Publications

2022
Michael Anne Kyle, Stacie B. Dusetzina, and Nancy L. Keating. 7/13/2022. “Evaluation of Trends in Oncology Drug Spending, 2016 to 2020.” JAMA Network Open, 5, 7. Publisher's Version
Rachel E Sachs and Michael Anne Kyle. 3/10/2022. “Step Therapy's Balancing Act - Protecting Patients while Addressing High Drug Prices.” New England Journal of Medicine, 386, 10, Pp. 901-904. Publisher's Version
2021
Michael Anne Kyle, Robert J. Blendon, Mary G. Findling, and John M. Benson. 10/29/2021. “Telehealth use and Satisfaction among U.S. Households: Results of a National Survey.” Journal of Patient Experience, 8. Publisher's VersionAbstract

Telehealth services have expanded dramatically during the coronavirus disease-2019 pandemic; we provide estimates of telehealth use and satisfaction based on a nationally representative, random survey of 3454 U.S. households. Fifty percent of households reported using telehealth because they could not receive medical care in person. Satisfaction was high among telehealth users (86%). However, satisfaction with telehealth was lower (65%) among households who reported experiences of delayed medical care for serious problems. Telehealth use was lower among rural households than urban households (46% vs. 53%) and among <$30,000 annually (47%), $30,000–<$50,000 (39%), and $75,000–<$100,000 (49%) compared with those earning $100,000 + (60%). Telehealth use was lower among households without high-speed internet compared to those with it (36 vs. 53%). Among users, satisfaction did not differ significantly by metro area, income, or internet quality. Telehealth may play a valuable role in access for many patient populations, but may not always be a perfect substitute for in-person care.

Michael Anne Kyle and Austin B. Frakt. 9/8/2021. “Patient administrative burden in the US health care system.” Health Services Research. Publisher's VersionAbstract

Objective

To assess the prevalence of patient administrative tasks and whether they are associated with delayed and/or foregone care.

Data Source

March 2019 Health Reform Monitoring Survey.

Study Design

We assess the prevalence of five common patient administrative tasks—scheduling, obtaining information, prior authorizations, resolving billing issues, and resolving premium problems—and associated administrative burden, defined as delayed and/or foregone care. Using multivariate logistic models, we examined the association of demographic characteristics with odds of doing tasks and experiencing burdens. Our outcome variables were five common types of administrative tasks as well as composite measures of any task, any delayed care, any foregone care, and any burden (combined delayed/foregone), respectively.

Data Collection

We developed and administered survey questions to a nationally representative sample of insured, nonelderly adults (n = 4155).

Principal Findings

The survey completion rate was 62%. Seventy-three percent of respondents reported performing at least one administrative task in the past year. About one in three task-doers, or 24.4% of respondents overall, reported delayed or foregone care due to an administrative task: Adjusted for demographics, disability status had the strongest association with administrative tasks (adjusted odds ratio [OR] 2.91, p < 0.001) and burden (adjusted OR 1.66, p < 0.001). Being a woman was associated with doing administrative tasks (adjusted OR 2.19, p < 0.001). Being a college graduate was associated with performing an administrative task (adjusted OR 2.79, p < 0.001), while higher income was associated with fewer subsequent burdens (adjusted OR 0.55, p < 0.01).

Conclusions

Patients frequently do administrative tasks that can create burdens resulting in delayed/foregone care. The prevalence of delayed/foregone care due to administrative tasks is comparable to similar estimates of cost-related barriers to care. Demographic disparities in burden warrant further attention. Enhancing measurement of patient administrative work and associated burdens may identify opportunities for assessing quality, value, and patient experience.

Michael Anne Kyle, Renuka Tipirneni, Nitya Thakore, Sneha Dave, and Ishani Ganguli. 4/26/2021. “Primary Care Access During the COVID-19 Pandemic: a Simulated Patient Study.” Journal of General Internal Medicine. Publisher's VersionAbstract

Background

Primary care practices have experienced major strains during the COVID-19 pandemic, such that patients newly seeking care may face potential barriers to timely visits.

Objective

To quantify availability and wait times for new patient appointments in primary care and to describe how primary care practices are guiding patients with suspected COVID-19.

Design

Trained callers conducted simulated patient calls to 800 randomly sampled primary care practices between September 14, 2020, and September 28, 2020.

Participants

We extracted complete primary care physician listings from large commercial insurance networks in four geographically dispersed states between September 10 and 14, 2020 (n=11,521). After excluding non-physician providers and removing duplicate phone numbers, we identified 2705 unique primary care physician practices from which we randomly sampled 200 practices in each region.

Main Measures

Primary care appointment availability, median wait time in days, and practice guidance to patients suspecting COVID-19 infection.

Key Results

Among 56% of listed practices that had accurate contact information listed in the directory, 84% offered a new patient in-person or virtual appointment. Median wait time was 10 days (IQR 3–26 days). The most common guidance in case of suspected COVID-19 was clinician consultation, which was offered in 41% of completed calls. Callers were otherwise directed to on-site testing (14%), off-site testing (24%), a COVID-19 hotline (8%), or an urgent care/emergency department (12%), while 2% of practices had no guidance to offer.

Conclusions

Despite resource constraints, most reachable primary care practices offered timely new patient appointments as well as direct COVID-19 care. Pandemic mitigation strategies should account for and support the central role of primary care practices in the community-based pandemic response.

2020
Michael Anne Kyle, J. Michael McWilliams, Mary Beth Landrum, Bruce E. Landon, Paul Trompke, David J. Nyweide, and Michael E. Chernew. 4/2020. “Spending Variation Among ACOs in the Medicare Shared Savings Program.” American Journal of Managed Care, 26, 4, Pp. 170-175. Publisher's VersionAbstract
OBJECTIVES: Understanding variation in spending across organizations, rather than across geographic areas, is important because care is delivered by organizations and interventions increasingly focus on organizations. Accountable care organizations (ACOs) are particularly important to study given their incentives to reduce spending. Analyzing spending differences across ACOs may help identify cost savings opportunities. STUDY DESIGN: Cross-sectional analysis of Medicare claims. METHODS: We stratified ACOs into quartiles based on the deviation between each ACO’s risk-adjusted spending and average risk-adjusted fee-for-service spending in the same market (hospital referral region). We compared spending between top- and bottom-quartile ACOs on each of 7 major service categories and 10 clinical condition groups to identify areas of potential savings. We simulated spending reductions if ACOs with high adjusted spending reduced spending to the levels of lower-spending ACOs. RESULTS: In 2016, geographically adjusted and risk-adjusted total per-beneficiary spending for the highest-spending quartile of ACOs was 14% higher than for ACOs in the lowest quartile. Variation between high- and low-spending ACOs was greatest, at 27%, in the use of skilled nursing facilities—a service category in which ACOs have reduced spending by the greatest percentage. Inpatient care was the largest driver of absolute dollar differences in spending, however, accounting for 37% of the total spread. If spending in ACOs above median adjusted spending were brought down to the median, savings would be 3% to 4%. CONCLUSIONS: By extending the variations literature to focus on ACOs, we illustrated that meaningful further savings opportunities exist both within and across markets.
Michael Anne Kyle, Emma-Louise Aveling, and Sara J. Singer. 2020. “Establishing High-Performing Teams: Lessons from Health Care.” MIT Sloan Management Review, 61, 3, Pp. 14-18. Publisher's VersionAbstract
Effective teams can be significant drivers of innovations that enable broader quality improvements and efficiency gains across organizations. But despite the wealth of research and managerial expertise describing characteristics of effective teams, people and organizations still struggle to deploy teams that achieve their potential, regardless of individual effort and good intentions. More puzzling is that teams following the same template of best practices can achieve different results. We studied new team formation to understand why some teams work and others struggle. Our research suggests that transitioning to effective teams depends on mutually reinforcing functional and cultural change processes. The way in which organizations combine these two key change processes is critical for success.
2019
Michael Anne Kyle, Lumumba Seegars, John M. Benson, Robert J. Blendon, Robert S. Huckman, and Sara J. Singer. 12/2019. “Toward a Corporate Culture of Health: Results of a National Survey.” Milbank Quarterly, 97, 4, Pp. 954-977. Publisher's VersionAbstract
Context: The private sector has a large potential role in advancing health and well-being, but attention to corporate practices around health tends to focus on a narrow range of issues and on large businesses. Systematically describing private sector engagement in health and well-being is a necessary step toward understanding the current state of the field and developing an agenda for businesses going forward.
Methods: We conducted a national survey of 1,017 private sector organizations to assess current levels of engagement in what we term a culture of health (CoH). We measured corporate CoH along four dimensions, which assess the extent to which businesses promote employee, environmental, consumer, and community health and well-being. We also explored potential explanations for the number of health-related actions taken in each dimension.
Findings: On average, businesses took 38% of health-related actions included in our survey. For each dimension, we found variation among businesses in the number of actions taken (on average, there were almost fourfold differences between the bottom and top quartiles of businesses in terms of actions taken). Mentioning health and well-being in the corporate mission, having a strategic plan for CoH, and perceiving a positive return on CoH investments were all associated with businesses’ actions taken. Fewer than half of businesses, however, perceived a positive return on their CoH investments.
Conclusions: Overall, the private sector is taking steps to foster health and well-being. However, there remains substantial variation among businesses and opportunity for growth, even among those currently taking the most action. Strengthening the business case for a corporate CoH may increase private sector investments in health and well-being. Actions taken by individual businesses, business groups, industries, and regulators have the potential to improve corporate engagement and impact.
Michael Anne Kyle, Robert J. Blendon, John M. Benson, Melinda K Abrams, and Eric C. Schneider. 11/2019. “Many Medicare Beneficiaries with Serious Illness Report Financial Hardships Despite Coverage.” Health Affairs, 38, 11, Pp. 1801-1806. Publisher's VersionAbstract
In a national survey, seriously ill Medicare beneficiaries described financial hardships resulting from their illness—despite high beneficiary satisfaction with Medicare overall and the fact that many have supplemental insurance. About half reported a serious problem paying medical bills, with prescription drugs proving most onerous.
Michael Anne Kyle, Emma-Louise Aveling, and Sara J. Singer. 10/2019. “A Mixed Methods Study of Change Processes Enabling Effective Transition to Team-based Care.” Medical Care Research and Review. Publisher's VersionAbstract
Team-based care is considered central to achieving value in primary care, yet results of large-scale primary care transformation initiatives have been mixed. We explore how underlying change processes influence the effectiveness of transition to team-based care. We studied 12 academically affiliated primary care practices participating in a learning collaborative, using longitudinal staff survey data to measure progress toward team-based care and qualitative interviews with practice staff to understand practice transformation. Transformation efforts focused on team formation and capacity building for quality improvement. Using thematic analysis, we explored types of change processes undertaken and the relationship between change processes and effective team-based care. We identified three prototypical approaches to change: pursuing functional and cultural change processes, functional only, and cultural only. Practice sites prioritizing both change processes formed the most effective teams: simultaneous functional and cultural change spurred a mutually reinforcing virtuous cycle. We describe implications for research, practice, and policy.
2018
Alyna Chien, Michael Anne Kyle, Antoinette S. Peters, Shalini Tendulkar, Molly Ryan, Karen Hacker, and Sara J. Singer. 2018. “Establishing Teams: How Does It Change Practice Configuration, Size, and Composition?” Journal of Ambulatory Care Management, 41, 2, Pp. 146-155. Publisher's VersionAbstract
Little is known about how practices reorganize when transitioning from traditional practice organization to team-based care. We compared practice-level (1) configuration as well as practice- and team-level (2) size and (3) composition, before and after establishing teams. We employed a pre-/poststudy using personnel lists of 1571 to 1711 staff (eg, job licenses, titles, and team assignment) and practice manager surveys. All personnel (physician and nonphysician) worked within 18 Massachusetts academic primary care practices participating in a 2-year learning collaborative aimed at establishing team-based care. We found that establishing team-based care can involve changing practice configurations and composition without substantially changing practice size.
2017
Rifat Atun and et al. 8/1/2017. “Diabetes in sub-Saharan Africa: from clinical care to health policy.” Lancet Diabetes and Endocrinology, 5, 8, Pp. 622-667. Publisher's VersionAbstract
Rapid demographic, sociocultural, and economic transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs) in sub-Saharan Africa. The impacts of these transitions and their health and economic consequences are evident. Whereas, in 1990, the leading causes of death in sub-Saharan Africa were HIV/AIDS, lower respiratory infections, diarrhoeal diseases, malaria, and vaccine-preventable diseases in children, in more recent years, cardiovascular diseases and their risk factors are replacing infectious diseases as the leading causes of death in this region, and rates of increase of cardiovascular risk factors are predicted to be greater in sub-Saharan Africa than in other parts of the world. Thus, sub-Saharan Africa—which contains a high proportion of the world's least developed countries—will face the multifaceted challenge of dealing with a high burden of infectious diseases and diseases of poverty, while also addressing the increasing burden of cardiovascular disease and its risk factors. At present, many of the health systems in sub-Saharan Africa struggle to cope with infectious diseases. Meeting the goals of the UN high-level meeting on NCDs (to reduce premature mortality from NCDs by 25% by 2025) and Sustainable Development Goals (SDGs; to reduce premature mortality from NCDs by a third by 2030) requires a coordinated approach within countries, which starts with a firm consideration of disease burden, needs, and priorities.