Medicare Advantage And Commercial Prices For Mental Health Services

Pelech, Daria; Hayford, Tamara

doi:10.1377/hlthaff.2018.05226

Cited by 35 publications

(34 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The three insurers cover approximately half of MA enrollees and about a quarter of enrollees with ESI ( 40 , 41 ). HCCI data have been previously used to analyze both MA claims and claims for ESI ( 34 , 41 – 47 ). The data on claims paid to healthcare providers appear comprehensive and high-quality, with certain known exclusions (specifically, enrollees in highly capitated plans and special needs plans) ( 34 ).…”

Section: Setting Data and Frameworkmentioning

confidence: 99%

Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform

Einav

Finkelstein

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Changes in the way health insurers pay healthcare providers may not only directly affect the insurer’s patients but may also affect patients covered by other insurers. We provide evidence of such spillovers in the context of a nationwide Medicare bundled payment reform that was implemented in some areas of the country but not in others, via random assignment. We estimate that the payment reform—which targeted traditional Medicare patients—had effects of similar magnitude on the healthcare experience of nontargeted, privately insured Medicare Advantage patients. We discuss the implications of these findings for estimates of the impact of healthcare payment reforms and more generally for the design of healthcare policy.

show abstract

Section: Setting Data and Frameworkmentioning

confidence: 99%

Randomized trial shows healthcare payment reform has equal-sized spillover effects on patients not targeted by reform

Einav

Finkelstein

et al. 2020

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

show abstract

“…Uninsured rate in the HSA is significantly associated with the odds of offering MH, CD, and combination services, and the association remains significant despite adjustment for other variables. This indicates that the cost and reimbursement levels for MH and CD services are a major factor in centers’ decision whether to offer them . The issue of reimbursement appears to be offset by economies of scale at the hospital level, in that larger hospitals show increased odds of offering each of the service types.…”

Section: Discussionmentioning

confidence: 99%

“…This indicates that the cost and reimbursement levels for MH and CD services are a major factor in centers' decision whether to offer them. 42 The issue of reimbursement appears to be offset by economies of scale at the hospital level, in that larger hospitals show increased odds of offering each of the service types.…”

Section: Discussionmentioning

confidence: 99%

Mental health and chemical dependency services at US transplant centers

Niazi

Spaulding

Vargas

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017‐2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital‐ and health services area‐level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients’ ability to access comprehensive psychosocial care and whether this affects patient outcomes.

show abstract

“…In 2014, commercial payors paid an average of 13-15% less for in-network mental health services compared to fee-for-service Medicare, despite paying 12% more than Medicare for other services. 3 The Centers for Medicare and Medicaid Services' creation of alternative payment models for primary care is a promising development, as is the recent influx of $1.4 billion from the federal Department of Health and Human Services' State Opioid Response grants to support medication-assisted treatment. However, we still have far to go in aligning healthcare with patient and community needs.…”

Section: Prioritize the Health In Healthcare: Invest In Services Thatmentioning

confidence: 99%