Maternal involvement with Child Protective Services (CPS) is common around childbirth, particularly for women with economic and health challenges. Federal and state policies aim to improve health care access and use for CPS-involved families, but evidence is needed to understand how CPS contact relates to health care for new mothers. We used linked population-based administrative data, representing all Medicaid-covered births in Wisconsin during the period 2010-19, to produce estimates of the associations of CPS interventions with maternal receipt of postpartum health care. After we adjusted for factors influencing risk for CPS involvement, women whose births were brought to the attention of CPS were around 13 percentage points less likely to receive postpartum care within twelve weeks after delivery, and this relation was present across different levels of CPS intervention and key population subgroups. These findings highlight the need to consider how child welfare and health care policies and practices can support connections with health care for new mothers and their infants.

Uncertainties about the benefits and harms of new drugs are common at the time of drugs' approval. It is unclear to what extent the Food and Drug Administration (FDA) communicates these uncertainties in the FDA-approved prescribing information (the drug label), which is the primary channel of communication between the FDA and physicians. Although physicians might not regularly consult the drug label for prescribing decisions, other information sources used by physicians either index or incorporate information from the label. We searched FDA review documents for uncertainties identified by FDA reviewers with new cancer drugs. We considered the subset of uncertainties highlighted in the FDA's Benefit-Risk Framework as important to the FDA's approval decision. During the period 2019-22, the FDA approved fifty-two new cancer drugs. In review documents, FDA reviewers identified a total of 213 clinical trial uncertainties with new cancer drugs, 50 percent of which were considered to be important uncertainties to the FDA's approval decision. Labels for physicians reported information on 26 percent of all uncertainties and 48 percent of uncertainties that were important to the FDA's approval decision. Communicating uncertainties about the evidence of drugs in the label is essential for informing physicians about drugs' safe and effective use.

There has been a significant shift in the composition of the Medicaid managed care market over the course of the past two decades. The market is consolidated among five national firms, and those firms have nearly half of all beneficiaries enrolled in managed care plans. State markets are even more consolidated, typically giving Medicaid beneficiaries only a few plan options. This article describes the Medicaid managed care market during the period 2006-20, using enrollment data and a novel data set on acquisitions. Our study found a marked decrease in the number of parent payers (unique firms that own at least one Medicaid managed care plan), despite an increase in total enrollment, as well as a high volume of acquisitions. In fact, approximately one in four plans were involved in at least one acquisition during the study period. National payers are playing an increasingly dominant role in Medicaid managed care, with both the number and the market share of local payers decreasing during the study period. Future research is needed to understand the consequences of these shifts for the level of competition in this market, state finances, and beneficiary health.

The voluntary Pennsylvania Rural Health Model (PARHM) provided participating rural hospitals with global budgets rather than traditional fee-for-service payments to improve financial stability. Whether participation in PARHM was associated with financial improvements is unknown. In this synthetic difference-in-differences study from the period 2014-23, we estimated changes in rural hospital finances associated with PARHM participation among seventeen PARHM participants and forty nonparticipating Pennsylvania comparison hospitals. In unadjusted models, participation was associated with a 4.5-percentage-point differential increase in operating margins and a 4.7-percentage-point differential increase in total margins; however, these changes were nonsignificant in adjusted models (3.0 and 3.2 percentage points, respectively). Results were similar when we compared PARHM participants with 160 border-state comparison hospitals and when we used alternative difference-in-differences estimators. These findings offer mixed evidence that global budgets may help stabilize rural hospital finances in the short term.

Through his drive and vision, John built <i>Health Affairs</i> into the world's leading publication on health policy.

Utilization management criteria influence patients' access to specialty drugs, yet the processes used by health plans to establish these criteria are not well understood. This study examined the alignment between clinical practice guidelines and plans' utilization management criteria. Using the Tufts Medicine Specialty Drug Evidence and Coverage Database (December 2023), we reviewed US-based guidelines for 389 drug-indication pairs, excluding oncology and biosimilar treatments. We categorized guidelines as recommending or not recommending utilization management, based on alignment with each drug's Food and Drug Administration label-specifically, line of therapy and clinical requirements (for example, disease severity). We analyzed 5,699 coverage policies from eighteen large commercial health plans. When guidelines recommended utilization management, 67 percent of plans' coverage decisions aligned with the recommendation; when guidelines did not recommend utilization management, only 37 percent of decisions were consistent. Most plans imposed utilization management criteria (61 percent of all decisions), and plans were more likely to be consistent with guideline recommendations when utilization management was recommended, indicating a weak alignment with guideline recommendations.

An emergency medicine physician at a rural hospital can neither treat nor transfer a patient who is in multiple organ failure.