Private Plans Research Articles

Seasonal surges and tumbles: Analyzing part D expenditure fluctuations in the Oncology Care Model.

39 Background: Medicare Part D (PD) provides prescription drug coverage through government-contracted private plans. It includes deductible, initial coverage, coverage gap, and catastrophic coverage (CC) phases. During the study period, Medicare reinsured 80% of drug costs above the out-of-pocket threshold (OOPT) in the CC, while also subsidizing costs for low-income beneficiaries with the Low-Income Cost Subsidy (LICS) in other phases. The Oncology Care Model (OCM), Medicare's value-based care model, considers reinsurance payments and LICS for PD drugs when benchmarking and evaluating performance. Methods: Using PD prescription data for 15 practices in The US Oncology Network, we obtained the gross drug costs below (GDCB) and above (GDCA) the OOPT, and LICS for prescriptions over a 6-year period (July 2016 – June 2022). We then evaluated the trends and patterns of per episode Part D expenditures (PEPDE) and LICS. Results: The analysis of 5.12M prescriptions for 99,623 patients revealed that episodes initiating in February and March had the highest PEPDE. However, per episode benchmark prices (PEBP) remained steady throughout. The seasonal variation in PEPDE was due to the PD plan design, with episodes crossing plan years (in January) having the lowest PEPDE. Consequently, performance periods (PP) starting with the calendar year had 15% higher PEPDE. Only 18% of patients received the LICS benefit, with 25% of payments occurring in January, coinciding with the entry of patients into CC. Conclusions: The design of PD plans creates seasonal patterns in PEPDE within models like OCM. Episodes with similar treatment patterns and beneficiary profiles can have different costs based on the start date, but a similar PEBP, leading to inconsistent performance outcomes. To ensure fair evaluation, a risk adjustment method that considers seasonality in the prediction model or balances fluctuations in expenses is needed. The impact of PD changes with the Inflation Reduction Act remains unexplored. Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Measure Month of Episode Initiation PEBP $47.8K $46.7K $47.8K $46.7K $46.3K $46.5K $47.4K $46.4K $47.2K $46.3K $46.7K $46.2K PEPDE $28.2K $31.2K $31.0K $29.2K $28.4K $27.7K $26.3K $26.2K $25.7K $25.1K $23.9K $24.0K Prescription Status % of Dispenses by Month of Dispense GDCB 90.7% 83.2% 80.5% 78.2% 76.2% 74.7% 72.7% 71.1% 69.7% 68.3% 66.8% 65.2% GDCA 9.3% 16.8% 19.4% 21.8% 23.8% 25.3% 27.3% 28.9% 30.3% 31.7% 33.2% 34.8% % of patients entering CC 12.5% 8.9% 8.0% 7.9% 8.0% 7.8% 8.7% 8.8% 8.7% 9.0% 8.8% 8.8% PP 1 2 3 4 5 6 7 8 9 10 11 PEPDE by PP $18.7K $21.8K $21.9K $25.9K $23.5K $28.9K $26.6K $34.2K $30.3K $37.2K $32.9K

On the possibility of the existence of an additional “dead” zone, which should be taken into account in the private planning of shortwave radio stations

On the possibility of the existence of an additional “dead” zone, which should be taken into account in the private planning of shortwave radio stations

Cancer information and population health resource: a resource for catchment area data and cancer outcomes research.

The University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center has developed a novel data resource, the Cancer Information and Population Health Resource (CIPHR), for conducting catchment area evaluation and cancer population health research that links the North Carolina Central Cancer Registry (NCCCR) to medical and pharmacy claims data from Medicare, Medicaid, and private plans operating within North Carolina. This study's aim was to describe the CIPHR data and provide examples of potential cohorts available in those data. We present the underlying populations included in the NCCCR and claims data before linkage and demonstrate estimated sample sizes when these data are linked and commonly used insurance enrollment criteria are applied. Data for the years 2003-2020 are present in CIPHR and include 947 977 cancer cases from the NCCCR and 21.6 million enrollees in public and private health insurance (cancer and noncancer cases). When limited to first or only cancers (n = 672 377), 86% could be linked to insurance enrollment for at least 1 month during 2003-2020 (n = 582 638), with 62% of individuals linking to enrollment during the month of cancer diagnosis. Among all registry cancer cases, 47% (n = 317 898) had continuous insurance enrollment for at least 12 months before and after cancer diagnosis. CIPHR illustrates the utility of establishing and maintaining a statewide, comprehensive cancer population health database. This resource serves to characterize the cancer center catchment area and aids in tracking cancer outcomes and trends in care delivery as well as identifying disparities that require intervention and policy focus.

Determinants of Neonatal and Postneonatal Mortality in Northeastern Brazil: A Cohort Study of Newborns Admitted to the Neonatal Intensive Care Unit.

Despite advances in neonatology, neonatal mortality from preventable causes remains high in the North and Northeast regions of Brazil. This study aimed to analyze the determinants associated with neonatal and postneonatal mortality in newborns admitted to a neonatal intensive care unit. A cohort study was carried out in a capital in the Brazilian Northeast from 2013 to 2018. The outcome studied was death. Poisson regression was performed in the multivariate analysis of variables. Four hundred and eighty newborns were eligible, and 8.1% (39 newborns) died. Among them, 34 died in the neonatal period. The determinants that remained significantly associated with neonatal and postneonatal mortality in the final adjustment model (p < 0.05) were history of abortion, perinatal asphyxia, early neonatal sepsis and umbilical venous catheterization. All causes of this outcome were preventable. The neonatal mortality rate, although it did not include twins, neonates with malformations incompatible with life and other conditions, was 3.47 deaths per thousand live births (95% CI:1.10-8.03‱), well below the national average. In this study, pregnant women from different social classes had in common a private plan for direct access to health services, which provided them with excellent care throughout pregnancy and postnatal care. These results indicate that reducing neonatal mortality is possible through public policies with strategies that promote improvements in access to health services.

Adverse selection and network design under regulated plan prices: Evidence from Medicaid

Health plans for the poor increasingly limit access to specialty hospitals. We investigate the role of adverse selection in generating this equilibrium among private plans in Medicaid. Studying a network change, we find that covering a top cancer hospital causes severe adverse selection, increasing demand for a plan by 50% among enrollees with cancer versus no impact for others. Medicaid’s fixed insurer payments make offsetting this selection, and the contract distortions it induces, challenging, requiring either infeasibly high payment rates or near-perfect risk adjustment. By contrast, a small explicit bonus for covering the hospital is sufficient to make coverage profitable.

Out-of-Pocket Expenditure for Selected Surgeries in the Cardiology Department for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Private Health Insurance, and Uninsured Patients in a Tertiary Care Teaching Hospital in Karnataka, India.

Cardiovascular diseases are a major public health issue and the leading cause of mortality globally. The global economic burden of out-of-pocket expenditure (OOPE) for cardiovascular surgeries and procedures is substantial, with average costs being significantly higher than other treatments. This imposes a heavy economic burden. Government insurance schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to enhance affordability and access to cardiac care. This retrospective study analyzed OOPE incurred for top cardiac surgeries under AB-PMJAY, private insurance, and uninsured patients at a tertiary care teaching hospital in Karnataka. Data of 1021 patients undergoing common cardiac procedures from January to July 2023 were analyzed using descriptive statistics (mean, median) and the Shapiro-Wilk test for normality. The study aims to evaluate financial risk protection offered by AB-PMJAY compared to private plans and inform effective policy-making in reducing the OOPE burden for surgeries in India. The study analyzed OOPE across 1021 patients undergoing any of four surgeries at a tertiary care teaching hospital in Karnataka. AB-PMJAY patients incurred zero OOPE across all surgeries. Uninsured patients faced the highest median OOPE, ranging from ₹1,15,292 (1390.57 USD) to ₹1,72,490 (2080.45 USD) depending on surgery type. Despite the presence of private insurance, the median out-of-pocket expenditure ranged from ₹1,689 (20.38 USD) to ₹68,788 (829.67 USD). Significant variations in OOPE were observed within different payment groups. Private insurance in comparison with AB-PMJAY had limitations like co-payments, deductibles, and limited coverage resulting in higher OOPE for patients. The results illustrate the efficacy of AB-PMJAY in reducing the financial burden and improving the affordability of cardiac procedures compared to private insurance. This emphasizes the significance of programmmes funded by the government in reducing the OOPE burden and ensuring equitable healthcare access. The comprehensive and particular estimates of OOPE for different surgical procedures, categorized by payment methods provide valuable information to guide the development of policies that aim to reduce OOPE and progress towarduniversal health coverage in India.

China's mixed-ownership reform and SOE profitability

The mixed-ownership reform has been the mainstream for the SOE reform in China, but rarely is known whether this reform can improve the overall profitability of SOEs. Therefore, this paper would like to fill this literature gap by testing the impact of China's ongoing mixed-ownership reform on SOEs profitability.This reform encourages private capital to purchase shares of SOEs, so it can be regarded as a privatization plan for SOEs. Using the Difference-in-Differences (DiD) approach, we treat SOEs undergoing the reform as the treatment group and those not undergoing the reform as the control group. Our results indicate that the reform significantly increases the profitability of reformed SOEs. Mechanism analysis suggests that the reform enhances SOE profitability by reducing redundant workers, administrative fees, and related-party transactions. We also find that the effects of the reform are heterogeneous, with greater impacts observed among SOEs in unregulated industries, local SOEs, and SOEs in areas with low marketization. Overall, our research enriches the literature on privatization and mixed-ownership reform, and also provides empirical evidence to promote mixed-ownership reform.

Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity

BackgroundIn ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce.ObjectiveThis study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians.MethodsA national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software.ResultsThe majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health.ConclusionOur findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.

Implementation of recommended treatment for children in weight management programs: Lessons from the stay in treatment study sites

ObjectivesPediatric obesity remains a public health crisis in the United States, exacerbated by the COVID-19 pandemic. There are recommended guidelines for multidisciplinary care, but they remain challenging to implement, even in tertiary care weight management programs. The aim of this analysis is to describe the implementation of these recommendations among four pediatric weight management programs in the United States. MethodsThis report capitalizes on a convenience sample of programs participating in the Stay In Treatment (SIT) Study, a multicenter study to address attrition among pediatric weight management programs in tertiary care, academic institutions in diverse geographic locations. The programs were compared regarding structure, program offerings, and funding support. ResultsThe four programs were interdisciplinary, offered individual and group treatment options, and were family-based. A range of clinicians provided interventions with nutrition, physical activity, behavioral and psychosocial components. Anti-obesity pharmacotherapy and bariatric surgery were offered, when appropriate. None of the programs were self-sustaining; they required institutional and philanthropic support to provide recommended, comprehensive treatment. ConclusionsOngoing state and national advocacy are needed in the US to create consistent coverage for private and public insurance plans, so that high-risk children can have access to recommended treatment.

Comparative effectiveness of sacubitril/valsartan versus angiotensin receptor blockers in patients with heart failure with preserved ejection fraction: A real-world study.

Sacubitril/valsartan (SAC/VAL) or angiotensin receptor blockers (ARBs) are recommended therapy for heart failure with preserved ejection fraction (HFpEF), but little is known about their real-world comparative effectiveness among patients with HFpEF. The objective of this study was to determine the comparative effectiveness of SAC/VAL vs ARBs in preventing HF-related hospitalization or all-cause hospitalization among patients with HFpEF. We conducted a cohort study using IBM MarketScan commercial and Medicare supplemental databases to identify patients aged 18 years or older with a diagnosis of HFpEF and initiation of SAC/VAL (2015-2020) or ARB (2009-2014) therapy. The index date was the date of the first SAC/VAL or ARB prescription fill. After propensity score (PS) matching with a ratio of 1 up to 3, Cox proportional hazards regression was used with robust variance estimators to compare the risks of HF-related hospitalization and all-cause hospitalization between the 2 therapies. Several subgroup and sensitivity analyses were conducted to check the robustness of the main analysis. After PS matching, 2,520 patients (846 receiving SAC/VAL and 1,674 receiving an ARB) were included in the final analyses. After controlling for covariates, there was no difference in the risk of HF-related hospitalization between SAC/VAL and ARB recipients (adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 0.99-1.77). There was also no difference in the risk of all-cause hospitalization between SAC/VAL and ARB recipients (aHR, 1.06; 95% CI, 0.91-1.24). Among individuals with private or Medicare Advantage insurance plans, there was no significant difference in the risk of HF-related hospitalization or all-cause hospitalization between adults with HFpEF who received SAC/VAL and those who received ARB therapy.

The financialization of healthcare

In contemporary capitalism, finance has extended its reach to encompass a growing array of economic sectors traditionally associated with public provisioning or social policy, with healthcare emerging as a prominent domain where fictitious capital has flourished. Financialization exerts a direct influence on the delivery of public health services while also reshaping the behavior and operations of private healthcare providers and health insurance firms. This paper aims to characterize the process of financialization of healthcare in Brazil by analyzing the behavior of firms in the private health insurance market from 2007 to 2019. These firms provide healthcare coverage alongside the functioning of the Unified Health System (SUS), constituting an avenue for the accumulation of capital. The paper analyzes how the strategies for managing assets, liabilities, and the equity of leader firms operating in the market of private healthcare plans firms, as expressed by the movements recorded in their balance sheets, inform us on their process of financialization. A set of financialization indexes is developed, addressing: (i) asset financialization; (ii) liability financialization; and (iii) the maximization of shareholder value. Economic-financial data and financial statements made available by the Brazilian Regulatory Agency for Private Health Insurance (ANS) are used to build such indexes. The results show a greater engagement of leader firms in the allocation of their resources in financial assets, but the weight of financial gains in total profits is small. Regarding indebtedness, results do not show an increase in leverage and financial burden, and does not confirm the hypothesis of increased susceptibility to creditor influence. Finally, changes in the equity structure and initial public offerings suggest a greater alignment of management practices with the standards of corporate governance established in capital markets. We conclude that those firms are increasingly serving as platforms for the financial accumulation of other economic agents and set a research agenda on this topic.

The evolution of Kenya's animal health surveillance system and its potential for efficient detection of zoonoses.

Animal health surveillance systems in Kenya have undergone significant changes and faced various challenges throughout the years. In this article, we present a comprehensive overview of the Kenya animal health surveillance system (1944 to 2024), based on a review of archived documents, a scoping literature review, and an examination of past surveillance assessments and evaluation reports. The review of archived documents revealed key historical events that have shaped the surveillance system. These include the establishment of the Directorate of Veterinary Services in 1895, advancements in livestock farming, the implementation of mandatory disease control interventions in 1944, the growth of veterinary services from a section to a ministry in 1954, the disruption caused by the Mau Mau insurrection from 1952 to 1954, which led to the temporary halt of agriculture in certain regions until 1955, the transition of veterinary clinical services from public to private, and the progressive privatization plan for veterinary services starting in 1976. Additionally, we highlight the development of electronic surveillance from 2003 to 2024. The scoping literature review, assessments and evaluation reports uncovered several strengths and weaknesses of the surveillance system. Among the strengths are a robust legislative framework, the adoption of technology in surveillance practices, the existence of a formal intersectoral coordination platform, the implementation of syndromic, sentinel, and community-based surveillance methods, and the presence of a feedback mechanism. On the other hand, the system's weaknesses include the inadequate implementation of strategies and enforcement of laws, the lack of standard case definitions for priority diseases, underutilization of laboratory services, the absence of formal mechanisms for data sharing across sectors, insufficient resources for surveillance and response, limited integration of surveillance and laboratory systems, inadequate involvement of private actors and communities in disease surveillance, and the absence of a direct supervisory role between the national and county veterinary services. To establish an effective early warning system, we propose the integration of surveillance systems and the establishment of formal data sharing mechanisms. Furthermore, we recommend enhancing technological advancements and adopting artificial intelligence in surveillance practices, as well as implementing risk-based surveillance to optimize the allocation of surveillance resources.

სახელმწიფოს როლი ტურისტული ბიზნესის განვითარებაში

Tourism business in Georgia is a means of stimulating the country's economy, it creates additional jobs, develops small businesses, is an important source of income for other business sectors, promotes the sale of products produced and imported in the country, and therefore, as in other countries, this sector is an important source of state income in Georgia. According to the information spread by the National Tourism Administration, in 2022, Georgia received 3.5 billion dollars in income from international travel. According to their own statement, the income received from travel in 2022 exceeded the figure of 2019 and showed a record figure of 3,516,634,479 USD, which is a recovery of the similar figure of 2019 by 107.6%. According to the data of the National Statistical Service of Georgia, in 2022, 5.4 million international non-residents travelled to Georgia, which is 2.9 times higher than the previous year. Most of the visits were made in Tbilisi at the regional level, 57.2%, followed by Adjara with 45.1% and Mtskheta-Mtianeti with 19%. From the rest of the regions, the most visits were made to Kvemo Kartli 7.9%, Samtskhe-Javakheti 7.7%, Imereti 7.5% and Kakheti 5.8%. In Georgia, in order to develop the tourism business during the pandemic and post pandemic period, it was necessary for the state to develop a systematic approach. It is worth noting that the government has shown some support in this direction and carried out the postponement of loans taken by individuals and legal entities, exempting a number of companies from taxes and establishing certain benefits, etc. The National Tourism Administration, in its turn, implemented the following activities: support of the private sector and trainings in the direction of adaptation of operations, communication with private sectors, recommendations and planning of future actions, deepening of international cooperation. The project "Work from Georgia" of the National Tourism Administration made a great contribution to the development of tourism, which meant hosting highly paid citizens of foreign countries who wish to work remotely in Georgia. This project contributed to the entry of more affluent tourists to Georgia, and what is very important, it increased the statistical stay period of travelers in Georgia compared to previous years. Tourism, like other economic sectors, needs the establishment of appropriate state policies and state support, both at the local, regional and national levels, for stable development. The development of tourism business in Georgia and the growth of incomes from this field were caused by the recognition of tourism as a priority area of the country's economy. For a country that actually has tourism potential and possesses certain competitive advantages, tourism should be one of the main pillars and priority areas of the country's development strategy. Our country really has this potential, and with the support of the state, the tourism business will become more competitive throughout the region. Conclusions 1. The state should make the population more informed about the existence of state programs promoting tourism business, so that interested people can get involved in it if they wish. 2. The state should actively take care of the arrangement of destinations and infrastructure. 3. The more the demand of foreign tourists based on the increased tourist flows will be satisfied with local products, the more stimulating it will be for the economy of our country. 4. Involvement of the state in the development of tourism business is undoubtedly necessary. 5. The development of tourism business can make a significant contribution to the solution of the country's unemployment problem and the stability of the exchange rate of the lari.

Use of New Audio-Only Telemedicine Claim Modifiers

Policymakers at both the state and federal levels face decisions about coverage of audio-only telemedicine amid a dearth of reliable data due to changes and variation in billing practices. To describe early trends in the use of new audio-only telemedicine claims modifiers 93 and FQ in Washington State, which were introduced to improve the designation and identification of audio-only telemedicine claims. This retrospective cohort study analyzed claims data from the Washington All-Payer Claims Database from January to November 2022. Participants included 4.3 million children and adults insured for at least 6 months in 2021 through public or private insurance plans. Use of audio-only telemedicine was compared by age, race, ethnicity, insurance type, rurality, and Social Vulnerability Index. Audio-only telemedicine services were identified by claims appended by Current Procedural Terminology (CPT) code modifiers 93 or FQ or that included telephone-only CPT codes. Modifiers 93 and FQ denote audio-only telemedicine services for any reason and for behavioral health concerns, respectively. In 2022, there were a total of 917 589 audio-only telemedicine services, of which 345 941 (38%) were appended with modifier FQ and 55 352 (6%) with modifier 93. Audio-only telemedicine services with these modifiers were most frequent for behavioral health diagnoses or routine prenatal and postpartum care. Individuals who used telemedicine exclusively via audio-only modality were more likely to be older (mean [SD] age, 46.0 [22.5] vs 42.0 [21.4] years) and insured by Medicare (41 758 of 196 225 [21%] vs 95 962 of 707 626 [14%]) than those who used at least 1 audiovisual service. In this cohort study of a statewide all-payer claims database, modifiers 93 and FQ offered the important capability to identify audio-only telemedicine services beyond telephone-only CPT codes, but their uptake remained low. Audio-only telemedicine appears to offer an important means for access to behavioral health and perinatal care access, but further work is needed to study outcomes and quality of care.

Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in Traditional Medicare and Medicare Advantage

AbstractBackgroundApproximately half of Medicare beneficiaries are enrolled in Medicare Advantage (MA) ‐ a private plan alternative to Traditional Medicare (TM). Yet little is known about diagnosed dementia rates among Medicare Advantage enrollees, limiting population estimates.Methods100% claims of Medicare beneficiaries using Encounter data for MA and claims for TM were used to quantify diagnosed dementia prevalence and incidence rates in MA, compare rates to TM, and provide estimates for the entire Medicare population and for different racial/ethnic populations.ResultDementia incidence and prevalence among MA beneficiaries was 2.54% (95%CI 2.53‐2.55) and 7.04% (95%CI 7.03‐7.06). Comparison to TM adjusted for sociodemographic and health differences among beneficiaries in MA and TM; the prevalence of diagnosed dementia among beneficiaries in MA was lower (7.1%; 95%CI 7.12‐7.13) than in TM (8.7%; 95%CI 8.71‐8.72). Diagnosed dementia incidence rate was also lower in MA (2.50%; 95%CI 2.50‐2.50) compared to TM (2.99%; 95%CI 2.99‐2.99). There were lower rates in MA compared to TM for men and women and White, Black, Hispanic, Asian, American Indian/Alaska Native persons. Diagnosed dementia prevalence and incidence for the entire Medicare population was 7.9% (95%CI: 7.91‐7.93) and 2.8% (95%CI: 2.77‐2.78).ConclusionLower diagnosed dementia rates in MA compared to TM may exacerbate racial/ethnic disparities in diagnosed dementia. Rates tracked over time will provide understanding of impact on dementia diagnosis of 2020 MA risk adjustment for dementia.

5 Poorer Memory Outcomes are Observed in Underinsured Latino Older Adults with Metabolic Syndrome

Objective:Metabolic Syndrome (MetS) is a constellation of deleterious cardiometabolic health conditions (e.g., diabetes, hypertension) that have been linked to cognitive impairment and accelerated cognitive decline in older adults. Research has shown that Latinos are at increased risk for developing MetS relative to non-Latino Whites and the prevention, maintenance, and treatment of cardiometabolic risk factors are largely contingent upon health insurance status. Within the United States there are considerable state-based differences in eligibility and access to health insurance coverage. Although Texas has the second largest population of Latinos, they are one of the most underinsured groups within the state. There is some evidence to suggest that inconsistent healthcare is associated with cognitive impairment among underserved/underprivileged groups. The current study sought to examine whether insurance status moderates the association between MetS and cognitive functioning in an effort to inform public health policy initiatives vital to reducing age-related health disparities amongst Latino older adults residing in Texas.Participants and Methods:The study sample included 850 primarily Spanish-speaking (67.6%) Latino older adults (mean age = 63.1±7.81) largely of Mexican origin/descent (95%) enrolled in the Health and Aging Brain Study-Health Disparities. All participants completed neuropsychological testing, a health exam, and questions about health insurance coverage. MetS status (MetS+ vs. MetS-) was determined by abnormal clinical abdominal obesity, triglycerides, high-density lipoprotein, blood pressure, and fasting glucose values. Health insurance status was determined by current enrollment in any private or public insurance plan. Cognition was assessed with Digit Span, Logical Memory I and II, Trail Making Test (A and B), Spanish-English Verbal Learning Test, and Letter Fluency (FAS). Raw scores were converted to z-scores which were subsequently averaged into two distinct memory and executive functioning composite scores. ANCOVAs controlling for age, sex, education, APOE e4 positivity, annual income, and primary language status were used examine health insurance status x MetS interactions on cognitive composites.Results:Approximately 54.6% of the sample met clinical criteria for MetS+ and 23.6% endorsed having no health insurance. There were no significant group differences in the proportion of MetS+ and MetS- individuals with and without health insurance (X 2 = .002, p =.96). Results revealed there was a significant MetS x health insurance status interaction on the memory composite (F = 5.39, p = .02). Post-hoc comparisons revealed that Latino older adults without health insurance demonstrated poorer memory performance relative to those with health insurance in the MetS+ group (p=.02). In contrast, there were no significant differences in memory performance across insurance status in the MetS- group (p=.35). Finally, there was no significant MetS x health insurance interaction on executive functioning (p=.60).Conclusions:Findings revealed that health insurance coverage differentially impacts memory, but not executive functioning, amongst Latinos with MetS+. Underinsured Latinos with chronic cardiometabolic health conditions may be at risk for poor memory outcomes and increasing access to affordable healthcare could help mitigate the adverse effects of MetS+ on memory. Future studies examining the relationship between health insurance, MetS status, and neuroimaging markers may yield additional insight into mechanisms underlying age-related dementia disparities.

Accessibility to Obstetric Care in South Florida Based on Insurance: A Cross-Sectional Study.

Introduction Obstetrical research confirms that earlier onset prenatal care significantly improves pregnancy and birth outcomes. Initiating care in the second trimester or having less than 50% of recommended visits has been associated with an increased risk of prematurity, stillbirth, neonatal, and infant death. Studies have shown that women on public health insurance plans initiate prenatal care substantially later into pregnancy than those on private plans. The purpose of this study is to assess whether public health insurance limits Florida patients' access to obstetric care. Methods A cross-sectional study was conducted by collecting data on the four most populated zip codes for Medicaid in South Florida using HealthGrades.com. The following search parameters were used: "obstetric care", "four stars and up" and "10-mile distance". Each obstetrician was called three times to assess appointment availability for fictional nulliparous women at eight weeks of gestation requesting prenatal care. Accepted insurance types (Medicaid, Cigna, and United Health Group (UHG)), time to an appointment in business days, and self-pay rates were recorded. Practices with invalid contact information and retired obstetricians were excluded. Summary statistics, chi-squared analysis, and a two-way t-test were conducted for the primary outcome. Results Seventy-one out of 178 obstetricians were successfully contacted, of which 31 physicians accepted all three insurances, and 40 physicians did not accept at least one insurance. Of those, 97.2% acceptedUnitedHealthcare, 98.6% accepted Cigna, and 45.1% accepted Medicaid. There was a statistically significant difference when comparing acceptance rates between UHC and Medicaid as well as Cigna and Medicaid (p<0.001). There was no statistically significant difference in acceptance rates in the direct comparison of the two private insurances, Cigna and UnitedHealthcare (p=0.559). The average number of days until the next available appointment was 12.7 (SD= 7.2) for UnitedHealthcare, 20.0 (SD=6.7) for Cigna, and 17.0 (SD=8.6) for Medicaid. There was a statistically significant trend between the type of insurance and the time to the earliest appointment (p=0.002). Conclusion This study demonstrated patients enrolled in Medicaid in South Florida have significantly less access to prenatal care than those with private insurance. This evidence shows that decreased access to care from Medicaid plans can possibly increase the risk of adverse outcomes associated with inadequate prenatal care. This information should be considered by policymakers when considering future Medicaid expansion.

Tropical grasses adaptability as a sustainable tool for recovering degraded pastures and restricting soil loss: Use diagnosis and future scenarios

Pastures, exposed soil and weeds correspond to 47.96% of Espírito Santo state territory, and most of these areas present low or no economic returns, due to the advanced degradation stage. Aiming to mitigate such effects, this study aimed to propose the insertion of high productive potential tropical grasses (Brachiaria brizantha, Cynodon dactylon and Panicum maximum), based on edaphoclimatic zoning elaborated in accordance with productive seasonality, as a low cost alternative to soil loss restriction and degraded areas recovery. The study has been developed for Espírito Santo state, Brazil and the method application consisted in edaphoclimatic zoning elaboration for three tropical grasses. A current soil loss estimate of suitable areas for Brachiaria cultivation was carried out later. Data from the current scenario were confronted with a new soil loss estimate in an alternative future scenario, aiming to quantify the grass insertion benefits in these areas according to their aptitude classes. The largest suitable areas were obtained for Cynodon genus, followed by Panicum and Brachiaria. Currently, it is estimated, on average, soil losses of 4.4 ton. ha−1. year−1 in dry season and 12.6 ton. ha−1. year−1 in rainy season. Projections into an alternative future scenario indicate that tropical grasses adoption considering technical criteria can lead to great soil loss reductions, achieving final rates of 0.24 ton. ha−1. year−1 in dry season (−94.5%) and 0.94 ton. ha−1. year−1 in rainy season (−92.5%), reducing new pasture areas demand and, consequently, promoting remnant forest conservation. This study results present significant contributions aimed at technical support of governmental and private action plans that work to promote conservationist and sustainable agricultural practices.

Estimates of diagnosed dementia prevalence and incidence among diverse beneficiaries in traditional Medicare and Medicare Advantage.

Approximately half of Medicare beneficiaries are enrolled in Medicare Advantage (MA), a private plan alternative to traditional Medicare (TM). Yet little is known about diagnosed dementia rates among MA enrollees, limiting population estimates. All (100%) claims of Medicare beneficiaries using encounter data for MA and claims for TM for the years 2015 to 2018 were used to quantify diagnosed dementia prevalence and incidence rates in MA, compare rates to TM, and provide estimates for the entire Medicare population and for different racial/ethnic populations. In 2017, dementia incidence and prevalence among MA beneficiaries were 2.54% (95% confidence interval [CI]: 2.53 to 2.55) and 7.04% (95% CI: 7.03 to 7.06). Comparison to TM adjusted for sociodemographic and health differences among beneficiaries in MA and TM; the prevalence of diagnosed dementia among beneficiaries in MA was lower (7.1%; 95% CI: 7.12 to 7.13) than in TM (8.7%; 95% CI: 8.71 to 8.72). The diagnosed dementia incidence rate was also lower in MA (2.50%; 95% CI: 2.50 to 2.50) compared to TM (2.99%; 95% CI: 2.99 to 2.99). There were lower rates in MA compared to TM for men and women and White, Black, Hispanic, Asian, American Indian/Alaska Native persons. Diagnosed dementia prevalence and incidence for the entire Medicare population was 7.9% (95% CI: 7.91 to 7.93) and 2.8% (95% CI: 2.77 to 2.78). Lower diagnosed dementia rates in MA compared to TM may exacerbate racial/ethnic disparities in diagnosed dementia. Rates tracked over time will provide understanding of the impact on dementia diagnosis of 2020 MA risk adjustment for dementia.

Differential Insurance Plan Coverage and Surgeon Reimbursement of Pediatric Circumcision at an Urban, Midwestern Hospital

To explore private versus public pediatric circumcision insurance coverage and surgeon reimbursement. (1) A telephone survey about circumcision coverage (Current Procedural Terminology codes: 54150, 54161) was conducted in October 2021 with insurance plan representatives from the 12 plans that comprised ≥1% of institutional pediatric urology visits to compare plan characteristics and coverage details. (2) Circumcision billing data were collected at one pediatric hospital to assess surgeon reimbursement (insurance + patient payment) by plan type using bivariate statistics. Ten plans (5 private and 5 public) responded (83.3% response rate). All except one public plan covered newborn circumcision. For non-newborn circumcisions, most public plans (80%) had unrestricted coverage, whereas all private plans required medical necessity. Median reimbursement for newborn circumcision (CPT: 54150) was $484 for private and $78 for public plans, p <0.001 while median reimbursement for non-newborn circumcision (CPT: 54161) was $314 for private and $147 for public plans, p <0.001. Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys.