JAMA Health Forum Editors' Summary

Cost sharing is particularly burdensome for some Medicare beneficiaries, particularly those with incomes just above the poverty level, those with disabilities, or those who have multiple chronic health conditions. Jeanne Madden, PhD, of the Northeastern University School of Pharmacy, and Eric Roberts, PhD, of the University of Pittsburgh Graduate School of Public Health, speak with JAMA Health Forum Editor John Ayanian and Deputy Editor Melinda Buntin about the implications of high cost-sharing burdens in Medicare and options for policy makers to limit these burdens for Medicare beneficiaries who are at greatest risk.

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• Affordability of Medical Care Among Medicare Enrollees
• Unequal Burdens of Cost Sharing for Medicare Beneficiaries

There are many actors in the drug supply and distribution system, and little is known about the share of drug expenditures going to each, making it more difficult to rein in costs. JAMA Health Forum Associate Editor, Julie Donohue, PhD, and Deputy Editor, Melinda Buntin, PhD, speak with Neeraj Sood, PhD, lead author in a JAMA Health Forum study that unpacks the distribution of insulin expenditures, revealing that a surprising share goes to intermediaries. They also spoke with Bernie Good, MD, who wrote an invited commentary about this study.

Related Content:

• Share of Net Insulin Expenditures Captured in the US Pharmaceutical Distribution System
• Decomposition of Expenditures for Insulins Across the Distribution Chain—Insights Into Rising Prices?

State Medicaid programs are required to cover all drugs approved by the US Food & Drug Administration (FDA), including those that have received accelerated approval from the FDA to treat serious or life-threatening illnesses such as HIV or cancer. These drugs with accelerated approval may be beneficial based on surrogate end points such as changes in imaging or blood test results, but they have not yet been shown to improve health outcomes or survival. Rachel Sachs, JD, MPH, of the Washington University in St. Louis School of Law speaks with JAMA Health Forum Editor, John Ayanian, and Deputy Editor, Melinda Buntin, about how utilization and spending for costly drugs with accelerated approval have grown in the Medicaid program nationally since 1992, representing 9% of all Medicaid drug spending for just 0.2% of all prescriptions in 2018.

Related Content:

Medicaid Use and Spending for Drugs With FDA Accelerated Approval

We know that the pandemic caused millions of people to lose their jobs, and potentially their job-based insurance, and yet new survey data showed surprisingly small changes in uninsurance rates at the end of 2020. Kate Bundorf, PhD, from the Sanford School of Public Policy at Duke University and Jessica Banthin, PhD, of the Urban Institute talk to JAMA Health Forum Deputy Editor Melinda Buntin about these trends and the role played by Medicaid and exchange coverage. JAMA Health Forum Editor John Ayanian and Melinda Buntin also discuss other recent work about health insurance coverage and the ACA that has appeared in JAMA Health Forum.

Related Content:

• Trends in US Health Insurance Coverage During the COVID-19 Pandemic
• Fewer People May Have Become Uninsured in 2020 Than Feared
• Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules
• Income Eligibility for Medicaid vs Marketplace Coverage for Insurance Enrollment Among Low-Income Adults
• Making the Affordable Care Act Marketplace More Affordable

Firearms are the most common method of suicide in the US over the past decade. Primary care and mental health clinicians frequently interact with individuals at risk for suicide, but clinicians are often unaware of whether these patients have access to firearms. Julie Richards, PhD, from the Kaiser Permanente Washington Health Research Institute talks to JAMA Health Forum Editor John Ayanian and Deputy Editor Melinda Buntin about how responses to standard firearm access questions can foster collaborative planning for safe storage of firearms to improve suicide prevention.

Related Content:

Self-reported Access to Firearms Among Patients Receiving Care for Mental Health and Substance Use

The COVID-19 pandemic has had far-reaching effects on the use of health care services. Dr Nora Becker of the University of Michigan talks about her research on reductions in the use of women’s preventive health services, and JAMA Health Forum Editors Dr John Ayanian and Dr Melinda Buntin discuss other JAMA Health Forum pieces on the effects of state “reopenings” on COVID-19 hospitalizations and deaths, the effects of day care closures on women’s participation in the labor force, and news about nursing home outbreaks of COVID-19.

Related Content:

• Utilization of Women’s Preventive Health Services During the COVID-19 Pandemic
• CDC Estimates Thousands of Excess Deaths Among US Patients with End-Stage Renal Disease During COVID-19 Pandemic’s Early Months
• Most US Nursing Homes Had Multiple, Sustained COVID-19 Outbreaks, GAO Reports
• Association of Childcare Facility Closures With Employment Status of US Women vs Men During the COVID-19 Pandemic
• US Trends in COVID-19–Associated Hospitalization and Mortality Rates Before and After Reopening Economies
• Lessons Emerging From COVID-19 Responses by US States

Participating in value-based incentive programs imposes financial and time costs on physician practices.  Dhruv Khullar of Weill Cornell Medical College and Jason Hockenberry of Yale School of Public Health discuss these burdens, the challenge of quality measurement, and ways increase the “value” of value-based payment programs like Medicare’s Merit-based Incentive Payment System (MIPS). 

Related Content:

• Time and Financial Costs for Physician Practices Participating in MIPS
• Cost of Compliance With CMS Physician Quality Monitoring

A portfolio approach to health care payment reform, where a set number of alternative payment models are selected for testing because they work together to reduce waste, could be a more efficient way to reduce costs and incentivize quality. Michael Chernew, PhD, of Harvard University explains the idea in a conversation with JAMA Health Forum editors John Ayanian, MD, MPP and Melinda Buntin, PhD.

Related Content:

Alternative Health Care Payment Models—The Case for A Portfolio Strategy

JAMA Health Forum is a peer-reviewed, open access, online journal, focused on health policy, health care systems, and population health.  Our podcast each month presents highlights of new content from the journal, including timely interviews with authors of research studies and commentaries.  Follow us on jamahealthforum.com and jamanetworkaudio.com.