Listen Now

Bundled payments have long been an experiment in the Medicare program to help reduce health care spending. The Affordable Care Act (ACA) gave the Centers for Medicare and Medicaid Services broad authority to test bundled payments, or paying providers for episodes of care instead of for each service provided. Research has found savings associated with participating in the Bundled Payment for Care Improvement (BPCI) initiative. While there have been encouraging results, Medicare has experienced net losses under BPCI when taking reconciliation payments into account. However, some alternative payment models have seen significant savings. There's still much to learn as the new iteration of BPCI — BCPI Advanced — continues. For example, Christopher Whaley, a policy researcher at the RAND Corporation, and coauthors recently published research in the March 2021 issue as part of the Health Affairs Considering Health Spending series. They found a bundled payment program developed by Carrum Health for orthopedic and surgical procedures in a commercially-insured population led to significant price reductions of more than 10%, or more than $4,000 per procedure, with employers capturing approximately 85% of the savings. In this episode of A Health Podyssey, listen to Alan Weil interview Christopher Whaley on bundled payments, the promise of direct payments in the commercial market, and whether alternative payments can become a mainstream payment model.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The COVID-19 pandemic caused an enormous wave of disruption to the U.S. economy, leading the unemployment rate to rise to a record high of 14.7% in April 2020. While unemployment has since improved — the unemployment rate in January 2021 was 6.3% — America has yet to reach the employment levels it held before the pandemic.In response to so many out of work, the Coronavirus Aid, Relief, and Economic Security (CARES) Act in March 2020 expanded eligibility for unemployment benefits. Within that legislative package, the Federal Pandemic Unemployment Compensation (FPUC) increased the amount of money people could receive through such programs. FPUC expired for the first time in July 2020, leading to insurance beneficiaries receiving smaller benefits.Employment and job security is a known social determinant of health and the relationship to suddenly losing a job and a person's health isn't yet widely understood. To study the how FPUC may have affected unmet health-related social needs, Seth Berkowitz from the University of North Carolina at Chapel Hill and Sanjay Basu from Harvard Medical School examined these needs and mental health among unemployment insurance beneficiaries before and after the initial expiration of FPUC.Published in the March 2021 edition of Health Affairs, Berkowitz and Basu's research found that the initial FPUC expiration was associated with a 10-percentage-point increase in risk for self-reported missed housing payments. In addition, risk for food insufficiency as well as depression and anxiety symptoms increased among households receiving unemployment insurance benefits.Seth Berkowitz joins Editor-in-Chief Alan Weil on A Health Podyssey to discuss his research, the potential health impact of unemployment insurance, the changing nature of work in the U.S., and how direct payments programs — such as universal basic income — could compliment social safety nets.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

There's no doubt that the COVID-19 pandemic spurred an increase in telemedicine use. As Americans were reluctant to venture out of their homes in the pandemic's early months, both public and private payers were quick to change telehealth reimbursement policies as admissions plummeted.According to new research published in the February edition of Health Affairs, 30.1% of all outpatient visits were provided via telemedicine from January 2020 to June 2020. The weekly number of telemedicine visits rose by a 23-fold increase during the same time period. Prior to 2020, telehealth hadn't yet become a mainstream avenue of care despite the technology being in place for at least a decade. As COVID-19 vaccines are deployed and mutations spread, a question remains whether telemedicine will finally become a popular care delivery option.On this episode of A Health Podyssey, Alan Weil interviews Dr. Michael Barnett, from the T.H. Chan School of Public Health, and Dr. Sadiq Patel, from Harvard Medical School, on their research published in Health Affairs, how specialty care providers are adopting telemedicine, the speed of their research, and where the telemedicine field may be heading. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

"Quite honestly, it is not easy to be a nerd on the reservation." - Dr. Donald WarnePathways are not predetermined in life. But, without readily available role models to point to, it can be difficult for young people to know what options may be available as they advance toward adulthood.Currently, there's a shortage of health care providers for Indigenous populations, which have been linked to limited access to care and higher rates of chronic health conditions. As native physicians are more likely than non-native physicians to serve these populations, increasing the number of native physicians is a critical strategy for improving access for this population.At the University of North Dakota, role-modeling is a key component to increase interest and build the next generation of American Indian physicians. Currently, American Indian or Alaskan native students make up about 1% of medical school students nationwide. At the University of North Dakota's medical school, 1 in 10 students came from Indigenous background, the highest ratio in the country.Since 1973, the Indians Into Medicine program has graduated over 250 American Indian and Alaskan Native physicians. It's a growing presence in the health profession and the subject of a Leading to Health article published in the February 2021 edition of Health Affairs. On A Health Podyssey, Alan Weil speaks with Dr. Donald Warne, a professor and director of the Indians Into Medicine program at the University of North Dakota and a member of the Oglala Lakota tribe, to discuss the shortage of health care providers for American Indians and Indigenous populations and how the program helps create an interest in medicine at an early age for American Indians. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

In the February 2021 edition, Health Affairs presented a collection of papers from the National Academy of Medicine (NAM) for their Vital Directions for Health and Health Care project.While originally established in 2016, NAM reassessed its priorities and found a vastly different health care landscape in 2020. Not only had the COVID-19 pandemic ripped through the health care ecosystem nationwide, but issues regarding maternal health, mental health, and elder care surfaced as pressing concerns. And, as always, health costs and financing was flagged for appraisal.But, as Dr. Victor Dzau, president of the National Academy of Medicine, and colleagues note in their opening commentary, health equity was present throughout every priority.The collection of commentaries from NAM sets forth health and health care priorities for 2021 and the new Biden administration. Vital Directions for Health and Health Care: Priorities For 2021 identifies the overarching theme of this series as the clear and urgent obligation for the US to turn its full attention to the growing problem of health inequities and to the structural racism that perpetuates health disparities.On this episode of A Health Podyssey, listen to Health Affairs Editor-in-Chief Alan Weil interview Dr. Victor Dzau on the new Vital Directions publication, why health equity is fundamental for shaping health system reform, and how converging science disciplines will shape the field of health and medicine.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The opioid epidemic has ravaged American life.It has claimed more than 750,000 lives as a result of a drug overdose since 1999. In 2018 alone, more than 2 million people had an opioid use disorder and more than 800,000 people used heroin.To alleviate these deaths of despair and get people the treatment they need, many individuals are looking to short-term residential facilities for substance use treatment programs, commonly referred to as rehabilitation, or rehab.But, as a paper in the 2021 February issue of Health Affairs notes, recruitment practices and cost of care at these facilities can raise concerns. The authors found most programs required up-front payments, with for-profit programs charging more than twice as much as nonprofits.Listen to Alan Weil interview Tamara Beetham, a PhD student in health policy and management at the Yale School of Medicine and lead author of the paper. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Have health economists been underestimating supply-side constraints when making predictions regarding cost and utilization for universal health coverage programs, such as Medicare For All? That's certainly what Dr. Adam Gaffney, a pulmonary specialist from Cambridge Health Alliance and Harvard Medical School, and colleagues posit in a new policy paper published in the January 2021 issue of Health Affairs.As Gaffney and co-authors note in their paper, "focusing only on the impact of health care reform on government expenditures is short-sighted." On the supply side, there's a natural limit to doctor and nurses' time as well as the number of hospital beds in a given facility.Their analysis suggest that while first-dollar universal coverage expansion would increase ambulatory visits by about 7-10% and hospital use by about 0-3%, modest administrative savings could offset the costs of these increases.On this episode of A Health Podyssey, Alan Weil and Adam Gaffney take listeners through health reform economics 101 before sharing the implications of the paper, ultimately questioning whether health reform is too focused on a demand-side framework.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

More than 500,000 individuals in the U.S. experience homeless at any given time, and many of those individuals qualify for Medicaid in states that expanded the program under the Affordable Care Act.Medicaid expansion can be helpful for individuals unable to afford private health insurance. Medicaid expansion has been found to slow rates of health decline for some low-income adults, for example. But to date, little is known about the relationship between those experiencing homelessness gaining coverage through Medicaid expansion and health care service use.With homelessness on the rise in the United States, it is important to study such trends and what implications they may have for both those experiencing homelessness and health care providers.On today's episode of A Health Podyssey, Alan Weil interviews Dr. Jeral Self, a researcher at Mathematica and an adjunct faculty member at the Tulane School of Public Health and Tropical Medicine, on how Medicaid expansion affected health care utilization for adults experiencing homelessness in Arkansas. Listen to what this new data reveal about the health care needs of those experiencing homelessness. Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

For better or worse, online platforms and social media have enabled individuals to publicly post their opinions of businesses online. As a result, business are at the mercy of public feedback, which can have an impact on their success. Hospitals and physicians are not immune to this trend. The Centers for Medicare and Medicaid Services has pushed the idea of consumerization through price transparency policies and the Five-Star Quality Rating System so that patients can rate their providers, for example.But what is the actual value of a star rating? On this episode of A Health Podyssey, Alan Weil interviews Dr. Adam Schwartz, associate professor of orthopedic surgery at the Mayo Clinic College of Medicine and Science, who wrote a research paper with colleagues in the January 2021 issue of Health Affairs on the monetary value of an additional hospital or physician star rating when choosing a provider for total joint replacement.While patients' interpretation of star ratings has been poorly understood historically, Schwartz and his colleagues put forward data to help spur further research to understand the value and trust patients place in publicly reported quality ratings.Listen to Alan Weill and Adam Schwartz discuss public reporting, quality ratings, and their implications on hospital and physician businesses.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Every year, Health Affairs publishes a retrospective look at national healthcare spending. In 2020, Anne Martin and colleagues from the CMS Office of the Actuary found that U.S. healthcare spending increased 4.6% to $3.8 trillion in 2019. The rate of health spending declined slightly from 2018, which noted a growth rate of 4.7%. Hospital care, physician and clinical services, and retail purchase of prescription drugs, which accounted for 61% of total national health spending, saw faster growth rates in spending in 2019.These figures predate the coronavirus, which has led to major changes in healthcare delivery and spending. In this week’s episode of A Health Podyssey, Alan Weil invites Sherry Glied, dean of the Robert F. Wagner Graduate School of Public Service at New York University, to the program. They take a step back from the main findings from the paper and discuss the relationship between administrative costs and the high costs of healthcare prices. Listen to Sherry Glied share why she thinks value-based care won’t be transformational and how public health is a desirable field to choose a career in now.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

As we close the books on the year 2020, we turn the tables on Health Affairs Editor-in-Chief Alan Weil wherein the interviewer becomes the interviewee.Alan shares a bit about his educational background, what it actually means to be the editor for the leading health policy journal, and how empirical research has changed since the COVID-19 pandemic.Looking back at the year's event, he elaborates on his blog post from June explaining his skepticism that the healthcare system can actually address social determinants of health. Looking forward to 2021, he predicts that administrative moves may continue to dominate the health policy landscape as a result of the 2020 election.Listen to Alan Weil talk about these topics and more on a special episode of A Health Podyssey.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

From severe weather such as the destructive wildfires in California to air pollution nationwide, there's a growing body of knowledge linking climate change to human health.On this episode of A Health Podyssey, host Alan Weil interviews Dr. Kristie Ebi, a professor in the Department of Global Health at the University of Washington, to discuss this complex relationship.Ebi served as the theme advisor for the December edition of Health Affairs, which is fully dedicated to exploring that link between climate and health. She published two papers in the issue. One notes that the people most harmed by climate change are those who have so far contributed the least to greenhouse gas emissions. The second connects how detection and attribution studies could quantify how climate change is affecting health.They note that while emissions have fallen during the COVID-19 pandemic, it's not enough to make a long-term impact. With the healthcare industry responsible for about 4.5% of the worldwide greenhouse gas emissions, hospitals and health systems can take the moment to re-evaluate their relationship to climate change.Listen to hear why Dr. Ebi believes individuals shouldn't feel hopeless in the face of climate change.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Does America have a healthy relationship with food?In addition to the direct health effects of diet, food production and distribution affects environmental factors, which then trickles down to our health statuses. For example, an estimated one quarter of global greenhouse gas emissions relate to food production.In a new paper published in the climate-centric December edition of Health Affairs, Mary Kathryn Poole, a PhD student in population health sciences at the Harvard T.H. Chan School of Public Health, and colleagues explored the relationship between The National School Lunch Program, one of the largest federal food programs, and its impacts on the environment.In this week’s episode of A Health Podyssey, Alan Weil interviews Mary Kathryn Poole to discuss her paper, the EAT-Lancet Commission’s reference diet, strategies to reduce red meat consumption, and how they relate to planetary health diets.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

How are Indigenous communities responding to climate change?It’s an important but often under-looked question. As a new paper published in the climate-centric December edition of Health Affairs posits, Indigenous communities are uniquely vulnerable as climate-related events can impact their day-to-day lives, self-determination, and physical and emotional health.In 2016, the Pala Band of Mission Indians tribe, who are located in southern California, conducted a vulnerability assessment regarding the effects of climate change. High temperatures, wildfires, storm flooding and drought were all identified as major concerns.And yet, the assessment revealed few participants were aware of many of the potential health consequences at the individual and community levels as a result of these threats.Indigenous communities have a history of adapting to their environment but some impacts from climate change for these communities are unexpected.In this week’s episode of A Health Podyssey, Alan Weil interviews Shasta Gaughen, director of the Pala Environmental Department for the Pala Band of Mission Indians, to discuss her recent paper and these unintended consequences of climate change as it relates to physical, mental, and cultural health for Indigenous communities.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

Brooke Cunningham is a general internist, sociologist, and assistant professor in the Department of Family Medicine and Community Health at the University of Minnesota.After George Floyd's killing, she wrote and published a Narrative Matters essay in Health Affairs on how the health effects of racism become embodied for her and other Black Americans.On this episode of A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil interviews Brooke Cunningham about the essay and what she hopes listeners and readers take from her writing. After the interview, Brooke reads her essay in full.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

In November, the pharma companies Pfizer and Moderna both announced substantial progress on a potential COVID-19 vaccine. While both vaccines showed promising results during clinical trials, questions remain for what's next and how to distribute a vaccine once it's available for public use.One major question mark concerns logistics. For example, the Pfizer vaccine needs to be kept at extremely cold temperatures while traveling through the supply chain — though that doesn't seem to be the case for Moderna's vaccine.Another worry is ensuring equitable access to an effective vaccine. Dr. Angela Shen, visiting scientist at the Children's Hospital of Philadelphia and vaccine policy expert, recently published a paper on the topic in a special cluster on COVID-19 vaccines in Health Affairs. She joins A Health Podyssey to discuss her paper, as well as the challenges and opportunities the US will face to secure equitable access to a COVID-19 vaccine.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

New York City was an initial focal point for COVID-19 outbreaks in the U.S. with the virus then quickly spreading across the country. With time, data, and analysis, researchers are learning more about how the novel coronavirus is affecting different swaths of the U.S. population.Leonard Egede, division chief of the Division of General Internal Medicine in the Department of Medicine and director of the Center for Advancing Population Science at the Medical College of Wisconsin, and colleagues recently published a paper in Health Affairs which aimed to understand the racial and ethnic differences in COVID-19 screening, hospitalization, and mortality rates in Milwaukee and Southeast Wisconsin.Using data from more than 31,500 adults, Egede and his colleagues found that blacks and Hispanics were both more than three times more likely to test positive for COVID-19 than non-Hispanic whites. In addition, both blacks and Hispanics were two times more likely to be hospitalized relative to whites.What do these findings mean for national hospitals, communities, and policymakers? Health Affairs Editor-in-Chief Alan Weil interviews Leonard Egede to discuss his paper and what the findings tell us about the challenges that lie ahead as the COVID-19 pandemic continues.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

The U.S. health policy community recognizes that fee-for-service models incentivize physicians and health systems to perform more tasks than may be needed. And, these models can contribute to industry fragmentation as organizations chase revenue.But is fee-for-service really the smoking gun when it comes to the high levels of U.S. health care spending?The answer is, unsurprisingly, complicated. To discuss, Health Affairs Editor-in-Chief Alan Weil interviews Dr. Michael K. Gusmano, professor at the Rutgers School of Public Health and research scholar at The Hastings Center, to examine how physician payments are set in France, Germany, and Japan. These countries all employ fee-for-service models but pay less than the U.S. when it comes to health spending.What can the U.S. learn from these countries? Is policy importation even possible?Alan Weil and Dr. Gusmano explore these questions and more on A Health Podyssey.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

No matter which side of the aisle you sit, the 2020 U.S. presidential election has been as memorable as it's been remarkable. On November 4th — less than 24 hours after the final polls closed — Health Affairs' Alan Weil sat down with Kimberly Leonard, Senior Healthcare Reporter at Business Insider, and Shannon Muchmore, Editor at Healthcare Dive, to share his perspective on what the future of health policy may look like when the election is finally in the rearview mirror. The group touches on the fate of the Affordable Care Act, what's on deck for future coronavirus relief packages, and how the next administration may continue federal policies on pricing transparency. We also hear how Alan, Kimberly, and Shannon maintain bipartisanship in their publications in the face of increasing polarization.Listen to hear what Alan, Kimberly, and Shannon are hearing across Washington, D.C. and how it could influence future health policies.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher

We’ve long known that community resources — good schools, walkability, food security, etc. — affect opportunities for children’s health and behaviors to develop. But how do we measure these characteristics and use our knowledge to create better policy? In this episode of A Health Podyssey, Health Affairs Editor-in-Chief Alan Weil interviews Brandeis University’s Dr. Dolores Acevedo-Garcia to discuss her research on racial and ethnic inequities in children’s neighborhoods.The results are stunning as they are surprising. While differences across the country were expected and noted, more than 90% of the variation in neighborhood opportunity occurs in metro areas.What are the implications at the policy level for these results? Alan Weil and Dr. Acevedo-Garcia discuss.Subscribe: RSS | Apple Podcasts | Google Podcasts | Spotify | Castro | Stitcher