Research Roundup: E-Prescriptions; Primary Care Physicians; And Medicare Advantage

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Access To E-Prescriptions And Related Technologies Before And After Hurricanes Harvey, Irma, And Maria
Hurricanes Harvey, Irma, and Maria devastated parts of the US mainland and Puerto Rico during the 2017 hurricane season, causing loss of life and substantial damage and interrupting access to health care for many people in the hurricane impact zones. Using data on e-prescriptions and medication history transactions from a large health information network for the period August 2017–May 2018, we examined providers’ access to these technologies across affected areas. Although e-prescribing and medication history transactions decreased considerably during each hurricane, transaction volumes returned to normal levels in the days immediately following Hurricanes Harvey and Irma in Texas and Florida. E-prescribing activity in Puerto Rico did not return to baseline levels at all during the study period, and medication history transactions returned to normal only after an extended period following Hurricane Maria. (Smith and Sow, 2/4)

JAMA Internal Medicine: Association Of Primary Care Physician Supply With Population Mortality In The United States, 2005-2015.
Primary care physician supply increased from 196 014 physicians in 2005 to 204 419 in 2015. Owing to disproportionate losses of primary care physicians in some counties and population increases, the mean (SD) density of primary care physicians relative to population size decreased from 46.6 per 100 000 population (95% CI, 0.0-114.6 per 100 000 population) to 41.4 per 100 000 population (95% CI, 0.0-108.6 per 100 000 population), with greater losses in rural areas. In adjusted mixed-effects regressions, every 10 additional primary care physicians per 100 000 population was associated with a 51.5-day increase in life expectancy (95% CI, 29.5-73.5 days; 0.2% increase), whereas an increase in 10 specialist physicians per 100 000 population corresponded to a 19.2-day increase (95% CI, 7.0-31.3 days). (Basu et al, 2/18)

The Henry J. Kaiser Family Foundation: 'Partial Medicaid Expansion' With ACA Enhanced Matching Funds: Implications For Financing And Coverage
The Affordable Care Act (ACA) provides enhanced federal matching funds to states that expand Medicaid to nonelderly adults up to 138% of the federal poverty level (FPL, $17,236/year for an individual in 2019). The ACA enhanced match (93% in 2019, and 90% in 2020 and thereafter) is substantially higher than states’ traditional Medicaid matching rate. A few states have sought Section 1115 demonstration waiver authority from the Centers for Medicare and Medicaid Services (CMS) to receive the substantially higher ACA enhanced match while limiting coverage to individuals at 100% FPL, instead of covering the full 138% FPL ACA group. (Rudowitz and Musumeci, 2/20)

Commonwealth Fund: Market Concentration Potential Competition Medicare Advantage
Medicare Advantage (MA), the private option to traditional Medicare, now serves roughly 37 percent of beneficiaries. Congress intended MA plans to achieve efficiencies in the provision of health care that lead to savings for Medicare through managed competition among private health plans. (Frank and McGuire, 2/14)

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