2b:T45d,

Provider consolidation may enable improved care coordination, but raises concerns about lack of competition. Physician patient-sharing relationships play a key role in constructing patient care teams, but it is unknown how organization affiliations affect these. We use the Massachusetts All Payer Claims Database to examine whether patient-sharing relationships are associated with sharing a practice site, medical group, and/or physician contracting network. Physicians were 17 percentage points more likely to have a patient-sharing relationship if they shared a practice site and 4 percentage points more likely if they shared a medical group, as compared with sharing no affiliation. However, there was no detectable increased probability of a patient-sharing relationship within the same physician contracting network. Our finding that physician patient-sharing relationships are concentrated within organizational boundaries at practice site and medical group levels helps illuminate referral incentives and provide insight into the role of organizational affiliations in patient care team construction.

2c:T439,

To combat risk selection, it is becoming increasingly common for payments to insurers (and providers) to adjust for patients’ chronic conditions. A possible unintended negative consequence is to reduce insurers’ (and providers’) incentives to prevent chronic conditions. This study examined the effect of Medicare’s risk adjustment for payments to Medicare Advantage plans, first introduced in 2004, on pneumonia and influenza vaccination for the elderly. The analysis used the 2000 through 2010 waves of the Medicare Current Beneficiary Survey and a difference-in-differences approach. Presumably by decreasing Medicare Advantage plans’ positive influence on vaccination, Medicare’s risk adjustment policy was estimated to have reduced pneumonia vaccination rates by 2.9 percentage points (4%, p = .039) and to have possibly reduced influenza vaccination rates by 2.2 percentage points (3%, p = .096). The results clarify an argument against including vaccine-preventable conditions, like pneumonia, in a risk adjustment model.

2d:T414,

Given the rising cost of long-term care (LTC) services, the selection of a private long-term care insurance (LTCi) policy with inflation protection has critical implications for the ability of this coverage to protect against potentially catastrophic LTC expenses. This study examines the effect of consumers’ numeric abilities on the decision to add inflation protection to private LTCi policies. Over 40% of current LTCi policies lack inflation protection. Higher scores on a three-question numeracy scale are associated with increases in the probability of choosing inflation protection at the time of policy purchase, with households answering all three questions correctly being 12 percentage points more likely to have this benefit type relative to those with a numeracy score of 0 (p = .002). Market reforms that simplify the task of evaluating LTCi plans and assessing the value of indexed benefits may be needed to ensure that LTCi policy purchasers are selecting adequate protection against future LTC costs.

2e:T402,

The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas. NPs and PAs are projected to increase the number of rural patients treated with buprenorphine by 10,777 (15.2%). Census Divisions varied substantially in the number of projected new treatment slots per 10,000 population (0.8-10.6). T