Health Affairs

JUST RELEASED The September 2024 issue is now available! Read Editor in Chief Alan Weil's introduction to the new issue on Access To Care, Coverage & More. Explore the issue: https://bit.ly/3Xs9OGT

In their new Forefront article, Jennifer Chen, Nancy Le, Steve Jang, and Anna Kaltenboeck of ATI Advisory discuss how the results from Medicare’s first year of negotiation with other price benchmarks shed light on the competitive dynamics and payer negotiations that shape what the U.S. pays for prescription drugs. "The Inflation Reduction Act (IRA), which Congress passed in 2022, was developed in response to concerns about growing unaffordability of prescription drugs under Medicare. The law overhauls how Medicare pays for prescription drugs, and includes giving the Centers for Medicare and Medicaid Services (CMS) the power to negotiate with pharmaceutical manufacturers. This negotiation authority breaks with this convention in two ways. One is that it dispenses with post-sale, confidential rebates to establish – and publish - an effective net price for Medicare, known as a drug’s Maximum Fair Price (MFP). Because MFP is determined without the need for post-sale adjudication, it will be known at the time a patient receives the drug. The other is that, unlike other net prices, MFP determines what pharmacies and other members of the supply chain are paid. To ensure appropriate compensation, the law requires that negotiated prices be published." Read the full article here: https://bit.ly/3MDqd5n

In their new Forefront article, Caroline S. Blaum, Helaine E. Resnick, Daniela Lawton, and Angelia Bowman from NCQA and RESNICK, CHODOROW AND ASSOCIATES, LLC argue that one way to begin addressing unmet needs among vulnerable Medicare beneficiaries is to identify a core measure set that uses existing quality measures. "These trends are important because, while most Medicare beneficiaries are healthy and functional, many—particularly those 75 and older—have considerable morbidity, diminished quality of life, and a high degree of caregiver burden. Growing numbers of medically complex Medicare beneficiaries, particularly of advanced age, provide a firm rationale for developing core measures for tracking and improving the quality of care this population receives." Read the full article here: https://bit.ly/3AXs2Yj

In their new Forefront article, Tom Frieden and Bruce Neal from Resolve To Save Lives and The George Institute for Global Health discuss how reduced-sodium salts look, work, and taste just like regular salt. So, they ask, why hasn’t a global salt-switch happened? "Reduced-sodium salts enriched with potassium are a great alternative to regular salt. They’re a double win, because nearly everyone consumes too much sodium and too little potassium. Improving the ratio of sodium to potassium has been shown to promote heart health. Manufacturers can use these healthier salts in packaged foods, governments can purchase them for use in public institutions, cooks can use them in restaurants and street foods, and we can all use them at home. When used instead of regular salt, they reduce blood pressure—one of the leading causes of stroke and heart attack, which in turn are the world’s leading causes of death." Read the full article here: https://bit.ly/3XCQyqs

ICE Detainer Requests Were Associated With Lower Medicaid And SNAP Enrollment Among Eligible Adults, 2011–19 By Caroline Kravitz, Amy H. Auchincloss, M. Pia Chaparro, Sofia Argibay, Alexandra Eastus, and Brent A. Langellier Read the full article: https://bit.ly/3zqAkat

In their new Forefront article, Teresa Janevic and Elizabeth Howell from the Columbia University Mailman School of Public Health and- the University of Pennsylvania discuss how media coverage refuting the existence of a maternal health crisis misses the mark and threatens to undermine progress. While maternal mortality statistics are complex, they argue, the overall picture of maternal health inequity in the US is crystal clear and presents a crisis upon which we must act. "The truth is that maternal mortality statistics are confusing, and measuring maternal mortality has long been challenging. The maternal mortality rate (MMR) calculated by the National Center for Health Statistics (NCHS), the statistic most recently under debate, uses state death certificates only and focuses on deaths within 42 days of delivery. The current controversy centers on the pregnancy checkbox on the death certificate and on recent research demonstrating that use of the checkbox corresponded with an increase in the reported maternal mortality rate. The checkbox was implemented between 2003 and 2017, in response to earlier investigations revealing that the method used to calculate the US maternal mortality rate was underestimating deaths." Read the full article here: https://bit.ly/3AWoVzQ

US Commercial Plans Increase Choice Of Biosimilar And Originator Products; Market Net Prices Decrease By Molly T. Beinfeld, Fariel LaMountain, William Wong, Eunice Kim, and James D. Chambers Read the full article: https://bit.ly/3TpLinn

In their new Forefront article, Alexander O. Everhart, Peter F. Lyu, Jason M. Hockenberry, and Kenton J. Johnston from Washington University in St. Louis, RTI International, and Yale University argue that policy efforts on addressing issues in Medicare Part B clinician payment programs and the growing costs of administrative complexity should be directed at engaging clinicians in a streamlined set of whole-person, population-based care models. "These changes have culminated in CMS’s widely publicized strategic objective for all traditional Medicare beneficiaries to be in accountable care relationships by 2030. To achieve this goal, CMS hosts an ever-expanding set of ACO, episode-based, disease-based, and other value-based and alternative clinician payment schemes enacted through the Innovation Center models, the MSSP, and the QPP. In the current year alone, we estimate there are more than 30 different payment program schemes—including ACO models and tracks-within models, other alternative and related Innovation Center payment models, and the Merit-based Incentive Payment System (MIPS)—that a clinician may participate in under Medicare Part B. However, it is unclear whether CMS’s 2030 accountable care objective is achievable amid the proliferation of available and evolving ACO and other payment models, begging the question of whether policy makers’ strategy requires rethinking." Read the full article here: https://bit.ly/47g5yxL

Email Nudges Increased Eligibility Verification And Subsidy Receipt In California’s ACA Marketplace By Rebecca Myerson and Andrew Feher Read the journal article: https://bit.ly/3zbxZ3b

In their new Forefront article, Michael Savides and Renee Hsia from Tufts University and University of California, San Francisco discuss how percutaneous coronary intervention (PCI) has proven lifesaving: Morbidity and mortality outcomes are significantly improved with PCI when compared to clot-busting therapy. "However, not all hospitals have the requisite personnel and catheterization labs, which are required to perform this procedure. This can cause delays, which are particularly dangerous because time to treatment matters when it comes to STEMI; PCI is only recommended over fibrinolysis when the patient presents to the emergency department in the first 90 minutes of symptom onset. Thus, the proximity of a patient to a PCI-capable facility can truly be a matter of life and death." Read the full article here: https://bit.ly/3AYLsfm