Researchers at the University of Minnesota Rural Health Research Center identify common factors and best practices for rural-based obstetrics with a look at what leaders have done at the community level in Wisconsin, Kansas, and Arkansas. Read more here.

As COVID-19 continues to have profound effects on people’s lives, the Federal Reserve Bank of Philadelphia, in partnership with the 11 other Reserve Banks and the Board of Governors of the Federal Reserve System, is surveying representatives of nonprofits, financial institutions, government agencies, and other community organizations to determine the pandemic’s impact on low- to moderate-income (LMI) communities.

Our latest Perspectives from Main Street report summarizes findings from our October survey. The majority of organizations said COVID-19’s impacts on a range of issues — from employment and education to basic consumer needs and health — got modestly or significantly worse since August.

While the Third District state data are not a representative sample, there are several areas where the results vary from or are more pronounced than national indicators in the full report:

• The majority of respondents in the nation (59 percent) and larger majorities of respondents in Pennsylvania (60 percent), New Jersey (69 percent), Delaware (67 percent), report that LMI communities are experiencing significant disruption and expect recovery to be difficult.
• Income and job loss were cited as the top impacts for respondents in the nation (38 percent) and in Pennsylvania (34 percent), New Jersey (45 percent), and Delaware (58 percent).
• The majority of respondents in the nation (56 percent) and in Pennsylvania (60 percent), New Jersey (79 percent), and Delaware (50 percent) report that it will take 12 months for community conditions to return to pre-pandemic levels.

Year-round, the Philadelphia Fed and the the Federal Reserve System work to foster economically resilient communities. Gathering actionable information is especially important during this unprecedented time. We’ll continue to seek and share ongoing perspectives from Main Street.

To learn about Philadelphia Fed’s Community Development and Regional Outreach Department, visit our website.

By Liz Carey
Research at the University of Kentucky gives hope for a holistic approach to treating addiction in rural areas, merging intravenous drug infections treatments with mental health and social services support.
Read more

This report from the National Academy for State Health Policy examines how Colorado, Minnesota, and Rhode Island are using accountable care programs to improve the delivery of behavioral health services. It was developed through HRSA’s cooperative agreement with the National Organizations of State and Local Officials.

Read the report.

As health care costs balloon in the U.S., experts say it may be important to analyze whether those costs translate into better population health. A new study led by a Penn State researcher analyzed existing data to find a dividing line — or “threshold — for what makes a treatment cost-effective or not.

David Vanness, professor of health policy and administration, led a team of researchers that created a simulation to consider health care treatment costs, insurance premiums, quality of life, and life expectancy to explore whether a treatment delivers enough value for its costs to be considered beneficial for population health.

According to Vanness, the term “treatment cost” in this research incorporates all the costs and savings related to a treatment. For example, the cost of a treatment to lower blood cholesterol would include how much it costs but also take into account potential savings for preventing a heart attack and its subsequent treatment.

“We know that we are spending more and more on health care in the U.S. and that we’re getting less and less for it,” Vanness said. “We do a good job of developing new treatments in this country, but we don’t do a good job of covering everybody or making sure that people have access to basic health care. We’re spending a lot on our medical treatments, but many of those treatments just don’t have a lot of value.”

Vanness added that in order to improve a population’s health without spending too much, it’s important to be able to tell whether the prices drug and device manufacturers are charging are justified by what they deliver in health improvements.

The researchers found that in their simulation, for every $10 million increase in health care expenditures, 1860 people became uninsured. This led to five deaths, 81 quality-adjusted life-years lost due to death, and 15 quality-adjusted life-years lost due to illness. In health care economics, one quality-adjusted life-year (QALY) is equal to one year of perfect health.

Vanness said these results — recently published in the Annals of Internal Medicine — suggests a cost effectiveness threshold of $104,000 per QALY.

“If a treatment is beneficial but it costs more than about $100,000 to gain one quality-adjusted life-year using that treatment, then it may not be a good deal,” Vanness said. “Because our simulation was using data estimates, we wanted to come up with a range of plausible values. So anything over a range of $100,000 to $150,000 per QALY gained is likely to actually make our population’s health fall.”

To create the simulation, Vanness said he and the other researchers used a variety of data, starting with estimates about how likely people are to drop their insurance when their premiums go up.

“We also used evidence from the public health literature on what happens to people’s health and mortality when they gain or lose health insurance,” Vanness said.

The simulation then compiled that data and estimated how much the health of a population goes down when costs increase. According to Vanness, that relationship determines the cost-effectiveness threshold — how much a treatment can cost relative to the health benefits it gives before it causes more harm than good.

The researchers said the findings could be especially important to organizations like the Institute for Clinical and Economic Review, which provides analysis to several private and public insurers to help negotiate prices with manufacturers. These organizations could use the findings as empirical evidence for what makes a treatment a good value in the United States.

“Moving forward, I think some changes could be made to national policy to make cost effectiveness analysis more commonly used,” Vanness said. “Our goal is to get that information out there with the hope that somebody is going to use it to help guide coverage or maybe get manufacturers to reduce their prices on some of these drugs.”

James Lomas at the University of York, and Hannah Ahn, a Penn State graduate student, also participated in this work.