Managed Care Updates

Trends in Outpatient Care Delivery and Telemedicine During the COVID-19 Pandemic in the US

Research Letter, JAMA Intern Med The coronavirus disease 2019 (COVID-19) pandemic has dramatically altered patterns of health care delivery in the US. In the context of declining in-person outpatient visits, many clinicians began using telemedicine for the first time, spurred in part by regulatory changes that expanded public and private insurer reimbursement for a wider range of telemedicine services. To understand how telemedicine compensated for declining outpatient volume and geographic variation in changing patterns of outpatient care, we examined telemedicine and in-person outpatient visits in 2020 among a national sample of 16.7 million individuals with commercial or Medicare Advantage insurance. Read more at https://jamanetwork.com/journals/ jamainternalmedicine/fullarticle/2773059

Saving Medicare for Baby Boomers and Beyond—A Looming Fiscal Crisis

Editor’s Comment, JAMA Health Forum The fiscal future of Medicare is an unavoidable challenge for the US federal government. The Medicare trustees’ annual report to Congress in April 2020 projected that the Medicare Hospital Insurance Trust Fund will become insolvent in 2026, when revenues will cover only 90% of expected Part A expenditures. Financed primarily through Medicare payroll taxes on working adults (nearly 90% of revenue) and income taxes on Social Security benefits of retired adults (approximately 8% of revenue), this trust fund covers Part A benefits for Medicare beneficiaries receiving hospital, skilled nursing, home health, and hospice care. Read more at https://jamanetwork.com/channels/health-forum/fullarticle/2773054

Cost Minimization Analysis of a Teledermatology Triage System in a Managed Care Setting

JN Learning, JAMA Dermatology Interview with Erin Amerson, MD, author of Cost Minimization Analysis of a Teledermatology Triage System in a Managed Care Setting. Listen here https://edhub.ama-assn.org/jn-learning/ audio-player/18561081

Association of Race, Health Insurance Status, and Household Income With Location and Outcomes of Ambulatory Surgery Among Adult Patients in 2 US States

Original Investigation, JAMA Surgery In this cohort study of 13 million patients who received ambulatory surgery in New York and Florida between 2011 and 2013, the likelihood of receiving surgery at a freestanding ambulatory surgery center compared with a hospital-based outpatient department was significantly lower among patients who were Black, had public health insurance, and resided in rural areas. Read more at https:// jamanetwork.com/journals/jamasurgery/article-abstract/2770165

Unemployment Insurance, Health-Related Social Needs, Health Care Access, and Mental Health During the COVID-19 Pandemic

Research Letter, JAMA Internal Medicine More than 30 million jobs have been lost during the coronavirus disease 2019 (COVID-19) pandemic. Unemployment insurance (UI) was temporarily expanded by the Coronavirus Aid, Relief, and Economic Security (CARES) Act, but further reform is under debate. Key CARES Act provisions were adding $600 weekly federal payments to state payments (Federal Pandemic Unemployment Compensation), longer benefit duration (Pandemic Emergency Unemployment Compensation), and broadened eligibility for minimum-wage, self-employed, contract, and gig workers (Pandemic Unemployment Assistance). Read more at https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2773234

Catastrophic Health Expenditures Across Insurance Types and Incomes Before and After the Patient Protection and Affordable Care Act

Research Letter, JAMA Network Open One decade after passage of the Patient Protection and Affordable Care Act (ACA), despite substantial gains in insurance coverage, health care affordability remains a major concern among US residents. Premiums are increasingly unaffordable, and underinsurance—incomplete financial protection despite coverage—is increasingly common. Although previous research has shown that the ACA’s Medicaid expansions decreased out-of-pocket spending among low-income adults, broader trends in outof-pocket spending have not been well characterized. We thus sought to analyze changes in financial risk protection associated with ACA implementation across all income strata and insurance types. Read more at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770949

The Uncertain Future of Children’s Health Insurance: New and Ongoing Threats

Viewpoint, JAMA Pediatrics Children’s health in the United States has largely been a success story. Since the adoption of the Children’s Health Insurance Program (CHIP) in 1997, the rate of uninsured children has decreased from 25% to less than 6% nationally. Improvements to children’s access to health insurance have been further supported by the Affordable Care Act (ACA) and Medicaid expansion. Yet, these successes conceal new and ongoing threats to the future of children’s health. The number of uninsured children has increased since 2016, with more than 4 million children uninsured. Partisan conflict, misaligned policies, and persistent racial and ethnic disparities threaten the future of children’s health. The 2020 election represents a potential turning point for strengthening or further crippling children’s access to health care. Read more at https://jamanetwork. com/journals/jamapediatrics/article-abstract/2769781

ACA Marketplaces Gain More Insurers for Third Year in a Row, Offering Consumers More Options

In the News, JAMA Health Forum US consumers buying their own health insurance for 2021 have more options to choose from as the number of companies participating in the Patient Protection and Affordable Care Act (ACA) insurance exchanges increased for the third year in a row, according to a new analysis from the Kaiser Family Foundation (KFF). The KFF researchers found that during the enrollment period now underway for 2021, 30 insurers are entering the ACA marketplaces across 20 states, and 61 insurers are expanding within states they already serve. Read more at https://jamanetwork.com/channels/health-forum/fullarticle/2773769