Nevin Manimala

Health Aff (Millwood). 2025 Jul;44(7):878-886. doi: 10.1377/hlthaff.2024.01189.

ABSTRACT

To address low take-up of Medicare Savings Programs for low-income Medicare beneficiaries, the Centers for Medicare and Medicaid Services issued regulations in 2023 aimed at streamlining the enrollment process. We analyzed 2016-22 data from the Medicare Current Beneficiary Survey to examine recent take-up of the largest and most generous Medicare Savings Program, the Qualified Medicare Beneficiary (QMB) program. We compared beneficiary characteristics and cost-related barriers to care among QMB enrollees and beneficiaries who were eligible but not enrolled. QMB take-up rose from 62 percent in 2016 to 66 percent in 2022. QMB-eligible beneficiaries who were Asian or Hispanic were more likely than eligible White beneficiaries to enroll in the program. Eligible beneficiaries younger than age sixty-five were more likely to enroll than those ages sixty-five and older, and beneficiaries in Medicaid expansion states were more likely to enroll than those in nonexpansion states. QMB enrollees were less likely than Medicare beneficiaries who were eligible but not enrolled to report delaying care because of cost or having problems paying for care. These findings suggest that additional policies and programs may be needed to increase QMB take-up and to improve health care access and affordability for millions of low-income Medicare beneficiaries.

PMID:40623256 | DOI:10.1377/hlthaff.2024.01189

Health Aff (Millwood). 2025 Jul;44(7):862-868. doi: 10.1377/hlthaff.2024.01111.

ABSTRACT

There has been a significant shift in the composition of the Medicaid managed care market over the course of the past two decades. The market is consolidated among five national firms, and those firms have nearly half of all beneficiaries enrolled in managed care plans. State markets are even more consolidated, typically giving Medicaid beneficiaries only a few plan options. This article describes the Medicaid managed care market during the period 2006-20, using enrollment data and a novel data set on acquisitions. Our study found a marked decrease in the number of parent payers (unique firms that own at least one Medicaid managed care plan), despite an increase in total enrollment, as well as a high volume of acquisitions. In fact, approximately one in four plans were involved in at least one acquisition during the study period. National payers are playing an increasingly dominant role in Medicaid managed care, with both the number and the market share of local payers decreasing during the study period. Future research is needed to understand the consequences of these shifts for the level of competition in this market, state finances, and beneficiary health.

PMID:40623255 | DOI:10.1377/hlthaff.2024.01111

Health Aff (Millwood). 2025 Jul;44(7):839-845. doi: 10.1377/hlthaff.2024.01484.

ABSTRACT

Utilization management criteria influence patients’ access to specialty drugs, yet the processes used by health plans to establish these criteria are not well understood. This study examined the alignment between clinical practice guidelines and plans’ utilization management criteria. Using the Tufts Medicine Specialty Drug Evidence and Coverage Database (December 2023), we reviewed US-based guidelines for 389 drug-indication pairs, excluding oncology and biosimilar treatments. We categorized guidelines as recommending or not recommending utilization management, based on alignment with each drug’s Food and Drug Administration label-specifically, line of therapy and clinical requirements (for example, disease severity). We analyzed 5,699 coverage policies from eighteen large commercial health plans. When guidelines recommended utilization management, 67 percent of plans’ coverage decisions aligned with the recommendation; when guidelines did not recommend utilization management, only 37 percent of decisions were consistent. Most plans imposed utilization management criteria (61 percent of all decisions), and plans were more likely to be consistent with guideline recommendations when utilization management was recommended, indicating a weak alignment with guideline recommendations.

PMID:40623253 | DOI:10.1377/hlthaff.2024.01484

Health Aff (Millwood). 2025 Jul;44(7):869-877. doi: 10.1377/hlthaff.2024.01163.

ABSTRACT

Recent policy initiatives such as the 988 Suicide and Crisis Lifeline aim to increase the use of crisis services. We conducted a probability survey of 5,006 US adults in 2023 and used latent class analysis to identify population segments that vary in crisis help-seeking preferences. We identified five segments: “Seek Help Nowhere,” “Definitely Not 988, Yes Friends And Family-Distressed,” “Seek Help Everywhere,” “Seek Help Most Places, But Not Religious Network,” and “Relatively Indifferent-Not Distressed.” Having serious prior-thirty-day psychological distress was positively associated with membership in the Definitely Not 988 segment and was negatively associated with the Relatively Indifferent segment. Respondents who were not aware of the 988 Lifeline were more likely to be in the Seek Help Nowhere and Definitely Not 988 segments. Political party affiliation was associated with membership in all segments. Communication campaigns that encourage the use of crisis services and help seeking may consider tailoring messages for these different audience segments.

PMID:40623251 | DOI:10.1377/hlthaff.2024.01163

Health Aff (Millwood). 2025 Jul;44(7):812-820. doi: 10.1377/hlthaff.2024.01250.

ABSTRACT

Maternal involvement with Child Protective Services (CPS) is common around childbirth, particularly for women with economic and health challenges. Federal and state policies aim to improve health care access and use for CPS-involved families, but evidence is needed to understand how CPS contact relates to health care for new mothers. We used linked population-based administrative data, representing all Medicaid-covered births in Wisconsin during the period 2010-19, to produce estimates of the associations of CPS interventions with maternal receipt of postpartum health care. After we adjusted for factors influencing risk for CPS involvement, women whose births were brought to the attention of CPS were around 13 percentage points less likely to receive postpartum care within twelve weeks after delivery, and this relation was present across different levels of CPS intervention and key population subgroups. These findings highlight the need to consider how child welfare and health care policies and practices can support connections with health care for new mothers and their infants.

PMID:40623250 | DOI:10.1377/hlthaff.2024.01250

Pain. 2025 Jul 2. doi: 10.1097/j.pain.0000000000003703. Online ahead of print.

ABSTRACT

Exacerbations of existing low back pain (LBP) or new LBP episodes are colloquially referred to as “flares.” Although the experience of flares is common to many people with LBP, few validated measures enable people to self-report if they are experiencing a flare. This study examined the convergent validity of a person-dependent definition of flares (“a worsening of your low back pain that lasts from hours to weeks”) as compared with (1) LBP intensity, (2) LBP-related pain interference, and (3) analgesic use, in a large, prospective research study of Veterans with LBP. Veterans seeking care for LBP (n = 465) were followed prospectively for up to 1 year. Participants completed up to 36 scheduled surveys and additional patient-initiated surveys (triggered by the onset of new flares) over follow-up. Each survey inquired about current flare status, pain intensity measured on a 0 to 10 numeric rating scale (NRS), LBP-related pain interference, and analgesic use. Linear mixed-effects models estimated the association between current flare status and pain intensity, with and without adjustment for potential confounding factors; secondary analyses examined associations with pain interference and analgesic use. In longitudinal analyses of 11,817 surveys, flare status was significantly associated with a 2.8-NRS point greater pain intensity (P < 0.0001), with and without adjustment for other factors. Statistically significant associations were found between flare status and LBP-related pain interference and analgesic use. New flare periods were associated with impacts on coping, functional limitations, and mood/emotions. These findings support the convergent validity of a person-dependent flare definition.

PMID:40623243 | DOI:10.1097/j.pain.0000000000003703

J Healthc Manag. 2025 Jul-Aug 01;70(4):269-287. doi: 10.1097/JHM-D-24-00002. Epub 2025 Jul 4.

ABSTRACT

GOAL: Despite the well-documented mental health impact of the COVID-19 pandemic on healthcare workers (HCWs), the literature holds limited research on their use of mental healthcare. This study assessed the prevalence and correlates of mental healthcare utilization among US HCWs, which can be used as baseline measurements to guide the evaluation of interventions and guide the development of those interventions.

METHODS: We used the 2020-2021 US National Health Interview Survey and restricted our analytic sample to respondents who worked in healthcare settings and reported daily, weekly, or monthly mental health symptoms (unweighted n = 1,412). Our outcome variables were: (1) receiving anxiolytic or antidepressant prescriptions, (2) receiving psychotherapy, and (3) not utilizing either treatment. We conducted multivariable logistic regression models to identify factors associated with each outcome. Based on Andersen’s behavioral model, we included predisposing factors (e.g., gender, healthcare role), enabling factors (e.g., social support, telehealth use), need factors (e.g., frequency of depressive or anxiety symptoms), and year.

PRINCIPAL FINDINGS: We found that 32.1% of HCWs received prescriptions, 22.3% received psychotherapy, and 59.0% were not currently using mental healthcare. Overall, some predisposing, enabling, and need factors were associated with all three outcome variables for mental healthcare utilization among HCWs. For instance, when examining the odds of not reporting current use of mental healthcare services, odds were higher among HCWs who were non-Hispanic Black/African American (odds ratio [OR] = 1.90, 95% confidence interval [CI] [1.16-3.12]), or Hispanic (OR = 2.68, 95% CI [1.63-4.39]) compared to those who were non-Hispanic White. Higher odds were also observed among HCWs who reported rarely or never received adequate social support (OR = 1.94, 95% CI [1.04-3.62]) as compared to those who reported always receiving adequate social support, those who were male (OR = 1.47, 95% CI [1.00-2.16]), and those without a usual source of care (OR = 2.08, 95% CI [1.12-3.88]). Inversely, lower odds were observed among HCWs who reported themselves as not heterosexual (OR = 0.58, 95% CI [0.34-0.99]) and those who had used telehealth appointments (OR = 0.32, 95% CI [0.24-0.44]). Lower odds were also observed among HCWs with more frequent anxiety symptoms: monthly (OR = 0.42, 95% CI [0.20-0.88]), weekly (OR = 0.36, 95% CI [0.18-0.73]), or daily frequency (OR = 0.27, 95% CI [0.14-0.55]), compared to never or few times a year. A similar pattern was observed among HCWs with more frequent depressive symptoms: monthly (OR = 0.33, 95% CI [0.22-0.49]), weekly (OR = 0.15, 95% CI [0.09-0.24]), or daily (OR = 0.11, 95% CI [0.05-0.21]), compared to never or few times a year. No differences in any outcome variable by type of HCW (diagnosing vs. nondiagnosing roles) were observed.

PRACTICAL APPLICATIONS: Our findings reveal a potential pattern of underutilization of mental health services among HCWs with mental health symptoms. To inform intervention design and delivery, additional research is needed to identify barriers to mental healthcare and preferences for their modalities that are specific to HCWs.

PMID:40623224 | DOI:10.1097/JHM-D-24-00002

J Bras Nefrol. 2025 Oct-Dec;47(4):e20240254. doi: 10.1590/2175-8239-JBN-2024-0254en.

ABSTRACT

OBJECTIVE: This study evaluated the performance of ChatGPT 4 and 3.5 versions in answering nephrology questions from medical residency exams in Brazil.

METHODS: A total of 411 multiple-choice questions, with and without images, were analyzed, organized into four main themes: chronic kidney disease (CKD), hydroelectrolytic and acid-base disorders (HABD), tubulointerstitial diseases (TID), and glomerular diseases (GD). Questions with images were answered only by ChatGPT-4. Statistical analysis was performed using the chi-square test.

RESULTS: ChatGPT-4 achieved an overall accuracy of 79.80%, while ChatGPT-3.5 achieved 56.29%, with a statistically significant difference (p < 0.001). In the main themes, ChatGPT-4 performed better in HABD (79.11% vs. 55.17%), TID (88.23% vs. 52.23%), CKD (75.51% vs. 61.95%), and DG (79.31% vs. 55.29%), all with p < 0.001. ChatGPT-4 presented an accuracy of 81.49% in questions without images and 54.54% in questions with images, with an accuracy of 60% for electrocardiogram analysis. This study is limited by the small number of image-based questions and the use of outdated examination items, reducing its ability to assess visual diagnostic skills and current clinical relevance. Furthermore, addressing only 4 areas of Nephrology may not fully represent the breadth of nephrology practice.

CONCLUSION: ChatGPT-3.5 was found to have limitations in nephrology reasoning compared to ChatGPT-4, evidencing gaps in knowledge. The study suggests that further exploration is needed in other nephrology themes to improve the use of these AI tools.

PMID:40623208 | DOI:10.1590/2175-8239-JBN-2024-0254en

G3 (Bethesda). 2025 Jul 7:jkaf154. doi: 10.1093/g3journal/jkaf154. Online ahead of print.

ABSTRACT

Mealybugs are frequently known for being pest insects to both ornamental and large-scale agricultural crops. Yet despite their agricultural importance, the genomic resources for this group remain quite limited. One such species is the hibiscus mealybug, Nipaecoccus viridis (Newstead) (Hemiptera: Coccomorpha: Pseudococcidae). This invasive mealybug species has recently expanded throughout Florida and has spread across the state. Genomic resources would provide a new means to better understand the invasive nature of this insect, and thus, we present the de novo genome assembly for Nipaecoccus viridis. Our genome assembly is 289 Mb, in which 91.2% of this sequence assembled into 5 chromosomal scaffolds. We report 15,370 genes to be present within our genome. We found that repetitive elements in the genome accounted for 32.40% of the sequence. These statistics follow similar trends to other previously sequenced pseudococcid species.

PMID:40623205 | DOI:10.1093/g3journal/jkaf154

Proc Natl Acad Sci U S A. 2025 Jul 15;122(28):e2413060122. doi: 10.1073/pnas.2413060122. Epub 2025 Jul 7.

ABSTRACT

Introducing neuromorphic computing paradigms into taste-sensing technology will bring unprecedented opportunities for developing new hardware architectures with perceptual intelligence. Constructing the biomimetic gustatory system, however, remains a challenge due to the scarcity of suitable components operating under wet conditions. Here, we report that ion confinement within the layered graphene oxide membranes can be used to develop a memristive device capable of implementing both synaptic function and chemical sensing. The continuum model and ion dynamics characterizations demonstrate that interfacial adsorption-desorption slows down ion transport and leads to memristive behavior. Based on this nanofluidic device, we built an artificial gustatory system in the physiological environment, which can efficiently classify different flavors according to the reservoir computing algorithm. Our results suggest a paradigm for in-sensor computing in liquid.

PMID:40623193 | DOI:10.1073/pnas.2413060122