Health Care Systems and Services

The Affordable Care Act (ACA), which turns 10 on March 23, dramatically changed Medicaid, making it available to millions of previously ineligible low-income adults. As some states continue to debate whether to expand Medicaid and policymakers propose more far-reaching changes to the program, it is critical to provide timely evidence on how the program is working and what the potential effect of major changes would be.

A new University of Michigan analysis reviews 46 studies evaluating interventions for "super-utilizers" of emergency department and prehospital care in the U.S. Here, the authors share their thoughts on the importance of their findings.

In June 2018, Arkansas became the first state to implement work requirements in Medicaid. Benjamin D. Sommers, Anna L. Goldman, Robert J. Blendon, E. John Orav, and Arnold M. Epstein of Harvard University provide the first independent assessment of early changes in beneficiary coverage and employment after the work requirements went into effect.

“Super-utilizers” have been the subject of much attention as health care systems work to reduce costs and provide better care. As part of their work to understand best practices for addressing the medical and social needs of high-need/high-cost patients, Samantha Iovan, Paula Lantz, Katie Allan, and Mahshid Abir published a systematic review examining interventions that are being implemented to address super-utilizers in prehospital and emergency care settings in the U.S.

Across the country, changes to Medicaid policy are under way. They hold the potential to dramatically alter the landscape of health care for millions of low-income individuals. Meanwhile, the 2018 midterm election results may lead to further Medicaid expansion in five states, three through ballot initiatives (Idaho, Nebraska, and Utah) and two with the election of new governors supportive of expansion, who replace outgoing governors who opposed it (Kansas and Maine). If all five states expand Medicaid, an estimated 500,000 people are expected to gain coverage.

Kai Hong, Kacie Dragan, and Sherry Glied from P4A's NYU Wagner Research Hub published a paper in the Journal of Health Economics exploring the health impacts of New York City’s 2014 roll-out of a Universal Pre-Kindergarten program.

In a recent opinion in The Milbank Quarterly, Dr. Lantz builds on insights from her P4A research portfolio to articulate concerns about the recent "medicalization" of population health within the health care system and its limits in making substantial improvements in population health.

Steven H. Goldberg, Paula M. Lantz, and Samantha Iovan from the University of Michigan P4A Research Hub examine the use of federal Medicaid dollars as a payout source for non-medical services aimed at addressing social determinants of health under the 2016 Medicaid Managed Care Final Rule.

Peter Jacobson of the University of Michigan research hub writes on Harvard Law's Bill of Health blog that while legal mandates are not necessary to carrying out HiAP (Health in All Policies) initiatives, political support for them is.

What kind of cost savings could be achieved if a "Pay for Success" (PFS) financing model were applied to a home-based, multi-component asthma intervention among low-income children on Medicaid in Detroit? The University of Michigan Research Hub team found that the economics of a PFS intervention are most viable if it targets children who have already experienced an expensive episode of asthma-related care.

Five years ago, a groundbreaking report showed people in the US in worse health and dying younger than those in other rich nations. Today, despite the alarm the report generated, we learned that life expectancy in the country declined for a second year in a row – astonishing by any standard.

Manmeet Kaur, executive director and founder of the Harlem-based community health organization City Health Works, is the inaugural recipient of the Janice Nittoli Practitioner Fellowship. Funded by the Rockefeller Foundation, the Nittoli Fellowship is awarded to innovative, entrepreneurial practitioners working in communities to address inequalities and is open to applications.