The April edition of Health Affairsillustrates the range of current research taking place in the Harvard Medical School Department of Health Care Policy. This month’s journal features six papers highlighting research by the following HCP faculty and researchers: Professor of Health Care Policy,  David Grabowski,PhD, Daniel C. Tosteson Professor of Health Care Policy, Alan Zaslavsky, PhD, Harvard Medical School’s Leonard D. Schaeffer Professor of Health Care Policy Michael Chernew, PhD, Professor of Health Care Policy,Bruce Landon, MD, MBA, MSc, PhD candidates J. Wyatt Koma, PhD candidate and data scientist, Fangli Gheng, research assistant Rhiannon Euhus, research associate Nancy Beaulieu, PhD, and former members of the HCP community: John Ayanian, MD, MPP, and Caitlin Carroll, PhD.

Health Affairs is a premier peer-reviewed journal of health policy research. Originally founded in 1981, the journal explores health policy issues of current domestic and international concern. The journal’s audience includes government and health industry leaders, advocates, and scholars of health, health care, and health policy in the United States and worldwide.

The journal’s research iscited by U.S. administration officials, U.S. lawmakers, and ministry of health leaders, in addition to national media outlets, including the Washington Post, New York Times, Wall Street Journal, network television and radio, and NPR.

Among the myriad research in this month’s edition, the following six publications feature HCP’s faculty and researchers:

The first article, Differences in Use of Services and Quality of Care in Medicare Advantage (MA) and Traditional Medicare, 2010 And 2017 is by Professor of Health Care Policy Bruce E. Landon, Alan M. Zaslavsky, and former HCP professor, John Z. Ayanian. The paper discusses the rise and repercussions of Medicare Advantages popularity; as enrollment in MA has increased dramatically over the past decade, the authors hypothesized that it would be difficult for MA health plans to maintain higher quality of care while still controlling expenditures. The study compared quality of care, patient experiences, and utilization for enrollees in Medicare Advantage and those in traditional Medicare to reveal that Medicare Advantage outperformed traditional Medicare in all of the domains examined over the time period 2010-2017.  Thus, despite substantial increases in enrollment, MA plans continue to outperform traditional Medicare in quality of care while also controlling utilization of services. 

Next the articleIncreased Medicare Advantage Penetration Is Associated with Lower Postacute Care Use for Traditional Medicare Patients by Fangli Geng, Professor David C. Grabowski and colleagues investigates how Medicare Advantage (MA) plans, which accounted for 45 percent of total Medicare enrollment in 2022 are incentivized to minimize spending on low-value services. This study found increased MA market penetration associated with reduced post-acute care use among traditional Medicare beneficiaries, without a corresponding increase in hospital readmissions. This association was generally stronger in markets with a greater share of traditional Medicare beneficiaries attributed to accountable care organizations, suggesting that policy makers should account for MA penetration when evaluating potential savings in Alternative Payment Models within traditional Medicare.

Third isAccess Problems and Cost Concerns of Younger Medicare Beneficiaries Exceeded Those of Older Beneficiaries In 2019 by J. Wyatt Koma and colleagues from KFF. This article sheds light on the gaps in access to care for an often-overlooked segment of the Medicare population: people younger than sixty-five with disabilities. They compared measures of access to care, cost concerns, and satisfaction with care for beneficiaries younger than age sixty-five to those ages sixty-five and older, using the 2019 Medicare Current Beneficiary Survey. The study found that Medicare beneficiaries younger than age sixty-five experienced worse access to care, more cost concerns, and lower satisfaction with care than beneficiaries ages sixty-five and older, regardless of their type of Medicare coverage. Beneficiaries in MA did no better or worse than those in traditional Medicare. Ultimately, the analysis finds that the current Medicare program inadequately meets the needs of beneficiaries with disabilities.

The Fourth articleReducing Medicare Advantage Benchmarks Will Decrease Plan Generosity, But Those Effects Will Likely Be Modest  by Professor Michael E. Chernew, and colleagues, addresses calls to reduce MA benchmarks amid concerns that MA plans are overpaid. Benchmarks are the dollar amounts set by CMS against which MA plans bid to set premiums and fund extra benefits.Reduced benchmarks may lead to higher MA enrollee premiums and decreased plan generosity. This study found that cuts to benchmarks would be felt; however, the overall effects would be minimal.

The fifth article, featured on the Health Affairs site is Hospital Survival in Rural Markets: Closures, Mergers, And Profitability by Caitlin Carroll, Rhiannon Euhus, Nancy Beaulieu, and Professor Michael Chernew. This article addresses the financial distress and struggle to stay in business increasingly faced by rural hospitals. While some hospitals have managed to survive, looming closure and mergers threaten to leave some rural communities without adequate access to care. This study investigates the circumstances surrounding the closures and mergers of these rural hospitals and suggests that in cases where hospitals are likely to close and merge, policy needs to be developed to support access to care and manage the effects of consolidation.

And the sixth article, Video Telemedicine Experiences In COVID-19 Were Positive, But Physicians And Patients Prefer In-Person Care For The Future by Ateev Mehrotraand colleagues aims to inform policy discussions about post pandemic telemedicine reimbursement and regulations via dual nationally representative surveys among primary care physicians and patients.  Findings revealed that while majorities of both populations reported satisfaction with video visits during the pandemic, most patients would prefer minimal care via telemedicine in the future, with only 36 percent of patients preferring to seek care by video or phone. Physicians and patients alike agreed that telemedicine was inferior to in-person care, citing the lack of physical exam as a key reason.

More about the methods and detailed findings for each of these studies can be found in the links to the articles. If you would like to read about the authors, please visit the HCP website.