Weiner, Janet
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Publication Window Shopping on Healthcare.gov and the State-Based Marketplaces: More Consumer Support Needed(2014-12-17) Baker, Tom; Beatty, Adrienne; Nirenburg, Gabbie; Weiner, JanetThis data brief examines the window-shopping experience that consumers encountered on each health insurance marketplace website during the first two weeks of the Affordable Care Act's second open enrollment period. The marketplaces have made some progress toward adopting the recommended "Top 5 Rules for Decision Support." Shoppers found plenty of sorting and filtering options, but insufficient information about providers and little true decision support. Although there is still a long way to go, there are grounds for optimism about further progress for the next open enrollment period.Publication Primary Care Shortages: More Than a Head Count(2014-11-21) Pauly, Mark V; Weiner, Janet; Naylor, Mary DThe existence of a primary care physician shortage, even prior to the ACA, is not universally accepted. A new report by the Institute on Medicine found “no credible evidence” that the nation faces a looming physician shortage in primary care specialties. There is greater consensus about a maldistribution of physicians, in terms of specialty, geography, and practice settings. This new LDI/ Interdisciplinary Nursing Quality Research Initiative (INQRI) research brief reviews the evidence and how the ACA might affect current and future patterns of delivering primary care.Publication Final Enrollment Rates Show Federally run Marketplaces Make up Lost Ground at end of Enrollment(2014-05-29) Polsky, Daniel; Weiner, Janet; Colameco, Christopher; Becker, Nora VerlaineThis new data brief updates our interim March 2014 findings with enrollment rates at the close of the Affordable Care Act's first open enrollment period. It focuses on enrollment rates by state and type of marketplace, and assesses changes in enrollment rates in the final six weeks. The final enrollment figures reveal that the federally facilitated marketplaces and some of the troubled state-based ones made up some ground in the last four to six weeks of the open enrollment period.Publication Primary Care: On the Front Lines of the Opioid Crisis(2016-08-09) Bachhuber, Marcus; Weiner, Janet; Mitchell, Julia; Samet, JeffreyThis Issue Brief discusses the role of primary care teams in identifying illicit drug use disorders in their patients, the continuum of treatments that they can offer, and opportunities for successful collaboration and integration with specialists. The authors find opportunities exist for increased patient screening and delivering medication-assisted treatment as well as established models for collaboration and integration of opioid treatments.Publication Health Insurance Rates and Rate Review(2014-06-27) Harrington, Scott E; Weiner, JanetHealth insurers participating in the new Marketplaces are filing rates for 2015 during the next few months. A few states have already released data on proposed rates. There is substantial economic, policy, and political interest in the magnitude of proposed rate changes. This brief provides background for understanding the economic drivers of proposed rates, state and federal rate review authority, the effects of rate changes on Marketplace enrollees and federal spending on premium credits, and the economic and political dynamics of the rate review and approval process.Publication Using Financial Incentives to Treat Stimulant Use Disorders(2024-01-18) Beatty, Benicio; Komaragir, Ameya; Weiner, JanetStimulants are playing a prominent role in the current U.S. overdose crisis. As stimulant use continues to mount, the need for evidence-based treatment grows more urgent. This brief highlights contingency management, the most effective treatment for stimulant use disorder, and reviews the current barriers to its widespread use along with practice and policy strategies for increasing implementation.Publication Health Insurance Marketplace Enrollment Rates by Type of Exchange(2014-03-28) Polsky, Daniel; Weiner, Janet; Colameco, Christopher; Becker, Nora VerlaineBecause the ACA gave them choices in how to implement insurance coverage, health reform looks different state to state. This Data Brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their potential impact on enrollment rates to date. We use existing data sources as well as a new database developed by researchers at the University of Pennsylvania that documents and codes state-level variation in the political setting, institutional structures, and operational decisions likely to affect outcomes on the marketplaces.Publication Effects of the ACA on Health Care Cost Containment(2017-03-02) Weiner, Janet; Marks, Clifford; Pauly, MarkThis brief reviews the evidence on how key ACA provisions have affected the growth of health care costs. Coverage expansions produced a predictable jump in health care spending, amidst a slowdown that began a decade ago. Although we have not returned to the double-digit increases of the past, the authors find little evidence that ACA cost containment provisions produced changes necessary to “bend the cost curve.” Cost control will likely play a prominent role in the next round of health reform and will be critical to sustaining coverage. gains in the long term.Publication Military Veteran Mortality Following a Survived Suicide Attempt(2011-01-01) Weiner, Janet; Richmond, Therese S; Wiebe, Douglas; Conigliaro, JosephBACKGROUND: Suicide is a global public health problem. Recently in the U.S., much attention has been given to preventing suicide and other premature mortality in veterans returning from Iraq and Afghanistan. A strong predictor of suicide is a past suicide attempt, and suicide attempters have multiple physical and mental comorbidities that put them at risk for additional causes of death. We examined mortality among U.S. military veterans after hospitalization for attempted suicide. METHODS: A retrospective cohort study was conducted with all military veterans receiving inpatient treatment during 1993-1998 at United States Veterans Affairs (VA) medical facilities following a suicide attempt. Deaths occurring during 1993-2002, the most recent available year at the time, were identified through VA Beneficiary and Records Locator System data and National Death Index data. Mortality data for the general U.S. adult population were also obtained from the National Center for Health Statistics. Comparisons within the veteran cohort, between genders, and against the U.S. population were conducted with descriptive statistics and standardized mortality ratios. The actuarial method was used estimate the proportion of veterans in the cohort we expect would have survived through 2002 had they experienced the same rate of death that occurred over the study period in the U.S. population having the age and sex characteristics. RESULTS: During 1993-1998, 10,163 veterans were treated and discharged at a VA medical center after a suicide attempt (mean age = 44 years; 91% male). There was a high prevalence of diagnosed alcohol disorder or abuse (31.8%), drug dependence or abuse (21.8%), psychoses (21.2%), depression (18.5%), and hypertension (14.2%). A total of 1,836 (18.1%) veterans died during follow up (2,941.4/100,000 person years). The cumulative survival probability after 10 years was 78.0% (95% CI = 72.9, 83.1). Hence the 10-year cumulative mortality risk was 22.0%, which was 3.0 times greater than expected. The leading causes overall were heart disease (20.2%), suicide (13.1%), and unintentional injury (12.7%). Whereas suicide was the ninth leading cause of death in the U.S. population overall (1.8%) during the study period, suicide was the leading and second leading cause among women (25.0%) and men (12.7%) in the cohort, respectively. CONCLUSIONS: Veterans who have attempted suicide face elevated risks of all-cause mortality with suicide being prominent. This represents an important population for prevention activities.Publication For Third Enrollment Period, Marketplaces Expand Decision Support Tools to Assist Consumers(2016-04-04) Polsky, Daniel; Wong, Charlene A; Weiner, Janet; Jones, Arthur T; Town, Robert; Baker, TomIn the latest open enrollment period, ACA marketplaces added features to help consumers browse and pick a health plan, including total cost estimators and provider look-up tools. Marketplaces differ in how they estimate out-of-pocket costs and how they display plan choices, although most continue to present plans in premium order.
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