October 19th, 2022
The Out-of-Pocket Health News Digest
Below you will find briefs about recent health policy news stories. Our hope is for students to have an information outlet at their fingertips to keep up-to-date with the most pressing news stories in health policy.

Produced by the HPSA Education Committee: Abigail Lindsay, Graceanne Horton, Olivia Rockwell, Ellie Jorling, Nia Allen, Ronnie Sharangpani, Easheta Shah, and Iulia Dobrin
New Recommendation Issued for Anxiety Screening in Adolescents
by Iulia Dobrin
The US Preventive Services Task Force (USPSTF) - a volunteer group of medical experts - recently issued a recommendation that all kids ages 8 and up be screened for anxiety, even if they exhibit no symptoms. Their research found with moderate certainty that such screening has a moderate net benefit. While there were existing recommendations about screening adolescents ages 12-18 for depression which the task force reaffirmed, screening for anxiety is a new recommendation. USPSTF has no regulatory authority, but its recommendations generally influence standards of care.

This recommendation comes amidst a mental health crisis among American children and teens, which has only been on the rise during the COVID-19 pandemic. As depression and anxiety in childhood often continue into adulthood, screening may help detect and treat these conditions early before it impacts child development and learning. 

According to the task forces’ JAMA publication, anxiety disorders are “characterized by a greater duration or intensity of impairment of a stress response”. Risk factors associated with this are genetic, environmental, and personality factors, such as attachment difficulties and interparental conflict. Low socioeconomic status is also associated with increased anxiety. LGBTQ youth also experience much higher rates of anxiety than other children and teens.

The task force intentionally did not recommend any specific screening mechanism so as to allow pediatricians to use their best judgment for their patient population and clinical setting. Early detection through screening can help indicate if a child needs additional support, but does not act as a diagnosis on its own. The potential harms associated with screening are minimal, but include false positives leading to unnecessary referrals that bring an increased time and economic burden, as well as potential labeling and stigma. 

Research suggests that half of American children with a treatable mental health condition do not receive treatment. While this recommendation is promising, we must look to future research to determine how soon and widespread these screenings are implemented in primary care.

Sources: JAMA, NYT
South Dakota voters to decide on Medicaid expansion
by Graceanne Horton
This November, South Dakota voters will have the opportunity to vote on the fate of Medicaid expansion in their state. This strategy has been used by progressives to achieve Medicaid expansion in red states by allowing voters to directly vote on a referendum. An August poll by the American Cancer Society Cancer Action Network found that 62 percent of voters support the initiative. Still, other polls, such as one done by SDSU, have found less convincing margins. Republican Governor Kristi Noem has vowed to accept and implement the expansion if voters approve it, even while she remains opposed.

Referendums have been used in six other Republican-controlled states in the past five years to expand Medicaid, but this pathway to expansion appears to be coming to an end. Of the eleven remaining states, after South Dakota, who have not expanded Medicaid, only three–Florida, Mississippi, and Wyoming–allow voters to collect signatures for a ballot initiative, and it appears unlikely that these three states will pass a ballot measure in the near future. The remaining eight states do not have a clear path to expansion. 
Innovating Primary Care Payments
by Abigail Lindsay
The U.S. grossly underfunds primary care, resulting in worse quality of care, access to care, and mortality rates. On average, primary care accounts for just 6.6% of total U.S. health expenditures. Primary care is key to accessing preventative services and is increasingly being used as a conduit to mental health and social services that improve health equity. 

Research funded by the Commonwealth Fund is looking to the Medicare Shared Savings Program (MSSP) to improve payment levels for primary care. For context, the MSSP was created by the Affordable Care Act and utilizes accountable care organizations (ACOs), a network that is collectively responsible for a group of patients' financial and medical needs, with the ultimate goal of improving the quality of patient care, while containing spending. For more information on the MSSP watch this video. 

The researchers propose using a voluntary payment that is a mix of population-based payments (PBP) and fee-for-service. The goal would be to incentivize and provide compensation for the diverse set of activities primary care practices provide but are not being paid for, such as emails, phone calls, and team-based care. Furthermore, payment levels for the PBP portion should be increased “to adequately compensate primary care providers and allow them to invest the time necessary to address patients’ mental health and social needs”. Services that are beneficial but rarely delivered would remain under a fee-for-service payment model. The proposed payment model contains additional factors than those described here.

This new strategy could be leveraged first in ACOs made up of independent provider practices. This would give practices an incentive to remain independent, reducing the likelihood of consolidation, which has contributed to rising healthcare prices. More initiatives are needed that promote prevention, and innovation in primary care payment models may be a necessary first step toward this goal.

Sources: HealthAffairs, JAMA
One-Liners
  • Next month, Colorado will be voting on a psychedelic ballot initiative. The proposition if passed, would allow for the personal use of psilocybin mushrooms by adults older than 21, and sales would only be allowed in licensed healing centers. Preliminary evidence indicates that mushrooms may be helpful for treatment-resistant depression and anxiety, but more research is needed. (KHN)
  • Neighborhood ‘cognability’: University of Michigan researchers at the Institute for Social Research created an interactive map that allows you to type in your address and determine how your neighborhood contributes to healthy cognitive aging. Check it out! (Institute for Social Research)
  • TikTok videos teaching you how to cement gems and drill your teeth are growing in popularity. Dentists warn caution, as these “cosmetic changes” can actually increase your risk of cavities and gum infections. (KHN)