The research team, led by emergency physician Hazar Khidir of Henry Ford Hospital and including investigators at Stanford University, the University of Washington, and Yale University, assembled one of the largest cohorts ever used to study this question. Drawing on 100 percent Medicaid claims files from 2016 through 2019, they identified 234,944 acute opioid-related events among 169,721 beneficiaries aged 18 to 64. To qualify, an encounter had to involve a nonfatal emergency department visit, an acute inpatient admission, or an inpatient rehabilitation or detoxification stay tied to opioid overdose, opioid withdrawal, or an infection caused by injection drug use. These are precisely the clinical junctures that addiction medicine specialists call teachable moments, when a patient has survived an overdose or been hospitalized for a serious infection and may be uniquely receptive to starting treatment.

The technical design of the study matters for interpreting its results. The researchers tracked three primary outcomes: whether patients filled a buprenorphine prescription within 30 days of discharge, whether they filled a naloxone prescription, the nasal spray that reverses opioid overdoses, within the same window, and whether they achieved what the field calls buprenorphine retention, defined as at least 150 days of the medication on hand within 180 days of the encounter. They also examined early engagement, measured as fills within just three days. To isolate the effect of race and ethnicity from other factors, the team used hierarchical logistic regression, a statistical approach well suited to claims data because it accounts for patients being clustered within states and years. The models adjusted for age, sex, comorbid medical conditions, prior treatment history, the specific diagnosis that brought the patient in, the state of residence, and the calendar year.

The baseline numbers alone are sobering. Across all 234,944 events, only 14.08 percent of patients filled a buprenorphine prescription within 30 days, and just 3.78 percent filled naloxone. Only 4.62 percent were retained on buprenorphine at 180 days. In other words, after surviving an overdose or being hospitalized for a life-threatening infection from injection drug use, fewer than one in seven Medicaid beneficiaries started the medication most strongly associated with keeping them alive, and fewer than one in twenty stayed on it long enough to derive its full protective effect. The cohort was 68.1 percent White, 11.5 percent Black, and 11.1 percent Hispanic, with a mean age of 37.48 years and 43.36 percent female.

When the researchers compared racial and ethnic groups after statistical adjustment, the disparities emerged clearly and consistently. Compared with non-Hispanic White patients, Black patients had significantly lower adjusted odds of filling buprenorphine within 30 days across every setting studied: the odds were 21 percent lower after emergency department visits (adjusted odds ratio 0.79, 95 percent confidence interval 0.71 to 0.88), 28 percent lower after inpatient admissions (0.72, 0.63 to 0.83), and 17 percent lower after rehab or detox stays (0.83, 0.71 to 0.97). Hispanic patients fared similarly, with 20 percent lower odds after emergency visits (0.80, 0.73 to 0.88) and 17 percent lower odds after inpatient admissions (0.83, 0.75 to 0.93). These are not marginal differences confined to one corner of the health system; they span the entire acute care continuum.

The retention findings were even more alarming. Among patients who did manage to start buprenorphine, Black patients had 36 percent lower adjusted odds of being retained at 180 days after an emergency department encounter (0.64, 0.55 to 0.74), 49 percent lower odds after an inpatient stay (0.51, 0.43 to 0.60), and 37 percent lower odds after rehab or detox (0.63, 0.48 to 0.82). Hispanic patients showed 30 percent lower odds after emergency visits (0.70, 0.62 to 0.79) and 34 percent lower odds after inpatient admissions (0.66, 0.56 to 0.78). An odds ratio of 0.51 means that, after accounting for every measured confounder, a Black patient hospitalized for an opioid-related crisis had roughly half the chance of a comparable White patient of still being on medication six months later. Retention is the single most important predictor of buprenorphine’s mortality benefit; studies have shown that interruptions in medication dramatically raise overdose risk.

The study’s focus on Medicaid is deliberate and consequential. Medicaid is the dominant payer for people with opioid use disorder in the United States, covering a population that bears a disproportionate share of the overdose burden. Because the program insures patients across state lines and across every type of acute care setting, it offers a rare, near-complete window into how the treatment system actually performs. Prior work had already documented a racial divide in buprenorphine access: a 2023 analysis in the New England Journal of Medicine found racial inequality in the receipt of medications for opioid use disorder, and studies of emergency departments across five health systems showed that Black patients were less likely to be started on buprenorphine during their visits. The new study extends that evidence to the post-discharge period and to inpatient and detoxification settings, using a multi-state design that rules out the possibility that the gaps are an artifact of any single state’s policy or any single hospital’s practice.

Why do these disparities persist even after adjusting for diagnosis, comorbidity, and prior treatment? The authors and the broader literature point to a layered set of mechanisms. On the provider side, clinicians may offer buprenorphine less often to patients of color, a pattern documented in emergency department studies and consistent with a bifurcated treatment system in which White patients are more often steered toward office-based medication while Black and Hispanic patients are channeled toward abstinence-oriented or criminal-legal pathways. On the structural side, counties with high levels of racial and ethnic segregation have less treatment capacity for opioid use disorder, meaning that even a motivated patient may leave a hospital without a nearby prescriber. Medicaid itself adds friction: prior authorization requirements and managed care formulary restrictions vary by state and can delay or block fills, and pharmacy deserts are more common in predominantly Black and Latino neighborhoods. Naloxone distribution, meanwhile, has historically under-reached communities of color even as fentanyl has made overdose risk universal.

The consequences of these gaps are measured in lives. Buprenorphine reduces mortality during treatment, and the period immediately after an overdose or hospital discharge is one of extreme vulnerability, with overdose risk elevated for weeks. Every failure to initiate or sustain medication during a transitional window compounds that risk. The study’s authors argue that improved transitional care, warm handoffs from emergency departments and hospitals to community-based treatment, overdose education, take-home naloxone, and follow-up appointments, combined with targeted Medicaid reforms such as streamlined coverage of medications and enhanced payment for transitional care management, could close the gap. The elimination of the federal buprenorphine waiver requirement, often called the MAT Act, has removed one prescriber-level barrier, but the new findings suggest that prescriber-level change alone will not be sufficient.

What makes this study resonate beyond the specialty literature is its scale and its consistency. Nearly a quarter of a million acute opioid-related events, spanning 19 states and four years, all point in the same direction: at the moments when the health system has the greatest leverage over the trajectory of opioid use disorder, Black and Hispanic patients are systematically less likely to receive and keep the treatment that best prevents death. The opioid crisis has often been described as having shifted demographically, with rising overdose rates among Black Americans in recent years, yet the treatment infrastructure has not kept pace with that shift. As policymakers weigh Medicaid reforms and health systems build out addiction consult services and emergency department buprenorphine programs, the study offers a clear benchmark: equitable access must be measured not just in who walks through the door, but in who leaves with a prescription filled, and who is still taking their medication six months later.

Subject of Research: Racial and ethnic disparities in buprenorphine and naloxone receipt and retention among Medicaid beneficiaries after acute opioid-related care

Article Title: Racial and Ethnic Disparities in Buprenorphine and Naloxone among Medicaid Beneficiaries after Emergency Department Visits and Hospitalizations

Article References: Khidir, H., Nedelec, L., Sebok-Syer, S. S., Sabbatini, A. K., Shin, I., Melnick, E. R., & Lin, M. P. (2026). Racial and Ethnic Disparities in Buprenorphine and Naloxone among Medicaid Beneficiaries after Emergency Department Visits and Hospitalizations. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10838-0

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10838-0

Keywords: opioid use disorder, buprenorphine, naloxone, Medicaid, health disparities, emergency department, hospitalization, treatment retention, overdose, addiction medicine, health equity, transitional care

Chest masculinization surgery, often called gender-affirming top surgery, is considered medically necessary for many transgender and nonbinary people experiencing chest dysphoria, the distress arising from a mismatch between chest anatomy and gender identity. The operation encompasses a range of techniques tailored to individual anatomy and goals, with double-incision mastectomy with free nipple grafting the most common approach. The evidence base supporting the procedure has grown considerably. Prospective studies using validated instruments have documented significant reductions in depression and anxiety alongside improvements in body image and psychosocial functioning six months after surgery. Long-term follow-up of 139 patients two or more years postoperative reported median satisfaction scores of 5 out of 5 and decisional regret scores of 0 out of 100, with no participants seeking reversal.

Population-level data reinforce these individual outcomes. An analysis of national insurance claims found significantly lower rates of antidepressant use, suicidal ideation and attempts, and substance misuse among people with gender incongruence who had undergone gender-affirming surgery. A secondary analysis of the 2015 U.S. Transgender Survey, which included 27,715 respondents, found that those who had surgery at least two years earlier had significantly lower odds of past-month psychological distress, past-year suicidal ideation, and past-year tobacco use compared with those who desired but had not yet received surgery. Critically, the analysis controlled for prior transition-related care such as counseling and hormone therapy, isolating the surgical contribution. In the 2022 U.S. Transgender Survey of 22,285 respondents, 97 percent of those who had received surgery reported greater life satisfaction afterward.

The policy backdrop to the Cincinnati study is essential to interpreting its results. Medicare reversed its exclusion of gender-affirming surgery in 2014, and in 2016 the U.S. Department of Health and Human Services implemented Section 1557 of the Affordable Care Act, expanding the definition of sex discrimination to include gender identity and thereby prohibiting insurance discrimination against gender-affirming care. Federal regulations now prohibit categorical exclusions of such care in health plans receiving federal funding, and as of 2024, twenty-four states and the District of Columbia have enacted laws or regulations barring blanket exclusions in private insurance. The volume of surgery reflects this shift: one analysis documented a 152-fold increase in gender-affirming surgeries between 2010 and 2018, with the steepest growth, 257 percent, occurring in the Midwest during the implementation period of Section 1557.

Against that backdrop, the Cincinnati team assembled its cohort using the ICD-10 diagnosis code for gender incongruence and extracted demographic, clinical, and insurance data from the electronic medical record. The 128 patients had a mean age of 26.9 years, and 79 percent identified as transgender men while 21 percent identified as nonbinary. Public insurance was the norm, covering 64 percent of patients, including 57 percent on Medicaid. The vast majority of consultations, 90 percent, occurred in 2019 or later, underscoring how rapidly demand grew in the second half of the study window. All procedures were performed by the same group of surgeons throughout, which the authors note strengthens the internal consistency of the wait-time analysis.

The insurance findings are nuanced. Overall, 27 patients, or 21 percent, received at least one denial of prior authorization, and two-thirds of those denials came from public insurers. Yet the likelihood of denial did not differ significantly between public and private coverage, at 21 percent versus 20 percent. Seventeen of the 27 denied patients were ultimately approved after resubmission, while eight did not proceed and were lost to follow-up. Nonbinary patients were significantly less likely than transgender men to experience a denial, 7 percent versus 24 percent, a difference the authors attribute in part to the fact that all nonbinary patients were engaged in psychiatric care, which may have strengthened the medical necessity documentation supporting their authorization requests.

Wait times emerged as the study’s most policy-sensitive metric. The mean interval from initial consultation to surgery was 249 days, or roughly 8.2 months, with a median of 208 days. Publicly insured patients waited an average of 259 days compared with 218 days for the privately insured, a 41-day difference that was not statistically significant. Consultation year, by contrast, was strongly associated with wait time, with the shortest waits, 186 days, recorded in 2022. Neither insurance type assessed year by year nor the duration of gender-affirming hormone therapy independently predicted how long patients waited. That last result carries practical weight: hormone therapy duration requirements embedded in insurer policies appear to do little to expedite care, suggesting that timely progression depends more on coordinated documentation from primary care and mental health clinicians and on surgeons willing to engage in the appeals process.

Surgical outcomes added a further layer of complexity. Among the 89 patients, or 70 percent of the cohort, who underwent surgery, mean tissue resected was 875.2 grams and postoperative complications occurred in 11 percent, including infections requiring antibiotics, hematomas or seromas requiring drainage, delayed wound healing, and nipple necrosis. No patient required a return to the operating room. Nonbinary patients had significantly greater mean tissue resected than transgender men, 1410.6 grams versus 742.9 grams, and more frequently opted for a no-nipple result. They also experienced a significantly higher rate of postoperative infection, 16 percent versus 1 percent, though rates of seroma, delayed healing, and revision surgery did not differ by gender identity. The authors suggest the larger resection volumes may have contributed to the infection difference and note that similar revision rates between groups imply comparable achievement of desired aesthetic outcomes.

The study’s limitations are acknowledged candidly. Spanning nearly a decade of overlapping legal and policy changes, the retrospective design cannot isolate the effect of any single reform, and the analysis was not powered for granular year-by-year comparisons. Records may have omitted contextual details, and institutional factors are difficult to disentangle from broader trends. The single-center setting in a region without state-level nondiscrimination protections limits generalizability, particularly given that an estimated 44 percent of the LGBTQ population lives in states lacking such safeguards. Nationally, disparities persist: 28 percent of 2022 U.S. Transgender Survey respondents reported avoiding medical care due to cost, and 35 percent of those assigned female at birth who sought chest surgery reported a denial in the past year, with Medicaid recipients disproportionately affected.

Even so, the core message stands out with unusual clarity for health services research. Access to chest masculinization surgery at this Midwestern center improved primarily along a temporal gradient that tracks federal policy change, not along the insurance fault line that so often divides American health care. The authors conclude that federal policy shifts were associated with meaningful improvements in access across insurance types, even in a region lacking state-level protections, while cautioning that access remains tightly linked to policy and increasingly vulnerable to reversal amid ongoing federal reconsideration of gender identity protections under Section 1557. As the legal landscape evolves, they argue, research in the regions most exposed to policy change will be critical to understanding how these dynamics shape access to medically necessary care for transgender and nonbinary adults.

Subject of Research: Trends in insurance coverage and surgical wait times for gender-affirming chest masculinization surgery among transgender and nonbinary adults in the United States

Article Title: A decade under review—trends in insurance coverage and wait times for chest masculinization surgery in the United States

Article References: A decade under review—trends in insurance coverage and wait times for chest masculinization surgery in the United States. (n.d.). https://doi.org/10.1186/s44452-026-00020-0

Image Credits: AI Generated

DOI: 10.1186/s44452-026-00020-0

Keywords: chest masculinization surgery, gender-affirming care, insurance denials, prior authorization, Affordable Care Act, Section 1557, transgender health, nonbinary patients, wait times, health policy, Medicaid, plastic surgery

The stakes of this gap are considerable. Serious emotional disturbance, defined as a mental, behavioral, or emotional disorder diagnosed before age 18 that causes significant functional impairment in family, school, and community life, affects an estimated 7 to 12 percent of the total U.S. youth population. Left untreated, these conditions carry a cascade of risks: school dropout, involvement with the juvenile justice system, repeated hospitalizations, and long-term residential placement. Roughly one-third of children with serious emotional disturbance also live with a chronic physical illness, with asthma the most common comorbidity. For families, the toll extends to relationships, employment, income, and physical health, and children with mental health disorders account for a remarkable 55 percent of Medicaid spending among 3-to-17-year-olds.

The Behavioral Health Home model was created under Section 2703 of the Affordable Care Act in 2010 as a way to knit together fragmented care. Its intellectual roots reach back to the Patient Centered Medical Home, a concept the American Academy of Pediatrics developed in the 1960s, but the Medicaid version targets high-need, high-cost populations and focuses on integrating mental, physical, and social care. The model pursues the so-called triple aim—better population health, better care quality, and lower costs—by embedding primary care services into community behavioral health settings, where many people with mental illness receive most of their care. Core components include preventive services, care coordination, population health management, transitional care, patient and family support, and referrals to community and social supports.

Typically nurse-led and team-based, though not standardized, the model gives states wide flexibility in design. Caseworkers, mental health counselors, psychiatrists, and peer support providers often play central roles, physician consultation is required, and expanded hours and service locations aim to improve access. Because federal rules require states offering health homes for serious mental health conditions to serve both adults and children, youth are enrolled in substantial numbers: roughly 20 percent of enrollment in Missouri, 13 percent in Maryland, and, under a dedicated State Plan Amendment, 100 percent of a Rhode Island program for children and youth with special healthcare needs.

Yet the evidence base underpinning the model was built almost entirely on adults with serious mental illness. Randomized trials and evaluations in adult populations have linked behavioral health home participation to improved primary care access, better screening and monitoring of cardiometabolic conditions, healthcare savings, reduced inpatient utilization, and higher patient satisfaction. But other comprehensive reviews found no significant effects on diabetes control, weight management, or smoking cessation, and only modest reductions in cardiometabolic risk with wide variability across studies. Researchers attribute these mixed real-world results to variations in implementation and the highly context-specific nature of a multilevel, multisystem intervention. Documented barriers in adult implementations include increased administrative load, financial constraints, difficulties with patient recruitment and retention, staffing problems, health information technology challenges, and misalignment between the model’s values and those of the host community mental health center.

Crucially, the review’s authors argue that children are not simply small adults in this context. Children with serious emotional disturbance typically have shorter enrollment periods, since their conditions often resolve with proper care, whereas adult behavioral health homes are designed as lifetime homes. Prevention carries greater weight in pediatric care, and children generally have fewer comorbid conditions. Most importantly, care coordination differs fundamentally: adult coordinators work mainly with primary and specialty medical providers, while children require coordination across child welfare, juvenile justice, and special education systems, each governed by legal mandates such as expedited health evaluations for children entering foster care. And where adult care is person-centered, pediatric care must be patient and family centered, incorporating the social and economic needs of the whole household.

The review itself followed rigorous PRISMA guidelines, with a protocol registered in PROSPERO. The team searched PubMed, CINAHL, and PsycINFO for studies published from 2010 through mid-2026, supplemented by a targeted gray literature search of state Medicaid agency websites and reports from policy research organizations. After removing 1,529 duplicates, reviewers screened 3,171 titles and abstracts, excluding 3,144 as unrelated to the intervention, focused on adults, or non-empirical. Twenty-seven full-text articles underwent independent dual review, and all 27 were excluded—most because they studied related integrated care models rather than the Medicaid Behavioral Health Home itself. Fifteen gray literature documents, including state program reports and evaluations from organizations such as the Urban Institute, were also assessed and all excluded for reasons ranging from unrelated outcomes to insufficient methodological rigor. Data extraction and coding using the Consolidated Framework for Implementation Research, the planned analytical lens, proved impossible because there was nothing to extract.

A null result of this kind is not a dead end but a redirection. Drawing on adjacent literatures—adult behavioral health homes, pediatric integrated care, and evidence-based parenting programs—the authors identify three likely battlegrounds for youth implementation. The first is family engagement. Unlike adult models, pediatric care depends on caregivers as the prime movers of treatment: they set routines around diet, sleep, and activity, model healthy behavior, and maintain continuity of care. Unmet caregiver psychosocial needs, stigma, distrust of health systems, fear of child welfare involvement, chaotic routines, and frequent residential moves all demonstrably reduce engagement in related programs. The authors suggest embedding family support providers with lived experience into care teams, giving program managers flexible assistance funds for urgent needs like transportation or utility bills, and pursuing broader policies on caregiver Medicaid coverage, housing, and childcare.

The second battleground is cross-system coordination. Adult implementation studies document fragmented organizational relationships, difficulty engaging primary care providers, inconsistent communication, and weak external partnerships—and colocation of services or data exchange alone proved insufficient to ensure coordination. For children, where coordination must extend into schools and courts, these challenges are likely amplified. Emerging evidence points to facilitators such as alternative payment models like Vermont’s hub-and-spoke structure and collaborative agreements emphasizing shared purpose, as seen in Ohio. The third battleground is measurement. The mandatory Health Home Core Set of quality measures skews toward adult-relevant indicators: Missouri’s 2024 pediatric measures included asthma medication adherence, diabetes control, and tobacco use, which capture only a sliver of enrolled youth. The authors point to promising alternatives, including North Carolina’s Integrated Care for Kids program, school attendance data sharing led by Children’s National Hospital, and cross-sector outcomes such as recidivism used by Multisystemic Therapy. Looking forward, they call for research grounded in implementation frameworks like the CFIR, hybrid effectiveness-implementation designs, and multi-axis conceptions of integration spanning vertical, horizontal, and longitudinal dimensions. Until such studies exist, the fate of a model serving some of the nation’s most vulnerable children rests on evidence borrowed from adults.

Subject of Research: Implementation barriers and facilitators of the Medicaid Behavioral Health Home model for children with serious emotional disturbance

Article Title: Opportunities to Strengthen Implementation of the Medicaid Behavioral Health Home Model for Children with Serious Emotional Disturbance: A Systematic Review

Article References: Winning Verry, T., Eisen, S., Farabi, S., Lengnick-Hall, R., & Dell, N. A. (2026). Opportunities to Strengthen Implementation of the Medicaid Behavioral Health Home Model for Children with Serious Emotional Disturbance: A Systematic Review. Community Mental Health Journal. https://doi.org/10.1007/s10597-026-01709-3

Image Credits: AI Generated

DOI: 10.1007/s10597-026-01709-3

Keywords: Medicaid, Behavioral Health Home, serious emotional disturbance, children's mental health, integrated care, care coordination, implementation science, Affordable Care Act, family engagement, health services research, systematic review, population health

Volara is a respiratory therapy device designed for secretion mobilization and lung expansion, delivering what clinicians call oscillation and lung expansion therapy, or OLE. The device works through two complementary mechanisms: continuous high-frequency oscillation, which loosens and mobilizes mucus from the airways, and continuous positive expiratory pressure, which helps keep airways open and supports lung expansion. Uniquely, the system can simultaneously administer aerosolized medication through an integrated nebulizer, combining three respiratory therapies into a single unit. It is prescribed for patients with chronic respiratory conditions that impair airway clearance, including bronchiectasis, chronic obstructive pulmonary disease, cystic fibrosis, cerebral palsy, amyotrophic lateral sclerosis, muscular dystrophy, and other neuromuscular disorders. Its portability and ease of use make it suitable for home settings, allowing patients who require long-term airway clearance to receive therapy outside the hospital.

The research team, led by investigators at Mathematica with collaborators at Baxter International and Johns Hopkins School of Medicine, conducted a retrospective descriptive analysis using complete administrative claims and encounter data from the Centers for Medicare and Medicare Services Virtual Research Data Center. They identified Medicare fee-for-service and Medicare Advantage beneficiaries who initiated Volara between January 2023 and June 2025, along with Medicaid fee-for-service and managed care enrollees who started the device during calendar year 2023. Initiation was defined by the earliest claim containing the relevant healthcare procedure codes paired with a supplier identifier specific to the device. Patients needed to be at least five years old and continuously enrolled for twelve months before initiation, and Medicaid enrollees dually eligible for Medicare were excluded to avoid incomplete capture of their utilization.

The two cohorts differed dramatically in their demographic and clinical composition. The Medicare cohort comprised 391 enrollees with a mean age of approximately 68 years, of whom 63 percent were female and 78 percent were non-Hispanic White. The overwhelming majority, 93 percent, had pre-existing bronchiectasis, COPD, or neuromuscular disease, with bronchiectasis alone accounting for 36 percent and bronchiectasis combined with COPD for another 33 percent. The Medicaid cohort of 220 enrollees was strikingly younger, with a mean age of just 21 years and 72 percent under age 21. Its disease distribution was broader and different: 37 percent had bronchiectasis or COPD, but substantial proportions had cerebral palsy at 22 percent, neuromuscular disease at 18 percent, prior COVID-19 at 22 percent, and cystic fibrosis at 7 percent. The Medicaid cohort was also more racially and ethnically diverse and lived in neighborhoods with considerably higher social vulnerability, as measured by the CDC Social Vulnerability Index, with 70 percent classified as high vulnerability compared with 43 percent of Medicare patients.

To assess outcomes, the researchers classified patients into mutually exclusive disease segments and measured emergency department visits and inpatient hospitalizations for respiratory exacerbations, along with associated costs, standardized as annualized rates and per-member-per-month costs to account for varying follow-up times. Respiratory events were captured under a broad tier that included COPD, bronchiectasis, COVID-19, asthma, pneumonia, bronchitis, acute respiratory failure, and unspecified respiratory disorders. Clinical risk was assessed using the Elixhauser Comorbidity Index, while social risk was assigned at the ZIP code level. Because payment information is not reported for most Medicaid managed care encounters, the team imputed costs using fee-for-service claims, deriving average shadow prices stratified by year, state, disease segment, event type, demographics, and proxies for severity such as length of stay.

Among Medicare enrollees, the post-initiation period showed consistently lower respiratory-related emergency department use. Annual emergency visit rates fell from 26.3 to 11.0 per 100 patients, a 58 percent reduction, while associated per-member-per-month costs dropped from 21 dollars to 12 dollars, a 39 percent decline. These differences held across all disease segments, ranging from 44 percent lower among patients with both bronchiectasis and COPD to 70 to 81 percent lower in other segments. Hospitalizations also declined, though more modestly: rates fell from 41.2 to 30.4 per 100 patients, a 26 percent reduction, and hospitalization costs fell 11 percent, from 512 dollars to 456 dollars per member per month. The hospitalization improvements were not uniform, however. Patients with COPD saw rates and costs fall by 38 and 36 percent respectively, while neuromuscular disease patients showed similar rates between periods with slightly higher costs afterward.

Subgroup analyses added further nuance. Emergency department reductions appeared across both clinical risk groups and both age groups, but hospitalization patterns diverged sharply. Among Medicare patients with higher clinical risk, hospitalization rates were 33 percent lower after Volara initiation, whereas lower-risk patients actually saw rates rise 8 percent. Social vulnerability produced a similar split: patients in higher-vulnerability neighborhoods experienced 41 percent lower hospitalization rates and 49 percent lower costs post-initiation, while those in lower-vulnerability areas saw costs rise 30 percent despite modestly lower rates. By age, hospitalization rates fell 25 percent among patients 65 and older but rose 6 percent among younger Medicare beneficiaries. Because the pre-initiation period overlapped the COVID-19 pandemic for many patients, the team ran sensitivity analyses excluding COVID-19-related events, and the overall pattern of lower post-initiation utilization and costs remained qualitatively unchanged. Excluding patients with ALS from the neuromuscular segment also did not meaningfully alter the findings.

The Medicaid picture was considerably messier. Emergency department visit rates were nearly flat, at 31.4 per 100 patients before initiation versus 29.6 after, a 5 percent decline, but associated costs rose 24 percent, from 135 dollars to 168 dollars per member per month. Segment-level patterns conflicted: patients with bronchiectasis or COPD had higher emergency visit rates and dramatically higher costs afterward, neuromuscular disease patients had higher rates but lower costs, and cerebral palsy patients showed lower utilization and costs. Hospitalizations told a more favorable story, with rates 24 percent lower and costs 6 percent lower post-initiation overall, though neuromuscular disease patients again moved against the trend. The authors caution that the smaller Medicaid sample makes these exploratory results especially sensitive to noise.

The study’s limitations are substantial and the researchers are explicit about them. As a purely descriptive one-group pre/post design without a comparison group, the analysis cannot establish causation, and regression to the mean may partly explain the lower post-initiation utilization, since some patients likely began Volara after a period of heightened respiratory morbidity such as a hospitalization. Secular changes in healthcare behavior during and after the pandemic cannot be excluded, claims data contain no information on how often or how long patients actually used the device, and concomitant treatments were not examined. Roughly 80 percent of Medicaid costs were imputed, introducing additional uncertainty, and small sample sizes limit generalizability. The study was funded by Baxter, which manufactures the Volara system, though the analysis was conducted by Mathematica under a data use agreement with CMS.

Despite these caveats, the study fills a genuine gap. Prior literature on related airway clearance therapies, including high-frequency chest wall oscillation and oscillating positive expiratory pressure devices, has reported reductions in hospitalizations and costs, but economic evidence specifically for oscillation and lung expansion therapy has been sparse. By documenting who initiates Volara under public insurance and how their utilization patterns shift, the analysis provides hypothesis-generating context for clinicians and payers alike. The pronounced heterogeneity across disease segments, risk strata, and age groups suggests that any future evaluation of the device’s effectiveness will need to account for the fundamentally different populations served by Medicare and Medicaid, from older adults with smoking-related lung disease to children with genetic and neurologic conditions that impair airway clearance. The authors call for comparative study designs with appropriate confounding adjustment to determine whether the observed favorable trends among Medicare beneficiaries reflect a true treatment effect or the interplay of disease course, patient selection, and broader healthcare dynamics.

Subject of Research: Real-world healthcare utilization and costs among Medicare and Medicaid patients initiating Volara oscillation and lung expansion respiratory therapy

Article Title: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study

Article References: Characteristics of Medicare and Medicaid Patients Initiating Volara Respiratory Therapy: A Medical Claims Study. (n.d.). https://doi.org/10.1007/s12325-026-03762-6

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03762-6

Keywords: Volara, oscillation and lung expansion therapy, Medicare, Medicaid, bronchiectasis, COPD, healthcare resource utilization, emergency department visits, hospitalizations, medical claims, real-world evidence, respiratory therapy