Srikanth Kadiyala

Authors randomized 48 primary care pediatric practices to online communication training vs. usual care. Online communication training reduced missed opportunities (MOs) for initial human papillomavirus (HPV) vaccination at well-child care (WCC) visits by 6.8 percentage points among children aged 11–17 years. The current study estimated implementation costs of the communication training intervention at WCC visits.

Authors analyzed monthly surveys completed by intervention practice lead clinicians to track clinician plus office staff personnel hours devoted to implementing the intervention. They converted personnel time into 2019 U.S. dollars using national median hourly wages for physicians and other health care workers; they tracked nonpersonnel costs. Authors calculated costs per practice (overall and by practice size) and estimated costs per averted MO for HPV vaccine initiation using an effectiveness estimate determined by grouped logistic regression at the practice level.

Findings: Practices varied from 1 to 24 clinicians and from 241 to 8,866 visits during the 6-month intervention. Total intervention costs varied substantially across the 24 intervention practices from $370 to $6,653, with a mean of $2,003 and median of $1,305. The incremental cost per averted MO for HPV vaccine initiation at WCC visits averaged $110 ($212 in practices with 1 or 2 physicians and $94 in practices with 3 or more physicians).

The implementation cost per averted MO for HPV vaccine initiation at WCC visits of this online communication training intervention was modest, particularly among larger pediatric practices.

The Inflation Reduction Act of 2022 (IRA) included additional federal subsidies to make health insurance more affordable in the individual market, but these expire at the end of 2025. If Congress does not extend the expanded subsidies and levels revert to those in the original Affordable Care Act, all 2.37 million Californians in the individual market — including those not receiving subsidies — would face higher health insurance premiums and be forced to choose between more expensive coverage, less generous coverage, or forgoing coverage altogether and going uninsured. Under this scenario, authors project that in 2026:

• 1,558,000 Californians would pay an average of $967 more per year but maintain coverage despite having their subsidies reduced or eliminated;
• 740,000 Californians enrolled in unsubsidized coverage would pay an average of $253 more per year due to the worse risk-mix of the individual market if the IRA subsidies were eliminated;
• 69,000 additional Californians would become uninsured.

Authors conclude that maintaining IRA-level subsidies in the individual market would protect 2.37 million Californians from insurance premium increases and keep 69,000 Californians covered. For these subsidies to continue, Congress must act in 2024 or 2025. In early 2025, insurers will develop their rates for the 2026 coverage year, and rates will be finalized by the middle of 2025. Congressional action before then could help avoid premium increases.

Summary: This policy brief examines geographic disparities in rates of potentially preventable hospitalizations and emergency department (ED) visits among adults ages 18 and older by Service Planning Areas (SPA) in Los Angeles County from 2016 to 2021. Authors look at three combinations of conditions that are typically preventable, given appropriate disease management: all conditions, chronic conditions, and diabetes-related conditions.

Findings: South Los Angeles (SPA 6) and the Antelope Valley (SPA 1) have the highest rates of potentially preventable hospitalizations and emergency department visits among Los Angeles’ 8 SPAs. South Los Angeles has a rate of preventable hospitalizations for all conditions that is 1.7 times that of West Los Angeles (SPA 5), which has the lowest rate. Also, SPA 6 has the highest proportion covered by Medi-Cal (35.2%), followed by SPA 1 (27.9%), while SPA 5 has the lowest percentage insured with Medi-Cal (10.7%). Authors recommend that state and local policymakers and payers should consider improving access to primary and specialty care and increasing payments for Medi-Cal providers to help prevent costly ED visits and hospitalizations.

Read the Publication:

• Policy Brief: Geographic Disparities in Preventable Hospitalizations and Emergency Department Visits in Los Angeles County
• Infographic

Summary: California’s historic expansion of Medi-Cal eligibility to all low-income Californians regardless of immigration status is scheduled to go into effect in January of 2024, when low-income undocumented adults ages 26-49 will become eligible for full-scope Medi-Cal coverage. 

Findings: Authors project that after the new enrollment has taken place, California’s uninsured population will decrease to a record low of 2.57 million under age 65. This represents substantial progress in access to health insurance. Close to 1 million undocumented Californians will have gained access to Medi-Cal through the expansions to children, young adults, older adults, and now adults ages 26-49. However, they also project there will be 520,000 uninsured undocumented residents who earn too much for Medi-Cal and do not have employer coverage. This group remains categorically excluded from enrolling in Covered California and cannot receive federal subsidies to make coverage more affordable. 

This policy brief is a joint effort by the UCLA Center for Health Policy Research and the UC Berkeley Labor Center.

Read the Publication:

• Policy Brief: California’s Uninsured in 2024: Medi-Cal Expands to All Low-Income Adults, But Half a Million Undocumented Californians Lack Affordable Coverage Options