Varied Health Spending Growth Across US States Was Associated With Incomes, Price Levels, And Medicaid Expansion, 2000–19

Johnson, Emily K.; Wojtesta, Matthew A; Crosby, Sawyer W; Duber, Herbert C.; Jun, Eunice; Lescinsky, Haley; Nguyen, Phong Thanh; Sahu, Maitreyi; Thomson, Azalea; Tsakalos, Golsum; Weil, Maxwell S; Haakenstad, Annie; Mokdad, Ali H.; Murray, Christopher J L; Dieleman, Joseph L

doi:10.1377/hlthaff.2021.01834

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Substantial differences were observed by state, with the odds of coding specificity higher across multiple states when compared to NY. This again could reflect differences in patient composition or complexity by state, but also the variability in spending per capita, price levels, overall healthcare affordability, and differences in uptake of Medicaid by state [29].…”

Section: Discussionmentioning

confidence: 99%

A Novel Method for Assessing Risk-Adjusted Diagnostic Coding Specificity for Depression Using a U.S. Cohort of over One Million Patients

Glass,

Melton,

Moore

et al. 2024

Diagnostics

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Depression is a prevalent and debilitating mental health condition that poses significant challenges for healthcare providers, researchers, and policymakers. The diagnostic coding specificity of depression is crucial for improving patient care, resource allocation, and health outcomes. We propose a novel approach to assess risk-adjusted coding specificity for individuals diagnosed with depression using a vast cohort of over one million inpatient hospitalizations in the United States. Considering various clinical, demographic, and socioeconomic characteristics, we develop a risk-adjusted model that assesses diagnostic coding specificity. Results demonstrate that risk-adjustment is necessary and useful to explain variability in the coding specificity of principal (AUC = 0.76) and secondary (AUC = 0.69) diagnoses. Our approach combines a multivariate logistic regression at the patient hospitalization level to extract risk-adjusted probabilities of specificity with a Poisson Binomial approach at the facility level. This method can be used to identify healthcare facilities that over- and under-specify diagnostic coding when compared to peer-defined standards of practice.

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Section: Discussionmentioning

confidence: 99%

A Novel Method for Assessing Risk-Adjusted Diagnostic Coding Specificity for Depression Using a U.S. Cohort of over One Million Patients

Glass,

Melton,

Moore

et al. 2024

Diagnostics

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“…• Payment increases (especially Medicaid payments), loan forgiveness, and other financial incentives are important for retaining primary care providers. Virginia should join the ranks of 21 other states that currently mandate minimum state primary care spending to ensure that the Commonwealth has the resources needed to retain and expand this workforce (Johnson et al, 2022;National Conference of State Legislatures, 2023). • Reducing patient-provider ratios by implementing team-based care in primary care settings should be evaluated as a strategy to reduce the burden of high patient volumes on providers.…”

Section: Primary Care Retention and Recruitmentmentioning

confidence: 99%

Identifying Strategies for Strengthening the Health Care Workforce in the Commonwealth of Virginia

2023

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Shortages in the nursing, primary care, and behavioral health workforces are an ongoing and widespread issue in the United States. This report assesses shortages in these health care workforces in the Commonwealth of Virginia and identifies potential interventions to address them. The report is the culmination of the second and third phases of a larger study. In the first phase of the study, the Virginia Health Workforce Development Authority (VHWDA) and its partners focused on initial data collection and analysis related to challenges faced by Virginia's health care workforce. This report extends the first phase to identify specific interventions for (1) retaining existing health care workers, (2) recruiting first-time future health care workers, and (3) maximizing the ability of the Virginia health care workforce to meet the Commonwealth's needs via structural efficiencies-for example, better geographic distribution of the Commonwealth's workforce via economic and social policy interventions or telehealth practice. We identified interventions to improve retention, recruitment, and structural efficiency using an environmental scan of peer-reviewed and grey literature; primary multi-stakeholder conference, interview, focus group, and survey data; and statistical analysis and simulation based on data from the Commonwealth and other relevant sources. Importantly, a wide variety of Virginia health care workforce stakeholders participated in and supported the research by attending the study conference, participating in interviews and focus groups, and serving on the study's advisory board. The participation of these Virginia stakeholders was critical to identifying solutions that better fit Virginia's specific health care workforce landscape and population needs.Appendixes A-H to this report, which provide details on the methods and analysis used for this research, are contained a separate annex, available at www.rand.org/t/RRA2903-1.This research was funded by VHWDA and carried out within the Access and Delivery Program in RAND Health Care. The Virginia General Assembly established VHWDA in 2010 to identify and address health workforce issues in the Commonwealth. As a public entity, VHWDA exercises public and essential governmental functions to secure the health, welfare, convenience, knowledge, benefit, and prosperity of Virginians. VHWDA's mission is to "facilitate the development of a statewide health professions pipeline that identifies, educates, recruits, and retains a diverse, geographically distributed and culturally competent quality workforce" (VHWDA, undated-a). VHWDA accomplishes this through core functions outlined in the Code of Virginia (Virginia's Legislative Information System, undated-c).RAND Health Care, a division of the RAND Corporation, promotes healthier societies by improving health care systems in the United States and other countries. We do this by providing health care decisionmakers, practitioners, and consumers with actionable, rigorous, objective evidence iv to support their most comple...

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Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991–2019

Gaffney,

McCormick,

Himmelstein

et al. 2024

International Journal of Social Determinants of Health and Heal

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For the last four decades, policymakers have attempted to control the United States's high health care costs by reducing patients’ demand for care (e.g., by imposing managed-care restrictions or high costs on patients at the time of use). Yet studies based mostly on data from the public Medicare program, which covers mostly elderly Americans, suggest that supply (e.g., number of physicians or hospital beds) rather than demand drives aggregate service use and, hence, costs. Using variation between U.S. states in per enrollee Medicare spending versus per capita spending of all other (non-Medicare) individuals, we find that greater supply boosts costs for the entire population. Furthermore, we find that factors that suppress demand in the non-Medicare population do reduce non-Medicare health care spending, but simultaneously increase Medicare spending. This suggests that for a given supply of medical resources, suppressing demand for one group of patients may produce a compensatory increase in provision of care to those whose demand has not been suppressed. Health planning to assure adequate medical resources where they are needed while preventing excess supply where it is duplicative and wasteful is likely a more effective cost control strategy than the imposition of managed-care restrictions or imposing higher costs onto patients seeking care.

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Varied Health Spending Growth Across US States Was Associated With Incomes, Price Levels, And Medicaid Expansion, 2000–19

Cited by 3 publications

References 23 publications

A Novel Method for Assessing Risk-Adjusted Diagnostic Coding Specificity for Depression Using a U.S. Cohort of over One Million Patients

A Novel Method for Assessing Risk-Adjusted Diagnostic Coding Specificity for Depression Using a U.S. Cohort of over One Million Patients

Identifying Strategies for Strengthening the Health Care Workforce in the Commonwealth of Virginia

Demand and Supply Drivers of Medicare and Non-Medicare Health Spending: An Analysis of U.S. States, 1991–2019

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