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José F. Figueroa

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by José F. Figueroa

joefigs.bsky.social
Three key findings:

1. In just 1yr, we saw a ~55% enrollment growth among full-benefit duals and >68% among partial duals into C-SNPs.

2. About 1 in 4 duals in 2025 C-SNPs came from plans w/ some form of integration.

3. About 15% of C-SNPs could be terminated if CMS applied “look-alike” rule

by José F. Figueroa

joefigs.bsky.social
In new #HealthAffairs Forefront piece, we show a troubling trend:

Rapid growth of “Chronic Condition Special Needs Plans (C-SNPs)” enrolling dual-eligibles.

We argue their growth is threatening national integrated care efforts for duals.

www.healthaffairs.org/do/10.1377/f...
Growth Of C-SNPs May Be Jeopardizing Medicare-Medicaid Integration | Health Affairs Forefront
With the new availability of Medicare enrollment data for 2025, we examine ongoing enrollment growth of chronic condition special needs plans (C-SNPs) overall and among the dual-eligible population.
www.healthaffairs.org
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by José F. Figueroa — Reposted by: Michael Barnett

joefigs.bsky.social
Federal funding reportedly sent to Harvard for about 200 grants totaling $46 million.

Some welcome relief hopefully to so many.

Story below:

www.thecrimson.com/article/2025...
Harvard Receives $46 Million in Federal Grants, Ending 4-Month Freeze | News | The Harvard Crimson
Millions of dollars in federal research grants from the National Institutes of Health began to flow to Harvard on Friday, the first grant money to return to the University since a judge struck down th...
www.thecrimson.com
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Reposted by: José F. Figueroa

jamahealthforum.com
Viewpoint: #Medicaid is vital for low-income, dual-eligible adults and people with disabilities, but coverage disruptions due to administrative barriers increase health risks. ja.ma/4pBxGUO
JAMA Health Forum viewpoint: "Mitigating the Dangers of Medicaid Churn Among Dual-Eligible Beneficiaries" by Eric T. Roberts and José F. Figueroa, published online September 12, 2025.
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by José F. Figueroa

joefigs.bsky.social
Sign of a broken health care system when patients with cancer feel like this:

“I always told myself the stress of dealing with insurance was worse than the cancer.”

Insights from patients w/ cancer dealing with prior authorizations in @jamanetworkopen.com study

jamanetwork.com/journals/jam...
Patient Perspectives on Prior Authorization for Cancer Care
This qualitative study characterizes the perspectives of patients with cancer regarding their experience with prior authorization for cancer care.
jamanetwork.com
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by José F. Figueroa — Reposted by: Ellen Meara

joefigs.bsky.social
The true cost of the reconciliation bill will be measured in lives—over 50,000 per year.

It’s a predictable result when you cut off insurance to people who are old, poor and sick.

Eric Roberts @pennldi.bsky.social and I discuss @msnbc.com @harvardhpm.bsky.social

www.msnbc.com/opinion/msnb...
Opinion | The true cost of the GOP’s megabill will be measured in lives. Tens of thousands of lives.
It’s a predictable result when you cut off health insurance to people who are old, poor and sick.
www.msnbc.com
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by José F. Figueroa

joefigs.bsky.social
Promising development in Congress:

A bipartisan group of House and Senate lawmakers considering finally fixing the MA to VA cost-shifting loophole that currently leads to billions in MA profits to provide zero care while VA foots the bill.

Story by @wsj.com

www.wsj.com/politics/pol...
Exclusive | Lawmakers Seek to Close VA Loophole That Funnels Billions to Private Medicare Insurers
A Wall Street Journal investigation found the federal government paid insurers an estimated $44 billion from 2018 through 2021 to cover veterans in Medicare Advantage plans who were also getting healt...
www.wsj.com
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by José F. Figueroa

joefigs.bsky.social
Our new @JAMAHealthForum study adds more evidence on how Medicare Advantage plans enrolling veterans are maximizing profits by not paying for care.

Veterans in high-veteran MA plans are much more likely to have surgical care paid by VA than plan itself—even when surgery occurs in non-VA hospitals…
jamahealthforum.com
JAMA Health Forum @jamahealthforum.com · Jun 9
Veterans enrolled in high-veteran Medicare Advantage plans are more likely to have their surgical care costs shifted to the Veterans Health Administration instead of being covered by the MA plans.

#ARM25 @academyhealth.bsky.social

https://ja.ma/4jKGy6e
Figure 1. Adjusted Inpatient Surgery Payment Sources for Veterans Health Administration Enrollees in High Veteran MA Plans vs. Other Medicare Advantage Plans, 2021
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Reposted by: José F. Figueroa, Stacie B. Dusetzina

jamahealthforum.com
Veterans enrolled in high-veteran Medicare Advantage plans are more likely to have their surgical care costs shifted to the Veterans Health Administration instead of being covered by the MA plans.

#ARM25 @academyhealth.bsky.social

https://ja.ma/4jKGy6e
Figure 1. Adjusted Inpatient Surgery Payment Sources for Veterans Health Administration Enrollees in High Veteran MA Plans vs. Other Medicare Advantage Plans, 2021
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by José F. Figueroa

joefigs.bsky.social
I’m honored and excited to have been selected as one of the 2025 Aspen Ideas Health Fellows this year!

Forum brings together a diverse set of people working on issues related to improving health.

Full list of @aspenideas.bsky.social Health Fellows:

www.aspenideas.org/articles/202...
2025 Aspen Ideas: Health Fellows | Aspen Ideas
The Aspen Ideas: Health Fellows are a diverse group of health leaders who are selected for their innovative work, inspired accomplishments, and ability to transform ideas into action. Get to know the ...
www.aspenideas.org
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by José F. Figueroa — Reposted by: José F. Figueroa

joefigs.bsky.social
CBO projects that House reconciliation bill will cause 1.38 million low-income Medicare beneficiaries to lose Medicaid coverage

We estimate that this will lead to over 18,000 avoidable deaths per year stemming from loss of drug subsidies

Link to our memo led by @pennldi.bsky.social:
bit.ly/4mwfcDA
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by José F. Figueroa

joefigs.bsky.social
Estimates are based on our recent @nejm.org study showing that loss of subsidized coverage (the Part D Low-Income Subsidy) led to significant increases in mortality among low-income Medicare beneficiaries.

@pennldi.bsky.social @harvardhpm.bsky.social

Link to study: www.nejm.org/doi/full/10....
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJM
A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. U...
www.nejm.org
7 21

by José F. Figueroa — Reposted by: Rachel C. Nethery

joefigs.bsky.social
Last week was hard for us @hsph.harvard.edu after losing all NIH grants.

This week, we are forced to reckon with what’s next, including shutting down research portfolios, considering staffing cuts, and scrambling to cover salaries.

HSPH: “ground zero” of NIH cuts

www.nytimes.com/2025/05/21/u...
Federal Cuts Become ‘All Consuming’ at Harvard’s Public Health School
www.nytimes.com
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by José F. Figueroa

joefigs.bsky.social
Link to study 1: www.nber.org/papers/w33719

Link to study 2, which is our @nejm.org study led by Eric Roberts: www.nejm.org/doi/full/10....
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJM
A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. U...
www.nejm.org

by José F. Figueroa

joefigs.bsky.social
Great summary of 2 recent studies in @npr.org by @lesliemwalker.bsky.social that show:

1) Value of having Medicaid (Wyse & Meyer, NBER)

2) Human costs of losing Medicaid & linked subsidized drug coverage in @nejm.org

Lives saved in study 1 and lives lost in study 2

www.npr.org/sections/sho...
New studies show what's at stake if Medicaid is scaled back
Researchers studied the health care program's effect on the health of millions of Americans and found tens of thousands of lives were saved.
www.npr.org
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by José F. Figueroa

joefigs.bsky.social
Taken together, the comprehensive CMS payments MA plans get to care for vets (especially those who get little to no medical care paid by MA) are simply not justified by the “extra” MA supplemental benefits.

Urgent need for VA and CMS to fix this inefficiency to tune of $BILLIONS per year.
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by José F. Figueroa

joefigs.bsky.social
Using national survey data, we find:

1. No significant differences in total utilization or spending of dental & vision services between vets in MA vs TM.

2. MA plans only spend ~$82 per veteran enrollee on dental care and ~$6 more on vision aids than what TM vets get.
1 1 1

by José F. Figueroa

joefigs.bsky.social
Many veterans enrolling in Medicare Advantage get zero care paid by plans.

MA insurers argue that vets get extra benefits (vision + dental).

But in new @jama.com study, we find that this claim is NOT actually the truth.

@adambeckman.bsky.social @hsph.harvard.edu

jamanetwork.com/journals/jam...
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Reposted by: José F. Figueroa, Michael Barnett, Ellen Meara

jama.com
Veterans in Medicare Advantage and Traditional Medicare used dental and vision services at similar rates, with no significant difference in total spending. #SGIM25

https://ja.ma/3ZficKj
Table 1. Characteristics of Veterans With Medicare Advantage vs Traditional Medicare, 2018-2021
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by Ellen Meara — Reposted by: José F. Figueroa

ermeara.bsky.social
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | New England Journal of Medicine www.nejm.org/doi/full/10....
How important is help with drug costs? For dual Medicare-Medicaid beneficiaries, it saves lives.
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJM
A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. U...
www.nejm.org
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Reposted by: José F. Figueroa, Michael Barnett, Ellen Meara , and 1 more

aschwartz.bsky.social
Eric Roberts and @joefigs.bsky.social led a groundbreaking new study on Medicaid and Medicare, out today in NEJM. I’m lucky to have been a part of it.

Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJM
A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. U...
www.nejm.org
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Reposted by: José F. Figueroa

adrianna.bsky.social
As @lesliemwalker.bsky.social writes for Tradeoffs today, discussing the paper’s findings, that regulation “was poised to help nearly 1 million more duals gain this extra medication assistance, but the latest Republican proposal delays that rule until 2035.”
Tradeoffs: How Cutting Medicaid Could be Deadly
Two new research papers add important data to the fierce political debate over Medicaid in Washington, D.C. Both offer strong evidence that Medicaid, the public insurance program that covers more than...
mailchi.mp
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Reposted by: José F. Figueroa, Michael Barnett

adrianna.bsky.social
Talk about some timely research.

Here's the punchline: "Loss of drug subsidies after Medicaid disenrollment was associated with higher mortality among low-income Medicare beneficiaries."

www.nejm.org/doi/full/10....
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Reposted by: José F. Figueroa

adrianna.bsky.social
The White House's "skinny budget" clarifies that they are, indeed, proposing to end all new extramural AHRQ funding while folding it into ASPE. www.whitehouse.gov/wp-content/u...

(Standard disclaimer that AHRQ is an agency created and funded by Congress, not at the whims of the executive branch)
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by José F. Figueroa

joefigs.bsky.social
This progress, however, is currently at threat with recent cuts to HIV programs.

hsph.harvard.edu/news/hiv-car...
HIV care quality has been improving for older adults | Harvard T.H. Chan School of Public Health
More people living with HIV and enrolled in Medicare are taking modern, less toxic antiretroviral drugs than ever before, according to a new study led by Harvard Chan School. This progress may be upen...
hsph.harvard.edu

by José F. Figueroa

joefigs.bsky.social
Quality of care has been improving for older people with HIV (PWH)

In new @JAMANetwOpen study, we show rates of filling older, toxic ART among PWH has substantially declined to near zero in favor of newer/preferred ART regimens.

jamanetwork.com/journals/jam...
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by José F. Figueroa

joefigs.bsky.social
And congrats to Meredith Rosenthal who will serve as interim chair!

@harvardhpm.bsky.social @hsph.harvard.edu
2

by José F. Figueroa

joefigs.bsky.social
After 28 years, the legendary Arnie Epstein is stepping down as chair of HPM at HSPH @hsph.harvard.edu

He’s been an incredible chair that has guided & grown the department for nearly 3 decades, and we will all miss him as our chair…

@harvardhpm.bsky.social
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by José F. Figueroa

joefigs.bsky.social
New study on Y1 of ACO REACH finds that it did not achieve its goal of enrolling organizations that serve beneficiaries with high levels of social risk.

“Without broader participation, ACO REACH is unlikely to achieve its goal of reducing health inequities.”

jamanetwork.com/journals/jam...
Year 1 of Medicare’s Accountable Care Organization Realizing Equity, Access, and Community Health Model
This cross-sectional study compares characteristics between participants in Accountable Care Organization Realizing Equity, Access, and Community Health with Medicare Shared Savings Program and the br...
jamanetwork.com

by José F. Figueroa

joefigs.bsky.social
As Harvard prepares for its defense against the federal govt and the looming NIH freeze, Mass General Brigham (MGB) leadership begins to distance itself from the Harvard name…
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References

Fields & subjects

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