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Full-Text Articles in Insurance

Accidental Prehabilitation: A Case Of Increased Exercise Frequency Before Thoracic Surgery, Jennifer Baima, Mark W. Maxfield, Maggie Powers, John M. Varlotto, Karl Uy Mar 2020

Accidental Prehabilitation: A Case Of Increased Exercise Frequency Before Thoracic Surgery, Jennifer Baima, Mark W. Maxfield, Maggie Powers, John M. Varlotto, Karl Uy

Orthopedics and Physical Rehabilitation Publications

Case Diagnosis: 67 year-old man was found down with dysarthria, dysphagia, and right lower limb weakness. He was diagnosed with left anterior cerebral artery ischemic stroke, acute renal failure, atrial fibrillation, and deep venous thrombosis. He remained hospitalized for months as he did not have insurance for inpatient rehabilitation care and could not be safely discharged home.

Case Description: During that time, he got physical therapy 5 times per week and then 2 times per week. While hospitalized, he was subsequently diagnosed with left upper lobe nodule from T2aN0M0 lung adenocarcinoma. Physical therapy was increased back to 5 times per ...


Hypertension And Diabetes Treatment Affordability And Government Expenditures Following Changes In Patient Cost Sharing In The "Farmacia Popular" Program In Brazil: An Interrupted Time Series Study, Isabel Cristina Martins Emmerick, Monica Rodrigues Campos, Rondineli Mendes. Da Silva, Luisa Arueira Chaves, Andrea Damaso Bertoldi, Dennis Ross-Degnan, Vera Lucia Luiza Jan 2020

Hypertension And Diabetes Treatment Affordability And Government Expenditures Following Changes In Patient Cost Sharing In The "Farmacia Popular" Program In Brazil: An Interrupted Time Series Study, Isabel Cristina Martins Emmerick, Monica Rodrigues Campos, Rondineli Mendes. Da Silva, Luisa Arueira Chaves, Andrea Damaso Bertoldi, Dennis Ross-Degnan, Vera Lucia Luiza

Surgery Publications

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmacia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability.

METHODS: Longitudinal, retrospective study using interrupted time ...


"The Healing Of America" And The Next Steps For American Healthcare, Carter A. Hanson Oct 2019

"The Healing Of America" And The Next Steps For American Healthcare, Carter A. Hanson

Student Publications

An exploration of three healthcare systems—France, United Kingdom, and Canada—and what can be learned for them. Elements from the three national systems are combined into a proposal for reforming the American healthcare system into a devolved single-payer system.


Experiences With The Veterans' Choice Program, Kevin T. Stroupe, Rachael Martinez, Timothy P. Hogan, Elisa J. Gordon, Beverly Gonzalez, Ibuola Kale, Chad Osteen, Elizabeth Tarlov, Frances M. Weaver, Denise M. Hynes, Bridget M. Smith Aug 2019

Experiences With The Veterans' Choice Program, Kevin T. Stroupe, Rachael Martinez, Timothy P. Hogan, Elisa J. Gordon, Beverly Gonzalez, Ibuola Kale, Chad Osteen, Elizabeth Tarlov, Frances M. Weaver, Denise M. Hynes, Bridget M. Smith

Population and Quantitative Health Sciences Publications

BACKGROUND: To address concerns about Veterans' access to care at US Department of Veterans Affairs (VA) healthcare facilities, the Veterans Access, Choice, and Accountability Act was enacted to facilitate Veterans' access to care in non-VA settings, resulting in the "Veterans Choice Program" (VCP).

OBJECTIVES: To assess the characteristics of Veterans who used or planned to use the VCP, reasons for using or planning to use the VCP, and experiences with the VCP.

DESIGN: Mixed-methods.

SUBJECTS: After sampling Veterans in the Midwest census region receiving care at VA healthcare facilities, we included 4521 Veterans in the analyses. Of these, 60 Veterans ...


Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon Jun 2019

Best Practices For Member Outreach And Engagement: How Effective Acos Build Understanding And Respect, Jessica Carpenter, Jocelyn Gordon

Commonwealth Medicine Publications

Targeted strategies and sustained efforts at member outreach and engagement are helping Accountable Care Organizations (ACOs) and their Community Partners (CPs) achieve their shared goals for delivering patient-centered care. The most successful organizations focus on activities designed to create a stronger connection with their members, building trust and a better understanding of individuals’ characteristics and care needs. Positive results of these efforts include successful person-centered care planning, improved compliance with care plans and prescriptions, and implementation of recommended lifestyle changes — changes that help support independent living, reduce medical costs and complications, and drive improvements in member satisfaction.


University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish Jun 2019

University Of Massachusetts Medical School Report To Minnesota Department Of Human Services Health And Incarceration Project, Katharine London, Jeremy Tourish

Commonwealth Medicine Publications

On behalf of the Minnesota Department of Health Services, Health Law & Policy experts from our Public and Private Health Solutions group completed a literature review of successful efforts to improve the health of previously incarcerated individuals. In addition, our experts conducted five focus groups to obtain recommendations from experienced professionals who work directly with previously incarcerated individuals regarding interventions likely to improve the health of this unique population.

This study came about at the direction of Minnesota Legislature. They were interested in developing a methodology for paying higher rates to health care providers who provide services to high cost and ...


Payment Reform For Kids, Robert W. Seifert Feb 2019

Payment Reform For Kids, Robert W. Seifert

Commonwealth Medicine Publications

Comprehensive care for children – including greater attention to behavioral health, socio-emotional development, and strong family relationships – may hold the key to lifelong health and well-being. With this premise, a group in Connecticut has just published recommendations for improving pediatric primary care through payment reform.


Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price Jan 2019

Lowering Out Of Pocket Drug Costs For Consumers, Mylissa K. Price

Commonwealth Medicine Publications

Prohibiting gag clauses could help lower consumer out-of-pocket pharmacy costs - if Pharmacy Benefits Managers don't raise prices to make-up the difference. Mylissa Price closes our blog series on President Trump's Blueprint to Lower Drug Costs in this final entry.


Deciphering State Medicaid Programs, Rachel Gershon Jan 2019

Deciphering State Medicaid Programs, Rachel Gershon

Commonwealth Medicine Publications

State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.


Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran Dec 2018

Will Removing Rebates Really Lower Drug List Prices?, Stephanie Tran

Commonwealth Medicine Publications

The Trump Administration Blueprint to Lower Drug Prices and Reduce Out-of-Pocket Costs calls for incentives to lower drug list prices, including removing rebates. Our clinical consultant Stephanie Tran continues our pharmacy blog series with an assessment of this potential change & its impacts.


New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri Dec 2018

New Aca Waiver Directives Signal Changes For State Health Insurance Marketplaces, Rachel Gershon, Catherine Torri

Commonwealth Medicine Publications

New Trump Administrations Section 1332 waiver guidance increases state ACA flexibility. Rachel Gershon & Catie Torri discuss what this could mean for health care policy.


Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor Nov 2018

Better Negotiations Between Payers And Manufacturers In An Effort To Reduce Drug Prices, Mckenzie Taylor

Commonwealth Medicine Publications

Mckenzie Taylor continues our monthly conversation on the strategies presented in The Trump Administration Blueprint to Low Drug Prices and Reduce Out-of-Pocket Costs, discussing the ways new negotiations between payers and manufacturers are helping to reduce drug prices.


How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih Oct 2018

How Can Improved Competition Lead To Lower Drug Prices?, Youkavet Samih

Commonwealth Medicine Publications

In this installment of our blog series on "President Trump's Blueprint to Lower Drug Prices and Reduce Out-Of-Pocket Costs," our pharmacy expert Youkavet Samih discusses how creating drug competition drives down prices for consumers.


The Implementation Process For Pharmacogenomic Testing For Cancer-Targeted Therapies, Ann Chen Wu, Kathleen M. Mazor, Rachel Ceccarelli, Stephanie Loomer, Christine Y. Lu Oct 2018

The Implementation Process For Pharmacogenomic Testing For Cancer-Targeted Therapies, Ann Chen Wu, Kathleen M. Mazor, Rachel Ceccarelli, Stephanie Loomer, Christine Y. Lu

Open Access Articles

Recent advances in genomic medicine have led to the availability of genomic tests that have the potential to improve population health, yet the process for obtaining these tests and getting them reimbursed by insurers has not been described. The objective of this study was to describe the process of ordering pharmacogenomic tests by interviewing providers, patients, and laboratories about cancer-related pharmacogenomic tests. We interviewed patients who were prescribed, providers who prescribed medications that should be guided by pharmacogenomic testing, and individuals from diagnostic laboratories. A total of 10 providers, 16 patients, and eight diagnostic laboratories described logistical and insurance issues ...


Association Between Practice Participation In A Pediatric-Focused Medical Home Learning Collaborative And Reduction Of Preventable Emergency Department Visits By Publicly-Insured Children In Massachusetts, Paul Kirby, Anna Christensen, Louise Bannister, Valerie Konar Aug 2018

Association Between Practice Participation In A Pediatric-Focused Medical Home Learning Collaborative And Reduction Of Preventable Emergency Department Visits By Publicly-Insured Children In Massachusetts, Paul Kirby, Anna Christensen, Louise Bannister, Valerie Konar

Commonwealth Medicine Publications

Introduction: This study evaluates the impact of practice participation in a pediatric patient-centered medical home learning collaborative on preventable emergency department (ED) visits among children in MassHealth (Massachusetts Medicaid/Children's Health Insurance Program).

Methods: Claims and enrollment data were extracted for child MassHealth members (aged 3–18) comprising 2 groups: members enrolled in a group of 13 child-serving practices that participated in an intensive, 29-month long patient-centered medical home learning collaborative (intervention group), and members enrolled in a group of 12 comparison practices with roughly similar panel size, type, and geographic location (comparison group). Preventable ED visits were identified ...


The Effect Of Lowering Public Insurance Income Limits On Hospitalizations For Low-Income Children., Jessica L. Bettenhausen, Matt Hall, Jeffrey D. Colvin, Henry T. Puls, Paul J. Chung Aug 2018

The Effect Of Lowering Public Insurance Income Limits On Hospitalizations For Low-Income Children., Jessica L. Bettenhausen, Matt Hall, Jeffrey D. Colvin, Henry T. Puls, Paul J. Chung

Manuscripts, Articles, Book Chapters and Other Papers

Background and objectives: Thirty million children are currently covered by public insurance; however, the future funding and structure of public insurance are uncertain. Our objective was to determine the number, estimated costs, and demographic characteristics of hospitalizations that would become ineligible for public insurance reimbursement under 3 federal poverty level (FPL) eligibility scenarios.

Methods: In this retrospective cohort study using the 2014 State Inpatient Databases, we included all pediatric (age <18) hospitalizations in 14 states from January 1, 2014, to December 31, 2014, with public insurance as the primary payer. We linked each patient's zip code to the American Community Survey to determine the likelihood of the patient being below 3 different public insurance income eligibility thresholds (300%, 200%, and 100% of the FPL). Multiple simulations were used to describe newly ineligible hospitalizations under each threshold.

Results: In 775 460 publicly reimbursed hospitalizations in 14 states, reductions in eligibility limits to 300%, 200%, or 100% of the FPL would have resulted in large numbers of newly ...


The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton Jun 2018

The Role Of Clinical Guidelines In A Managed Long Term Services & Supports Framework, Jessica Carpenter, Jill Morrow-Gorton

Commonwealth Medicine Publications

This presentation describes the managed long-term services and supports (MLTSS) national landscape since 2012 as well as some LTSS utilization trends. A key part of the presentation is our MLTSS best practice framework and the role of LTSS clinical guidelines in that framework. The presentation includes a case study.

Experts from Disability Community Services and the Office of Clinical affairs gave the presentation during a webinar hosted by the Association for Community Affiliated Plans.


Insurance Coverage Policies For Pharmacogenomic And Multi-Gene Testing For Cancer, Christine Y. Lu, Stephanie Loomer, Rachel Ceccarelli, Kathleen M. Mazor, James Sabin, Ellen Wright Clayton, Geoffrey S. Ginsburg, Ann Chen Wu May 2018

Insurance Coverage Policies For Pharmacogenomic And Multi-Gene Testing For Cancer, Christine Y. Lu, Stephanie Loomer, Rachel Ceccarelli, Kathleen M. Mazor, James Sabin, Ellen Wright Clayton, Geoffrey S. Ginsburg, Ann Chen Wu

Open Access Articles

Insurance coverage policies are a major determinant of patient access to genomic tests. The objective of this study was to examine differences in coverage policies for guideline-recommended pharmacogenomic tests that inform cancer treatment. We analyzed coverage policies from eight Medicare contractors and 10 private payers for 23 biomarkers (e.g., HER2 and EGFR) and multi-gene tests. We extracted policy coverage and criteria, prior authorization requirements, and an evidence basis for coverage. We reviewed professional society guidelines and their recommendations for use of pharmacogenomic tests. Coverage for KRAS, EGFR, and BRAF tests were common across Medicare contractors and private payers, but ...


Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry May 2018

Accounting For Geographic Variation In Social Security Disability Program Participation, John Gettens, Pei-Pei Lei, Alexis D. Henry

Commonwealth Medicine Publications

There is wide geographic variation in Social Security Disability Insurance and Supplementary Security Income participation across the United States. Some policymakers and members of the public may assume that interregional administrative inconsistencies are a major reason for the geographic variation. To test this assumption, and to reveal other potential explanations for the variation, we decompose the total variation into components by examining regional differences in disability prevalence and in program participation among persons with disabilities as well as the correlation between those two factors. We further decompose the variation in participation among persons with disabilities into socioeconomic components. Our findings ...


The Kentucky Medicaid Waiver Penalizes Enrollees For Emergency Room “Misuse”, Rebecca Laes-Kushner Jan 2018

The Kentucky Medicaid Waiver Penalizes Enrollees For Emergency Room “Misuse”, Rebecca Laes-Kushner

Commonwealth Medicine Publications

Kentucky’s 1115 Medicaid Waiver, approved by CMS on January 12, 2018, uses small financial incentives and punishments to try to change the behavior of enrollees.

Enrollees in Kentucky’s Medicaid program, Kentucky HEALTH (Helping to Engage and Achieve Long Term Health), will receive virtual accounts, called a My Rewards Account, into which credits will be placed for their positive activities related to health (completing health risk assessment - $25) and careers (passing the GED - $50). The credits can be used to pay for certain services not covered by health plans, such as vision and dental services.

However, members’ accounts will ...


Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal Jan 2018

Out-Of-Pocket Cost For Individuals Being Treated For Opioid Dependence In Rutland County, Vermont, Christopher T. Veal

Family Medicine Clerkship Student Projects

Each day more than 140 Americans die from drug overdoses, 91 specifically due to opioids. In Vermont, more than 50 people die each year from opioid poisoning. With insurance coverage being a critical component of Opioid Dependence Recovery, many people seeking treatment are unaware of the financial barriers to recovery- namely the out-of-pocket costs associated with treatment. This study sought to provide insight on the financial impact of Opioid Dependence Treatment on the patient, and provide financial assistance information to the Rutland County community.


Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington Sep 2017

Stabilizing Individual Health Insurance Markets With Subsidized Reinsurance, Scott E. Harrington

Issue Briefs

Subsidized reinsurance represents a potentially important tool to help stabilize individual health insurance markets. This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. It summarizes specific state initiatives and Congressional proposals that include subsidized reinsurance. It compares approaches to each other and to more direct subsidies of individual market enrollment. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the ...


Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang Sep 2017

Narrow Networks On The Individual Marketplace In 2017, Daniel Polsky, Janet Weiner, Yuehan Zhang

Issue Briefs

This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.


Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering Apr 2017

Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering

Independent Study Project (ISP) Collection

The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the ...


Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling Jan 2017

Social Health Insurance Coverage And Financial Protection Among Rural-To-Urban Internal Migrants In China: Evidence From A Nationally Representative Cross-Sectional Study, Wen Chen, Qi Zhang, Andre M. N. Renzaho, Fangjing Zhou, Hui Zhang, Li Ling

Community & Environmental Health Faculty Publications

INTRODUCTION: Migrants are a vulnerable population and could experience various challenges and barriers to accessing health insurance. Health insurance coverage protects migrants from financial loss related to illness and death. We assessed social health insurance (SHI) coverage and its financial protection effect among rural-to-urban internal migrants (IMs) in China.

METHODS: Data from the '2014 National Internal Migrant Dynamic Monitoring Survey' were used. We categorised 170 904 rural-to-urban IMs according to their SHI status, namely uninsured by SHI, insured by the rural SHI scheme (new rural cooperative medical scheme (NCMS)) or the urban SHI schemes (urban employee-based basic medical insurance (UEBMI ...


Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zach T. Croll Ba, Andrew F. Coburn Phd Oct 2016

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zach T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of ...


Why Not Fix It?, William H. Lane May 2016

Why Not Fix It?, William H. Lane

English Faculty Publications

Have you felt the pinch of rising health care costs this year? If not, maybe you haven't actually needed to see a doctor or pay for a prescription. Even those of us who are lucky enough to be "covered" at work have noticed rapidly rising deductibles and copays - and shrinking networks of providers. Employers, facing a big, one-year increase in insurance costs, naturally enough go shopping for a new plan. But the big savings with a new plan often mean a big effective pay cut for everyone who's covered under it when employee contributions, deductibles and copays all ...


Essays On Household Health Expenditures, National Health Insurance And Universal Access To Health Care In Ghana, Evelyn Kwakye Mar 2016

Essays On Household Health Expenditures, National Health Insurance And Universal Access To Health Care In Ghana, Evelyn Kwakye

Doctoral Dissertations

Access to quality health services is essential for maintaining a healthy population and economic development hence the growing global consensus that universal health coverage is necessary. Ghana attempts to expand access by making basic health services free at the point of delivery through its National Health Insurance Scheme (NHIS). Prior studies indicate NHIS increases demand for health services, but questions remain about its impact on out of pocket payments, quality of services, and the financial viability of the program. Hence, this dissertation analyzes the financial risk in health care seeking, the effect of NHIS on out of pocket payments and ...


Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd Nov 2015

Rural Disabled Medicare Beneficiaries Spend More Out-Of-Pocket Than Their Urban Counterparts, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Andrew F. Coburn Phd

Access / Insurance

The majority of Medicare beneficiaries experience gaps between the care they need and costs covered by Medicare and seek supplemental coverage to meet this gap, including private plans offered by former employers or purchased individually, or public coverage through Medicaid. Since rural beneficiaries are more likely to purchase supplemental indemnity coverage individually, to participate in Medicaid, or to go without supplemental coverage altogether, it is likely that their out-of-pocket spending differs from that of urban residents, although the magnitude and direction of these differences may vary for individual beneficiaries. This study used data from the 2006-2010 Medical Expenditure Panel Survey ...


Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando Jul 2015

Disparities In Hospital Services Utilization Among Patients With Mental Health Issues: A Statewide Example Examining Insurance Status And Race Factors From 1999-2010, Viann N. Nguyen-Feng, Hind A. Beydoun, Michael K. Mcshane, James D. Blando

Community & Environmental Health Faculty Publications

There exist many disconnects between the mental and general health care sectors. However, a goal of the Affordable Care Act (ACA) of 2010 is to change this by improving insurance access and the intersection of mental and general health care. As insurance status intersects with race, the present study examines how race, insurance status, and hospital mental health services utilization differ across groups within the state of New Jersey. The present study aims to determine trends in hospital mental health care utilization by insurance status and race from 1999 to 2010. The rate of self-pay for mental health disorders in ...