Joseph P Newhouse

Verified

Joseph verified their affiliation via an institutional email.

Learn more

Verified

Joseph verified their affiliation via an institutional email.

Learn more

• PhD
• Research Professor at Harvard University

Background: We developed a classifier to infer acute ischemic stroke (AIS) severity from Medicare claims using the Modified Rankin Scale (mRS) at discharge. The classifier can be utilized to improve stroke outcomes research and support the development of national surveillance tools. Methods: This was a multistate study included all participating ce...

Background In CLARITY‐AD, lecanemab both slowed cognitive decline and increased intracranial hemorrhages (ICHs), particularly among participants concurrently using anticoagulants. The Alzheimer’s Association’s expert guidance is to avoid co‐prescribing; however, CMS and FDA do not restrict or warn against co‐prescribing. We used a microsimulation m...

During the initial year of the COVID-19 pandemic, a disproportionate share of COVID-19–related deaths occurred among nursing home residents. Initial estimates of all-cause mortality rates also spiked in early and late 2020 before falling to near or below historical rates by early 2021. During the first 3 years of the pandemic, the US nursing home r...

Objective To examine how a novel payer‐provider joint venture (JV) between one payer and multiple competitive delivery systems in New Hampshire (NH), which included value‐based payment, care management, and non‐financial supports, impacted healthcare value and payer and provider group experiences. Study Setting and Design We conducted a mixed‐meth...

BACKGROUND Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level. METHODS We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We sele...

Background The National Institutes of Health Stroke Scale (NIHSS) scores have been used to evaluate acute ischaemic stroke (AIS) severity in clinical settings. Through the International Classification of Diseases, Tenth Revision Code (ICD-10), documentation of NIHSS scores has been made possible for administrative purposes and has since been increa...

Importance Since 2019 and 2020, Medicare Advantage (MA) plans have been able to offer supplemental benefits that address long-term services and supports (LTSS) and social determinants of health (SDOH). Objective To examine the temporal trends and geographic variation in enrollment in MA plans offering LTSS and SDOH benefits. Design, Setting, and...

Rationale Despite guideline warnings, older acute ischemic stroke (AIS) survivors still receive benzodiazepines (BZD) for agitation, insomnia, and anxiety despite being linked to severe adverse effects, such as excessive somnolence and respiratory depression. Due to polypharmacy, drug metabolism, comorbidities, and complications during the sub-acut...

Fall-related injuries (FRIs) are a major cause of hospitalizations among older patients, but identifying them in unstructured clinical notes poses challenges for large-scale research. In this study, we developed and evaluated Natural Language Processing (NLP) models to address this issue. We utilized all available clinical notes from the Mass Gener...

Objective To measure and compare the scope of US insurers’ policies for prior authorization (PA), a process by which insurers assess the necessity of planned medical care, and to quantify differences in PA across insurers, physician specialties, and clinical service categories. Design Cross sectional analysis. Setting PA policies for five insurer...

Background The National Institutes of Health Stroke Scale (NIHSS) scores have been used to evaluate Acute Ischemic Stroke (AIS) severity in clinical settings. Through the International Classification of Diseases, Tenth Revision Code (ICD-10), documentation of NIHSS scores has been made possible for administrative purposes and has since been increas...

Background: Benzodiazepine use in older adults following acute ischemic stroke (AIS) is common, yet short-term safety concerning falls or fall-related injuries remains unexplored. Methods: We emulated a hypothetical randomized trial of benzodiazepine use during the acute post stroke recovery period to assess incidence of falls or fall related injur...

Importance The Medicare Part D Low Income Subsidy (LIS) program provides millions of beneficiaries with drug plan premium and cost-sharing assistance. The extent to which LIS recipients experience subsidy losses with annual redetermination cycles and the resulting associations with prescription drug affordability and use are unknown. Objective To...

The U.S. healthcare system is undergoing a period of substantial change with hospitals purchasing many physician practices (“vertical integration”). In theory, this vertical integration could improve quality by promoting care coordination but could also worsen it by impacting the care delivery patterns. The evidence quantifying these effects is lim...

In 2021 the American Rescue Plan Act increased premium subsidies for people purchasing insurance from the Affordable Care Act Marketplaces and provided zero-premium Marketplace plans that covered 94 percent of medical care costs (silver 94 plans) to recipients of unemployment compensation. Using data on adult enrollees in on- and off-Marketplace in...

The U.S. healthcare system is undergoing a period of substantial change, with hospitals purchasing many physician practices ("vertical integration"). In theory, this vertical integration could improve quality by promoting care coordination, but could also worsen it by impacting the care delivery patterns. The evidence quantifying these effects is l...

Background: The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes...

Festa and colleagues highlight underrecognized factors that may bias research, policy, and population health strategies predicated upon claims-based ascertainment of Alzheimer’s Disease and Related Dementias within the United States.

Fall-related injuries (FRIs) are a leading cause of hospitalizations among older patients, yet the large-scale research needed to investigate these injuries is stymied by an inability to identify FRIs efficiently and accurately in unstructured clinical notes. In this study, we developed and evaluated the performance Natural Language Processing (NLP...

Purpose of the Review: To evaluate the quality of evidence about the association of primary seizure prophylaxis with antiseizure medication (ASM) within 7 days postinjury and the 18- or 24-month epilepsy/late seizure risk or all-cause mortality in adults with new-onset traumatic brain injury (TBI), in addition to early seizure risk. Results: Twent...

Many older Americans do not receive needed care for mental health and substance use disorders (MHSUD), and there are substantial racial and ethnic disparities in receipt of this care across the lifespan. Medicare introduced cost-sharing parity for outpatient MHSUD care during the period 2010-14, reducing beneficiaries' out-of-pocket share of MHSUD...

BACKGROUND Older adults occasionally receive seizure prophylaxis in an acute ischemic stroke (AIS) setting, despite safety concerns. There are no trial data available about the net impact of early seizure prophylaxis on post-AIS survival. METHODS Using a stroke registry (American Heart Association’s Get With the Guidelines) individually linked to...

Objective: Older adults receive benzodiazepines for agitation, anxiety, and insomnia after acute ischemic stroke (AIS). No trials have been conducted to determine if benzodiazepine use affects post-stroke mortality in the elderly. Study design and setting: We examined the association between initiating benzodiazepines within one week after AIS a...

The U.S. healthcare system is undergoing a period of substantial change, with hospitals purchasing many physician practices (“vertical integration”). In theory, this vertical integration could improve quality by promoting care coordination, but could also worsen it by impacting the care delivery patterns. The evidence quantifying these effects is l...

In 2020 Medicare reintroduced Alzheimer's disease and related dementias (ADRD) Hierarchical Condition Categories (HCCs) to risk-adjust Medicare Advantage and accountable care organization (ACO) payments. The potential for Medicare spending increases from this policy change are not well understood because the baseline accuracy of ADRD HCCs is uncert...

Background: Each year, thousands of older adults develop delirium, a serious, preventable condition. At present, there is no well-validated method to identify patients with delirium when using Medicare claims data or other large datasets. We developed and assessed the performance of classification algorithms based on longitudinal Medicare administ...

Objectives: The 2021 American Rescue Plan Act (ARPA) increased the availability and magnitude of premium tax credits (PTCs) for consumers purchasing individual marketplace plans in 2021-2022. Millions currently purchase PTC-ineligible plans off of the marketplace. We estimate the proportion of off-marketplace enrollees who would be eligible for th...

Importance: Young adults historically have had the highest uninsured rates among all age groups. In 2014, in addition to Medicaid expansion for adults with low income (≤133% of the federal poverty level [FPL]) through the Patient Protection and Affordable Care Act, Massachusetts also extended eligibility for children (≤150% FPL) to beneficiaries a...

This cohort study evaluates the ascertainment of Alzheimer disease and related dementia using diagnostic codes in various health care settings.

Background The Affordable Care Act (ACA) increased funding for Federally Qualified Health Centers (FQHCs). We defined FQHC service areas based on patient use and examined the characteristics of areas that gained FQHC access post-ACA. Methods We defined FQHC service areas using total patient counts by ZIP code from the Uniform Data System (UDS) and...

Little is publicly known about coverage denials for medical services that do not meet medical necessity criteria. We characterized the extent of these denials and their key features, using Medicare Advantage claims for a large insurer from the period 2014-19. In this setting, claims could be denied because of traditional Medicare's coverage rules o...

Importance Medicare Advantage (MA) has entailed a major expansion of government-financed, privately administered health insurance in the US. As policy makers consider options to expand Medicare further, it is informative to compare the performance of traditional Medicare (TM) and MA. Objective To assess whether MA is associated with differential c...

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national dat...

Objective: The Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease-related services to high out-of-pocket costs. B...

Research Objective Coverage policy may be an important tool to reduce spending while discouraging low-value medical services. Government and private insurers may also differ in their scope of coverage restrictions for suspected low-value services. However, basic facts about coverage denials are unknown because denials are not identifiable in standa...

Importance Limited evidence is available concerning optimal seizure prophylaxis after spontaneous intracerebral hemorrhage (sICH). Objective To evaluate which of 4 seizure prophylaxis strategies provides the greatest net benefit for patients with sICH. Design, Setting, and Participants This decision analysis used models to simulate the following...

Importance Health insurers use prior authorization to evaluate the medical necessity of planned medical services. Data challenges have precluded measuring the frequency with which medical services can require prior authorization, the spending on these services, the types of services and clinician specialties affected, and differences in the scope o...

I look at prevention through an economic lens and make three main points. First, those advocating preventive measures are often asked how much money a given measure saves. This question is misguided. Rather, preventive measures can be thought of as insurance, with a certain cost in the present that may or may not pay off in the future. In fact, alt...

Background/objectives: No data exist regarding the validity of International Classification of Disease (ICD)-10 dementia diagnoses against a clinician-adjudicated reference standard within Medicare claims data. We examined the accuracy of claims-based diagnoses with respect to expert clinician adjudication using a novel database with individual-le...

Background: Physicians often receive lower payments for dual-eligible Medicare-Medicaid beneficiaries versus nondual Medicare beneficiaries because of state reimbursement caps. The Affordable Care Act (ACA) primary care fee bump temporarily eliminated this differential in 2013-2014. Objective: To examine how dual payment policy impacts primary c...

The papers in this volume examine a series of important questions that influence the transition from full time employment to complete retirement. Retirement is shown to be a process as individuals move from career jobs to bridge jobs to being out of the labor force. The articles examine the characteristics of bridge jobs and the employment conditio...

Objective To illustrate a method that accounts for sampling variation in identifying suppliers and counties with outlying rates of a particular pattern of inconsistent billing for ambulance services to Medicare. Data Sources US Medicare claims for a 20% simple random sample of 2010‐2014 fee‐for‐service beneficiaries. Study Design We identified in...

Importance The Patient Protection and Affordable Care Act (ACA) temporarily increased primary care practitioners’ (PCP) Medicaid fees to that of Medicare for 2013 to 2014 (fee bump) to help accommodate potential increases in demand for care with ACA coverage expansion. This also increased fees for PCPs treating dual-eligible Medicare and Medicaid b...

Importance Federally qualified health centers (FQHCs) receive federal funding to serve medically underserved areas and provide a range of services including comprehensive primary care, enabling services, and behavioral health care. Greater funding for FQHCs could increase the local availability of clinic-based care and help reduce more costly resou...

This article, prepared as part of a special issue on multiarmed experiments, describes the design of the RAND Health Insurance Experiment, paying particular attention to the choice of arms. It also describes how the results of the Experiment were used in a simulation model and, looking back, how the design might have differed, and how the results a...

Purpose To examine indications for, duration of use, and rate of adverse drug events (ADE) attributable to anticonvulsant initiation, as adjudicated by expert review of electronic health records (EHR) of older adults. Methods We identified a cohort of community dwelling Medicare beneficiaries with linked EHR (aged 65+, continuously enrolled with a...

Importance: Medicare has historically imposed higher beneficiary coinsurance for behavioral health services than for medical and surgical care but gradually introduced parity between 2009 and 2014. Although Medicare insures many people with serious mental illness (SMI), there is limited information on the impact of coinsurance parity in this popul...

Objective: Access to specialty mental health care may be poor because many psychiatrists do not accept health insurance reimbursement, whereas many patients rely on insurance to help pay for care. The objective of this study was to examine the extent of participation in private insurance by licensed psychiatrists. Methods: Using 2013 Massachuset...

Importance Most people with commercial health insurance in the US have high-deductible plans, but the association of such plans with major health outcomes is unknown. Objective To describe the association between enrollment in high-deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants Thi...

Improvements in medical treatment have contributed to rising health spending. Yet there is relatively little evidence on whether the spending increase is “worth it” in the sense of producing better health outcomes of commensurate value—a critical question for understanding productivity in the health sector and, as that sector grows, for deriving an...

High-deductible health plans (HDHP) that require large out-of-pocket payments for retinopathy screening and ophthalmologist visits could delay retinopathy screening, retinopathy diagnosis, and vision loss diagnosis. We studied 2004-2014 data in a large commercial and Medicare Advantage claims database. We included a national sample of 39,798 HDHP m...

Before the implementation of cost-sharing parity in Medicare, beneficiaries faced higher cost sharing for mental health services than for other medical services. The Medicare Improvements for Patients and Providers Act of 2008 phased in cost-sharing reductions in Medicare for outpatient mental health services in the period 2010-14. Using data for 2...

The U.S. healthcare system is undergoing a period of substantial change, with hospitals purchasing many physician practices (“vertical integration”). In theory, this vertical integration could improve quality by promoting care coordination, but could also worsen it by impacting the care delivery patterns. The evidence quantifying these effects is l...

Objectives: Banner Health, a large delivery system in Maricopa County, Arizona, entered into both Medicare and commercial insurance contracts that varied the amount of financial risk that Banner assumed. Rates of utilization and spending under these various contracts were investigated. Study design: Prior to 2012, Banner held Medicare Advantage...

High-deductible health plan (HDHP) effects on major cardiovascular outcomes are unknown. We studied a 2004-2014 national sample of 63,363 HDHP members aged 40-64 years with diabetes, cardiovascular disease, hypertension, or hyperlipidemia, who were continuously enrolled for 1 year in a low-deductible (≤$500) plan followed by 3 years in a HDHP (≥$10...

Background The Affordable Care Act expanded Medicaid and increased federal funding for Community Health Centers (CHCs). To examine the role of Medicaid coverage on care patterns for those with available safety net care, we assessed differences in access to care for CHC patients with continuous Medicaid coverage vs. gaps in insurance coverage in the...

Overall mortality rates, adjusted for age, sex, and Medicaid status, in Medicare Advantage have been below those in traditional Medicare for many years. Much attention has been paid to the resulting issue of favorable selection in Medicare Advantage. The common study design used to estimate causal effects of Medicare Advantage on utilization and ou...

Objectives To compare existing algorithms for classifying screening vs diagnostic colonoscopies and to quantify the increase in screening colonoscopy rates when Medicare began reimbursement in 2001 and when the Affordable Care Act (ACA) eliminated cost‐sharing. Data Sources Twenty percent random sample of fee‐for‐service (FFS) Medicare claims, 200...

Background Few studies have used preference-based quality-of-life outcomes to assess how autism spectrum disorders (ASDs) affect children and parents, and none have examined variation by ASD severity. Objective Our objective was to derive parent valuations of child and parent health associated with varying ASD severity levels. Methods Parents of...

As the population ages and life expectancy at older ages increase, it becomes more challenging for individuals, firms, and governments to finance adequate living standards in retirement. Working longer is an important option that must be considered if well-being in retirement is to be sustained. The papers in this Special Issue of the Journal of Pe...

The tax penalty for noncompliance with the Affordable Care Act's individual mandate is to be eliminated starting in 2019. We investigated the potential impact of this change on enrollees' decisions to purchase insurance and on individual-market premiums. In a survey of enrollees in the individual market in California in 2017, 19 percent reported th...

We investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. We matched 23 cities with bond downgrades and 31 cities with stable bond ratings to sampling units in the Medical Expenditure Panel Survey. Starting the year before the downgrade and for the four...

Background: Little is known about the long-term effects of high-deductible insurance on care for chronic medical conditions. Objective: To determine whether a transition from low-deductible to high-deductible insurance is associated with delayed medical care for macrovascular complications of diabetes. Design: Observational longitudinal compar...

Objective The Affordable Care Act (ACA) introduced reforms to mitigate adverse selection into and within the individual insurance market. We examined the traits and predicted medical spending of enrollees in California post‐ACA. Data Sources Survey of 2,103 enrollees in individual market plans, on‐ and off‐exchange, in 2014. Study Design We compa...

We ascertain the degree of service-level selection in Medicare Advantage (MA) using individual-level data on the 100 most frequent hierarchical coexisting conditions (HCCs) or combination of HCCs from two national insurers in 2012–13. We find differences in the distribution of beneficiaries across HCCs between traditional Medicare (TM) and MA, prin...

Much of the risk adjustment literature has focused on how persons should be classified and given weights. It has given less attention to the amount of funds in the risk adjustment pool. If, however, there is an outside option, as there is in the principal American risk adjustment systems, there can be favorable or adverse selection in the risk pool...

The technique of instrumental variables (IV) was developed by econometricians in the 1930s and 1940s to address situations in which an explanatory variable or variables are correlated with the error term in an ordinary least squares regression. In such a case, ordinary least squares (OLS) methods produce inconsistent estimates of the regression coe...

Background: Risk-adjustment algorithms typically incorporate demographic and clinical variables to equalize compensation to insurers for enrollees who vary in expected cost, but including information about enrollees' socioeconomic background is controversial. Methods: We studied 1 182 847 continuously insured 0 to 19-year-olds using 2008-2012 Bl...

Objectives To investigate whether outcomes of patients who were admitted to hospital differ between those treated by younger and older physicians. Design Observational study. Setting US acute care hospitals. Participants 20% random sample of Medicare fee-for-service beneficiaries aged ≥65 admitted to hospital with a medical condition in 2011-14 and...

Appendix: Supplementary tables

Importance: While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians. However, the degree to which spending varies across physicians and the clinical consequences of that variation are unknown. Objective: To investigate variation in spending acros...

The Affordable Care Act includes financial assistance that reduces both premiums and cost-sharing amounts for lower-income Americans, to increase the affordability of health insurance coverage and care. To receive both types of assistance, enrollees must purchase a qualified health plan through a public insurance exchange, and those eligible for th...

We investigate the role of physician agency in determining health care supply and patient outcomes. We show that an increase in health care supply due to a change in private physician incentives has a theoretically ambiguous impact on patient welfare. The increase can reflect either induced demand for ineffective care or a reduction in prior ration...

Medicare Advantage: Issues, Insights, and Implications for the Future Paul Cotton, Joseph P. Newhouse, PhD, Kevin G. Volpp, MD, PhD, A. Mark Fendrick, MD, Susan Lynne Oesterle, Pat Oungpasuk, Ruchi Aggarwal, Gail Wilensky, PhD, and Kathleen Sebelius Editorial S-2 D.B. Nash, and A.Y. Schwartz The History, Impact, and Future of the Medicare Advantage...

Challenges facing public retirement plans - Volume 15 Issue 3 - ROBERT L. CLARK, JOSEPH P. NEWHOUSE