Erin K. Kaplan

Impact of the REACH II and REACH VA Dementia Caregiver Interventions on Healthcare Costs

Examine caregiver and care recipient healthcare costs associated with caregivers’ participation in Resources for Enhancing Alzheimers Caregivers Health (REACH II or REACH VA) behavioral interventions to improve coping skills and care recipient management.

Medication therapy management and adherence among US renal transplant recipients

Background Medication therapy management (MTM) services among patient populations with a range of disease states have improved adherence rates. However, no published studies have examined the impact of Medicare Part D MTM eligibility on renal transplant recipients’ (RTRs) immunosuppressant therapy (IST) adherence. This study’s purpose was therefore, to determine the effects of Medicare Part D MTM on IST adherence among adult RTRs at 12 months posttransplant. Methods Cross-sectional analyses were performed on Medicare Parts A, B, and D claims and transplant follow-up data reported in the United States Renal Data System. The sample included adult RTRs who were transplanted between 2006 and 2011, had graft survival for 12 months, were enrolled in Part D, and were prescribed tacrolimus. IST adherence was measured by medication possession ratio for tacrolimus. MTM eligibility was determined using criteria established by the Centers for Medicare and Medicaid Services. Descriptive statistics were calculated. Adherence was modeled using multiple logistic regression. Results In all, 17,181 RTRs were included. The majority of the sample were male (59.1%), and 42% were MTM-eligible. Mean medication possession ratio was 0.91±0.17 (mean ± standard deviation), with 16.83% having a medication possession ratio of <0.80. MTM eligibility, sex, age, and number of prescription drugs were significantly associated with adherence in the full model (P<0.05). MTM-eligible RTRs were more likely to be adherent than those who were not MTM-eligible (odds ratio =1.13, 95% confidence interval 1.02–1.26, P=0.02). Conclusion The findings provide evidence that access to MTM services increases IST adherence among RTRs.

The U.S. Health Insurance Marketplace: Are Premiums Truly Affordable?

Starting in 2014, the Patient Protection and Affordable Care Act (ACA) requires that individuals have health insurance or pay a penalty; however, those without access to affordable coverage are exempt from this mandate. The decision to purchase insurance depends on many complex factors, including the individuals perceived need for health care services, the affordability of premiums and out-of-pocket expenses, and the cost of potential penalties for lack of coverage. For those with a low perceived need for health care services, the cost of premiums relative to the penalty may play a pivotal role in coverage decisions. To examine how premium affordability varies according to age, income, and geographic area, we analyzed premium data for all health plans offered on state and federal health insurance marketplaces, commonly referred to as health insurance exchanges, for every county in the United States. Marketplace Overview The ACA established a modified community rating system, allowing insurance premiums to vary within strict limits on the basis of 4 factors: geographic region, family size, age, and tobacco use. For age-based premium variation, most plans follow the federally established standard age curve, where premiums for each age are determined by a schedule of fixed ratios such that the premium for a 64-year-old is 3 times greater than the base premium (that is, the premium for a 21-year-old) (1). Four states and the District of Columbia established their own age curves, which also increase with age but at different ratios than those specified by the standard age curve. Two states imposed a pure community rating, which prohibits variation in insurance premiums based on age. Marketplace health plans are categorized into 4 metal levels on the basis of the percentage of health care costs that the plan will pay for the average enrollee: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum). All plans available provide financial protection for unforeseen costly medical events and access to many preventive services free of charge; however, out-of-pocket costs vary substantially across plans. Bronze plans have lower premiums than other levels but higher out-of-pocket costs. Individual Mandate The ACA requires individuals to have health insurance or pay a yearly penalty. However, those without access to affordable coverage, for whom the cost of the least-expensive bronze plan available is greater than 8% of their income, are exempt from this penalty. The penalty for 2014 is

Hospital volume and acute myeloid leukemia mortality in Medicare beneficiaries aged 65 years and older

95 per person or 1% of total household income, whichever is higher. It will increase to

Cyclical unemployment and infant health

695 per person or 2.5% of income, whichever is higher, by 2016. Subsidy Overview Households with incomes between 100% and 400% of the federal poverty level (FPL)

Economic Analyses of an Alcohol Misconduct Prevention Program in a Military Setting

11670 and

Three years in – changing plan features in the U.S. health insurance marketplace

46680, respectively, for an individual in 2014qualify for subsidies on the basis of their income and the premium cost of the benchmark plan, defined as the silver plan with the second-lowest premium (2). Subsidies are calculated so that the benchmark plan can be purchased with a fixed percentage of income (Table 1). For example, in 2014, individuals earning 200% of the FPL (

Reply to: Over-REACHing Conclusions

23340) receive a subsidy so that they have to pay only 6.3% of their income (or

Labor Supply Impacts of the Affordable Care Act

123 per month) for the benchmark plan. If the cost of the benchmark plan available in an individuals county were

Capitalization of School Quality in Housing Prices: Evidence from Boundary Changes in Shelby County, Tennessee

300 per month, the subsidy would be equal to the difference between the market cost of the plan and the fixed income threshold, or