Dear John,

The September issue of Health Affairs includes articles addressing various aspects of access to and coverage of health care services.

Laura Tollen leads off the issue with the first report from the Eye On The IRA project, supported by the National Pharmaceutical Council, which examines how to judge the recently released results of the first round of Medicare drug price negotiations that were implemented as part of the IRA (Inflation Reduction Act) of 2022.

A C C E S S   A N D   C O V E R A G E

Megan Cole and coauthors analyze service use and quality metrics for pregnant enrollees in Medicaid accountable care organizations (ACOs) in Massachusetts.

Enrollment in the ACO program was associated both with improvement in three of six perinatal quality measures and with increases in the number of office visits during the perinatal period relative to those not enrolled in an ACO.

Noting that “miscarriage management and abortion management involve similar medications and procedures,” Jenna Nobles and coauthors estimate that nearly 400,000 miscarriages occur in states with current abortion bans.

Efforts to ban the use of mifepristone warrant “attention to the potential broader effects of these challenges on reproductive health.”

Kaylyn Swankoski and coauthors compare utilization by Medicare enrollees whose primary care is provided by “senior-focused” primary care organizations that receive capitation payments from a Medicare Advantage (MA) plan with that of MA enrollees who receive their care elsewhere.

The authors find greater use of primary care, fewer hospitalizations and emergency department visits, and higher quality, with the differences particularly pronounced for Black enrollees.

Jiani Yu and coauthors analyze telehealth use by physician and practice characteristics and find greater telehealth use among female physicians, psychiatrists, and primary care physicians, as well as among physicians in the Northeast and West.

Jonathan Cantor and coauthors estimate the relationship between in-person school closures during the COVID-19 pandemic and nurse labor supply.

They find a 12.5-percentage-point decline in employment among female nurses with young children, with no declines seen among female nurses with older children.

Eric Roberts and coauthors document increased enrollment in plans that integrate care for nursing home residents dually enrolled in Medicare and Medicaid, with the share enrolled in such plans increasing from 6.5 percent in 2013 to 16.9 percent in 2020.

Melissa Aldridge and coauthors document the growing number of hospices acquired by private equity firms.

In Narrative Matters, Jen Farnsworth describes the challenges of obtaining Medicaid coverage as a graduate student studying public health.

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

The complex system of drug rebates makes it difficult to calculate the actual cost of drugs.

Justine Mallatt and coauthors find that during the period 2007–20, annual list price increases were 9.1 percent, negotiated price increases were 4.3 percent, and out-of-pocket price increases were 5.8 percent, leading them to conclude:

“Concerns about price growth align more closely with the persistent increase in out-of-pocket prices than the recently stagnating growth in negotiated prices.”

Molly Beinfeld and coauthors examine commercial insurance coverage of biologics and biosimilars during the period 2017–22 and find sizable declines in preferred coverage only for a single product, along with rapid growth in copreferred coverage of multiple products.

Observing an average 63 percent drop in sales price four years after the introduction of the first biosimilar, the authors conclude:

“The impact of biosimilars on originator-biosimilar market pricing is encouraging and suggests a well-functioning market.”

Medicare’s coverage of new anti-obesity medicines is currently quite limited.

Benedic Ippolito and Joseph Levy model the costs of expanded coverage and find that “if 5 percent or 10 percent of newly eligible enrollees with obesity or overweight were prescribed a GLP-1…annual program costs would increase by $3.1 billion or $6.1 billion, respectively.”

G L O B A L   H E A L T H   P O L I C Y

Maternity care is an increasing domain for bundled payments—a single payment for all services associated with an episode of care.

Zoë Scheefhals and coauthors analyze the effects of bundled payments for maternity care introduced in the Netherlands in 2017.

They find that “participation in the model was associated with a shift from obstetrician-led, hospital-based deliveries to midwife-led, outpatient deliveries,” along with a 5 percent reduction in maternity spending growth and no decrements in health outcomes.

Astrid Van Wilder and coauthors analyze thirteen adverse hospital events in Belgium.

Adverse event rates ranged from 0.04 to 3.1 per 1,000 discharges, leading the authors to conclude that “even though individual adverse event rates…were low during 2016–18, they were generally higher than the rates reported for 4,252 US hospitals in 2019.”

Jiani Yu on the Current Telehealth Landscape & Opportunities

Health Affairs' Editor-in-Chief Alan Weil interviews Jiani Yu of Cornell University about her recent paper that explores how telehealth use and delivery differs significantly by physician and practice characteristics.

Interpreting The First Round Of Maximum Fair Prices Negotiated By Medicare For Drugs

Immaculada Hernandez et al.

Momentum Is Growing To Stabilize Coverage In Medicaid And CHIP For Young Children

Alice Hm Chen