Importance:Enrollment in public benefits is associated with improved health outcomes, yet many eligible individuals do not claim them. Public benefit programs are important policy tools to address health-related social needs. Health systems have developed new partnerships with community organizations to assist patients with enrollment in benefits. Objective:To determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department. Design, Setting, and Participants:This 2-arm, nonblinded, randomized clinical trial was conducted from November 2023 to April 2024 at 2 academic hospital emergency departments in Philadelphia, Pennsylvania, and included adult individuals in stable condition with Medicaid or Medicare insurance who were discharged from the emergency department and eligible for at least 1 of 10 public benefit programs. Individuals were excluded if they were unable to read English or did not have access to a mobile phone. Data were analyzed from May 2024 to November 2024. Interventions:Eligible participants were randomized in a 1:1 ratio. Participants allocated to the intervention received a series of 4 automated text messages over 14 days that prompted them to contact a benefits navigator telephone line operated by a community partner; those allocated to the control group received a paper flyer. Main Outcomes and Measures:The primary outcome was whether study participants called benefits navigators within 14 days. Secondary outcomes included whether study participants submitted any benefits application within 14 days. Results:Of 1778 patients screened, there were 160 participants enrolled. Participants' mean (SD) age was 44 (17) years; 94 (59%) were women, 145 (91%) were non-Hispanic Black, and 11 (7%) were non-Hispanic White. In the intervention group, 20 participants (25%) contacted benefits navigators vs 0 in the control group (difference, 25 percentage points; 95% CI, 16%-35%). In the intervention group, 11 participants (14%) submitted at least 1 application for public benefits compared with 0 in the control group (difference, 14 percentage points; 95% CI, 6-22). Conclusions and Relevance:The trial results suggest that text messages were more effective than paper referrals to help eligible emergency department patients seek assistance with public benefits applications. Text messages may offer a tool to allow health systems, in collaboration with community partners, to address health-related social needs. Trial Registration:ClinicalTrials.gov Identifier: NCT05654220.

QuestionAre text messages more effective than paper referrals in encouraging emergency department patients to seek assistance in applying for unclaimed public benefits?FindingsIn this randomized clinical trial of 160 patients who were discharged from the emergency department, 25% who received text message reminders contacted benefits navigators compared with 0 who received paper flyers alone.MeaningThe trial results suggest that health system interventions that address social needs, including benefits navigation, may benefit from using text messages in their design. ImportanceEnrollment in public benefits is associated with improved health outcomes, yet many eligible individuals do not claim them. Public benefit programs are important policy tools to address health-related social needs. Health systems have developed new partnerships with community organizations to assist patients with enrollment in benefits.ObjectiveTo determine whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.Design, Setting, and ParticipantsThis 2-arm, nonblinded, randomized clinical trial was conducted from November 2023 to April 2024 at 2 academic hospital emergency departments in Philadelphia, Pennsylvania, and included adult individuals in stable condition with Medicaid or Medicare insurance who were discharged from the emergency department and eligible for at least 1 of 10 public benefit programs. Individuals were excluded if they were unable to read English or did not have access to a mobile phone. Data were analyzed from May 2024 to November 2024.InterventionsEligible participants were randomized in a 1:1 ratio. Participants allocated to the intervention received a series of 4 automated text messages over 14 days that prompted them to contact a benefits navigator telephone line operated by a community partner; those allocated to the control group received a paper flyer.Main Outcomes and MeasuresThe primary outcome was whether study participants called benefits navigators within 14 days. Secondary outcomes included whether study participants submitted any benefits application within 14 days.ResultsOf 1778 patients screened, there were 160 participants enrolled. Participants' mean (SD) age was 44 (17) years; 94 (59%) were women, 145 (91%) were non-Hispanic Black, and 11 (7%) were non-Hispanic White. In the intervention group, 20 participants (25%) contacted benefits navigators vs 0 in the control group (difference, 25 percentage points; 95% CI, 16%-35%). In the intervention group, 11 participants (14%) submitted at least 1 application for public benefits compared with 0 in the control group (difference, 14 percentage points; 95% CI, 6-22).Conclusions and RelevanceThe trial results suggest that text messages were more effective than paper referrals to help eligible emergency department patients seek assistance with public benefits applications. Text messages may offer a tool to allow health systems, in collaboration with community partners, to address health-related social needs.Trial RegistrationClinicalTrials.gov Identifier: NCT05654220 This randomized clinical trial examines whether text messages were more effective than paper referrals in prompting patients to contact benefits navigators following discharge from the emergency department.

Over 16 million adult patients visit the emergency department (ED) for diabetes-related conditions yearly. Although most patients are discharged from the ED without requiring hospitalization, it is unknown how often these individuals obtain outpatient follow-up care for medication adjustment, symptom monitoring, and counseling. To describe incidence, timing, and patient characteristics associated with outpatient follow-up after discharge from the ED for diabetes-related encounters in a national cohort. Retrospective cohort study. Adults with commercial insurance or Medicare Advantage who were discharged from the ED with principal encounter diagnosis related to type 1 or type 2 diabetes mellitus. The primary outcome was an outpatient visit for diabetes-related care within 30 days of ED discharge. Return ED visit prior to outpatient follow-up was treated as a competing outcome. Multivariable competing risk regression models were used to estimate adjusted hazard ratios (aHRs) for patient characteristics associated with obtaining follow-up, including demographic, socioeconomic, and clinical factors. Of the 131,881 patients included in this study (mean age, 63.0 years; 51.6

This cross-sectional study uses Medicare data to compare 2 definitions of safety-net ambulatory practices to investigate the extent to which safety-net practices overlap.

To date, most bundled payment programs have been voluntary in design. However, such programs are limited by provider and patient selection, the potential exacerbation of health disparities, and results with limited generalizability. In 2026, Medicare will address these concerns through the Transforming Episode Accountability Model (TEAM), the first mandatory program to require nationwide participation across multiple surgical procedures. To anticipate whether the TEAM model can provide generalizable evidence for scaling bundled payments nationwide, the authors used Medicare data to conduct a cross-sectional analysis comparing the characteristics of markets and hospitals selected to participate in TEAM with those that were not. The current study found that, although the 186 TEAM markets were larger than the 618 markets that will not participate, they were similar with regard to structural characteristics (e.g., Medicare advantage penetration, exposure to prior bundled payment programs) and population characteristics (e.g., education, income). The 727 TEAM hospitals differed from the 2155 others with regard to key characteristics, including teaching and safety-net status, profit margin, and patient volume. Overall, these findings suggest that TEAM may generate findings that can be generalized to all US markets while expanding the types of hospitals that have participated in bundled payment programs.

Study objective To describe the use of telemedicine for outpatient follow-up care after discharge from the emergency department (ED) in a large cohort of patients with commercial insurance or Medicare Advantage and determine whether telemedicine follow-up was associated with greater return hospitalizations compared with in-person care. Methods Using administrative claims data, we conducted a retrospective cohort study of adults discharged from the ED with congestive heart failure, diabetes, chronic obstructive pulmonary disease, or asthma, from 2020 to 2022. The primary outcome was modality of the first outpatient visit within 14 days, either in person or via telemedicine. We used multivariable logistic regression to examine patient characteristics associated with use of telemedicine compared with in-person follow-up. We also used time-to-event methods to estimate the risk of return hospitalization for patients who obtained telemedicine versus in-person follow-up. Results Among 147,561 patients discharged from the ED (mean age 63.9 years; 56.5% women), we found that 4,107 (2.8%) obtained telemedicine follow-up visits and 34,882 (23.6%) obtained in-person follow-up. An additional 7,487 (5.1%) patients were hospitalized prior to obtaining any follow-up. Use of telemedicine varied across conditions and was associated with younger age, female sex, more comorbidities, and ED visit complexity. Telemedicine was not associated with greater risk of return hospitalization compared with in-persnon follow-up. Conclusion ED patients used telemedicine for outpatient follow-up visits at low rates, with comparable rates of return hospitalization to those who obtained in-person follow-up. Future studies may examine focused interventions to deploy telemedicine to expand access to follow-up care for selected patients.

This cross-sectional study characterizes beneficiaries who received care through Medicare’s largest voluntary payment models from 2013 to 2022.

This cohort study describes the outcome of 2 text messaging interventions to reach patients eligible for government benefits programs.

This Viewpoint discusses strategies for implementing and scaling hospital-at-home programs, which could help improve hospital capacity, quality, and patient experience.

Importance:Independent evaluations of Bundled Payments for Care Improvement Advanced (BPCI-A) have focused on hospitals and have not assessed the performance of physicians in participating physician group practices (PGPs). However, PGPs are accountable for a larger proportion of surgical procedures, including for lower-extremity joint replacement, in the BPCI-A model than are hospitals. Objective:To evaluate the association of treatment by BPCI-A-participating physicians and hospitals with health care spending, quality, and utilization for joint replacement procedures compared to nonparticipants. Design, Setting, and Participants:This cohort study used Medicare claims of beneficiaries receiving lower-extremity joint replacement between April 2016 and September 2019 and data on BPCI-A-participating PGPs and hospitals to assess spending, quality, and utilization. Differences-in-differences methods adjusting for patient and market characteristics (aDID) were used with matched comparison groups of nonparticipating physicians and hospitals. Data analysis was performed from January 2023 to January 2025. Exposures:Lower-extremity joint replacement by a physician in a PGP or hospital that began BPCI-A participation in October 2018. Main Outcomes and Measures:Ninety-day total episode spending for joint replacement. Secondary outcomes were postacute care utilization, mortality, hospital readmissions, and joint replacement complications. Results:The matched cohort included 846 529 Medicare beneficiaries (mean [SD] age, 73.7 [8.3] years; 63.8% female) who obtained a joint replacement in April 2016 to September 2019, of whom 281 189 were treated by 2820 physicians in BPCI-A-participating PGPs, and 69 107 by 174 BPCI-A-participating hospitals. An additional 28 309 beneficiaries were treated by physicians and hospitals both participating in BPCI-A. The remaining 467 924 were treated by 4671 nonparticipating physicians and 432 nonparticipating hospitals. Before BPCI-A participation, total unadjusted baseline episode spending was $26 483 for participating physicians and $29 854 for participating hospitals. Treatments by BPCI-A participating physicians and hospitals were each associated with differentially lower total spending (physician aDID, -$855; 95% CI, -$1074 to -$636; hospital aDID, -$613; 95% CI, -$1039 to -$187). Treatment by a BPCI-A-participating physician or hospital was associated with differentially lower institutional postacute care utilization. Physician participation was associated with a differential increase in outpatient visits 7 days postdischarge (aDID, 2.9 percentage points; 95% CI, 2.0 to 3.8), while hospital participation was not associated with a change in outpatient visits. Differential changes in mortality, readmissions, and complications were not observed for either participant type. Conclusions and Relevance:This cohort study found that participation in BPCI-A for joint replacement was associated with differentially lower total spending for both physicians and hospitals. Given that physicians in PGPs accounted for 73% of all the joint replacement episodes, these findings highlight the importance of facilitating alignment between hospitals and physicians in future bundled-payment models, including those that allow only hospitals.

This Viewpoint describes the hospital-at-home model for delivering hospital-level services in the home, barriers to implementation of pediatric hospital-at-home programs, current opportunities for these programs, and policy changes needed to support their growth and meet the changing needs of pediatric populations.

Introduction:Individuals dually eligible for insurance through both Medicaid and Medicare ("duals") have more comorbidities, higher costs, and poorer outcomes compared to other groups. Unfortunately, policy and care redesign initiatives suffer from limited knowledge about ambulatory care patterns among duals. Methods:Using 2022 Medicare fee-for-service claims and other sources of clinician and geographic data, we described care patterns for ambulatory services among dual vs non-duals. Our sample consisted of 967 820 dual and 4 600 486 non-dual individuals receiving a total of 67 122 906 ambulatory services from 106 545 practices and 815 827 clinicians. Results:We found that duals received fewer ambulatory, in particular subspecialty, services than non-duals, while duals received slightly more services through primary care physicians and advanced practice professionals. Among duals, most services were provided in office rather than federally qualified health centers or rural health clinics by a disproportionally small number of geographically dispersed practices and clinicians. High-dual practices and clinicians differed from non-high dual counterparts with respect to multiple characteristics. Conclusion:These differences highlight the opportunity to improve access and outcomes among duals by targeting policy and practice changes toward certain groups and clinicians.