities such as workforce shortages in refining fee levels.” Read the full article: https://bit.ly/3SiH0O6

In their new Forefront article, Gui Woolston and Amy Finkelstein of Aledade, Inc. and the Massachusetts Institute of Technology (MIT) call on Medicaid programs across the country to take advantage of opportunities to pursue test-and-learn approaches through randomized evaluations to achieve their policy goals and ultimately improve members’ health. "At the Connecticut Medicaid program that I (Gui) ran until May 2024, we believe that engaging in test-and-learn approaches based on rigorous evaluation methods such as randomized evaluations (often called randomized controlled trials or RCTs) is crucial to achieving these policy goals and ensuring that programs work for our members. Despite this, Medicaid offices across the country face a range of barriers to getting these evaluations off the ground. We propose two approaches that can overcome these challenges, along with five practical steps states can take to effectively pursue RCTs. By rigorously evaluating our programs and sharing results, we can build knowledge to help allocate resources more effectively, better serve our members, and support other Medicaid programs nationwide." Read the full article here: https://bit.ly/3VWlY9f

In his new forefront article Rob Lott, the Senior Deputy Editor of Health Affairs, pays tribute to our Director of Events, Debbie Boylan, who sadly passed away last week. "Some have said, with tongue in cheek, that the people of Washington, DC can be sorted into two distinct camps: political hacks and policy wonks. Somehow, Debbie embodied the best features of both: she was really good at building affinity and understanding how stakeholders defined and defended their priorities. She also had a deep understanding of policy’s impact on people’s lives, and of the important and imperfect role that policymakers had in shaping that policy, for better and for worse. These skills became lessons she shared with the many young professionals who crossed her path over the years. She was the rare mentor who could make her mentees feel like genuine friends and partners, on equal footing even as they learned from her years of experience." Read the full article here: https://bit.ly/3YdL3ir

In the July issue of Health Affairs, Shiram Parashuram of the NORC at the University of Chicago and his team of coauthors explore the effects of the Next Generation Accountable Care Organization (NGACO) on Medicare Parts A and B spending between 2016-21. The researchers conclude that NGACO was associated with significant reductions in Medicare Parts A and B spending with annual declines growing larger “in nearly every subsequent year of the model” but no decline in net spending. Read the full article: https://bit.ly/3LzQeBQ

In the July issue of Health Affairs, Sungchul Park of Korea University and Rishi Wadhera of Beth Israel Deaconess Medical Center examine the use of high- and low-value health care among US adults by income level. The researchers find that “those with high incomes were significantly more likely than those with low incomes to use nearly all high-value services.” These results were consistent across all age categories. For low-value care, there was no consistent pattern in the use of these services among adults. Read the full paper: https://bit.ly/3WhKLot

Sources of coding intensity in Medicare Advantage: Paul Jacobs of the Agency for Healthcare Research and Quality examines the relative impacts of in-home health risk assessments and chart reviews on risk scores used for payments to Medicare Advantage (MA) plans. The author concludes, after examining 22.9 million MA enrollees, that encounter-based risk scores for MA enrollees were 7.4 percent higher when in-home health risk assessments and chart reviews were included. These findings were associated with a $15 billion increase in payments to MA plans in 2021. Read the full study: https://bit.ly/46mmkLa

In their new Forefront article, J. Nwando Olayiwola, Ene Anteyi, Faith Obanua, Andy Rollins, Laura B. Baustien, Tamara Smith, Stephanie M. Franklin, and Candy Magaña from Humana discuss how health plans and health care organizations need comprehensive strategies to address low/limited health literacy as a foundational contributor to health inequities. "For health plans and care delivery organizations in particular, health literacy is critical because it is necessary for optimal health maintenance, prevention, health resource use, treatment and medication compliance, patient experience, and health-related decision making. Limited health literacy is considered a key contributor to total cost of care. It also contributes to US health care system inefficiency, estimated to add $106–$238 billion in costs to the health care system, through more frequent use of inpatient services, emergency department visits and revisits, and more costly care needs from poor health." Read the full article here: https://bit.ly/3YcWA1A

What was the vaccine impact of the COVID-19 Uninsured Program? The COVID-19 Uninsured Program reimbursed providers for vaccines administered to those who are uninsured. In the July issue of Health Affairs, Yuping Tsai and colleagues at the Centers for Disease Control and Prevention examine the contributions of the COVID-19 Uninsured Program to vaccinations at the state level. The researchers conclude that “a total of 12,150 providers received COVID-19 Uninsured Program reimbursements, with a total reimbursement of $1.6 billion, covering approximately 38.9 million COVID vaccine doses administered.” Nationally, program-funded vaccine doses administered accounted for 5.7 percent of the total doses distributed in the US. Read the full article: https://bit.ly/3Wy0X6l

In their new Forefront article Zachary Baron, Sheela Ranganathan, Andrew Twinamatsiko, and Sara Rosenbaum of the O'Neill Institute for National and Global Health Law and The George Washington University- Milken Institute School of Public Health argue that, following SCOTUS's repeal of the Chevron doctrine, courts more than ever will have the final say on complex policy decisions that affect the health of millions of Americans. "The scale of Loper’s potential impact on health care policy is coextensive with the importance and vastness of federal regulatory policy in the health care field. Federal health and health care rules may be especially vulnerable because of their scope and impact. They are also vulnerable because they interpret and implement laws, often enacted decades ago, when broadly worded statutory drafting was coupled with extensive delegation of interpretive power to the federal agencies charged with the implementation of those laws. The fight over who holds the power to determine the policy choices that the laws permit—agencies or courts—lies at the heart of Loper." Read the full article here: https://bit.ly/3zR4qUI