Medicare Advantage now covers twenty-eight million older adults, many of whom have mental health needs. Enrollees are often restricted to providers who participate in a plan’s network, which may present barrier care. We used novel data set linking network service areas, plans, and compare psychiatrist breadth—the percentage given area that considered “in network” for plan—across Advantage, Medicaid managed care, Affordable Care Act plan markets. found nearly two-thirds networks were narrow...

Factors contributing to racial and ethnic disparities in medication for opioid use disorder (MOUD) receipt during pregnancy are largely unknown. We quantified the contribution of individual, healthcare access quality, community factors racial-ethnic MOUD postpartum among Medicaid-enrolled pregnant women with (OUD).This retrospective cohort study used regression nonlinear decomposition examine how explain OUD who had a live birth from 2011 2017. The exposure was self-reported race ethnicity....

Objectives Overdose mortality has risen most rapidly among racial and ethnic minority groups while buprenorphine prescribing increased disproportionately in predominantly non-Hispanic White urban areas. To identify whether availability equitably meets the needs of diverse populations, we examined differential geographic areas with greater concentrations groups. Methods Using IQVIA longitudinal prescription data, OneKey Microsoft Bing Maps, calculated 2 outcome measures across continental...

This study aimed to measure the changes in rural hospital bypass for 11 common elective surgeries following implementation of Pennsylvania Rural Health Model (PARHM), a global budget payment model. We leveraged natural experiment arising from phase-in PHARM Pennsylvania. conducted comparative interrupted time series analysis assess bypass, comparing trends among patients service areas (HSAs) with PARHM-participating hospitals control HSAs eligible but not participating PARHM. Analyses...

The COVID-19 pandemic has created an urgent need to expand access substance use disorder (SUD) treatment through telehealth. A more permanent adoption of tele-SUD options could positively alter the future SUD treatment. We identify four steps that will help ensure a broader transition telehealth be successful in improving health outcomes patients with SUDs. These are: (1) investing infrastructure enable care providers and telehealth; (2) training equipping provide (3) providing financial...

The termination of cost-sharing reduction subsidy payments to insurers in 2017 by the administration President Donald Trump resulted a proliferation Marketplace plans having zero-dollar premiums 2018 and 2019. While it is known that lower increase enrollment, not clear whether zero-price effect exists which enrollment spikes when health insurance free. We examined such an found increased availability premium would have caused 14.1 percent among lower-income enrollees If had been available...

Abstract Objective The objective of this study is to identify disparities in geographic access medical oncologists at the time diagnosis. Data Sources/Study Setting 2014–2016 Pennsylvania Cancer Registry (PCR), 2019 CMS Base Provider Enrollment File (BPEF), 2018 Physician Compare, 2010 Rural‐Urban Commuting Area Codes (RUCA), and 2015 Deprivation Index (ADI). Study Design Spatial regressions were used estimate associations between oncologists, measured with an enhanced two‐step floating...

Sixteen states have used Section 1332 waivers to implement reinsurance programs that aim reduce premiums and increase enrollment in the Affordable Care Act's health insurance Marketplaces. Although successfully reduced for unsubsidized enrollees, little is known about how affects Marketplace premiums, minimum cost of coverage, large majority enrollees who receive premium subsidies. Using a difference-in-differences analysis matched counties straddling Georgia's borders examine 2022...

Purpose: For patients with muscle-invasive bladder cancer (MIBC), time to cystectomy and receipt of neoadjuvant chemotherapy are associated improved survival. Travel burden may be an important barrier timely guideline concordant treatment. Materials Methods: We conducted a cross-sectional study in Pennsylvania first lifetime diagnosis MIBC who underwent radical at nonfederal short-term general hospitals identified 2010 2016 Cancer Registry linked Healthcare Cost Containment Council (PHC4)...

Abstract Objective To compare measures of spatial access to care commonly used by policy makers and researchers with the more comprehensive enhanced two‐step floating catchment area (E2SFCA) method. Study Setting Fourteen southwestern Pennsylvania counties. Design We estimated buprenorphine‐waivered prescribers using three measures—Euclidean travel distance closest prescriber, time provider, provider‐to‐population ratios—and E2SFCA. Unlike other measures, E2SFCA captures provider capacity,...

Affordable Care Act provisions implemented in 2014 could have influenced employers' decisions to offer health insurance. Using data for from the Medical Expenditure Panel Survey-Insurance Component, we found little change employer-sponsored insurance offerings: More than 95 percent of employers either continued offering coverage or not it between 2013 and 2014. Fewer 3.5 dropped coverage, 1.1 added coverage.

<h3>Importance</h3> Access to reproductive health services is a public goal. It unknown how geographic and plan network availability of Catholic non-Catholic hospitals may be associated with access in the United States. <h3>Objective</h3> To characterize market share States, both overall within Marketplace insurance plans' hospital networks. <h3>Design, Setting, Participants</h3> This cross-sectional study US counties used data on hospitals' affiliation discharges, networks plans, Census...

Medicaid managed care insurers play a crucial role in facilitating access to buprenorphine treat opioid use disorder. Using novel set of provider directory and prescription claims data, we examined variation in-network buprenorphine-prescribing primary providers among enrollees. Approximately 32.2 percent enrollees had fewer than one prescriber per 100,000 county residents. On average, there were greater number states with higher compared lower overdose death rates. However, most lived areas...

Abstract Twenty‐one U.S. states have passed recreational cannabis laws as of November 2022. Cannabis may be a substitute for prescription opioids in the treatment chronic pain. Previous studies assessed laws' effects on opioid prescriptions financed by specific private or public payers dispensed to unique endpoint. Our study adds literature three important ways: (1) examining these impacts dispensing across all and endpoints, (2) adjusting opioid‐related policies such prescribing limits, (3)...

Abstract Objective To investigate how changes in insurer participation and composition as well state policies affect health plan affordability for individual market enrollees. Data Sources 2014‐2019 Qualified Health Plan Landscape Files augmented with supplementary insurer‐level information. Study Design We measured subsidized enrollees using premium spreads, the difference between benchmark lowest cost plan, levels unsubsidized estimated spreads varied participation, composition, log‐linear...

Abstract The opioid epidemic in the United States has accelerated during COVID‐19 pandemic. As of 2021, roughly a third Americans now live state with recreational cannabis law (RCL). Recent evidence indicates RCLs could be harm reduction tool to address epidemic. Individuals may use manage pain, as well relieve withdrawal symptoms, though it does not directly treat disorder. It is thus unclear whether are an effective policy reduce adverse opioid‐related health outcomes. In this study, we...

Provider networks in Medicaid Managed Care (MMC) play a crucial role ensuring access to buprenorphine, highly effective treatment for opioid use disorder. Using difference-in-differences approach that compares network breadth across provider specialties and market segments within the same state, we investigated association between three policies of MMC buprenorphine prescribers: expansion, substance disorder (SUD) adequacy criteria, SUD carveouts. We found both expansion criteria were...