399 results on '"MEDICAID costs"'
Search Results
2. Immediate Postpartum Long-Acting Reversible Contraception for Preventing Severe Maternal Morbidity: A Cost-Effectiveness Analysis.
- Author
-
Bullard, Kimberley A., Ramanadhan, Shaalini, Caughey, Aaron B., and Rodriguez, Maria I.
- Subjects
- *
STERILIZATION (Birth control) , *PREMATURE labor , *MEDICAID costs , *MEDICAL care costs , *COST effectiveness - Abstract
OBJECTIVE: To estimate the cost effectiveness of Medicaid covering immediate postpartum long-acting reversible contraception (LARC) as a strategy to reduce future short interpregnancy interval (IPI), severe maternal morbidity (SMM), and preterm birth. METHODS: We built a decision analytic model using TreeAge software to compare maternal health and cost outcomes in two settings, one in which immediate postpartum LARC is a covered option and the other where it is not, among a theoretical cohort of 100,000 people with Medicaid insurance who were immediately postpartum and did not have permanent contraception. The primary outcome was the incremental cost-effectiveness ratio (ICER), which represents the incremental cost increase per an incremental quality-adjusted life-years (QALY) gained from one health intervention compared with another. Secondary outcomes included subsequent short IPI, defined as time between last delivery and conception of less than 18 months, as well as SMM, preterm birth, overall costs, and QALYs. We performed sensitivity analyses on all costs, probabilities, and utilities. RESULTS: Use of immediate postpartum LARC was the cost-effective strategy, with an ICER of 211,880,220,102. Use of immediate postpartum LARC resulted in 299 fewer repeat births overall, 178 fewer births with short IPI, two fewer cases of SMM, and 34 fewer preterm births. Coverage of immediate postpartum LARC resulted in 25 additional QALYs and saved $2,968,796. CONCLUSION: Coverage of immediate postpartum LARC at the time of index delivery can improve quality of life and reduce health care costs for Medicaid programs. Expanding coverage to include immediate postpartum LARC can help to achieve optimal IPI and decrease SMM and preterm birth. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
3. Electronic Health Record Implementation Enhances Financial Performance in High Medicaid Nursing Homes.
- Author
-
Dayama, Neeraj, Pradhan, Rohit, Davlyatov, Ganisher, and Weech-Maldonado, Robert
- Subjects
ELECTRONIC health records ,FINANCIAL performance ,NURSING care facilities ,MEDICAID ,MEDICAID costs ,MANAGEMENT of electronic health records ,RESOURCE-based theory of the firm - Abstract
Introduction: The nursing home (NH) industry operates within a two-tiered system, wherein high Medicaid NHs which disproportionately serve marginalized populations, exhibit poorer quality of care and financial performance. Utilizing the resource-based view of the firm, this study aimed to investigate the association between electronic health record (EHR) implementation and financial performance in high Medicaid NHs. A positive correlation could allow high Medicaid NHs to leverage technology to enhance efficiency and financial health, thereby establishing a business case for EHR investments. Methods: Data from 2017 to 2018 were sourced from mail surveys sent to the Director of Nursing in high Medicaid NHs (defined as having 85% or more Medicaid census, excluding facilities with over 10% private pay or 8% Medicare), and secondary sources like LTCFocus.org and Centers for Medicare & Medicaid Services cost reports. From the initial sample of 1,050 NHs, a 37% response rate was achieved (391 surveys). Propensity score inverse probability weighting was used to account for potential non-response bias. The independent variable, EHR Implementation Score (EIS), was calculated as the sum of scores across five EHR functionalities—administrative, documentation, order entry, results viewing, and clinical tools—and reflected the extent of electronic implementation. The dependent variable, total margin, represented NH financial performance. A multivariable linear regression model was used, adjusting for organizational and market-level control variables that may independently affect NH financial performance. Results: Approximately 76% of high Medicaid NHs had implemented EHR either fully or partially (n = 391). The multivariable regression model revealed that a one-unit increase in EIS was associated with a 0.12% increase in the total margin (p = 0.05, CI: − 0.00– 0.25). Conclusion: The findings highlight a potential business case —long-term financial returns for the initial investments required for EHR implementation. Nonetheless, policy interventions including subsidies may still be necessary to stimulate EHR implementation, particularly in high Medicaid NHs. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
4. Using Real-World Data to Inform Value-Based Contracts for Cell and Gene Therapies in Medicaid.
- Author
-
Zemplenyi, Antal, Leonard, Jim, DiStefano, Michael J., Anderson, Kelly E., Wright, Garth C., Mendola, Nicholas D., Nair, Kavita, and McQueen, R. Brett
- Subjects
- *
GENE therapy , *BLOOD coagulation factor IX , *MEDICAID , *MEDICAID costs , *HEALTH policy - Abstract
Objective: High upfront costs and long-term benefit uncertainties of gene therapies challenge Medicaid budgets, making value-based contracts a potential solution. However, value-based contract design is hindered by cost-offset uncertainty. The aim of this study is to determine actual cost-offsets for valoctocogene roxaparvovec (hemophilia A) and etranacogene dezaparvovec (hemophilia B) from Colorado Medicaid's perspective, defining payback periods and its uncertainty from the perspective of Colorado Medicaid. Methods: This cost analysis used 2018–2022 data from the Colorado Department of Health Care Policy & Financing to determine standard-of-care costs and employed cost simulation models to estimate the cost of Medicaid if patients switched to gene therapy versus if they did not. Data encompassed medical and pharmacy expenses of Colorado Medicaid enrollees. Identified cohorts were patients aged 18+ with ICD-10-CM codes D66 (hemophilia A) and D67 (hemophilia B). Severe hemophilia A required ≥ 6 claims per year for factor therapies or emicizumab, while moderate/severe hemophilia B necessitated ≥ 4 claims per year for factor therapies. Patients were included in the cohort in the year they first met the criteria and were subsequently retained in the cohort for the duration of the observation period. Standard-of-care included factor VIII replacement therapy/emicizumab for hemophilia A and factor IX replacement therapies for hemophilia B. Simulated patients received valoctocogene roxaparvovec or etranacogene dezaparvovec. Main measures were annual standard-of-care costs, cost offset, and breakeven time when using gene therapies. Results: Colorado Medicaid's standard-of-care costs for hemophilia A and B were $426,000 [standard deviation (SD) $353,000] and $546,000 (SD $542,000) annually, respectively. Substituting standard-of-care with gene therapy for eligible patients yielded 8-year and 6-year average breakeven times, using real-world costs, compared with 5 years with published economic evaluation costs. Substantial variability in real-world standard-of-care costs resulted in a 48% and 59% probability of breakeven within 10 years for hemophilia A and B, respectively. Altering eligibility criteria significantly influenced breakeven time. Conclusions: Real-world data indicates substantial uncertainty and extended payback periods for gene therapy costs. Utilizing real-world data, Medicaid can negotiate value-based contracts to manage budget fluctuations, share risk with manufacturers, and enhance patient access to innovative treatments. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Comparing Medicaid Expenditures for Standard and Enhanced Therapeutic Foster Care.
- Author
-
Lanier, Paul, Rose, Roderick, and Domino, Marisa Elena
- Subjects
- *
FOSTER home care , *MEDICAID costs , *MEDICAID , *MENTAL health services , *MEDICAL care costs , *CHILD services - Abstract
Therapeutic foster care (TFC) is a service for children with high behavioral health needs that has shown promise to prevent entry into more restrictive and expensive care settings. The purpose of this study was to compare Medicaid expenditures associated with TFC with Medicaid expenditures associated with an enhanced higher-rate service called Intensive Alternative Family Treatment (IAFT). We conducted a secondary analysis of Medicaid claims in North Carolina among children entering care in 2018–2019. Using propensity score analysis with difference-in-difference estimation, we compared monthly Medicaid expenditures before and after initiating TFC and IAFT (N = 5472 person-months). Youth entering IAFT had higher expenditures prior to treatment than those entering TFC. Both standard TFC and IAFT were associated with a downward trend in expenditures following treatment initiation. Both TFC and IAFT reverse a trend of increasing Medicaid costs prior to care among children with high behavioral health needs. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. A Cross-Sectional Study of Patient Out-of-Pocket Costs for Antipsychotics Among Medicaid Beneficiaries with Schizophrenia.
- Author
-
Lin, Dee, Pilon, Dominic, Morrison, Laura, Shah, Aditi, Lafeuille, Marie-Hélène, Lefebvre, Patrick, and Benson, Carmela
- Subjects
MEDICAID beneficiaries ,ARIPIPRAZOLE ,MEDICAID eligibility ,MEDICAID costs ,CROSS-sectional method ,ANTIPSYCHOTIC agents ,GENERIC drugs - Abstract
Background: Patient affordability is an important nonclinical consideration for treatment access among patients with schizophrenia. Objective: This study evaluated and measured out-of-pocket (OOP) costs for antipsychotics (APs) among Medicaid beneficiaries with schizophrenia. Methods: Adults with a schizophrenia diagnosis, ≥ 1 AP claim, and continuous Medicaid eligibility were identified in the MarketScan
® Medicaid Database (1 January 2018–31 December 2018). OOP AP pharmacy costs ($US 2019) were normalized for a 30-day supply. Results were descriptively reported by route of administration [ROA; orals (OAPs), long-acting injectables (LAIs)], generic/branded status within ROAs, and dosing schedule within LAIs. The proportion of total (pharmacy and medical) OOP costs AP-attributable was described. Results: In 2018, 48,656 Medicaid beneficiaries with schizophrenia were identified (mean age 46.7 years, 41.1% female, 43.4% Black). Mean annual total OOP costs were $59.97, $6.65 of which was AP attributable. Overall, 39.2%, 38.3%, and 42.3% of beneficiaries with a corresponding claim had OOP costs > $0 for any AP, OAP, and LAI, respectively. Mean OOP costs per patient per 30-day claim (PPPC) were $0.64 for OAPs and $0.86 for LAIs. By LAI dosing schedule, mean OOP costs PPPC were $0.95, $0.90, $0.57, and $0.39 for twice-monthly, monthly, once-every-2-months, and once-every-3-months LAIs, respectively. Across ROAs and generic/branded status, projected OOP AP costs per-patient-per-year for beneficiaries assumed fully adherent ranged from $4.52 to $13.70, representing < 25% of total OOP costs. Conclusion: OOP AP costs for Medicaid beneficiaries represented a small fraction of total OOP costs. LAIs with longer dosing schedules had numerically lower mean OOP costs, which were lowest for once-every-3-months LAIs among all APs. [ABSTRACT FROM AUTHOR]- Published
- 2023
- Full Text
- View/download PDF
7. Modeling of Out-Of-Pocket Costs Across Medicaid and Medicare Plans of Standard-of-Care Radiosurgery Duration for Metastatic Spine Cancer.
- Author
-
Wu, V.S., Khlopin, M., and McClelland III, S.
- Subjects
- *
STEREOTACTIC radiotherapy , *DOSE fractionation , *QUALITY of life , *MEDICARE costs , *MEDICAID costs - Abstract
Spine radiosurgery/stereotactic body radiation therapy (SBRT) for metastatic disease is defined by United States billing as treatment ranging from 1-5 fractions. The out-of-pocket (OOP) costs that patients face under this radiation modality and fractionation methods is understudied. Our study aims to evaluate expenses across three public insurance plans, aiming to enhance comprehension and transparency regarding treatment costs. We relied on the recommendations outlined in the National Comprehensive Cancer Network (NCCN) guidelines and the insights of experts to define the standard treatment protocol for managing symptomatic metastatic spine cancer. Out-of-pocket (OOP) costs were determined by combining annual deductibles, treatment expenditures, and copayments across three public insurance plans: Original Medicare, Medigap Plan G, and Medicaid. The calculations spanned a two-year timeframe (without adjustments for inflation), with the assumption that all treatments and evaluations occurred at a hospital in Ohio. RT-specific treatment charges include on-treatment radiation oncologist visits, treatment planning, simulation and verification, RT delivery, on-treatment visits, and follow-up visits. Under Original Medicare plans, beneficiaries are faced with an OOP cost of 20% of the approved claims charges after the annual $240 deductible is met. For Spine SBRT, Medicare beneficiaries are faced with an OOP cost of $1,127.03, $1,444.92, $1,762.82, $2,080.71, and $2,398.60 after two years for one-, two-, three-, four-, and five-fractions of SBRT, respectively. Medigap Part G beneficiaries are faced with a total OOP charge after two years of $480 for all SBRT fractionations. Under Medicaid insurance, beneficiaries are faced with no OOP expenses with no limitations. In spine SBRT, single-fraction is the least financially toxic regimen with regard to OOP costs under Medicare at two-years post-treatment, while five-fraction is the most toxic – 113% more than single-fraction, 66% more than two-fraction, and 36% more than three-fraction. Even the commonly utilized three-fraction regimen is 56% and 22% more toxic than single and two-fraction regimens. Finally, for the only regimen supported by Level 1 evidence (two-fraction; PMID 34126044), reduction to one fraction reduces toxicity by 28% at two-years post-treatment. These findings provide further support that minimizing spine SBRT fractionation (when safely and efficaciously achievable) provides the best chance of optimizing patient quality of life. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
8. Disparities in Elective Spine Surgery for Medicaid Beneficiaries: A Systematic Review.
- Author
-
Reddy, Akshay, Mumtaz, Mohammed, Sharaf, Ramy, Tabarestani, Arman, and Mederos, Christopher
- Subjects
MEDICAID beneficiaries ,ELECTIVE surgery ,SPINAL surgery ,MEDICAID costs ,MEDICAID ,BUNDLED payments (Medical care costs) - Abstract
This letter to the editor discusses a systematic review titled "Disparities in Elective Spine Surgery for Medicaid Beneficiaries." The review examined disparities in access to care and health outcomes among Medicaid patients undergoing elective spine surgeries. The authors found consistent disparities in both access to care and health outcomes for Medicaid patients compared to non-Medicaid patients. However, the review did not investigate the factors contributing to these disparities. The authors suggest further exploration into a wider range of elective spine surgeries and the role of Medicaid in influencing access and outcomes. They also mention the potential value of bundled care payment models in spinal surgery. The authors express a desire for more detailed understanding of the overlap between disparities and low socioeconomic status, race, and Medicaid coverage. They believe that further investigation will lead to more cost-effective and holistic plans that do not compromise patient outcomes. [Extracted from the article]
- Published
- 2024
- Full Text
- View/download PDF
9. Two Jolts in 3 Days Caught Health Insurance Investors Off-Guard.
- Author
-
Tozzi, John
- Subjects
WALL Street (New York, N.Y.) ,INVESTORS ,MEDICAID costs ,HEALTH insurance ,MEDICARE Part C ,EARNINGS per share ,MEDICAID - Abstract
The largest US health insurers surprised investors with cuts to their forecasts, causing stock prices to plummet and erasing $55 billion from their combined market value. Elevance Health Inc. and UnitedHealth Group Inc. both issued disappointing outlooks, attributing the challenges to rising costs in Medicaid and changes in Medicare payments. The unexpected events have raised concerns about the future of the health insurance industry, particularly in relation to government health programs like Medicare and Medicaid. The upcoming US presidential election adds another layer of uncertainty for health investors, with potential implications for different insurers depending on the election outcome. [Extracted from the article]
- Published
- 2024
10. Home care agencies lead NYC in wage theft violations.
- Author
-
Geringer-Sameth, Ethan
- Subjects
HOME care services ,HOME health aides ,WAGE theft ,MEDICAID costs ,BROKERS ,MINIMUM wage - Abstract
New York City's home care industry has a significant issue with wage theft violations, with the worst offenders being home health care agencies. These agencies owe millions of dollars in unpaid wages to their workers. The lack of regulation and accountability in the industry has allowed for these violations to occur. The state government is taking steps to restructure the program and reduce the number of middlemen companies involved in brokering Medicaid payments to improve oversight and address the soaring Medicaid costs. However, there is resistance from a coalition of brokers who argue that this will disrupt the program for those who rely on it. [Extracted from the article]
- Published
- 2024
11. Study Results from Oregon Health & Science University (OHSU) Broaden Understanding of Obstetrics and Gynecology (Expanding Comprehensive Pregnancy Care for Emergency Medicaid Recipients: a Cost-effectiveness Analysis).
- Subjects
MEDICAID costs ,HEALTH of minorities ,WOMEN'S health ,MEDICAID ,UNPLANNED pregnancy - Abstract
A study conducted by researchers at Oregon Health & Science University (OHSU) examined the cost-effectiveness of different strategies for providing pregnancy coverage to Emergency Medicaid recipients. The study found that extending Emergency Medicaid to 60 days after delivery was a cost-saving strategy that resulted in improved health outcomes. By providing postpartum care and contraception, the policy change led to more people receiving effective contraception and prevented unintended pregnancies. The research concluded that including postpartum care and contraception for low-income immigrant women was beneficial in terms of cost and health outcomes. [Extracted from the article]
- Published
- 2024
12. Study finds Americans want pandemic-era ease of applying for Medicaid.
- Subjects
COVID-19 pandemic ,MEDICAID ,MEDICAID costs ,RACISM ,HEALTH policy - Abstract
A study conducted by researchers from Texas A&M University and the University of Michigan found that more than 23 million Americans lost their Medicaid coverage after the COVID-19 pandemic was no longer considered a public health emergency. The study assessed Americans' tolerance for administrative burdens in the wake of this policy change. The researchers surveyed over 8,000 Americans and found broad support for reducing the administrative burden of Medicaid enrollment. However, there were ideological divisions, with those expressing empathy, negative experiences, or viewing the burden as systemic racism having less tolerance, while those with conservative beliefs or racial resentments had higher tolerance. The study highlights the widening health equity gap post-pandemic. [Extracted from the article]
- Published
- 2024
13. Centene Plunges as Medicaid View Disappoints Street.
- Author
-
Tozzi, John
- Subjects
BUSINESS insurance ,INVESTORS ,HEALTH insurance exchanges ,POOR people ,MEDICAID costs - Abstract
Centene Corp., an insurer, saw a significant drop in its shares after releasing a projection for its Medicaid program that disappointed investors. The company stated that membership in the Medicaid program for low-income individuals would be around 13 million this year, lower than its previous forecast of 13.6 million members by the end of 2024. This decrease in membership means that Centene will collect less in premiums, putting pressure on its medical-loss ratio. Despite this, the company affirmed its guidance for adjusted earnings in 2024, although it suggested that Wall Street's expectations for the quarterly pace might be too optimistic. Higher costs in the Medicaid business are being offset by strong performance in the company's health insurance exchange segment, as well as reductions to other expenses and investment income. [Extracted from the article]
- Published
- 2024
14. Costs of colorectal cancer screening with colonoscopy, including post-endoscopy events, among adults with Medicaid insurance.
- Author
-
Fisher, Deborah A., Princic, Nicole, Miller-Wilson, Lesley-Ann, Wilson, Kathleen, and Limburg, Paul
- Subjects
- *
EARLY detection of cancer , *FECAL occult blood tests , *COLORECTAL cancer , *COLONOSCOPY , *MEDICAID costs , *DNA nanotechnology - Abstract
To examine the healthcare utilization and costs associated with colorectal cancer (CRC) screening by colonoscopy, including costs associated with post-endoscopy events, among average-risk adults covered by Medicaid insurance. This cohort study evaluated a population of adults (ages 50–75 years) with CRC screening between 1/1/2014 and 12/31/2018 (index = earliest test) from the IBM MarketScan Multi-State Medicaid database. Individuals at above-average risk for CRC or with prior CRC screening were excluded. CRC screening was reported by screening type: colonoscopy, fecal immunochemical test [FIT], fecal occult blood test [FOBT], multi-target stool DNA [mt-sDNA]. Frequency and costs of events potentially related to colonoscopy (defined as occurring within 30 days post-endoscopy) were reported overall, by event type, and by individual event. We identified a total of 13,134 average-risk adults covered by Medicaid insurance who received screening by colonoscopy; 63.6% (8350) had Medicare dual-eligibility while 36.4% (4785) did not have Medicare dual-eligibility. The mean (SD) cost of a colonoscopy procedure was $684 ($907) and mean (SD) out-of-pocket costs were $6 ($132). Serious gastrointestinal (GI) events (perforation and bleeding) were observed in 4.6% of individuals with colonoscopy, 4.3% had other GI events, and 3.0% had an incident cardiovascular/cerebrovascular event. Mean (SD) event-related costs were $1233 ($5784) among individuals with a serious GI event, $747 ($1961) among individuals with other GI events, and $4398 ($19,369) among individuals with a cardiovascular/cerebrovascular event. This large, claims-based cohort study reports average (SD) out-of-pocket costs for Medicaid beneficiaries at $6 ($132), which could be one factor contributing to the accessibility of CRC screening by colonoscopy. The incidence of events potentially associated with colonoscopy (i.e. within 30 days after the screening) was 3–4%, and the event-related costs were considerable. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
15. Eviction, Healthcare Utilization, and Disenrollment Among New York City Medicaid Patients.
- Author
-
Schwartz, Gabriel L., Feldman, Justin M., Wang, Scarlett S., and Glied, Sherry A.
- Subjects
- *
EVICTION , *MEDICAID costs , *MEDICAID , *OUTPATIENT medical care , *HEALTH services accessibility , *CAUSAL inference , *MEDICAL care costs , *RESEARCH , *RESEARCH methodology , *REGRESSION analysis , *EVALUATION research , *PATIENTS' attitudes , *COMPARATIVE studies - Abstract
Introduction: Although growing evidence links residential evictions to health, little work has examined connections between eviction and healthcare utilization or access. In this study, eviction records are linked to Medicaid claims to estimate short-term associations between eviction and healthcare utilization, as well as Medicaid disenrollment.Methods: New York City eviction records from 2017 were linked to New York State Medicaid claims, with 1,300 evicted patients matched to 261,855 non-evicted patients with similar past healthcare utilization, demographics, and neighborhoods. Outcomes included patients' number of acute and ambulatory care visits, healthcare spending, Medicaid disenrollment, and pharmaceutical prescription fills during 6 months of follow-up. Coarsened exact matching was used to strengthen causal inference in observational data. Weighted generalized linear models were then fit, including censoring weights. Analyses were conducted in 2019-2021.Results: Eviction was associated with 63% higher odds of losing Medicaid coverage (95% CI=1.38, 1.92, p<0.001), fewer pharmaceutical prescription fills (incidence rate ratio=0.68, 95% CI=0.52, 0.88, p=0.004), and lower odds of generating any healthcare spending (OR=0.72, 95% CI=0.61, 0.85, p<0.001). However, among patients who generated any spending, average spending was 20% higher for those evicted (95% CI=1.03, 1.40, p=0.017), such that evicted patients generated more spending on balance. Marginally significant estimates suggested associations with increased acute, and decreased ambulatory, care visits.Conclusions: Results suggest that eviction drives increased healthcare spending while disrupting healthcare access. Given previous research that Medicaid expansion lowered eviction rates, eviction and Medicaid disenrollment may operate cyclically, accumulating disadvantage. Preventing evictions may improve access to care and lower Medicaid costs. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
16. Estimating the impact of neonatal abstinence system interventions on Medicaid: an incremental cost analysis.
- Author
-
López-Soto, Diana and Griffin, Paul M.
- Subjects
- *
MEDICAID costs , *DIRECT costing , *COST analysis , *NEONATAL abstinence syndrome , *OPIOID abuse - Abstract
Background: Neonatal abstinence syndrome (NAS) incidence has significantly increased in the US in recent years. It is therefore important to develop effective intervention protocols that mitigate the long-term consequences of this condition for the mother, her child, and the community.Methods: We used Monte Carlo simulation to estimate the impact of four interventions for NAS and their combinations on pregnant women with opioid use disorder. The key outputs were changes in incremental costs from baseline from the Medicaid perspective and from a total systems perspective and effect size changes. Simulation parameters and costs were based on the literature and baseline model validation was performed using Medicaid claims for Indiana.Results: Compared to baseline, the resulting simulation estimates showed that three interventions significantly decreased Medicaid incremental costs by 8% (mandatory opioid testing (MOT)), 4% (patient navigators), and 3% (peer recovery coaches). The combination of the three interventions reduced Medicaid direct costs by 26%. Reductions were similar for total system incremental costs (ranging from 2 to 24%), though MOT was found to increase costs of overdose death based on productivity loss. NAS case reductions ranged from 1% (capacity change) to 13% (MOT).Conclusions: Using systems-based modeling, we showed that costs associated with NAS can be significantly reduced. However, effective implementation would require the involvement and coordination of several stakeholders. In addition, careful protocols for MOT should be considered to ensure pregnant women don't forgo prenatal care for fear of punitive consequences. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
17. Medicaid and fiscal federalism during the COVID‐19 pandemic.
- Author
-
Clemens, Jeffrey, Ippolito, Benedic, and Veuger, Stan
- Subjects
MEDICAID costs ,COVID-19 pandemic ,AMERICAN Rescue Plan Act of 2021 (U.S.) ,MEDICAID ,PUBLIC finance ,LOCAL finance ,FINANCIAL planning ,FEDERAL aid to education - Abstract
We analyze the effects of the COVID‐19 pandemic on state and local government finances, with an emphasis on health spending needs and the role of the Medicaid program. We first find that enhanced federal matching funds are roughly the same size as expected increases in state Medicaid costs nationwide over the entirety of the federal budget window. Second, we show that there is substantial variation in states' exposure to increases in Medicaid program costs. Third, we show that the formulas through which fiscal relief has been distributed impact the extent to which aid targets the states experiencing the greatest need. Applications for Practice: –During the COVID‐19 pandemic, states' Medicaid programs have been both a source of heightened expenditures and a vehicle through which federal aid has flowed.–Nationwide, we find that enhanced federal Medicaid matching funds are roughly the same size as expected increases in states' Medicaid costs over the entirety of the federal budget window.–We find that enhanced Medicaid matching funds are not correlated with variations in states' Medicaid enrollment increases and thus do not effectively target the states that have experienced the largest increases in program cost.–We find that the American Rescue Plan Act's unemployment‐based formula for allocating federal dollars does a moderately better job than the enhanced Medicaid matching funds at targeting resources at states that have experienced the largest increases in Medicaid enrollment. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
18. Clinical, Quality of Life and Cost Outcomes in Patients with Early Stage Non Small Cell Lung Cancer Undergoing Surgery or SBRT.
- Author
-
Thuppal, S., Chawla, K., Bowman, R., Sleiman, A., Nestler, A., Ferraro, D.J., Bradbury, C.M., Markwell, S., Hazelrigg, S., and Crabtree, T.
- Subjects
- *
QUALITY of life , *ONCOLOGIC surgery , *DISEASE risk factors , *MEDICAID costs , *TREATMENT effectiveness - Abstract
To compare frailty, QOL and 90-day cost of treatment between patients who underwent surgery or SBRT for early stage NSCLC and identify objective parameters that could aide treatment selection and shared decision-making. Data from treatment naïve adult patients newly diagnosed with early stage NSCLC was collected prospectively. Combined decision on treatment option was based on multidisciplinary clinical assessment and patient preference. Demographics, PFT, NSQIP risk scores were collected. Frailty index score ≥3 was considered frail. Cancer specific QOL questionnaires QLQ-C30/QLQ-LC13/mMRC were administered. Patients were more likely to undergo SBRT if frail (OR-4.92), required functional assistance (IADL, OR-5.01), had pre-clinical morbidity/disability (OR-3.48), worse mobility (TUG test, OR-4.04) or poor nutritional status (MNA, OR- 2.18). Multivariate modeling demonstrated that an increase in NSQIP estimated risk of death (OR=12.60), higher frailty index (OR - 4.80) and decreasing FEV1% increased the probability of receiving SBRT. More surgery patients had complications (41% vs 17%, p<0.05). OS estimates at six months, one and two-years for surgery was 99.1%, 97.3% and 90.7% vs 95.7%, 86.2 and 70.1% for SBRT (p<0.05), respectively. RFS at one and two-year for surgery was 95.1% and 81.5% vs 88.2% and 64.8% for SBRT (p<0.05). Among QOL measures in the surgical cohort, the change in physical functioning, fatigue and dyspnea scores declined over the two-year period from baseline. There was no change from baseline in QOL measures with SBRT. At two-years the change in QOL measure was similar between the cohorts, except change in role functioning was significantly lower in SBRT patients. Median 90-day treatment-related Medicare/Medicaid costs were lower in SBRT $11,188 vs surgery $15,018 (p<0.05). In patients without major complications, treatment related costs were similar between SBRT and surgery ($11,188 vs $11,846, p<0.05). Frailty assessment, when used as part of a multifactorial risk model inclusive of increased comorbidities, higher pack year history, poor pulmonary function, and increased NSQIP risk, helped to identify patients selected for SBRT. While QOL did not differ, OS and RFS declined significantly with SBRT at 2 years in this unmatched comparison. Future longitudinal registries with long-term follow-up are needed to provide better discriminatory ability regarding the treatment impact on QOL and to develop robust treatment selection criteria. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
19. Robotic Prostatectomy and Prostate Cancer–Related Medicaid Spending: Evidence from New York State.
- Author
-
Ko, Hansoo and Glied, Sherry A.
- Subjects
- *
PROSTATECTOMY , *SURGICAL technology , *MEDICAID , *DIAGNOSIS , *MEDICAID costs , *ROBOTICS - Abstract
Background: Robotic prostatectomy is a costly new technology, but the costs may be offset by changes in treatment patterns. The net effect of this technology on Medicaid spending has not been assessed. Objective: To identify the association of the local availability of robotic surgical technology with choice of initial treatment for prostate cancer and total prostate cancer–related treatment costs. Design and Participants: This cohort study used New York State Medicaid data to examine the experience of 9564 Medicaid beneficiaries 40–64 years old who received a prostate biopsy between 2008 and 2017 and were diagnosed with prostate cancer. The local availability of robotic surgical technology was measured as distance from zip code centroids of patient's residence to the nearest hospital with a robot and the annual number of robotic prostatectomies performed in the Hospital Referral Region. Main Measures: Multivariate linear models were used to relate regional access to robots to the choice of initial therapy and prostate cancer treatment costs during the year after diagnosis. Key Results: The mean age of the sample of 9564 men was 58 years; 30% of the sample were White, 26% were Black, and 22% were Hispanic. Doubling the distance to the nearest hospital with a robot was associated with a reduction in robotic surgery rates of 3.7 percentage points and an increase in the rate of use of radiation therapy of 5.2 percentage points. Increasing the annual number of robotic surgeries performed in a region by 10 was associated with a decrease in the probability of undergoing radiation therapy of 0.6 percentage point and a $434 reduction in total prostate cancer–related costs per Medicaid patient. Conclusions: A full accounting of the costs of a new technology will depend on when it is used and the payment rate for its use relative to payment rates for substitutes. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
20. Does the ACA Medicaid Expansion Affect Hospitals' Financial Performance?
- Author
-
Zhang, Pengju and Zhu, Ling
- Subjects
FINANCIAL performance ,MEDICAID costs ,MEDICAID ,HOSPITALS ,PATIENT Protection & Affordable Care Act ,HEALTH care reform ,FINANCIAL planning ,PANEL analysis - Abstract
This paper examines the effects of states' Medicaid expansion under the Affordable Care Act (ACA) on hospitals' financial performance in the United States. Extending previous studies that primarily focus on the immediate short-term impact of the ACA's Medicaid expansion, we investigate if the fiscal effects persist over a longer-term and if the fiscal effects vary across different hospitals. Using panel data on hospitals from 2011 to 2018, we find that hospitals' financial performance, as gauged either by Medicaid net revenue and uncompensated care cost or by multiple profitability measures, improves in Medicaid expansion states, and the positive effects continue over time. In addition, there are significant heterogeneities in the fiscal effects across different hospitals. Hospitals' profitability improves the most in the public sector, rural areas, and less wealthy counties. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
21. Family Treatment Drug Court Cost Analysis: An In-depth Look at the Cost and Savings of a Southeastern Family Treatment Drug Court.
- Author
-
Logsdon, Ashley R., Antle, Becky F., and Kamer, Cindy
- Subjects
- *
FAMILIES , *DRUG courts , *COST effectiveness , *CHILD welfare , *MEDICAID costs , *HOSPITAL emergency services , *COGNITIVE therapy , *TREATMENT of drug addiction , *CHILDBIRTH , *CHILD abuse , *PSYCHOEDUCATION , *COST control , *MEDICAL care use , *COURTS , *MEDICAID , *PARENTS - Abstract
This study examines the cost and benefits of a family treatment drug court (FTDC) in an urban county in a southeastern state. This study utilized a cost-benefit analysis that enters the costs of family treatment drug court and child welfare activities and considers potential savings in areas such as length of time in care, substance-affected childbirth, Medicaid costs, and emergency room utilization for each child and parent in the program. The unique features of this FTDC, including a trauma-informed parent psychoeducation group and trauma-focused cognitive behavioral therapy, add to the literature on cost studies for FTDCs through assessment of this expanded model. This study documents an overall savings ranging from $168,993.30 to $837,993.30 (range based on variables in specific outcomes). Recommendations for how to expand the current model are discussed. [ABSTRACT FROM AUTHOR]
- Published
- 2021
22. Evaluating Emergency Department Utilization for Mobile Mental Health Patients: A Correlational Retrospective Analysis.
- Author
-
Weissinger, Alyssa C., Burns, Rachel, and Campbell, Nancy J.
- Abstract
Background: Patients who have barriers to attending traditional mental health clinics are at risk for psychiatric decompensation, which can lead to inappropriate utilization of emergency departments (EDs). Mobile health clinics have the potential to reduce avoidable ED visits by providing easily accessible care. Aims: To determine whether psychiatric patients have a significant reduction in ED visits after admission to the mobile mental health clinic (MMHC). Method: This study is a replication of a pilot study on the first 43 patients admitted to the MMHC that was conducted soon after the opening. Results of that study were promising. In the current study, health records from a sample of 265 patients from the MMHC were reviewed retrospectively to determine the number of ED visits post admission to the MMHC. ED visits were examined 8 months prior to admission to the MMHC and 8 months after. Descriptive statistics and paired t -tests were used to analyze demographics and determine differences in ED visits pre- and post admission to the MMHC. Results: Findings demonstrated that patients admitted to the MMHC had a significant reduction (p <.05) in ED utilization. There was also a decrease in mean ED visits in patients who received combined treatment, which included medication management and counseling. Conclusion: The MMHC is an effective initiative to reduce ED overutilization, thereby decreasing Medicaid costs. Psychiatric care provided directly in the home can promote health and prevent destabilization. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
23. Investigators at University of Tennessee Discuss Findings in Managed Care (An Age Group Comparison of Concurrent Hospice Care).
- Subjects
MANAGED care programs ,MEDICAID costs ,TERMINAL care ,HOSPICE care ,HEALTH policy - Abstract
A study conducted at the University of Tennessee examined the cost-effectiveness of concurrent hospice care compared to standard care among pediatric patients of different age groups. The study used a national Medicaid database and calculated incremental cost-effectiveness ratios (ICERs) for concurrent care versus standard hospice care for children in four age categories. The results showed that concurrent hospice care reduced live discharges but had a higher total Medicaid cost compared to standard hospice care. The study concluded that concurrent hospice care is an effective way to reduce live discharges but comes at a higher cost. [Extracted from the article]
- Published
- 2024
24. New Findings from Johns Hopkins University in the Area of Insurance Reported (Adopting a Nurse-led Model of Care To Advance Whole-person Health and Health Equity Within Medicaid).
- Subjects
MENTAL health services ,HEALTH insurance policies ,MEDICAID costs ,HEALTH services accessibility ,HEALTH insurance ,HEALTH insurance exchanges - Abstract
A recent study conducted by Johns Hopkins University explores the potential benefits of adopting a nurse-led model of care within Medicaid. The research emphasizes the need for Medicaid payment reforms and innovative delivery models to transform healthcare in the United States. The study examines the implications of nurse-led models for improving healthcare access, quality, and reducing costs for Medicaid recipients. It also highlights the importance of addressing social determinants of health, adopting population health approaches, and integrating behavioral and physical healthcare within Medicaid. The research has been peer-reviewed and provides valuable insights for policymakers and healthcare professionals. [Extracted from the article]
- Published
- 2024
25. Centene Shares Jump After Executives Reassure on Medicaid Costs.
- Author
-
Tozzi, John and Vahanvaty, Sophia
- Subjects
MEDICAID costs ,MEDICAID ,HEALTH insurance exchanges ,STOCK prices ,INVESTORS ,COVID-19 pandemic - Abstract
Centene Corp., the largest seller of Medicaid managed care plans, saw its shares jump the most since 2022 after executives reassured investors about Medicaid costs. The company's second-quarter results eased concerns that Medicaid payments from states wouldn't be sufficient to cover the costs of care for remaining members. Centene executives expressed confidence that states would increase payments to meet the medical needs of patients in their Medicaid programs. This news comes after health insurance stocks fell in May due to concerns about Medicaid payments lagging behind care costs. [Extracted from the article]
- Published
- 2024
26. Why Do Health Insurers Keep Getting Slammed With Higher Costs?
- Author
-
Wainer, David
- Subjects
- *
HEALTH insurance , *INVESTORS , *MEDICAID costs , *INSURANCE companies ,INFLATION Reduction Act of 2022 - Abstract
Health insurers are facing higher costs and disappointing earnings due to a variety of factors, including impacts from the Covid-19 pandemic. Insurers like UnitedHealth, CVS, and Elevance have reported falling short of Wall Street's expectations, leading to stock price declines. The surge in Medicaid costs, driven by a sicker and costlier patient pool post-pandemic, has been a major challenge for insurers. Despite these challenges, insurers are optimistic about eventually seeing improved profits in government-backed programs like Medicare and Medicaid. [Extracted from the article]
- Published
- 2024
27. Elevance Shares Dive After Insurer Faces 'Unprecedented' Medicaid Challenge.
- Author
-
Mathews, Anna Wilde
- Subjects
- *
NATIONAL health insurance , *HEALTH insurance , *HEALTH maintenance organizations , *INVESTORS , *MEDICAID costs , *HEALTH insurance exchanges - Abstract
Elevance Health experienced a significant decrease in shares after reporting adjusted earnings below analysts' projections, primarily due to challenges in its Medicaid business. The company cited an "unprecedented challenge" in Medicaid, with healthcare costs running three to five times higher than usual. Elevance expects these issues to persist into the next year, impacting its earnings growth and highlighting the broader concerns over rising healthcare costs in the insurance industry. [Extracted from the article]
- Published
- 2024
28. GAME WATCH.
- Subjects
MEDICAID costs ,JUNIOR high schools ,INFLUENZA vaccines ,SCHOOL nursing ,NURSING schools - Published
- 2024
29. Medication adherence, healthcare resource utilization, and costs among Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate or once-every-three-months paliperidone palmitate.
- Author
-
Lin, Dee, Pilon, Dominic, Zhdanava, Maryia, Joshi, Kruti, Lafeuille, Marie-Hélène, Côté-Sergent, Aurélie, Vermette-Laforme, Maude, and Lefebvre, Patrick
- Subjects
- *
PATIENT compliance , *MEDICAID beneficiaries , *MEDICAID costs , *ARIPIPRAZOLE , *HOME care services , *MEDICAL care costs - Abstract
Antipsychotics with reduced dosing frequency may improve adherence and clinical outcomes for patients with schizophrenia. This study compared treatment patterns, healthcare resource utilization (HRU), and costs between Medicaid beneficiaries with schizophrenia treated with once-monthly paliperidone palmitate (PP1M) and those who transitioned to once-every-three-months paliperidone palmitate (PP3M). Adults with schizophrenia were identified in a four-state Medicaid database (18 May 2014 to 31 March 2019). The index date was the first PP3M claim (PP3M cohort), or a random PP1M claim (PP1M cohort), following ≥4 months of continuous PP1M treatment among patients with ≥12 months of continuous Medicaid enrollment pre- and post-index. Adherence (proportion of days covered by the index treatment ≥80%), persistence (no gap >90/30 days in the PP3M/PP1M supply), HRU, and costs were compared during the 12-month post-index period between cohorts matched 1:1. Among 2374 patients identified, 374 remained in each cohort after matching (mean age 42 years; 30.5% female). Compared to the PP1M cohort, the PP3M cohort was 2.39 times more likely to be adherent (p <.001), 4.63 times more likely to be persistent (p <.001), 33% less likely to have ≥1 hospitalization (p =.011), and 32% less likely to have ≥1 day with home care services (p =.012). Mean annual medical costs were similar between cohorts ($24,970 in the PP3M cohort and $25,736 in the PP1M cohort; p =.854). Medicaid beneficiaries who transitioned to PP3M had higher adherence and persistence, and a reduced likelihood of hospitalization relative to those who continued treatment with PP1M. The results suggest potential clinical value to transitioning eligible patients to PP3M. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
30. Risk of subsequent relapses and corresponding healthcare costs among recently-relapsed Medicaid patients with schizophrenia: a real-world retrospective cohort study.
- Author
-
Patel, Charmi, Emond, Bruno, Morrison, Laura, Lafeuille, Marie-Hélène, Lefebvre, Patrick, Lin, Dee, Kim, Edward, and Joshi, Kruti
- Subjects
- *
MEDICAL care costs , *PEOPLE with schizophrenia , *MEDICAID , *MEDICAID costs , *COHORT analysis - Abstract
To compare adherence, rates of subsequent schizophrenia-related relapses, healthcare resource utilization, and healthcare costs among Medicaid beneficiaries with schizophrenia who initiated once-monthly paliperidone palmitate (PP1M) versus a new oral atypical antipsychotic (OAA) following a recent schizophrenia-related relapse. Six-state Medicaid data (01/2009–03/2018) were used to identify adults with schizophrenia initiated on PP1M or OAA (index date) within 30 days following a schizophrenia-related relapse (defined as a schizophrenia-related inpatient or emergency room visit). Patients were required to have 12 months of continuous eligibility before (baseline) and after (observation) the index date. Differences in baseline characteristics between PP1M and OAA patients were accounted for using 1:3 matching. After matching, characteristics were well-balanced between PP1M (N=208, mean age=39 years, 35.6% female) and OAA patients (N=624, mean age=40 years, 34.6% female). During the 12-month observation period, the mean proportion of days covered for the index medication was 41.2% in the PP1M cohort and 34.7% in the OAA cohort (p=.008). Relative to the OAA cohort, PP1M patients were 33% (p=.013) less likely to have a subsequent relapse and had 29% (p=.004) fewer all-cause inpatient admissions per-patient-per-year (PPPY). Consequently, a significant mean reduction of $6273 in medical costs PPPY (p=.028) was observed, which fully offset the $4770 (p<.001) increase in pharmacy costs PPPY and resulted in a numerical but not statistically significant, decrease in total healthcare costs of $1503 PPPY (p=.621) relative to OAA patients. Among patients with a recent schizophrenia-related relapse, PP1M was associated with a lower risk of subsequent relapse while remaining a cost neutral therapeutic option compared to OAAs. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
31. Estimated Medicaid Costs Associated with Hepatitis A During an Outbreak - West Virginia, 2018-2019.
- Author
-
Batdorf, Samantha J., Hofmeister, Megan G., Surtees, Tamara C., Thomasson, Erica D., McBee, Shannon M., and Pauly, Nathan J.
- Subjects
- *
MEDICAID costs , *HEPATITIS A - Abstract
Hepatitis A is a vaccine-preventable disease caused by the hepatitis A virus (HAV). Transmission of the virus most commonly occurs through the fecal-oral route after close contact with an infected person. Widespread outbreaks of hepatitis A among persons who use illicit drugs (injection and noninjection drugs) have increased in recent years (1). The Advisory Committee on Immunization Practices (ACIP) recommends routine hepatitis A vaccination for children and persons at increased risk for infection or severe disease, and, since 1996, has recommended hepatitis A vaccination for persons who use illicit drugs (2). Vaccinating persons who are at-risk for HAV infection is a mainstay of the public health response for stopping ongoing person-to-person transmission and preventing future outbreaks (1). In response to a large hepatitis A outbreak in West Virginia, an analysis was conducted to assess total hepatitis A-related medical costs during January 1, 2018-July 31, 2019, among West Virginia Medicaid beneficiaries with a confirmed diagnosis of HAV infection. Among the analysis population, direct clinical costs ranged from an estimated $1.4 million to $5.6 million. Direct clinical costs among a subset of the Medicaid population with a diagnosis of a comorbid substance use disorder ranged from an estimated $1.0 million to $4.4 million during the study period. In addition to insight on preventing illness, hospitalization, and death, the results from this study highlight the potential financial cost jurisdictions might incur when ACIP recommendations for hepatitis A vaccination, especially among persons who use illicit drugs, are not followed (2). [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
32. Strange Bedfellows: Coordinating Medicare and Medicaid to Achieve Cost-Effective Care for Patients with the Greatest Health Needs.
- Author
-
Elmaleh-Sachs, Arielle and Schneider, Eric C.
- Subjects
- *
MEDICAID costs , *PATIENT care , *MEDICAL care costs , *MEDICARE , *MEDICAID - Abstract
This perspective describes federal efforts in the United States (U.S.) to integrate care for an especially complex, vulnerable, and costly patient population: adults eligible for both Medicare and Medicaid insurance. The goal of the paper is to demystify for clinical policy leaders and practicing clinicians the origins and evolution of the Dual-Eligible Special Needs Plans (D-SNPs) recently permanently authorized by the U.S. Congress and to explore the potential for these policy changes to help such health plans improve care for the sickest and most vulnerable Americans. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
33. Binghamton University Researchers Provide Details of New Studies and Findings in the Area of Opioids (Retrospective study investigating naloxone prescribing and cost in US Medicaid and Medicare patients).
- Subjects
INTERNET content management systems ,MEDICAID costs ,NALOXONE ,DRUG prescribing ,MEDICARE ,RESEARCH personnel - Abstract
A recent study conducted by researchers at Binghamton University examined the prescribing and cost of naloxone, an opioid antagonist used to prevent overdoses, in Medicaid and Medicare patients in the United States. The study found that there was a significant increase in the number of naloxone prescriptions to Medicaid patients from 2018 to 2021, indicating a national response to the opioid crisis. However, there were pronounced state-level disparities in naloxone prescription rates, with some states having much higher rates than others. The researchers suggest that further investigation is needed to understand the origins of these disparities. [Extracted from the article]
- Published
- 2024
34. State Medicaid costs poised to surge from pandemic lows.
- Author
-
Theal, Justin and Judd, Riley
- Subjects
COVID-19 pandemic ,MEDICAID costs ,FEDERAL aid ,FISCAL year ,OPERATING budgets - Abstract
State Medicaid costs are expected to increase after reaching pandemic lows in fiscal year 2021. The decrease in state funds dedicated to Medicaid was due to a surge in tax revenue and temporary federal funding. However, as federal aid concludes and Medicaid enrollment remains high, experts predict that the share of state funds spent on Medicaid will rise. Factors such as rising prescription drug prices and increased healthcare provider payment rates are contributing to the upward pressure on state Medicaid spending. The federal government covers a significant portion of state Medicaid costs, ranging from 60.3% to 83.5% in federal fiscal year 2021. The pandemic led to a temporary surge in Medicaid enrollment, but states expect a decline in fiscal years 2024 and 2025. [Extracted from the article]
- Published
- 2024
35. New Advocacy Toolkit for Dentists Now Available.
- Subjects
DENTISTS ,DENTAL associations ,MEDICAID costs ,DENTAL facilities - Published
- 2024
36. Supervised mixture of experts models for population health.
- Author
-
Shou, Xiao, Mavroudeas, Georgios, Magdon-Ismail, Malik, Figueroa, Jose, Kuruzovich, Jason N., and Bennett, Kristin P.
- Subjects
- *
POPULATION health , *GAUSSIAN mixture models , *ELECTRONIC health records , *MEDICAID costs , *MIXTURES - Abstract
We propose a machine learning driven approach to derive insights from observational healthcare data to improve public health outcomes. Our goal is to simultaneously identify patient subpopulations with differing health risks and to find those risk factors within each subpopulation. We develop two supervised mixture of experts models: a Supervised Gaussian Mixture model (SGMM) for general features and a Supervised Bernoulli Mixture model (SBMM) tailored to binary features. We demonstrate the two approaches on an analysis of high cost drivers of Medicaid expenditures for inpatient stays. We focus on the three diagnostic categories that accounted for the highest percentage of inpatient expenditures in New York State (NYS) in 2016. When compared with state-of-the-art learning methods (random forests, boosting, neural networks), our approaches provide comparable prediction performance while also extracting insightful subpopulation structure and risk factors. For problems with binary features the proposed SBMM provides as good or better performance than alternative methods while offering insightful explanations. Our results indicate the promise of such approaches for extracting population health insights from electronic health care records. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
37. Patient Navigation to Reduce Emergency Department (ED) Utilization Among Medicaid Insured, Frequent ED Users: A Randomized Controlled Trial.
- Author
-
Kelley, Lauren, Capp, Roberta, Carmona, Juan F., D'Onofrio, Gail, Mei, Hao, Cobbs-Lomax, Darcey, and Ellis, Peter
- Subjects
- *
RANDOMIZED controlled trials , *HOSPITAL emergency services , *MEDICAID costs , *MEDICAL care , *HEALTH services accessibility , *RESEARCH , *RESEARCH methodology , *PATIENT-centered care , *MEDICAL cooperation , *EVALUATION research , *COMPARATIVE studies , *MEDICAID , *LONGITUDINAL method - Abstract
Background: Some Medicaid enrollees frequently utilize the emergency department (ED) due to barriers accessing health care services in other settings.Objectives: To determine whether an ED-initiated Patient Navigation program (ED-PN) designed to improve health care access for Medicaid-insured frequent ED users could decrease ED visits, hospitalizations, and costs.Methods: We conducted a prospective, randomized controlled trial comparing ED-PN with usual care (UC) among 100 Medicaid-enrolled frequent ED users (defined as 4-18 ED visits in the prior year), assessing ED utilization during the 12 months pre- and post-enrollment. Secondary outcomes included hospitalizations, outpatient utilization, hospital costs, and Medicaid costs. We also compared characteristics between ED-PN patients with and without reduced ED utilization.Results: Of 214 eligible patients approached, 100 (47%) consented to participate. Forty-nine were randomized to ED-PN and 51 to UC. Sociodemographic characteristics and prior utilization were similar between groups. ED-PN participants had a significant reduction in ED visits and hospitalizations during the 12-month evaluation period compared with UC, averaging 1.4 fewer ED visits per patient (p = 0.01) and 1.0 fewer hospitalizations per patient (p = 0.001). Both groups increased outpatient utilization. ED-PN patients showed a trend toward reduced per-patient hospital costs (-$10,201, p = 0.10); Medicaid costs were unchanged (-$5,765, p = 0.26). Patients who demonstrated a reduction in ED usage were older (mean age 42 vs. 33 years, p = 0.03) and had lower health literacy (78% low health literacy vs. 40%, p = 0.02).Conclusion: An ED-PN program targeting Medicaid-insured high ED utilizers demonstrated significant reductions in ED visits and hospitalizations in the 12 months after enrollment. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
38. Clinical Decision Support System for Managing COPD-Related Readmission Risk.
- Author
-
Huang, C. Derrick, Goo, Jahyun, Behara, Ravi S., and Agarwal, Ankur
- Subjects
OBSTRUCTIVE lung diseases ,MEDICAL personnel ,DECISION support systems ,MEDICAID costs ,INHALERS ,MEDICARE costs ,PATIENT readmissions - Abstract
Hospital readmission is an important quality-of-care indicator that reflects challenges in quality of in-patient care and the difficulty of coordination of care after the transition back into the community. It can also be a significant financial burden, especially as it relates to Medicare and Medicaid costs now and into the future. In this study, we develop a text-mining-based methodology for providing decision support to identify patients with Chronic Obstructive Pulmonary Disease (COPD), one of the leading causes of disability and mortality worldwide, that are likely to be readmitted. The proposed methodology is tested with real-life data to demonstrate how it can be used to help healthcare providers target high-risk discharged patients to reduce readmission. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
39. A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.
- Author
-
Komaromy, Miriam, Bartlett, Judy, Gonzales-van Horn, Sarah R., Zurawski, Andrea, Kalishman, Summers G., Zhu, Yiliang, Davis, Herbert T., Ceballos, Venice, Sun, Xi, Jurado, Martin, Page, Kimberly, Hamblin, Allison, and Arora, Sanjeev
- Subjects
- *
MEDICAID costs , *NURSE practitioners , *TIME series analysis , *COMMUNITY mental health services , *MEDICAL care costs , *MEDICAID , *ECHO , *RESEARCH , *HOSPITAL emergency services , *RESEARCH methodology , *MEDICAL cooperation , *EVALUATION research , *PATIENTS' attitudes , *COMPARATIVE studies , *HOSPITAL care - Abstract
Background: A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.Objective: To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.Design: Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.Participants: ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.Intervention: ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients' physical, behavioral, and social issues.Main Measures: We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.Key Results: ECHO Care was associated with significant changes in patients' use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.Conclusions: ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions. [ABSTRACT FROM AUTHOR]- Published
- 2020
- Full Text
- View/download PDF
40. The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment.
- Author
-
Finkelstein, Amy, Hendren, Nathaniel, and Luttmer, Erzo F. P.
- Subjects
HEALTH insurance ,MEDICAID ,MEDICAID costs ,MEDICAID beneficiaries ,WILLINGNESS to pay - Abstract
We develop frameworks for welfare analysis of Medicaid and apply them to the Oregon Health Insurance Experiment. Across different approaches, we estimate low-income uninsured adults' willingness to pay for Medicaid between $0.5 and $1.2 per dollar of the resource cost of providing Medicaid; estimates of the expected transfer Medicaid provides to recipients are relatively stable across approaches, but estimates of its additional value from risk protection are more variable. We also estimate that the resource cost of providing Medicaid to an additional recipient is only 40 percent of Medicaid's total cost; 60 percent of Medicaid spending is a transfer to providers of uncompensated care for the low-income uninsured. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
41. Will the American Rescue Plan Overcome Opposition to Medicaid Expansion?
- Author
-
O'Mahen, Patrick N. and Petersen, Laura A.
- Subjects
- *
AMERICAN Rescue Plan Act of 2021 (U.S.) , *MEDICAID , *MANAGED care programs , *CHILDREN with disabilities , *MEDICAID costs - Abstract
ARPA broadens numerous Affordable Care Act (ACA) policies extending health insurance to the uninsured.[1] These reforms include generous financial incentives for states to accept the ACA's Medicaid expansion. In the ACA Medicaid expansion, the federal government pays for 90% of costs for the Medicaid expansion population, which consists of adults in households with incomes under 138% of the Federal Poverty Line (FPL). However, marketplace coverage is inferior to Medicaid coverage on several metrics, most notably that it charges higher out-of-pocket costs and may feature narrower networks.[20] Another potential workaround is creating a federally funded public option plan, which anyone living in a state that did not expand Medicaid and making under 138% of FPL could enroll free of charge. [Extracted from the article]
- Published
- 2021
- Full Text
- View/download PDF
42. Variations in Generic Combination Opioid Use Across State Medicaid Programs.
- Author
-
Lee, ChangWon C., Kesselheim, Aaron S., and Avorn, Jerry
- Subjects
- *
MEDICAID , *MEDICAID costs , *OPIOIDS , *GENERIC drugs , *DRUG utilization , *DRUG accessibility - Abstract
Yet, we found that brand-name Percocet (9% of all brand-name oxycodone-acetaminophen prescriptions) and Vicodin (28% of all brand-name hydrocodone-acetaminophen prescriptions) continued to be widely dispensed despite the existence of interchangeable generic versions. Graph: Figure 1 State-level variation in generic proportions of oxycodone-acetaminophen tablet and capsule opioid formulations and hydrocodone-acetaminophen tablet and capsule opioid formulations, 1991 to 2018. RESULTS Ten brand-name formulations containing oxycodone-acetaminophen and 19 containing hydrocodone-acetaminophen were prescribed in Medicaid during the study period. [Extracted from the article]
- Published
- 2021
- Full Text
- View/download PDF
43. Medicaid Was a Boon to Insurers During the Pandemic. Now, Not So Much.
- Author
-
Wainer, David
- Subjects
- *
MEDICAID , *NATIONAL health insurance , *INSURANCE companies , *HEALTH insurance exchanges , *HEALTH insurance , *MEDICAID costs - Published
- 2024
44. The state of Iowa's Medicaid makeover.
- Author
-
DeWitte, Dave
- Subjects
MEDICAID ,HEALTH insurance ,MEDICAL personnel ,MEDICAID costs ,BUSINESS planning - Abstract
The article informs that Iowa turned over its Medicaid program to private insurance carriers, the debate has not died over whether for-profit business competition has been good medicine for Iowa's rising Medicaid budget. It mentions that Medicaid program is the health insurance safety for, filling big health insurance coverage gaps that have been especially critical during the COVID-19 pandemic.
- Published
- 2020
45. The Impact of Medicaid Expansion on States' Budgets.
- Author
-
Ward, Bryce
- Subjects
UNCOMPENSATED medical care ,MENTAL health services ,MEDICAID ,MEDICAID costs ,BUDGET ,MEDICAID eligibility - Abstract
ISSUE: The impact of Medicaid expansion on state budgets is a concern cited by policymakers in nonexpansion states. GOAL: To estimate the financial impact of Medicaid expansion on state budgets based on state experiences to date. METHODS: Using historical data, projections of cost, and difference-indifferences analysis, we estimate the impact of expanding eligibility for Medicaid on states' spending on the program and the overall effect on their budgets. KEY FINDINGS: During 2014-17, Medicaid expansion was associated with a 4.4 percent to 4.7 percent reduction in state spending on traditional Medicaid. Estimates of savings outside of the Medicaid program vary significantly. Savings on mental health care, in the corrections system, and from reductions in uncompensated care range from 14 percent of the cost of expansion in Kentucky to 30 percent in Arkansas. CONCLUSION: It is not necessary to cut other spending or raise revenue by 10 percent of the cost of expansion -- their share in 2020 -- to balance their budgets. States have a variety of means to offset some or all of expansion's statutory costs. Thus, the net cost of Medicaid expansion to states is different from the "sticker price." In some cases, the net cost is negative. [ABSTRACT FROM AUTHOR]
- Published
- 2020
46. Direct medical cost of oropharyngeal cancer among patients insured by Medicaid in Texas.
- Author
-
Zhao, Bo, Fu, Shuangshuang, Wu, Chi-Fang, Dahlstrom, Kristina R., Domgue, Joël Fokom, Tam, Samantha, Xu, Li, Sturgis, Erich M., Lairson, David R., and Fokom Domgue, Joël
- Subjects
- *
MEDICAL care costs , *DIRECT costing , *MEDICAID , *MEDICAID costs , *PROPENSITY score matching , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *EVALUATION research , *OROPHARYNGEAL cancer - Abstract
Objectives: The aim of this study was to estimate the direct 2-year mean incremental medical care costs for incident oropharyngeal cancer (OPC) from the perspective of the Texas Medicaid program.Methods: OPC patients treated from 2008 to 2012 were selected in the Texas Medicaid database. Using a two-step 1:1 propensity score matching method, we selected controls to determine the differential cost associated with OPC. Monthly and yearly direct costs were estimated for 2 years after the cancer diagnosis. For patients without 2-year complete follow-up, a generalized linear model with gamma distribution and log link function was applied to predict costs for the censored months.Results: A total of 352 patients with OPC and the same number of controls were included in the study. Among OPC patients, 204 (58%) were covered by Medicaid and Medicare, and 148 patients (42%) were insured under Medicaid only. The adjusted first- and second-year mean differential costs were $45,102 and $11,684 for Medicaid-only enrollees and $5734 and $2162 for Medicaid-Medicare dual-eligible enrollees, respectively. Being male, Hispanic, Medicaid-only eligible, living in the Harlingen region, and having more comorbidities were positively associated with monthly cost. Lubbock residents experienced lower costs.Conclusions: The direct incremental medical costs associated with OPCs among patients insured by Texas Medicaid were substantial in the first 2 years after cancer diagnosis and should be considered in assessing the economic consequences of increasing the investment in HPV vaccination in Texas. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
47. Impact of Serious Mental Illness on Medicaid and Other Public Healthcare Costs in Texas.
- Author
-
Begley, Charles, Turibekov, Bakbergen, Morgan, Robert, Rowan, Paul, and Fu, Shuangshuang
- Subjects
- *
MEDICAID beneficiaries , *MENTAL illness , *MEDICAID , *MEDICAL care , *MEDICAID costs , *MEDICAL care costs - Abstract
Medicaid-enrolled adults with serious mental illness may be dually-enrolled in Medicare, and may receive health care services from other state and local programs. To understand cross-program costs of care, we linked 2012 payment data across Medicaid, Medicare, state, and local programs. Average costs were calculated according to presence/absence of SMI, Medicare coverage, SSI coverage, medical comorbidities, and other characteristics. Costs for Medicaid adults with SMI were 57.4% greater than adults without SMI, but only 23.6% of costs were SMI-related. Greater costs were associated with Medicaid-Medicare dual-eligibility, multiple SMI diagnoses, and medical comorbidities. The results support cross-program efforts such as joint Medicaid-Medicare managed care and integrated care. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
48. Association of Pharmacist Prescription of Hormonal Contraception With Unintended Pregnancies and Medicaid Costs.
- Author
-
Rodriguez, Maria I. MD, MPH, Hersh, Alyssa MPH, Anderson, Lorinda B. PharmD, Hartung, Daniel M. Pharm D, MPH, Edelman, Alison B. MD, MPH, Rodriguez, Maria I, Hersh, Alyssa, Anderson, Lorinda B, Hartung, Daniel M, and Edelman, Alison B
- Subjects
- *
MEDICAID costs , *CONTRACEPTION , *PHARMACISTS , *QUALITY-adjusted life years , *MONTE Carlo method - Abstract
Objective: To estimate unintended pregnancies averted and the cost effectiveness of pharmacist prescription of hormonal contraception.Methods: A decision-analytic model was developed to determine the cost effectiveness of expanding the scope of pharmacists to prescribe hormonal contraception compared with the standard of care and contraceptive access in clinics. Our perspective was that of the payor, Oregon Medicaid. Our primary outcome was unintended pregnancies averted. Secondary outcomes included: costs and quality-adjusted life years (QALYs). Model inputs were obtained from an analysis of Medicaid claims for the first 24 months after policy implementation in Oregon, and the literature. Univariate and bivariate sensitivity analyses, as well as a Monte Carlo simulation, were performed.Results: Among Oregon's Medicaid population at risk for unintended pregnancy, the policy expanding the scope of pharmacists to prescribe hormonal contraception averted an estimated 51 unintended pregnancies and saved $1.6 million dollars. Quality of life was also improved, with 158 QALYs gained per 198,000 women. Sensitivity analysis demonstrated that the model was most sensitive to the effect on contraceptive continuation rates. If contraceptive continuation rates among women receiving care from a pharmacist are 10% less than among clinicians, than pharmacist prescription of hormonal contraception will not avert unintended pregnancies.Conclusion: Pharmacist prescription of hormonal contraception averts unintended pregnancies and is cost effective. Full implementation of the policy is needed for maximum benefits. Prospective data on the effect of the policy on contraceptive continuation rates are needed. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
- View/download PDF
49. Medicaid's Role for Children with Special Health Care Needs.
- Author
-
Musumeci, MaryBeth
- Subjects
- *
MEDICAID , *MEDICAL care of children with disabilities , *MEDICAID costs , *CHILD health insurance , *MEDICAL care costs , *MEDICAID finance , *CHILDREN with disabilities , *CHILD health services , *CHILDREN'S health , *INSURANCE , *DISABILITY insurance , *HEALTH insurance , *LONG-term health care , *MEDICAL needs assessment , *ELIGIBILITY (Social aspects) , *SOCIOECONOMIC factors - Abstract
This commentary explores Medicaid's role for children with special health care needs today and considers how changes to Medicaid's federal financing structure under a per capita cap or block grant could affect coverage for these children. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
50. Can Outcomes-Based Pharmaceutical Contracts Reduce Drug Prices in the US? A Mixed Methods Assessment.
- Author
-
Seeley, Elizabeth, Chimonas, Susan, and Kesselheim, Aaron S.
- Subjects
- *
OUTCOME-based contracts , *DRUG prices , *PHARMACEUTICAL industry , *CONTRACTS , *MEDICAL care costs , *PHARMACEUTICAL industry & economics , *MEDICAID costs , *COST , *COMPARATIVE studies , *COST control , *INTERVIEWING , *RESEARCH methodology , *MEDLINE , *ONLINE information services , *HEALTH outcome assessment , *RESEARCH , *SYSTEMATIC reviews , *QUALITATIVE research , *DATA analysis software ,DRUGS & economics - Abstract
To improve the value of pharmaceutical spending, some manufacturers and payers have introduced outcomes-based contracts, where rebates are tied to specified outcomes. We reviewed the literature and interviewed key experts to assess these contracts' potential to slow pharmaceutical spending. We found that while outcomes-based contracts are increasingly common in the US, they are still limited by multiple factors — including the lack of meaningful outcomes data. Moreover, there is no evidence to date that they slow pharmaceutical spending or increase access. Experts favored having CMS test and rigorously evaluate this model to achieve a better understanding of the implications. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.