Dear John,

The August issue of Health Affairs includes articles on how effectively the health care system meets people’s needs, analyses of recent policies related to pharmaceuticals, and more.

It leads with Entry Points by Michele Cohen Marill and Harris Meyer that explore efforts to improve care for people who are dually eligible for Medicare and Medicaid, which are companions to our Forefront series, supported by Arnold Ventures, on Medicare and Medicaid integration.

M E E T I N G   C A R E   N E E D S

Brandy Lipton and coauthors examine Medicaid’s adult vision coverage by state and find that most fee-for-service programs cover routine eye exams but have notable gaps in coverage for glasses and other low-vision aids.

Managed care plans “generally [provide] consistent or enhanced coverage relative to fee-for-service programs.”

From 2020 to 2023, the Department of Veterans Affairs (VA) conducted a nationwide rideshare program to improve access to health care for unhoused veterans.

Jack Tsai and colleagues find that those who used the program “used significantly more VA outpatient, inpatient, [emergency department] or urgent care, and homeless services” and had fewer no-show appointments.

Olga Vsevolozhskaya and colleagues use detailed needs assessments to analyze the concordance between behavioral and mental health service needs and use among youth in Idaho who have serious emotional disturbance.

The authors find that a notable proportion of youth were identified as underusing services, potentially because of stringent utilization management, whereas few youth were overusers.

Nithya Krishnamurthy and colleagues review state-level hospital nurse staffing ratio requirements and find “significant national variation, with seven states having minimum staffing ratios, eight states having staffing committees, eleven states having staffing plans, and twenty-three states having no requirement related to nurse staffing.”

Dhruv Khullar and colleagues interview leaders of accountable care organizations (ACOs) regarding their plans to identify and address the needs of socially vulnerable patients.

The authors identify seven central themes, including that ACOs are in the early stages of collecting social needs data and that patients are primarily stratified by medical, rather than social, risk.

P H A R M A C E U T I C A L S

In 2020, Colorado became the first state to cap out-of-pocket spending for insulin prescriptions.

Benjamin Ukert and coauthors analyze the effects of the first two years of the law’s implementation and find an approximately 40 percent reduction in out-of-pocket spending per insulin prescription and average annual savings of $184 for patients.

Kelly Anderson and coauthors use national data and find some reductions in out-of-pocket spending after the imposition of state-level caps on insulin costs, but no significant increases in insulin use.

This aligns with their finding that “most commercial enrollees were already paying out-of-pocket expenses below the cap amounts.”

In a Perspective, Dana Goldman argues that “it is tough not to draw the conclusion that state [insulin pricing] policies—although earnest—also were inconsequential in light of larger market forces and federal policies.”

Dongzhe Hong and coauthors explore trends in biosimilar uptake in the US during the period 2013–22 among commercially insured and Medicare Advantage patients.

The percentage of patients initiating biosimilar versions of biologic drugs increased from 1 percent in 2013 to 27 percent in 2022.

F I N A N C I N G

Kirstin Woody Scott and coauthors analyze hospitals’ trauma activation fees and find that “trauma centers that were larger, metropolitan, located in the West, and associated with proprietary…hospitals had higher trauma activation fees.”

Kamyar Nasseh and coauthors assess trends in private equity (PE)-affiliated dentists and dental practices in 2015–21.

During that period, PE affiliation nearly doubled, going from 6.6 percent to 12.8 percent, with the increase most pronounced among larger practices and dental specialists.

Megan Cole and coauthors examine trends in federal funding to health centers during the COVID-19 pandemic.

They find that centers with the greatest funding “were more likely rural and in the South; employed lower percentages of physicians; and had the highest percentages of sicker, uninsured, and unhoused patients.”

Please support our work by becoming a Health Affairs subscriber. The cost of an online journal subscription is less than $200 for the year.

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Health Affairs Branded Post:

UnitedHealthcare invests in doula care program supporting improved birth outcomes

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Sponsored by UnitedHealthcare

Join Health Affairs Monday, August 19, for a virtual event on the implications of recent nursing home developments for residents, their families, and the future of long-term care.