Health Affairs

JUST RELEASED The September 2024 issue is now available! Read Editor in Chief Alan Weil's introduction to the new issue on Access To Care, Coverage & More. Explore the issue: https://bit.ly/3Xs9OGT

In their new Forefront article, Olivia Thomas, Jacob Mirsky, Norma Gonzalez, Benaye Wadkins, and Jaclyn Albin from Boston Medical Center (BMC), Massachusetts General Hospital, UT Southwestern Medical Center, and Crossroads Community Services argue that, by advancing the integration of Food Is Medicine in health care through community collaboration, we can significantly enhance patient outcomes, improve health care delivery, and proactively address future health challenges. "We work as direct-service providers in hospital systems and community-based organizations (CBOs) and have experience implementing FIM interventions in health care settings. And we believe that it is possible to elevate the current FIM movement, help tackle food insecurity at its roots, support health equity, and ensure sustainable care models that mitigate strain on health care organizations and providers. To that end, we offer three guiding principles, developed through our own experience, trial and tribulation to ensure the success of Food Is Medicine." Read the full article here: https://bit.ly/484axBY

Olivier Wouters and Jouni Kuha of London School of Economics highlight global disparities in essential medicine availability across income levels. Read the full article here: https://bit.ly/3ZStvtj

In her new Forefront article, Jody Sindelar from Yale University argues that, while greater food- and nutrition-security should be prioritized to improve population health, Food Is Medicine (FIM) programs through the medical system may not be the best approach with the attendant concerns and given the alternatives. discusses how greater food- and nutrition-security should be prioritized to improve population health. Society should invest significantly. But FIM programs through the medical system may not be the best approach with the attendant concerns and given the alternatives. "I believe that policy makers should prioritize these current government programs that subsidize nutritious foods and provide related services. These programs can and should be improved and expanded with more funding, attention, and innovations. These might be better investments than developing a new medical-food system infrastructure. This argument applies most to low-income populations as they both suffer more from food insecurity and have access to alternative, established, free, food programs. Growing attention to and government funding of FIM medical programs might deter needed expansions to these effective, established, government food, and nutrition programs." Read the full article here: https://bit.ly/4eCTcT1

Stephen Soumerai of Harvard Medical School et al, conducted a systematic review to examine the adverse effects of FDA-issued black-box warnings on child and adolescent mental health outcomes such as reduced depression diagnosis and increased suicide rate. Read the full article here: https://bit.ly/3XVNEMu

In their new Forefront article, T. Joseph Mattingly II, Adrian Towse, and Louis P. Garrison Jr. from the University of Utah, the Office of Health Economics, and the University of Washington discuss how CMS must develop and share publicly a clear evidence synthesis process that it will follow in future rounds of the Medicare Drug Price Negotiation Program. "Sound methods for evidence synthesis lie at the center of decision making in health care and, as such, are a prerequisite for CMS developing a rigorous, objective, and consistent process for establishing MFPs. In recent guidance on this subject, CMS refers to “reviewing the literature” and a “CMS-led literature review” multiple times. These literature reviews will be particularly challenging for the agency in light of the substantial evidence base that will have accrued across multiple drug indications and comparators between initial Food and Drug Administration (FDA) approval and the time the agency may begin establishing the MFP for a specific drug, seven to 11 years later." Read the full article here: https://bit.ly/3NkTOks

Call for Abstracts | Interested authors are invited to submit abstracts for the upcoming theme issue on research and policy insights about the opioid crisis, to be published September 2025. The submission portal for abstracts will be open November 12-December 2, 2024. Learn more: https://bit.ly/3U3riqW

In his new Forefront article, Matthew Fiedler of The Brookings Institution discusses how HHS breaks some notable new ground by proposing to account for receipt of HIV pre-exposure prophylaxis (PrEP) when calculating enrollee risk scores and by seeking public comment on how the risk adjustment program should account for the time value of money. "Because receipt of PrEP is not a diagnosis, it would not meet the criteria to be a hierarchical condition category (HCC) or a prescription drug category (RXC), the two types of enrollee health characteristics that are already used as predictor variables in the HHS’ risk score models. Instead, HHS proposes to make receipt of PrEP the first in a new class of predictor variables called affiliated cost factors (ACFs). HHS lays seven principles to govern creation of ACFs. These include that a prospective ACF should be clinically meaningful and specific, have meaningful and predictable costs, affect enough patients to provide an adequate sample size for estimating the coefficient on the factor, and pose a low risk of inappropriate prescribing." Read the full article here: https://bit.ly/3TY7h5l

It's been a big week at Health Affairs. Welcome to our biggest Linkedin newsletter ever. Learn more about our new October issue, a recent ahead-of-print article, events this month, and the upcoming request for abstracts for a 2025 theme issue!

In his new Forefront article, J. Michael McWilliams from Harvard Medical School discusses how there has been less attention paid to the role of alternative payment models in advancing the goals of physician payment reform, despite the fact that a major underlying motivation for payment reform is longstanding dissatisfaction with fee-for-service. "A fee-for-service system is ill-suited to services that are multidimensional and hard to price. This is the case for telehealth and much of the clinical effort involved in chronic disease management, care coordination, and primary care. In a fee-for-service system, decisions about adding codes or increasing rates face a tradeoff between expanding or preserving access and containing costs. Telehealth epitomizes this tradeoff—broader coverage and higher reimbursement improve access but increase spending, including a risk of overuse. As has played out repeatedly in Medicare’s history, attempts to limit spending growth by constraining fee growth have inevitably prompted “fixes” motivated by concerns about maintaining beneficiary access to physicians. Under fee-for-service, holding fee updates well below the rate of inflation (as under current law) would make serving Medicare patients progressively less sustainable for providers over time as per-service margins erode, eventually compromising access (as has been observed in Medicaid)." Read the full article here: https://bit.ly/3BAKBSl