Two important reports released last Wednesday point to a disconnect in how policymakers are managing the U.S. economy and how the health economy fits.
Report One: The Federal Reserve Open Market Meeting
At its meeting last week, the Governors of the Federal Open Market Committee (FOMC) voted unanimously to keep the target range for the federal funds rate at 5% to 5.25%–the first time since last March that the Fed has concluded a policy meeting without raising interest rates.
In its statement by Chairman Powell, the central bank left open the possibility of additional rate hikes this year which means interest rates could hit 5.6% before trending slightly lower in 2024.
In conjunction with the (FOMC) meeting, meeting participants submitted projections of the most likely outcomes for each year from 2023 to 2025 and over the longer run:
|Median||2023||2024||2025||Longer Run||Longer Run Range|
|% Change in GDP||1.1||1.1||1.8||1.8||1.6-2.5|
|Unemployment rate &||4.1||4.5||4.5||4.0||3.6-4.4|
|PCE Inflation rate||3.2||2.5||2.1||2.0||2.0|
|Core PCE Inflation||3.9||2.6||2.2||*||*|
*Longer-run projections for core PCE inflation are not collected.
Notes re: the Fed’s projections based on these indicators:
- The GDP (a measure of economic growth) is expected to increase 1% more this year than anticipated in its March 2023 analysis while estimates for 2024 were lowered just slightly by 0.1%. Economic growth will continue but at a slower pace.
- The unemployment rate is expected to increase to 4.1% by the end of 2023, a smaller rise in joblessness than the previous estimate of 4.5%. (As of May, the unemployment rate was 3.7%). Unemployment is returning to normalcy impacting the labor supply and wages.
- inflation: as measured by the Personal Consumption Expenditures index, will be 3.2% at the end of 2023 vs. 3.3% they previously projected. By the end of 2024, it expects inflation will be 2.5% reaching 2.1% at the end of 2025. Its 2.0% target is within reach on or after 2025 barring unforeseen circumstances.
- Core inflation projections, which excludes energy and food prices, increased: the Fed now anticipates 3.9% by the end of 2023–0.3% above the March estimate. Price concerns will continue among consumers.
Based on these projections, two conclusions about nation’s monetary policy may be deduced the Fed’s report and discussion:
- The Fed is cautiously optimistic about the U.S. economy in for the near term (through 2025) while acknowledging uncertainty exists.
- Interest rates will continue to increase but at a slower rate than 2022 making borrowing and operating costs higher and creditworthiness might also be under more pressure.
Report Two: CMS
On the same day as the Fed meeting, the actuaries at the Centers for Medicare and Medicaid Services (CMS) released their projections for overall U.S. national healthcare spending for the next several years:
“CMS projects that over 2022-2031, average annual growth in NHE (5.4%) will outpace average annual growth in gross domestic product (GDP) (4.6%), resulting in an increase in the health spending share of GDP from 18.3% in 2021 to 19.6% in 2031. The insured percentage of the population is projected to have reached a historic high of 92.3% in 2022 (due to high Medicaid enrollment and gains in Marketplace coverage). It is expected to remain at that rate through 2023. Given the expiration of the Medicaid continuous enrollment condition on March 31, 2023 and the resumption of Medicaid redeterminations, Medicaid enrollment is projected to fall over 2023-2025, most notably in 2024, with an expected net loss in enrollment of 8 million beneficiaries. If current law provisions in the Affordable Care Act are allowed to expire at the end of 2025, the insured share of the population is projected to be 91.2%. In 2031, the insured share of the population is projected to be 90.5%, similar to pre-pandemic levels.”
The report includes CMS’ assumptions f: or 4 major payer categories:
- Medicare Part D: Several provisions from the Inflation Reduction Act (IRA) are expected to result in out-of-pocket savings for individuals enrolled in Medicare Part D. These provisions have notable effects on the growth rates for total out-of-pocket spending for prescription drugs, which are projected to decline by 5.9% in 2024, 4.2% in 2025, and 0.2% in 2026.
- Medicare: Average annual expenditure growth of 7.5% is projected for Medicare over 2022-2031. In 2022, the combination of fee-for-service beneficiaries utilizing emergent hospital care at lower rates and the reinstatement of payment rate cuts associated with the Medicare Sequester Relief Act of 2022 resulted in slower Medicare spending growth of 4.8% (down from 8.4% in 2021).
- Medicaid: On average, over 2022-2031, Medicaid expenditures are projected to grow by 5.0%. With the end of the continuous enrollment condition in 2023, Medicaid enrollment is projected to decline over 2023-2025, with most of the net loss in enrollment (8 million) occurring in 2024 as states resume annual Medicaid redeterminations. Medicaid enrollment is expected to increase and average less than 1% through 2031, with average expenditure growth of 5.6% over 2025-2031.
- Private Health Insurance: Over 2022-2031, private health insurance spending growth is projected to average 5.4%. Despite faster growth in private health insurance enrollment in 2022 (led by increases in Marketplace enrollment related to the American Rescue Plan Act’s subsidies), private health insurance expenditures are expected to have risen 3.0% (compared to 5.8% in 2021) due to lower utilization growth, especially for hospital services.
And for the 3 major recipient/payee categories:
- Hospitals: Over 2022-2031, hospital spending growth is expected to average 5.8% annually. In 2023, faster growth in hospital utilization rates and accelerating growth in hospital prices (related to economy wide inflation and rising labor costs) are expected to lead to faster hospital spending growth of 9.3%. For 2025-2031, hospital spending trends are expected to normalize (with projected average annual growth of 6.1%) as there is a transition away from pandemic public health emergency funding impacts on spending.
- Physicians and Clinical Services: Growth in physician and clinical services spending is projected to average 5.3% over 2022-2031. An expected deceleration in growth in 2022, to 2.4% from 5.6% in 2021, reflects slowing growth in the use of services following the pandemic-driven rebound in use in 2021. For 2025-2031, average spending growth for physician and clinical services is projected to be 5.7%, with an expectation that average Medicare spending growth (8.1%) for these services will exceed that of average Private Health Insurance growth (4.6%) partly as a result of comparatively faster growth in Medicare enrollment.
- Prescription Drugs: Total expenditures for retail prescription drugs are projected to grow at an average annual rate of 4.6% over 2022-2031. For 2025-2031, total spending growth on prescription drugs is projected to average 4.8%, reflecting the net effects of key IRA provisions: Part D benefit enhancements (putting upward pressure on Medicare spending growth) and price negotiations/inflation rebates (putting downward pressure on Medicare and out-of-pocket spending growth).
Thus, CMS Actuaries believe spending for healthcare will be considerably higher than the growth of the overall economy (GDP) and inflation and become 19.6% of the total US economy in 2031. And it also projects that the economy will absorb annual spending increases for hospitals (5.8%) physician and clinical services (5.3%) and prescription drugs (4.6%).
Side-by-side, these reports present a curious projection for the U.S. economy through 2031: the overall economy will return to a slightly lower-level pre-pandemic normalcy and the healthcare industry will play a bigger role despite pushback from budget hawks preferring lower government spending and employers and consumers frustrated by high health prices today.
They also point to two obvious near-term problems:
1-The Federal Reserve pays inadequate attention to the healthcare economy. In Chairman Powell’s press conference following release of the FOMC report, there was no comment relating healthcare demand or spending to the broader economy nor a question from any of the 20 press corps relating healthcare to the overall economy. In his opening statement (below), Chairman Powell reiterated the Fed’s focus on prices and called out food, housing and transportation specifically but no mention of healthcare prices and costs which are equivalent or more stressful to household financial security:
“Good afternoon. My colleagues and I remain squarely focused on our dual mandate to promote maximum employment and stable prices for the American people…My colleagues and I are acutely aware that high inflation imposes hardship as it erodes purchasing power, especially for those least able to meet the higher costs of essentials like food, housing, and transportation. We are highly attentive to the risks that high inflation poses to both sides of our mandate, and we are strongly committed to returning inflation to our 2% objective.”
2-Congress is reticent to make substantive changes in Medicare and other healthcare programs despite its significance in the U.S. economy. It’s politically risky. In the June 2 Congressional standoff to lift the $31.4 debt ceiling, cuts to Medicare and Social Security were specifically EXCLUDED. Medicare is 12% of mandated spending in the 2022 federal budget and is expected to grow from a rate of 4.8% in 2022 to 8% in 2023—good news for investors in Medicare Advantage but concerning to consumers and employers facing higher prices as a result.
Even simplifying the Medicare program to replace its complicated Parts A, B, C, and D programs or addressing over-payments to Medicare Advantage plans (in 2022, $25 billion per MedPAC and $75 billion per USC) is politically tricky. It’s safer for elected officials to support price transparency (hospitals, drugs & insurers) and espouse replacing fee for service payments with “value” than step back and address the bigger issue: how should the health system be structured and financed to achieve lower costs and better health…not just for seniors or other groups but everyone.
These two realities contribute to the disconnect between the Fed and CMS. Looking back 20 years across 4 Presidencies, two economic downturns and the pandemic, it’s also clear the health economy’s emergence did not occur overnight as the Fed navigated its monetary policy. Consider:
- National health expenditures were $1.366 trillion (13.3% of GDP) in 2000 and $4.255 billion in 2021 (18.3% of the GDP). This represents 210% increase in nominal spending and a 37.5% increase in the relative percentage of the nation’s GDP devoted to healthcare. No other sector in the economy has increased as much.
- In the same period, the population increased 17% from 282 million to 334 million while per capita healthcare spending increased 166% from $4,845 to $12,914. This disproportionate disconnect between population and health spending growth is attributed by economists to escalating unit costs increases for the pills, facilities, technologies and specialty-provider services we use—their underlying cost escalation notably higher than other industries.
- There were notable changes in where dollars were spent: hospitals were unchanged (from $415 billion/30.4% of total spending to $1.323 trillion/31.4% of total spending), physician services shrank (from $288.2 billion/21.1% of total spending to 664.6 billion/15.6% pf total spending), prescription drugs were unchanged (from $122.3 billion/8.95% to $378 billion/8.88% of total spending) and public health increased slightly (from $43 billion/$3.2% of total spending to $187.6 billion/4.4% of total spending).
- And striking differences in sources of funding: out of pocket spending shrank from $193.6/14.2% of payments to $433 billion/10.2% % of payments; private insurance shrank from $441 billion/32.3% of payments to $1.21 trillion/28.4% of total payments; Medicare grew from $224.8 billion/16.5% of payments to $900.8 billion/21.2% of payments; Medicaid + CHIP grew from $203.4 billion/14.9% to $756.2 billion/17.8% of payments; and Veterans Health grew from $19.1 billion/1.4% of payments to $106.0 billion/2.5% of payments.
Thus, if these trends continue…
- Aggregate payments to providers from government programs will play a bigger role and payments from privately insured individuals and companies will play a lesser role.
- Hospital price increases will exceed price increases for physician services and prescription drugs.
- Spending for healthcare will (continue to) exceed overall economic growth requiring additional funding from taxpayers, employers and consumers AND/OR increased dependence on private investments that require shareholder return AND/OR a massive restructure of the entire system to address its structure and financing.
What’s clear from these reports is the enormity of the health economy today and tomorrow, the lack of adequate attention and Congressional Action to address its sustainability and the range of unintended, negative consequences on households and every other industry if left unattended. It’s illustrative of the disconnect between the Fed and CMS: one assumes it controls the money supply while delegating to the other spending and policies independent of broader societal issues and concerns.
The health economy needs fresh attention from inside and outside the industry. Its impact includes not only the wellbeing of its workforce and services provided its users. It includes its direct impact on household financial security, community health and the economic potential of other industries who get less because healthcare gets more.
Securing the long-term sustainability of the U.S. economy and its role in world affairs cannot be appropriately addressed unless its health economy is more directly integrated and scrutinized. That might be uncomfortable for insiders but necessary for the greater good. Recognition of the disconnect between the Fed and CMS is a start!
PS: The Emancipation Proclamation signed by President Abraham Lincoln Jan. 1, 1863 freed enslaved African Americans becoming the 13th Amendment to the US population. President Joe Biden signed legislation on June 17, 2021, making Juneteenth the 11th official U.S. federal holiday after Congress passed The Juneteenth National Independence Day Act that same month. And 28 states and the District of Columbia recognize Juneteenth in some way, either as an official holiday, a day of observance. In the 160 years since passage, some good things have happened but much is yet to be done. Access, mortality and morbidity and representation in leadership remain sore spots. The work is unfinished.
Federal Reserve Board and Federal Open Market Committee release economic projections from the June 13-14 FOMC meeting www.federalreserve.gov
CMS Office of the Actuary Releases 2022-2031 National Health Expenditure Projections CMS June 14, 2023 www.cms.gov/newsroom/press-releases/cms-office-actuary-releases-2022-2031-national-health-expenditure-projections
National Health Expenditure Projections, 2022–31: Growth to Stabilize Once The COVID-19 Public Health Emergency Ends Health Affairs June 14, 2023 www.healthaffairs.org
Kevin Freking “Government shutdown warnings rise as Republicans seek deeper cuts in budget battle” Associated Press June 17, 2023 https://apnews.com/
Quotable for the Week of June 12-18, 2023
Re: Medicare modernization: “The Medicare program is at a fiscal and policy crossroads. Programmatic reforms, including decoupling Medicare from administrative pricing, offers an opportunity to achieve fiscal responsibility and provides a framework for prospective, population-based program budgeting for the first time in the program’s history, saving the program for future generations and improving outcomes for patients, orientating Medicare toward health rather than sickness. Now is the time to double down on the transition from volume to value.”
Miller et al “Medicare Modernization—The Urgent Need for Fiscal Solvency” JAMA Health Forum June 16,2023;4(6):e231571. doi:10.1001/jamahealthforum.2023.1571
Re: the healthcare economy: “The greatest threat to healthcare’s financial and credit foundation remains the federal government’s role as lead payer. As Congress looks for levers to pull, any solution—no matter the pace, timing, or mix of options—is likely to mean constrained resources for healthcare for the foreseeable future.”
– Eric Jordahl, Managing Director, Treasury & Capital Markets—Kaufman Hall www.kaufmanhall.com
Re: quality measures in primary care: For many years, experts have made repeated, unsuccessful calls to reduce the quality measure reporting burden. CMS has taken promising steps since the 2017 release of the “Meaningful Measures Initiative,” particularly by reducing the number of quality measures for ACOs in the Medicare Shared Savings Program from 25 measures in 2016 to five priority measures today…But there has been no similar reduction in Medicare Advantage nor in most Medicaid or commercial programs. The result last year for our national network of primary care practices was 108 different quality measures, with a single physician required to report on as many as 46 distinct measures.
Meanwhile, despite unequivocal evidence that primary care is a proven path to better health at lower cost, primary care remains a scarce resource in the United States. More than a quarter of adults do not have a usual source of care, and it would take every primary care physician 27 hours per day to address all evidence-based guideline recommendations for those who do. Meanwhile the average physician spends 785 hours per year dealing with the reporting of quality measures at a cost of more than $15.4 billion, a burden that is borne disproportionately by primary care.”
Annette DuBard, Joshua Israel, Farzad Mostashari “Less Is More: Quality Measurement In Primary Care” Health Affairs June 15, 2023 www.healthaffairs.org
Re: Kaiser Permanente/Geisinger deal: “Risant Health is not about becoming Kaiser Permanente. It’s a completely other organization…it’s about bringing the expertise of Kaiser Permanente into community settings, partnering with the health plan, partnering with the multi-provider groups, etc., and moving value-based care, population health, community health forward in this country. There was a need for a strong, solid … not-for-profit alternative to the disruption that we’re seeing.”
Greg Adams, CEO of Kaiser Permanente at AHIP Policy Conference June 13, 2023/www.bing.com
Re: drip pricing: “Add-on fees are driving consumers crazy. From restaurants and hotels to concerts and food delivery, we are increasingly shown a low price online, only to click through and find a range of fees that yield a much higher price at checkout.
Everyone says they hate these fees, but four experiments illustrate why “drip pricing,” as it’s called by researchers and regulators, is so effective at getting us to pay more. Note that this isn’t about emotional blackmail, as with tipping: Drip pricing isn’t negotiable. Nor does it explain why the cost of living might seem higher than the official data suggests: The consumer-price index reflects these fees and taxes.
The experiments explain why the fees proliferate. The conclusion: Consumers themselves are to blame… Our instincts as consumers are unfortunately the opposite: We punish transparency, think we’re clever enough to figure out any complexity, get sucked in by low offers then upgrade our ambitions, and conclude it’s too much hassle to start over. When we shop that way, we have mostly ourselves to blame.”
Josh Zumbrun “Who’s to Blame for All Those Hidden Fees? We Are” June 16, 2023 www.wsj.com
Re: AMA President Elect priorities for physician: “We have faced 20 years of stagnant Medicare pay, and in inflation-adjusted dollars, that has resulted in a 22% reduction in what physicians are paid in 2021 compared to 2020, and in 2022 and 2023 there were further reductions.
At the same time, particularly in the last year, all of my expenses have increased. Almost on a weekly basis, one of my employees is asking for more money; they need more money to pay the gas bills and food bills…
What magnifies the problem is that private payers, years ago, figured this whole thing out, and they have linked their contracts to the Medicare pay rate. So, in effect, they save money because they don’t give us any kind of an inflationary increase [because Medicare doesn’t] …And then [there is] the administrative burden. I spent time on the phone today talking to someone to get a CT scan authorized. And the person I was talking to didn’t even know how to say the anatomical phrases that we were theoretically discussing. And my fellow physicians all face the same challenges.”
Bruce Scott, MD, President Elect of the American Medical Association “Medicare Pay and Prior Authorization Among Priorities for AMA President-Elect” MedPage June 16, 2023 https://www.medpagetoday.com/publichealthpolicy
Re: Hospital benchmarking: “Historical approaches to benchmarking have been ineffective in improving the performance of the U.S. health economy, particularly the hospitals that are the lifeblood of the industry, The industry has chased vanity rankings like U.S. News & World Report’s ‘Hospital Honor Roll’ for decades, even though the names on those lists rarely change. In 2023, every health system faces significant challenges, and many are in grave financial distress. This is no time for ‘aspirational’ benchmarking…What this data-driven analysis reveals is that the hospitals deemed most prestigious in the U.S. are rarely similar to each other, and their closest peers are often not the hospitals that you would expect. In fact, the most prestigious hospitals are so different that they are not relevant benchmarks for each other, much less the typical community hospital in America, which underscores why hospital executives should stop trying to emulate what the ‘top hospitals,’ as determined by lists that use surveys or other subjective information, are doing.”
Hal Andrews, Trilliant Health president and CEO,
Re: Cost of Disparities: “…the economic burden of health disparities in the United States is much higher than previously thought. In 2018, racial and ethnic health disparities cost the U.S. economy $451 billion, a 41% increase from the previous estimate of $320 billion in 2014.
The study also finds that the total burden of education-related health disparities for persons with less than a college degree in 2018 reached $978 billion, about two times greater than the annual growth rate of the U.S. economy in 2018.”
Leviest et al “The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US” JAMA May 16, 2023 https://jamanetwork.com/journals/jama/
Fitch: Wage cost pressure in nonprofit hospitals slows, remains problematic: Per Fitch Ratings:
- “In U.S. nonprofit hospitals this spring, average hourly earnings wage growth decelerated compared to 2022, while quits and job openings remained high.
- In April, average hourly earnings (AHE) growth remained above pre-pandemic levels at 5.1% year over year — down from June 2022’s high of 8.4%. Still, hospitals continue to hire. As of May, hospital and ambulatory healthcare services payrolls have risen for 16 and 28 consecutive months, respectively.”
“Wage Growth Levels Off as Job Openings Remain High for U.S. NFP Hospitals” Fitch Ratings June 12, 2023 www.fitchratings.com/research/us-public-finance/wage-growth-levels-off-as-job-openings-remain-high-for-us-nfp-hospitals
AMA House of Delegates pass resolution against hospital consolidation: “RESOLVED, that our American Medical Association commit to undertaking an annual report assessing nationwide health system and hospital consolidation in order to assist policymakers and the federal government in assessing rapidly evolving and accelerating healthcare consolidation for the benefit of patients and physicians who face an existential threat from healthcare consolidation (Directive to Take Action)”
AMA House of Delegates June 2023 Resolution 727 Passed: June 16, 2023 /www.ama-assn.org/system/files/a23-refcomm-g-annotated.pdf
Fed study: Economic Well-Being of U.S. Households in eroded in 2022: Highlights of the Fed’s 10th annual Survey of Household Economics and Decisionmaking (SHED) conducted in October 2022:
- Overall Financial Well-Being: Overall financial well-being declined markedly over the prior year. 73% of adults were doing at least okay financially in 2022, down 5% from 2021. The share of adults who said they were worse off financially than a year earlier rose to 35%,
the highest level since the question was first asked in 2014.
- Income: 40% of adults said their family’s monthly spending increased in 2022 compared with the prior year, while 33% said their monthly income increased. 23% said that their spending had increased but their income had not.
- Expenses: Consistent with declines in overall financial well-being, 63% said they would cover
a hypothetical $400 emergency expense exclusively using cash or its equivalent, down from a high of 68% in 2021. When asked for the largest expense they could cover using only savings, 18% said the largest expense they could cover with savings was under $100 and an additional 14% said the largest expense they could cover was between $100 and $499.
- Retirement and Investments: Progress toward retirement savings goals declined in 2022. 31% of non-retirees thought their retirement savings plan was on track, down from 40% in 2021.
“Economic Well-Being of U.S. Households in 2022” Federal Reserve May 22, 2023 www.federalreserve.gov/consumerscommunities
USC Study: MA overpayments in 2023 higher than expected: “Rapid growth in Medicare Advantage (MA) has led to almost equal numbers of Medicare beneficiaries in 2023 receiving benefits from MA plans and from traditional fee-for-service (FFS). But MA rates paid to plans are based on spending by FFS beneficiaries, resulting in Medicare overpaying MA plans by 6% ($27 billion) in 2023 alone, according to the Medicare Payment Advisory Commission (MedPAC). Overpayments were due primarily to “coding intensity” ($23 billion) and Star Rating (quality) bonuses. Importantly, the MedPAC overpayment estimate does not include the effects of favorable selection into MA, but favorable selection likely generates a larger magnitude of overpayment… Focusing on those who switched from FFS to MA plans from 2015 through 2019, we estimate that these distortions in payment rates led to overpayments on the order of 14.4%, with sensitivity analysis suggesting the estimate remains relatively stable under alternative assumptions. This favorable selection into MA makes the current approach of basing MA payments on FFS increasingly problematic and costly to the government, increasing annual overpayments in 2023 from the $27 billion estimated by MedPAC to $75 billion or more.”
Medicare Advantage Enrolls Lower-Spending People, Leading to Large Overpayments USC Schaeffer Center for Health Policy and Economics June 13, 2023 https://healthpolicy.usc.edu/research/ma-enrolls-lower-spending-people-leading-to-large-overpayments
Studies: Member satisfaction with health insurance slipping: J.D. Power’s 2023 U.S. Commercial Member Health Plan Study analyzed enrollee satisfaction in 147 health plans. Highlights:
- Overall satisfaction fell 13 points (on a 1,000-point scale) due in part to a 33-point decline in satisfaction with customer service. Other areas that suffered notable decline were coverage and benefits (-20), provider choice (-16), and information and communication (-16).
- “Sicker patients are less likely to receive proactive care coordination compared to patients with a self-reported health status of “very good/excellent… among patients with a self-reported health status of “poor/fair,” 36% said their health plan helped them coordinate care. That figure jumped to 43% among patients with a self-reported status of “very good/excellent.”
- The average Net Promoter Score (NPS)for new members was 6 (on a scale of -100 to 100), compared to 25 for established plan members, “indicating that health plans are falling short on providing information and support on navigating their benefits.”
KFF surveyed representative 3,605 adults in the U.S. with health insurance coverage in Feb-Mar 2023. Findings
“58% people with health insurance say they encountered at least one problem using their coverage in the past year, with even larger shares of people with the greatest health care needs reporting such problems. Such problems vary across types of insurance but include such things as denied claims for care they thought was covered, difficulty finding an in-network doctor or other provider, and delays and denials of care that involved an insurer’s prior authorization. “Problems are persistent across all types of coverage–employer, Medicaid, the Affordable Care Act’s marketplace, and Medicare and more frequent for members with health conditions.
Member Satisfaction with Commercial Health Plans Declined in 2023 JD Power June 14, 2023 www.jdpower.com
KFF Survey Shows Complexity, Red Tape, Denials, Confusion Rivals Affordability as a Problem for Insured Consumers, With Some Saying It Caused Them to Go Without or Delay Care KFF June 15, 2023 www.kff.org
Study: Medicaid recipient access to opioid use medications: Researchers conducted a cross-sectional study of more than 8 million Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020 to access their access to. Analyses were conducted from January through March 2022 medications for opioid use disorder (MOUD). Findings:
“Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020).”
Austin et al “Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs” JAMA Health Forum June 16, 2023;4(6):e231422. doi:10.1001/jamahealthforum.2023.1422