Perkinswiese0322

Fifty-six percent reported negative margins, or costs that exceeded revenues. Seventeen percent of plans in contracts in the lowest quartile of gross margins were terminated in 2015, compared to under 5% of plans in the highest-margin contracts. CONCLUSIONS In 2014, MA contracts reported MLRs greater than the mandatory minimum of 85%. Gross margins likely contribute to trends in plan and insurer availability. MLR reports from subsequent years can help explain fluctuations in insurers' participation in MA.OBJECTIVES We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference -1.29 percentage points; confidence interval -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy.OBJECTIVE To investigate whether paresthesia of the lower extremities following exposure to the World Trade Center (WTC) disaster was associated with signs of neuropathy, metabolic abnormalities, or neurotoxin exposures. METHODS Case-control study comparing WTC-exposed paresthesia cases with "clinic controls" (WTC-exposed subjects without paresthesias), and "community controls" (WTC-unexposed persons). RESULTS Neurological histories and examination findings were significantly worse in cases than controls. Intraepidermal nerve fiber densities were below normal in 47% of cases and sural to radial sensory nerve amplitude ratios were less than 0.4 in 29.4%. Neurologic abnormalities were uncommon among WTC-unexposed community controls. BGB-8035 solubility dmso Metabolic conditions and neurotoxin exposures did not differ among groups. CONCLUSIONS Paresthesias among WTC-exposed individuals were associated with signs of neuropathy, small and large fiber disease. The data support WTC-related exposures as risk factors for neuropathy, and do not support non-WTC etiologies.OBJECTIVE To understand the practicalities of undertaking 2-3 min of light to moderate intensity physical activity after every 30 min of prolonged sitting by examining barriers and facilitators. METHODS 27 (n = 22 women) employees working in higher education who sat for ≥ 5 hours during a work day participated in a focus group discussion. RESULTS Through inductive thematic analysis, themes characterising workplace culture and having the knowledge (or not) of benefits were found to be a facilitator and a barrier. Additional barriers were a perceived reduction in work productivity and specific work tasks that precluded taking activity breaks. Extrinsic motivators and prompts were suggested to facilitate participation. CONCLUSIONS Environmental and individual strategies are required to build capability, opportunity and motivation for undertaking regular activity breaks and should inform the development of an ecologically valid workplace intervention.OBJECTIVE According to Self Determination Theory, autonomy and competence are two essential basic human needs. It is the aim of this study to show that mental demands at the workplace (WPMDs) which address those basic needs can protect employees against depressiveness. METHODS Using a sample of 346 working participants (average age 56.2), we derived three WPMDs (Information Load, Time Control, Exploration) via principal component analysis. We then analyzed in how far they predict depressiveness, and in how far this mechanism is mediated by perceived fit between job and person (PJF). RESULTS Time Control and Exploration significantly reduced depressiveness, and the relationship between Exploration and depressiveness was mediated by PJF. CONCLUSIONS Our results emphasize the importance of addressing basic human needs at the workplace, and the relevance of PJF for employee mental health.OBJECTIVE To measure the prevalence of opioid use disorder (OUD) and employee health care and productivity costs with and without OUD and to assess whether utilization of pharmacotherapy for OUD reduces those costs. METHODS We conducted a cross-sectional analysis of 2016-2017 commercial enrollment, health care, and pharmacy claims and health risk assessment data using the IBM® MarketScan® Databases. We estimated regression models to assess the association between OUD and annual employee health care and productivity costs. RESULTS Health care and productivity costs for employees with OUD who did and did not receive pharmacotherapy were approximately $6,294 and $21,570 more than for other employees, respectively. CONCLUSIONS Employers can make a business case for expanding access to pharmacotherapy treatment for OUD based on our finding that receipt of pharmacotherapy significantly reduces overall health care costs.