Vital Directions, Quality, And More

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From the Editor-In-Chief Health AffairsVol. 40, No. 2: Vital Directions, Quality & More Vital Directions, Quality, And MoreAlan R. WeilPUBLISHED:February 2021Free Accesshttps://doi.org/10.1377/hlthaff.2021.00033AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSQuality of careHealth equityHealth disparitiesRacismMedicaidMedicare AdvantageMedicaid patientsAccess to carePandemicsOut-of-pocket expensesNonprofit statusMortality ratesMortalityMedicare savings programs PhysiciansEmergency departmentsWomen's healthChildren's healthMental healthSubstance use disorderThis month’s issue leads with articles from the National Academy of Medicine’s Vital Directions for Health and Health Care 2021 project, which sets forth priorities for the new administration of President Joe Biden, who took office January 20, 2021.Vital DirectionsVictor Dzau and coauthors identify the overarching theme of the Vital Directions series as “the clear and urgent obligation for the US to turn its full attention to the growing problem of health inequities and to the structural racism that perpetuates such disparities.” Peter Daszak and coauthors review US pandemic preparedness and outline steps to strengthen our ability to anticipate and respond to future pandemics. Elena Fuentes-Afflick and coauthors draw on a life-course framework to identify promising interventions to improve the health of women and children. Terry Fulmer and coauthors identify six strategies to improve care and quality of life for older adults. Margarita Alegría and coauthors describe new models of care that focus on mental health and addiction. William Shrank and coauthors discuss health cost and financing priorities to advance access, affordability, and equity.QualityDavid Meyers and coauthors use data from a natural experiment to quantify the degree to which Medicare Advantage (MA) plans with higher star ratings provide better care. Enrollees in an MA plan with one more star were 3.4 percent more likely to use a higher-rated hospital and 2.6 percent less likely to be readmitted within ninety days of discharge.Peter Smulowitz and coauthors describe physician-level variation in emergency department admission rates for Medicare fee-for-service patients. Within-hospital admission rates range from 32.2 to 45.6 percent for physicians at the tenth and ninetieth percentiles, leading the authors to conclude that there is “substantial variation in rates of admissions among physicians at the same hospital that is not related to observable patient characteristics.”Fabian Duarte and coauthors show that the reduction in the rate of uninsurance among adults ages 60–64 due to the Affordable Care Act greatly increased rates of cancer detection for this population. Fifty-nine additional incidents of cancer were detected per 100,000 people, and 68 percent of these were early- and middle-stage cancers—and thus more likely treatable.EquityAll-cause mortality rates increased dramatically in 2020 because of coronavirus disease 2019 (COVID-19). Maria Polyakova and coauthors show that excess mortality in April 2020 was much higher for Blacks than for Whites and that racial and ethnic disparities varied significantly by state.Rishi Wadhera and coauthors analyze all-cause mortality rates for rural and urban Medicare beneficiaries dually enrolled in Medicaid from 2004 to 2017. Although all-cause mortality declined for both groups across the study period, rates were higher among rural beneficiaries (92.8 per 1,000) than among their urban counterparts (75.1 per 1,000).Lisa Iezzoni and coauthors surveyed US physicians about their perceptions of care for people with disability. Only 40.7 percent of respondents were “very confident” they could “provide the same quality of care” to patients with disability as to patients without disability.This month, Health Affairs launches our own equity initiative. Please keep an eye out for more information on the Health Affairs Blog.Access To CareIn 2012 the South Carolina Medicaid program began paying for long-acting reversible contraceptive (LARC) separately from the global maternity payment. Maria Steenland and coauthors find that this increased immediate postpartum LARC use among adolescents by 0.19 percentage points per month.Johanna Catherine Maclean and coauthors find that Medicaid acceptance by residential substance use disorder treatment facilities increased in states that received Institutions for Mental Diseases waivers by 19 percent in the first year and 34 percent in the second year.Tamara Beetham and coauthors audited 368 residential addiction treatment programs in the US. They find that 65 percent of for-profit programs use one or more aggressive recruitment techniques compared with only 9 percent of nonprofit programs.Steven Chen and coauthors analyze commercial health insurance claims in 2017 and find that “nearly 40 percent of commercially insured people incurred half of their annual out-of-pocket spending in just one encounter, and 26 percent incurred 90 percent of their annual out-of-pocket spending in only one or two encounters.”AcknowledgmentsHealth Affairs thanks the Gordon and Betty Moore Foundation, The John A. Hartford Foundation, the National Academy of Medicine, and the Robert Wood Johnson Foundation for their financial support of publication of the Vital Directions articles in this issue. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 February 2021 Information© 2021 Project HOPE—The People-to-People Health Foundation, Inc.PDF download