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 The Skinny on Narrow Networks in Health Insurance Marketplace Plans(2015-06-23) Polsky, Daniel; Weiner, JanetThe Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. The percent of physician networks that were classified as small or x-small came to 41% overall, 55% for HMO networks, and 25% for PPO networks.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 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 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 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 No-Trespass Policies in Public Housing(2016-01-01) Weiner, JanetIncreasingly, public housing authorities (PHAs) are implementing “no-trespass” policies designed to combat crime by non-residents in their developments. These policies allow PHAs to develop “ban lists” of unwanted non-residents who may be cited for criminal trespass if found on PHA property. Implementation of such policies may conflict with resident’s rights to have visitors, and invitees’ rights to visit. The effects of these policies on crime, perceptions of safety, and associational rights are unknown. Through legal analysis and case studies of three PHAs—Yonkers, NY; Chester, PA; and Annapolis, MD—I investigate the impact of these policies on residents, PHA officials, project managers, police, and people who are banned. My findings suggest that a no-trespass policy, narrowly targeted and as part of a larger security strategy, can promote perceptions of safety among public housing residents. Strong, stable PHA management and a collaborative relationship with residents are key to successful implementation. With due process protections and clear procedures for assuring that tenants’ rights to have visitors are not violated, it can pass constitutional muster. Whether it is an effective, or cost-effective, form of crime control is very much in debate. Implemented in isolation, however, a no-trespass policy is not likely to be effective in reducing crime and promoting perceptions of safety, and runs the risk of being used to police residents, rather than to protect them. If the policy is not narrowly tailored, it can divide families unnecessarily and discourage familial ties that create stability in a community. No-trespass policies can be blunt weapons against crime that cast very wide nets over a community, restrict movement, and interfere with family relationships. Applied arbitrarily and targeted indiscriminately, these policies are not likely to be constitutional. PHAs should consider whether no-trespass policies are worth the considerable resources needed to implement and maintain them, and reassess how these policies fit the larger objective of fostering safe places in which to live and raise a family. Longer-term safety may be better served by developing residents’ human and social capital, and by providing social supports and services, rather than on banning criminals from PHA property.Publication How Nursing Affects Medicare’s Outcome-Based Hospital Payments(2015-11-12) Yakusheva, Olga; Weiner, Janet; Lindrooth, Richard C; Pauly, Mark V; Spetz, JoanneImproving value is one of the central aims of recent and ongoing health care reform. In our last LDI/INQRI Brief, we reviewed the evidence of the role of nurses in increasing the value of health care. In this companion brief, we dig deeper into the three reimbursement strategies that Medicare uses to align hospital financial incentives with quality of care, and we calculate the potential effects of nursing-sensitive quality indicators on hospital payments.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.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.
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