2022’s most interesting health care research papers, according to the experts

Though the pandemic and all its attendant health care crises remained the major health care story of 2022, churning all the while in the background has been the critical work of academic scholars, operating on longer timelines, who are still trying to make sense of US health care and of medicine itself, to get a better idea of what’s wrong and how to make it better.

To wrap up this year, I asked a couple dozen health policy experts what research released this year (though, as one of them reminded me, these papers are often years in the making) had surprised them, changed their thinking, or struck them as especially notable.

Here are five particularly interesting papers, at least in my view. Because many more than that warrant mention, I have tried to cram in as many references to other work as I could. One of my lessons from this exercise was that there are noteworthy new studies being produced all the time. The US health system certainly merits such extensive investigation, given the number and diversity of its flaws.

These studies cover a broad range of subjects, from the intricacies of Medicaid provider networks to prescription uptake by Medicare beneficiaries to how bystanders react when a person experiences a cardiac episode in public. But first, on the topic of the pandemic…

1) Vaccination education campaigns in nursing homes didn’t make much difference

Several experts pointed me to data sets related to Covid-19 vaccination in nursing homes, the scenes of so much illness and death in that frightening first year of the pandemic. Larry Levitt, executive vice president of the Kaiser Family Foundation, flagged one recent KFF survey that found less than half of nursing-home residents are up to date on their vaccines.

That put into sharp relief the findings of a study that Harvard Medical School’s David Grabowski cited as one of his favorites of the year. The paper, published in JAMA Internal Medicine in January 2022, evaluated an effort to use educational campaigns and other incentives to improve vaccination rates among residents and staff in nursing homes.

They did not find a meaningful effect, despite three months of programming. There was plenty of room to grow, particularly among the staff, roughly half of whom were unvaccinated during the study period. (Vaccination rates among residents were already high at the time, though the experiment still did not find a significant effect of the multi-faceted campaign.)

“The conventional wisdom was that a big part of lagging vaccination rates was a lack of information and knowledge about the benefits of vaccination,” Grabowski said. But this study found instead that “these educational efforts were unsuccessful at encouraging greater vaccination. Although information campaigns sound like great policy, they really aren’t.”

He lamented that the study had been ignored by policymakers, noting federal efforts to increase vaccination rates among this population remain focused on education. Grabowski said the policies with the strongest evidence are vaccine clinics and vaccine mandates for staff.

2) Medicaid’s

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U.S. Healthcare: A Conglomerate Of Monopolies

The Taylor Swift ticketing debacle of 2022 remaining hundreds of pissed off ‘Swifties’ without having a opportunity to see their favorite artist in live performance. And it also highlighted the difficulty that arises when firms like Ticketmaster acquire monopolistic manage.

In any sector, current market consolidation boundaries competitiveness, selection and access to products and solutions, all of which travel up costs.

But there’s another—often overlooked—consequence.

Sector leaders that improve way too effective come to be complacent. And, when that comes about, innovation dies. Healthcare offers a key example.

And business of monopolies

De facto monopolies abound in almost each individual health care sector: Hospitals and health and fitness units, drug and product producers, and physicians backed by personal equity. The end result is that U.S. health care has develop into a conglomerate of monopolies.

For two many years, this extreme focus of ability has inflicted harm on individuals, communities and the wellbeing of the nation. For most of the 21st century, medical fees have risen quicker than all round inflation, America’s daily life expectancy (and general health and fitness) has stagnated, and the pace of innovation has slowed to a crawl.

This posting, the first in a collection about the ominous and omnipresent monopolies of healthcare, focuses on how merged hospitals and powerful wellness methods have lifted the price tag, reduced the excellent and lowered the comfort of American medicine.

Foreseeable future content will glance at drug corporations who wield unfettered pricing power, coalitions of expert medical professionals who gain monopolistic leverage, and the payers (companies, insurers and the govt) who tolerate market consolidation. The series will conclude with a glimpse at who stands the best probability of shattering this conglomerate of monopolies and bringing innovation again to healthcare.

How hospitals consolidate energy

The medical center marketplace is now residence to a pair of seemingly contradictory tendencies. On one hand, economic losses in current a long time have resulted in report rates of hospital (and clinic services) closures. On the other hand, the in general sector sizing, price and earnings of U.S. hospitals are developing.

This is no incongruity. It is what comes about when hospitals and health systems merge and get rid of level of competition in communities.

Now, the 40 premier wellbeing devices own 2,073 hospitals, around just one-3rd of all emergency and acute-care amenities in the United States. The top rated 10 overall health devices very own a sixth of all hospitals and merge for $226.7 billion in internet affected individual revenues.

However the Federal Trade Fee and the Antitrust Division of the DOJ are billed with implementing antitrust legislation in health care markets and preventing anticompetitive perform, legal loopholes and intensive lobbying continue to spur clinic consolidation. Seldom are clinic M&A requests denied or even challenged.

The ills of healthcare facility

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St. Joe Corporation, Tallahassee Memorial and FSU split floor on new overall health care campus

Growth strategies incorporate an 80,000-sq.-foot professional medical office environment constructing scheduled to be complete in 2024. This developing will in the long run property TMH Health practitioner Partners – Principal Treatment, Tallahassee Memorial Urgent Care Heart, an ambulatory surgical procedures middle, as well as cardiology and orthopedic services.

Strategies include a 100-mattress clinic with an unexpected emergency center and other inpatient companies, together with surgical procedures, cardiology procedures and imaging, to be finish by the finish of 2027.

Customers of the FSU community celebrated the construction kickoff of the FSU Health-TMH medical campus in Panama Metropolis Seaside. From Left: University of Nursing Dean Jing Wang, Panama Town Campus Dean Randy Hanna, FAMU-FSU Higher education of Engineering Dean Suvranu De, FSU Faculty of Medicine Senior Associate Dean Alma Littles, FSU President Richard McCullough, 1st Woman Jai Vartikar, VP for Investigate Stacey Patterson and Main Medical Officer Joe Frascella.

This will also include things like possibilities for FSU researchers concentrated on getting older and electronic well being, as effectively as residency plans and clinical rotations for FSU health-related pupils.

“Today’s building kickoff will come at a pivotal time for TMH as we rejoice our 75th anniversary this yr,” said Mark O’Bryant, president and CEO of TMH, which serves a 21-county location in North Florida, Georgia and Alabama. “We have developed from a modest, city-owned clinic into a detailed overall health treatment program. As the population in our location boosts, TMH has recognized a substantial need to expand health treatment products and services. Over the earlier 7 and a 50 % a long time, we’ve crafted a standing for excellent, compassionate and local treatment, and we are proud to now give our products and services to the Panama Town Beach front communities.”

The St. Joe Company, Florida State University and Tallahassee Memorial HealthCare celebrated the construction kickoff of a health care campus in Panama City Beach Jan. 17, 2023. (Photo by Tori Schneider)
The St. Joe Company, Florida Point out College and Tallahassee Memorial Health care celebrated the construction kickoff of a well being care campus in Panama City Seaside Jan. 17, 2023. (Photograph by Tori Schneider)

Above the previous various a long time, Florida Condition University has been growing its wellbeing study portfolio even though also pursuing partnerships with major well being care devices this sort of as TMH and many others. It is also enhanced alternatives for students via its College of Medication, opening a doctor assistant schooling method, and is welcoming the first cohort of its new doctoral program in nursing at the College of Nursing this fall.

“FSU has extensive enjoyed becoming a portion of this community by means of our Panama Town Campus,” said FSU President Richard McCullough. “Now, we’re searching ahead to expanding our existence and continuing to serve the inhabitants listed here by this health treatment initiative. Analysis universities can play an vital part in a lively wellness care shipping program, and FSU appears to be forward to taking part in that job correct in this article in Bay County. This place is suffering from an extraordinary boom in inhabitants and the possibilities — and desires — have under no circumstances been better. There are incredible prospects

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Well being treatment winners and losers from the omnibus

With Tuesday’s release of the omnibus bill text (eventually!), it’s time to chat about the winners and losers of this year’s well being care appropriations time.

  • And really don’t worry, Pro viewers! You might be all winners in our e book.
Winners:
  • Sens. Richard Burr and Patty Murray: They pushed through significantly of their pandemic preparedness monthly bill.
  • Educational health care facilities: They blocked the Legitimate Act from currently being provided, arguing it would have imposed burdensome rules on them.
  • Puerto Rico: The territory will have elevated Medicaid funding and an FMAP of 76% for the next five a long time.
  • Moms and children: The bill will make long-lasting the capability of states to supply 12 months of Medicaid coverage postpartum. It also gives kids on Medicaid one 12 months of ongoing coverage.
  • Telehealth stakeholders (Medicare individuals, vendors and hospitals): Telehealth teams were pushing for as very long of an extension of PHE flexibilities as attainable. It appeared like a one particular-year extension was in enjoy last week, but now it is really grow to be two a long time.
  • PBMs (for now): A PBM transparency monthly bill that had handed the Household before this 12 months was not bundled. But, as we have documented, it is commonly expected that PBM reform will be a target of oversight in the future Congress.
  • Reps. Paul Tonko and Mike Turner, and Sens. Maggie Hassan and Lisa Murkowski: They got their monthly bill provided to boost accessibility to opioid treatment by eradicating a special DEA waiver that providers needed to prescribe the remedy.
Losers:
  • Up coming-technology vaccines: Congress did not satisfy the White House request for COVID-19 funding, such as for acquiring greater vaccines that focus on an array of variants.
  • Hospice companies: They’re assisting to fork out for the offer. The offsets include extending variations to the cap on how significantly hospice providers can recoup from Medicare.
  • Medical device firms: They pushed for the Legitimate Act, arguing the current diagnostic examination oversight process is outdated, but didn’t get it. AdvaMed CEO Scott Whitaker referred to as the bill’s absence “really disappointing,” adding, “The final matter we need is more Theranos-form assessments in our overall health care program.”
Someplace in the middle:
  • Wellbeing care vendors: Congress gave medical professionals relief from some of their Medicare cuts, but physicians say it’s not more than enough.

  • “The AMA is incredibly disappointed and dismayed that Congress unsuccessful to avert Medicare cuts next year, threatening the monetary viability of medical professional techniques and endangering accessibility to treatment for Medicare beneficiaries,” American Health-related Association president Jack Resneck stated in a statement Monday.
  • The bill produced an hard work to lengthen the reward payment medical doctors get for participating in value-centered treatment courses, but minimize it down from 5% to 3.5% and ongoing it for only one particular much more yr.
  • The offer does contain a two-yr extension for the Clinic at Residence system, which is a earn for the market.
  • The house wellbeing field:
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Top 10 Healthcare Industry Predictions For 2023

The year 2022 is almost behind us and the healthcare industry is preparing for what promises to be a most interesting 2023.

Deals—big and small—and increasing regulatory scrutiny will make 2023 a year to remember for all.

Given the prescience and accuracy of my 2022 predictions, many of you have asked about my methodology.

If you must know (and seek to remove the mystery of it all), it’s pure clairvoyance—a divine gift with which I was born.

Joking aside, some predictions are pure hunch; others are extensions of trends observed in 2022 that will continue into 2023; and others still are a reflection of my deepest hopes—some of which I hope I will nudge into being by writing it here in this column.

Without further ado, I give you the year ahead in healthcare, 2023 edition:

1) Medicare Advantage Will Remain Under A Microscope

I predicted last year that that the Medicare Advantage debate that my mentors Don Berwick and Rick Gilfillan started in 2021 would intensify. The year 2022 didn’t disappoint as Don and Rick used the pages of the Health Affairs blog to spar with numerous Medicare Advantage defenders including heavyweights WellBe Medical CEO Jeff Kang, former Kaiser Permanente CEO George Halvorson, and former CAPG CEO Don Crane. New York Times writers Reed Abelson and Margot Sanger Katz followed on with a provocative set of articles on Medicare Advantage utilization management practices; revenue capture; and broker practices. The microscope is turned on and examining Medicare Advantage in high resolution—and this scrutiny will continue deep into 2023.

As the CEO of Medicare Advantage plans for 7 years running, I have strong conviction that the Medicare Advantage is an important program that enables innovation to serve older adults, but also acknowledge that there is significant room to improve it. To address some of the emerging skepticism of Medicare Advantage, plans should proactively implement more stringent revenue coding practices; commit to access-to-care “never events” to ensure beneficiaries always have access to care in a timely manner; and continue to enhance the quality of benefits delivered through their products. The best answer to the critics is to be irrefutably and consistently better for Medicare beneficiaries—and that is the challenge to all companies that operate plans.

Whether the pundits find value in the program or not, it is here to stay—as more than 40% percent of older adults rely on it for their care. Our focus should be on aligning on ideas to improve the program, not arguing whether it’s better or worse than traditional fee-for-service Medicare (as with most things, the answer is, it depends). The leadership of the Centers for Medicare and Medicaid

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Amazon helps make a new force into wellbeing treatment

AS Large TECH companies facial area a brutal gradual-down the hunt is on for new regions of growth. Amazon, which is now America’s second-most significant company by earnings, is a circumstance in point. In the last quarter of 2022 its sales are expected to grow by just 6.7% year-on-year. On November 17th Andy Jassy, its chief govt, verified that the agency had begun laying off employees and would fire far more up coming 12 months. He explained it was the most difficult decision he experienced built given that turning into manager. But he also noted that “big opportunities” lie in advance. A person is the biggest, most beneficial and hellishly tricky business in The usa: overall health treatment.

Pay attention to this tale.
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A lot of tech corporations have well being-care ambitions. Apple tracks effectively-getting by the Iphone. Microsoft delivers cloud-computing solutions to wellness companies. Alphabet sells wearable gadgets and is pumping dollars into biotech analysis. But Amazon is now producing the most ambitious offering of all. Two times just before Mr Jassy’s statement it released “Amazon Clinic”, an on the web company functioning in 32 states that presents digital overall health treatment for around 20 conditions, from acne breakouts to allergy symptoms. Amazon describes the company as a digital storefront that connects end users with third-get together well being providers.

The Amazon Clinic launch follows a $3.9bn takeover, declared in July, of One particular Health-related, a key-treatment service provider with 790,000 customers that offers telehealth providers on-line and bricks-and-mortar clinics (the offer is however to close). The deal was led by Neil Lindsay, formerly accountable for Primary, Amazon’s subscription support. He has said wellbeing care “is large on the listing of ordeals that require reinvention”.

These most up-to-date moves enhance Amazon’s present belongings. Its Halo band, a wearable machine that went on sale in 2020, screens the wellness status of customers. In 2018 it acquired PillPack, a electronic pharmacy that is now section of Amazon Pharmacy, for $753m. Amazon Net Products and services introduced certain cloud companies for wellbeing-care and existence-science companies in 2021.

The go into primary care, jargon for the purpose of the family health practitioner, is a huge phase but a sensible just one. Walgreens, a pharmacy chain, reckons the field is really worth $1trn a yr. Around half of Era z and millennial Americans do not have a most important-treatment health practitioner and A person Medical’s membership has pretty much doubled given that 2019. Amazon Clinic will take dollars for its providers, instead than relying on America’s nightmarish insurance policies procedure to recoup fees.

The firm is betting that primary care will turn out to be much more digital. It is possible that it will search for to integrate these solutions with other components of its wellness-treatment featuring. Amazon Clinic’s new users

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