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Humans, Pneumonia, Viral, Coronavirus Infections, Civil Defense, Health Services Needs and Demand, State Medicine, Organizational Innovation, Primary Health Care, England, Pandemics, Quality Improvement, Health Information Exchange, Betacoronavirus, Change Management, Public Health and Health Services, and General & Internal Medicine

Cancer, Drug approval, Drug legislation, Drug prescriptions, Pharmaceutical research, Oncology and Carcinogenesis, and Oncology & Carcinogenesis

A number of important drugs used to treat cancer-many of which serve as the backbone of modern chemotherapy regimens-have outdated prescribing information in their drug labeling. The Food and Drug Administration is undertaking a pilot project to develop a process and criteria for updating prescribing information for longstanding oncology drugs, based on the breadth of knowledge the cancer community has accumulated with the use of these drugs over time. This article highlights a number of considerations for labeling updates, including selecting priorities for updating; data sources and evidentiary criteria; as well as the risks, challenges, and opportunities for iterative review to ensure prescribing information for oncology drugs remains relevant to current clinical practice.

Community and home care: staff roles, Medicare/Medicaid, caregiving: filial, policies/policy analysis, staff responsibilities, staffing patterns, work issues, Clinical Research, Nursing, Public Health and Health Services, and Gerontology

In California Medicaid home-and-community-based services (HCBS), recipients' family members receive payment as home care aides (HCAs). We analyzed data on first-time HCBS recipients to examine factors associated with the likelihood of switching HCAs within the first year of services. Those with family HCAs were less than half as likely to change than those with non-family HCAs and racial/ethnic minorities with non-family HCAs had the highest switching rates. Lower wages and local unemployment were associated with switching of non-family HCAs but not family HCAs. Policymakers can foster continuity of home care by paying family members for home care and raising worker wages.

Cancer, Drug approval, Drug legislation, Drug prescriptions, Pharmaceutical research, Rare Diseases, 6.1 Pharmaceuticals, Oncology & Carcinogenesis, and Oncology and Carcinogenesis

A number of important drugs used to treat cancer-many of which serve as the backbone of modern chemotherapy regimens-have outdated prescribing information in their drug labeling. The Food and Drug Administration is undertaking a pilot project to develop a process and criteria for updating prescribing information for longstanding oncology drugs, based on the breadth of knowledge the cancer community has accumulated with the use of these drugs over time. This article highlights a number of considerations for labeling updates, including selecting priorities for updating; data sources and evidentiary criteria; as well as the risks, challenges, and opportunities for iterative review to ensure prescribing information for oncology drugs remains relevant to current clinical practice.

Cancer, Drug approval, Drug legislation, Drug prescriptions, Pharmaceutical research, Rare Diseases, 6.1 Pharmaceuticals, Oncology & Carcinogenesis, and Oncology and Carcinogenesis

A number of important drugs used to treat cancer-many of which serve as the backbone of modern chemotherapy regimens-have outdated prescribing information in their drug labeling. The Food and Drug Administration is undertaking a pilot project to develop a process and criteria for updating prescribing information for longstanding oncology drugs, based on the breadth of knowledge the cancer community has accumulated with the use of these drugs over time. This article highlights a number of considerations for labeling updates, including selecting priorities for updating; data sources and evidentiary criteria; as well as the risks, challenges, and opportunities for iterative review to ensure prescribing information for oncology drugs remains relevant to current clinical practice.

General & Internal Medicine and Public Health and Health Services

Medicare, quality, insurance, physicians, health care organization, Public Health and Health Services, Applied Economics, and Health Policy & Services

BACKGROUND:A growing proportion of Medicare beneficiaries is covered by private insurers through Medicare Advantage, yet little is known about how these plans are structured in terms of relationships with physicians and implications for quality of care. OBJECTIVE:The objective of this study was to assess whether greater physician concentration of services across insurers was associated with higher quality in Medicare Advantage (MA), overall and particularly among MA insurers serving a high proportion of vulnerable enrollees. RESEARCH DESIGN:A retrospective cohort design with regression analysis. DATA SOURCES:The primary dataset was 2014 MA encounter records submitted by insurers to the Centers for Medicare and Medicaid Services, covering 600,329 physicians across 119 insurers. These data were merged with Centers for Medicare and Medicaid Services data on MA contract quality rating as well as physician characteristics in the Medicare Data on Provider Practice and Specialty file. MEASURES:Two measures were generated to capture the concentration of physician services across insurers: the percentage of a physician's Medicare services which was through MA (MA penetration); and the percentage of a physician's MA services with a specific insurer (insurer share of MA services). RESULTS:Greater MA penetration and insurer share of MA services were each associated with higher MA plan quality. The relationship between insurer share and quality was stronger in contracts with a relatively high percentage of disabled enrollees. CONCLUSION:Greater physician concentration of services across MA insurers was associated with a higher quality of care overall and especially among vulnerable enrollees.

bilingual physicians, immigrant health, limited English proficiency, and primary care

Purpose: The population with limited English proficiency (LEP) in California is growing. We sought to determine whether enough primary care physicians (PCPs) have the language skills to meet patient needs. Methods: The authors determined the number of PCPs who self-report proficiency in the five most common non-English languages spoken in California (Spanish, Cantonese, Mandarin, Tagalog, and Vietnamese) using Medical Board of California data from 2013 to 2015. The authors estimated LEP populations during 2011-2015 using Census data. They calculated PCP supply (the ratio of PCPs/100,000 LEP individuals) compared to a federal standard to judge adequacy. They performed a sensitivity analysis adjusting the percentage of LEP patients in a bilingual physicians' practice from 100% to the percentage of LEP individuals in California who spoke that language. Results: Of 19,310 PCPs in California, 15,933 (83%) provided information about languages they speak. There were 5,203 (33%) Spanish-, 486 (3%) Cantonese-, 986 (6%) Mandarin-, 956 (6%) Tagalog-, and 671 (4%) Vietnamese-speaking PCPs. PCP supply, compared to a federal standard, was adequate if we assumed that bilingual PCPs only care for LEP patients. However, if one assumes the number of LEP patients in a PCP's practice reflects the percentage in the general population, there is a large PCP undersupply for all languages. Conclusion: Estimates of access to language-concordant PCPs for LEP individuals are sensitive to assumptions about the percentage of LEP patients in a PCP's panel. Ensuring language-concordant access will require deliberate effort to match LEP patients with bilingual PCPs.

Humans, Primary Health Care, Delivery of Health Care, Canada, United States, Congresses as Topic, Public Health And Health Services, General & Internal Medicine, and Public Health and Health Services

Health Policy, Public Health And Health Services, Health Policy & Services, Public Health and Health Services, and Policy and Administration

Public Health And Health Services, Health Policy & Services, Public Health and Health Services, and Policy and Administration

Humans, Chronic Disease, Patient Discharge, Survival Rate, Aged, Home Care Services, Health Care Costs, Health Expenditures, Medicare, United States, Female, Male, Transitional Care, Opthalmology and Optometry, Public Health and Health Services, and Clinical Sciences

Importance:Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. To bill for the 30-day service, a care team member must communicate with the beneficiary or the caregiver within 2 business days after the discharge and the clinician must provide an office visit within 14 days. Objective:To investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. Design, Setting, and Participants:Retrospective cohort analysis of all Medicare fee-for-service claims for the period of January 1, 2013, through December 31, 2015, for 18 756 707 Medicare fee-for-service beneficiaries with discharges eligible for subsequent TCM services. Discharges from a hospital, an inpatient psychiatric facility, a long-term care hospital, a skilled nursing facility, an inpatient rehabilitation facility, or an outpatient facility for an observational stay were included. Data analysis was performed from July 2016 to March 2018. Exposure:Furnishing of TCM services for the 30 days following an eligible discharge for Medicare beneficiaries as reflected in Medicare fee-for-service claims. Main Outcomes and Measures:Total Medicare (Parts A, B, and D) health care costs and mortality in the 31 to 60 days after discharge, which is 30 days beyond the potential period for which the beneficiary could receive TCM services. Health care costs and mortality were adjusted for beneficiary age, sex, risk score, dual eligibility for Medicare and Medicaid, type of eligible discharge, year of discharge, and whether the eligible discharge to the community included home health care. Results:Of 18 756 707 eligible Medicare beneficiaries during the study period, 43.9% were male and had a mean (SD) age of 72.5 (13.8) years. Transitional care management services were billed following eligible discharges in 3.1% of cases in 2013, 5.5% in 2014, and 7.0% in 2015. The adjusted total Medicare costs ($3358; 95% CI, $3324-$3392 vs $3033; 95% CI, $3001-$3065; P

Humans, Health Care Reform, Insurance Coverage, Insurance, Health, United States, California, Patient Protection and Affordable Care Act, Universal Health Insurance, Financing Health Care, State/Local Issues, Public Health And Health Services, Applied Economics, Health Policy & Services, and Public Health and Health Services

California has long sought to achieve universal health insurance coverage for its residents. The state's uninsured population was dramatically reduced as a result of the Affordable Care Act (ACA). However, faced with federal threats to the ACA, California is exploring how it might take greater control over the financing of health care. In 2017 the state Senate passed the Healthy California Act, SB-562, calling for California to adopt a single-payer health care system. The state Assembly did not vote on the bill but held hearings on a range of options to expand coverage. These hearings highlighted the many benefits of unified public financing, whether a single- or multipayer system (which would retain health plans as intermediaries). The hearings also identified significant challenges to pooling financial resources, including the need for federal cooperation and for new state taxes to replace employer and employee payments. For now, California's single-payer legislation is stalled, but the state will establish a task force to pursue unified public financing to achieve universal health insurance. California's 2018 gubernatorial and legislative elections will provide a forum for further health policy debate and, depending on election outcomes, may establish momentum for more sweeping change.

Humans, Diffusion of Innovation, Financing, Government, Health Services Research, Organizational Innovation, Delivery of Health Care, Research Support as Topic, Evidence-Based Practice, Financing, Government, Medical And Health Sciences, General & Internal Medicine, and Medical and Health Sciences

Humans, Long-Term Care, Retrospective Studies, Adult, Aged, Middle Aged, Disabled Persons, Nursing Homes, Medicaid, Eligibility Determination, United States, California, Female, Male, Cognitive Dysfunction, home and community-based services, long-term services and supports, skilled nursing facilities, Aging, Clinical Research, Behavioral and Social Science, Brain Disorders, Health Services, Mental Health, Health Policy & Services, and Public Health and Health Services

Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.

Humans, Evidence-Based Medicine, United States Agency for Healthcare Research and Quality, Health Services Research, Organizational Objectives, Patient Care Management, Quality of Health Care, United States, Quality Improvement, Opthalmology and Optometry, Public Health and Health Services, and Clinical Sciences

Humans, Social Responsibility, Patient-Centered Care, Delivery of Health Care, Quality Improvement, and Nursing