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• Article | Health Affairs | 2020

  Treatment Of Opioid Use Disorder Among Commercially Insured US Adults, 2008–17

  Karen Shen, Eric Barrette and Leemore S. Dafny

  There is abundant literature on efforts to reduce opioid prescriptions and misuse, but comparatively little on the treatment provided to people with opioid use disorder (OUD). Using claims data representing 12–15 million nonelderly adults covered through commercial group insurance during the period 2008–17, we explored rates of OUD diagnoses, treatment patterns, and spending. We found three key patterns: The rate of diagnosed OUD nearly doubled during 2008–17, and the distribution has shifted toward older age groups; the likelihood that diagnosed patients will receive any treatment has declined, particularly among those ages forty-five and older, because of a reduction in the use of medication-assisted treatment (MAT) and despite clinical evidence demonstrating its efficacy; and treatment spending is lower for patients who choose MAT. These patterns suggest that policies supporting the use of MAT are critical to addressing the undertreatment of OUD among the commercially insured and that further research to assess the costeffectiveness of treatment with versus without medication is needed.

  Citation:

  Shen, Karen, Eric Barrette, and Leemore S. Dafny. "Treatment Of Opioid Use Disorder Among Commercially Insured US Adults, 2008–17." Health Affairs 39, no. 6 (2020): 993–1001.  View Details

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• Article | Health Affairs Blog | May 21, 2020

  Primary Care Is Hurting: Why Aren't Private Insurers Pitching In?

  Leemore S. Dafny and J. Michael McWilliams

  Primary care clinicians are the front line for patients with suspected infection. We rely on them to diagnose, triage, and manage patients with potential or confirmed COVID infections. They are also responsible for keeping non-COVID medical conditions under control.
  
  This central role makes it of even greater concern that primary care practices are far more financially vulnerable than other medical specialties, where margins are higher and pockets deeper. Only half of primary care clinicians report enough cash to stay open for the next four weeks. The potential outcomes are grim: practices will go under, patients will lose access, and, when the dust settles, more clinicians will either leave primary care or seek employment in hospital-owned or large groups with greater reserves. These acquisitions have been shown to raise prices and spending.
  
  Supporting primary care is not only in the public interest; it’s in the interest of commercial health insurers. If primary care practices are decimated and absorbed, not only might patients receive more expensive specialty care in lieu of primary care, but insurers will have less ability to pick and choose “in-network” practices based on efficiency and pricing.
  
  Commercial insurers have excess premiums due to the downturn in healthcare demand, and they could help to support this front line and strengthen our post-pandemic healthcare system in so doing. They would also would benefit from helping providers at a moment when the public perceives them to be sitting on the sidelines. But there is a free-rider problem to address: clinicians serve enrollees from multiple insurers. We propose a simple solution that would deliver funds where needed, and promptly.

  Keywords: COVID-19; Primary Care; Health Pandemics; Health Care and Treatment; Financial Condition; Insurance;

  Citation:

  Dafny, Leemore S., and J. Michael McWilliams. "Primary Care Is Hurting: Why Aren't Private Insurers Pitching In?" Health Affairs Blog (May 21, 2020).  View Details

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• Chapter | The Trillion Dollar Revolution | 2020

  Health Care Markets a Decade After the ACA: Bigger, but Probably Not Better

  Leemore S. Dafny

  Love it or hate it, the Affordable Care Act (ACA) embraced and extended the role of private markets in financing and delivering health care in the United States. Ten years after the ACA’s passage, it is unclear whether health care markets are better (along a range of dimensions, including delivering health per dollar spent), but there is no doubt that they are bigger. While growth in the share of U.S. GDP devoted to health care has slowed since the ACA, the absolute level has risen from 16.3 percent in 2008 (before the ACA had taken shape) to 17.9 percent in 2017, the most recent year for which data are currently available. Between 2008 and 2015 (five years following the ACA), the S&P 500 Health Care Index more than doubled. By comparison, the S&P 500 Index (spanning all sectors) increased only 45 percent during the same period, notwithstanding its greater sensitivity to the economic recovery following the 2009 recession. To put it colloquially, the ACA “has not been bad for business,” notwithstanding the trepidation of various industry stakeholders—or perhaps owing to concessions negotiated as a result of that trepidation on the eve of its passage. But this growth has not been accompanied by more robust competition to serve patients’ needs, the much-vaunted benefit of market-based systems.

  Keywords: Health Care and Treatment; Markets; Laws and Statutes; Outcome or Result; Health Industry; United States;

  Citation:

  Dafny, Leemore S. "Health Care Markets a Decade After the ACA: Bigger, but Probably Not Better." Chap. 15 in The Trillion Dollar Revolution: How the Affordable Care Act Transformed Politics, Law, and Health Care in America, edited by Ezekiel J. Emanuel and Abbe R. Gluck. New York: PublicAffairs, 2020.  View Details

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