About

Daniel E. Polsky, Ph.D., is an Adjunct Professor of Medicine in the Department of Medicine (General Internal Medicine) at the University of Pennsylvania's Perelman School of Medicine. He is also affiliated with the Johns Hopkins Bloomberg School of Public Health, specifically in the Department of Health Policy and Management. Dr. Polsky holds a background in economics and public policy, having earned a B.A. in Economics from the University of Michigan in 1988, an M.P.P. in Public Policy from the University of Michigan's Gerald R. Ford School of Public Policy in 1989, and a Ph.D. in Economics from the University of Pennsylvania in 1996. His research focuses on health policy, health economics, and the analysis of healthcare systems, with a particular interest in cost-effectiveness, risk selection, and patient outcomes. Dr. Polsky has contributed to understanding the economic aspects of healthcare delivery and policy, and he maintains active engagement in academic research and public health policy.

Research topics

• Political Science
• Medicine
• Family medicine
• Business
• Economics
• Environmental health
• Finance
• Geography
• Database
• Emergency medicine
• Physics
• Internal medicine
• Public administration
• Demographic economics
• Medical emergency
• Nursing

Selected publications

• Federal housing assistance, cancer care, and overall survival among older adults with prostate cancer

  JNCI Journal of the National Cancer Institute · 2026-04-15

  article

  BACKGROUND: Survival disparities in prostate cancer are driven in part by social and economic factors, including housing insecurity. Rent subsidies in the form of federal housing assistance are a well-established strategy for alleviating housing insecurity, but their association with prostate cancer care and survival is unknown. METHODS: Using linked federal housing assistance data, SEER cancer registry data, and Medicare claims, we assessed workup and treatment receipt and two-year survival among individuals aged 66 to 95 who were diagnosed with prostate cancer in 2007 to 2019. We used logistic and Cox regression models to compare outcomes between individuals receiving housing assistance upon prostate cancer diagnosis and a comparison group without housing assistance, using propensity score matching to balance sociodemographic and clinical characteristics. RESULTS: There were 1,839 individuals with housing assistance (and 5,517 without assistance) included in the workup and treatment analyses and 4,451 individuals with housing assistance (and 13,353 without assistance) in the survival models. Receipt of housing assistance was not associated with guideline-concordant workup (62.7% vs 61.2%, OR 1.02 [95% CI 0.97, 1.07], p = 0.48) or active treatment (63.7% vs 62.2%, OR 1.02 [95% CI: 0.99, 1.06], p = 0.22) but was associated with improved overall survival in the 2 years following diagnosis (hazard ratio for mortality: 0.88 [95% CI: 0.81, 0.96]). CONCLUSIONS: Older adults receiving housing assistance at the time of a prostate cancer diagnosis experienced better overall survival than a matched comparison group without housing assistance. Results suggest that expanding access to housing assistance might support greater and more equitable survival in prostate cancer.

  PublisherDOI

• Efficient Subsidy Targeting in the Health Insurance Marketplaces

  ArXiv.org · 2025-10-15

  preprintOpen accessSenior author

  Enrollment in the Health Insurance Marketplaces created by the Affordable Care Act reached an all-time high of approximately 25 million Americans in 2025, roughly doubling since enhanced premium tax credit subsidies were made available in 2021. The scheduled expiration of enhanced subsidies in 2026 is estimated to leave over seven million Americans without health insurance coverage. Ten states have created supplemental Marketplace subsidies, yet little attention has been paid to how to best structure these subsidies to maximize coverage. Using administrative enrollment data from Maryland's Marketplace, we estimate demand for Marketplace coverage. Then, using estimated parameters and varying budget constraints, we simulate how to optimally allocate supplemental state premium subsidies to mitigate coverage losses from enhanced premium subsidy expiration. We find that premium sensitivity is greatest among enrollees with incomes below 200 percent of the federal poverty level, where the marginal effect of an additional ten dollars in monthly subsidies on the probability of coverage is approximately 6.5 percentage points, and decreases to roughly 2.5 percentage points above 200 percent FPL. Simulation results indicate that each 10 million dollars in annual state subsidies could retain roughly 5,000 enrollees, though the cost-effectiveness of these subsidies falls considerably once all enrollees below 200 percent of the federal poverty level are fully subsidized. We conclude that states are well positioned to mitigate, but not stop, coverage losses from expanded premium tax credit subsidy expiration.

  PublisherOA PDFDOI

• The Role of Medicare Insurance Coverage Type in Annual Wellness Visits: A Comparison Between Traditional Medicare and Medicare Advantage Plan

  Journal of General Internal Medicine · 2025-10-07 · 1 citations

  articleOpen accessSenior author

  BACKGROUND: The Medicare Annual Wellness Visit (AWVs) was introduced in 2011 as a preventive services visit. AWV uptake has been increasing but remains disproportionately low among vulnerable populations in Traditional Medicare (TM). However, less is known about the differential uptake of the AWV by Medicare insurance coverage type-a consequence of the increasing beneficiary enrollment shifts from TM to Medicare Advantage (MA) plans. OBJECTIVE: This study aims to quantify the differential effects of Medicare insurance coverage type (MA versus TM) on AWV uptake for key subpopulations. DESIGN: We used 20% nationally representative Medicare insurance claims data from 2018 to 2019. Probit models assessed the likelihood of AWV uptake, with subgroup analyses by age, race/ethnicity, dual eligibility, chronic conditions, and ADRD status. PARTICIPANTS: We included 8,799,206 Medicare beneficiaries aged 65 and older, among whom 41.2% were enrolled in MA, and 58.8% were enrolled in TM. MAIN MEASURES: The outcome is whether to have an AWV; the independent variable is the Medicare insurance coverage type. KEY RESULTS: Over 1/3 (37.3%) of beneficiaries received an AWV in 2019. MA enrollees were 4.3 percentage points more likely to receive an AWV than TM enrollees (p < 0.001). Subgroup analysis showed higher AWV uptake in MA across all key subgroups of interest (all p < 0.001), with the largest differences among the oldest-old adults aged above 85 + (5.6 percentage points), dual eligibles (11.5 percentage points), Black beneficiaries (8.9 percentage points), and those with ADRD (6.6 percentage points). CONCLUSION: Enrollment in an MA plan is associated with a higher probability of AWV uptake, particularly among vulnerable populations from racial and ethnic minorities, dual eligibility, and those diagnosed with ADRD. These findings highlight MA's potential role in promoting preventive care and health equity. Future studies need to examine whether higher AWV uptake leads to improved patient outcomes in MA plans.

  PublisherDOI

• Growth of the Program of All-Inclusive Care for the Elderly and the role of for-profit programs

  Health Affairs Scholar · 2025-01-01 · 4 citations

  articleOpen accessSenior author

  The Program of All-Inclusive Care for the Elderly (PACE) is a managed care program financed by capitated government payments that primarily serves adults aged 55 or older requiring nursing home level of care who are dual-eligible for Medicare and Medicaid. While PACE programs have historically been nonprofit entities, in 2016, a regulation change allowed for-profit PACE programs to help expand the program. We describe PACE program growth from 2010 to 2022. Both the number of PACE programs and enrollees grew from 2010 to 2022. Yet, after allowing for-profits to enter the market, the enrollment rate of growth slowed overall (13.4% vs 7.0%), though for-profit program enrollment grew more rapidly compared to nonprofit programs (13.2% vs 5.7%). Entry of new programs drove for-profit growth primarily. Despite the growth of for-profit programs, most enrollees continued to receive care from nonprofit programs (78%) by 2022. Allowing for-profit programs did not increase PACE enrollment rates overall. Given emerging evidence that for-profit ownership in other health care sectors may reduce quality compared to nonprofits, policymakers should carefully monitor care quality and patient outcomes in PACE as for-profit entities increase.

  PublisherDOI

• Federal Housing Assistance and Stage at Cancer Diagnosis Among Older Adults in the US

  JAMA Network Open · 2025-10-08 · 1 citations

  articleOpen access

  Importance: A growing number of older adults live in unaffordable and unstable housing; however, whether programs designed to counter housing insecurity contribute to earlier-stage cancer diagnosis remains largely unknown. Objective: To examine the association between the receipt of federal housing assistance, which limits household spending on rent and utilities, and cancer stage at diagnosis among older adults in the US. Design, Setting, and Participants: This comparative cohort study used the Surveillance, Epidemiology, and End Results cancer registry program and Medicare database linked with data from the US Department of Housing and Urban Development (HUD). Participants were individuals aged 66 to 95 years who received new diagnoses of breast cancer, colorectal cancer, non-small cell lung cancer (NSCLC), or prostate cancer between 2007 and 2019. Data were acquired in 2023, and the data analysis was performed from June 2023 through March 2025. Exposure: Receipt of federal housing assistance. Main Outcomes and Measures: The primary outcome was stage at cancer diagnosis, defined as in situ (for breast cancer only), localized, regional, or distant. Odds ratios (ORs) for the association between having HUD assistance at diagnosis and cancer stage at diagnosis were estimated using multinomial (nonproportional odds) regression. Individuals with HUD assistance were propensity score matched to individuals without housing assistance. Results: A total of 52 532 individuals (mean [SD] age at diagnosis, 76.3 [6.8] years; 33 608 women [64.0%]) with housing assistance at diagnosis were included: 16 064 had breast cancer, 10 807 had colorectal cancer, 17 156 had NCSLC, and 8505 had prostate cancer; 38 183 (72.7%) were enrolled in Medicaid, and 38 539 (73.4%) had Part D low-income cost sharing. Compared with matched controls, fewer individuals with housing assistance received a diagnosis of distant breast cancer (1071 patients [6.7%] vs 3485 patients [7.2%]; adjusted OR [aOR], 0.85; 95% CI, 0.82- 0.90), distant colorectal cancer (2398 patients [22.2%] vs 7562 patients [23.3%]; aOR, 0.90; 95% CI, 0.83-0.98), and distant NSCLC (8810 patients [51.4%] vs 27 901 patients [54.2%]; aOR, 0.83; 95% CI, 0.79-0.86) compared with localized cancers. Housing assistance was not significantly associated with stage at diagnosis for individuals with prostate cancer. The association between housing assistance and stage at cancer diagnosis varied across the different types of housing assistance, including the Housing Choice voucher program, multifamily housing, and public housing. Conclusions and Relevance: The findings of this cohort study of older adults with cancer suggest that federal housing assistance was associated with earlier-stage diagnosis of breast cancer, colorectal cancer, and NSCLC, highlighting its potential role in mitigating the adverse associations of housing insecurity with cancer outcomes.

  PublisherDOI

• The Evaluation of Telehealth’s Impact on Medicare Annual Wellness Visits and Dementia Diagnosis

  Innovation in Aging · 2025-12-01

  articleOpen accessSenior author

  Abstract Background Telehealth has emerged as an essential tool in modern healthcare, providing the potential for the early screening and diagnosis of mild cognitive impairment (MCI) and Alzheimer’s Disease and Related Dementias (ADRD). For example, telehealth enhances access to care and streamlines cognitive assessment during Medicare Annual Wellness Visits (AWVs). Our study aims to evaluate the impact of telehealth on AWV uptake using a large population dataset. Method We used the data from Traditional Medicare (TM) and Medicare Advantage (MA) plans. We applied a probit regression model to examine the relationship between telehealth adoption and AWV uptake among beneficiaries aged 65 and older continuously enrolled in traditional FFS plans or MA in 2020-2022. Results Preliminary analysis using 2020 TM data revealed that 39% of beneficiaries had ever adopted at least one telehealth visit. 7% of the AWVs were delivered via telehealth among those AWV adaptors. There was a significant increase in AWV uptake among telehealth users by 10.2 percentage points to non-telehealth users in the TM plan (p &amp;lt; 0.001). We will extend this analysis to MA beneficiaries, where we anticipate a more pronounced effect. MA likely has greater capabilities to manage health expenditures and provide resources, such as internet access and incentives for preventive care. Conclusions Our study underscores the role of telehealth in increasing AWV uptake and facilitating cognitive assessments. Telehealth holds promises for bridging the gaps in cognitive screening and enhancing early detection of MCI and ADRD, thereby supporting timely diagnosis and care planning.

  PublisherOA PDFDOI

• Medicaid managed care organizations' experiences with network adequacy

  Health Affairs Scholar · 2025-03-13 · 3 citations

  articleOpen access

  Access to behavioral health care continues to be a challenge in Medicaid, where most enrollees are restricted to networks of providers and facilities contracted with managed care organizations (MCOs). While state and federal regulations have sought to ensure access to care, little is known about how health plans perceive and respond to these network adequacy standards. We interviewed 27 administrators and executives across 19 local, regional, and national Medicaid MCOs to assess their behavioral health networks and perceived barriers and facilitators in these efforts. We purposively sampled MCOs for maximum heterogeneity, with early findings used to refine subsequent recruitment targets until thematic saturation. We used an iterative inductive coding approach with code discrepancies analyzed and reconciled until consensus was reached. Five major themes arose: existing regulations often failed to capture true access gaps; MCOs used supplementary approaches to monitor network adequacy; limited corrective actions were available; access measures were more meaningful when grounded in enrollee experiences; and provider directory accuracy was challenged by logistical barriers. In this first study to examine MCOs' experiences with network adequacy monitoring, our findings suggest key deficiencies with current regulations and opportunities to support MCOs more broadly as policymakers seek to strengthen network adequacy regulations.

  PublisherOA PDFDOI

• Growth In Number Of Practices And Clinicians Participating In Concierge And Direct Primary Care, 2018–23

  Health Affairs · 2025-12-01 · 2 citations

  articleOpen access

  Primary care clinicians have expressed growing interest in concierge and direct primary care practices, which often feature smaller patient panels and greater clinical autonomy compared with traditional primary care models. We assessed practice and workforce characteristics using a national sample of concierge and direct primary care practices identified through novel linkages of public and proprietary data. From 2018 to 2023, the number of direct primary care and concierge practice sites grew by 83.1 percent and the number of clinicians participating in them by 78.4 percent. The share of clinicians in concierge and direct primary care practices who were physicians declined from 67.3 percent to 59.7 percent, whereas the proportion of advanced practice clinicians increased. Approximately 60 percent of these clinicians participated in Medicare, suggesting concierge or hybrid practice. Independent ownership decreased from 84.0 percent to 59.7 percent, whereas corporate-affiliated practices grew by 576 percent during this period. The growth in these primary care models may offer substantive benefits to patients and clinicians, but it also raises broader questions about changing clinical practice and access to care.

  PublisherOA PDFDOI

• Price‐Shifting? Spillovers of Medicare Advantage Network Inclusion on Hospital Prices Paid by Commercial Insurers

  Health Services Research · 2025-05-08

  articleOpen access

  OBJECTIVE: To compare inpatient hospital prices in the commercial insurance market between insurers that do and do not include hospitals in their Medicare Advantage (MA) networks. STUDY SETTING AND DESIGN: We compared inpatient negotiated commercial prices between insurers at the same hospital that do not include the hospital in their MA network and those that do. We used Poisson regression with hospital fixed effects, adjusting for insurer fixed effects and insurer-market covariates. DATA SOURCES AND ANALYTIC SAMPLE: Using data from Turquoise Health, the American Hospital Association survey, and Clarivate DRG, we identified 5654 insurer-hospital pairs for seven large insurers that participate in both the commercial and MA markets. PRINCIPAL FINDINGS: Insurers pay 4.7% higher commercial prices for major joint replacements when the hospital is in their MA network (95% confidence interval: 2.0, 7.5%). The average adjusted negotiated commercial price in our sample was $28,889.91 when the insurer did not have the hospital in its MA network but $30,249.16 when it did. We find similar magnitudes for the four other "shoppable service" diagnosis related groups commonly reported in the transparency data. CONCLUSION: On average, insurers pay higher commercial prices to hospitals that are in their MA network.

  PublisherOA PDFDOI

• Inertia, Market Power, and Adverse Selection in Health Insurance: Evidence from the ACA Exchanges

  The Review of Economics and Statistics · 2025-10-29

  articleSenior author

  Abstract We study how inertia interacts with market power and adverse selection in health insurance. We incorporate inertia into a model of plan selection and price competition, and estimate it using data from the California ACA exchange. We estimate inertia costs equaling 26% of average premiums. Our simulations indicate that inertia exacerbates market power, but has minimal interaction with selection. Eliminating inertia reduces average premiums by 6.6%. Maintaining premium-linked subsidies or reducing consumer churn increases the impact of inertia by enhancing market power. Provider network attachment is an important impediment to plan switching, but substantial inertia remains after accounting for networks.

  PublisherDOI

Recent grants

• NIH Grant R01DA017221

  NIH · $944k · 2009

• Hopkins Economics of Alzheimer's Disease & Services Center

  NIH · $10.7M · 2020–2027

• NIH Grant R01AG024451

  NIH · $1.4M · 2008

• NIH Grant R01AA012664

  NIH · $1.3M · 2005

• NIH Grant R01HL088586

  NIH · $1.5M · 2012

Frequent coauthors

• Kevin A. Schulman

  Stanford University

  97 shared

• Henry A. Glick

  University of Michigan–Ann Arbor

  97 shared

• Richard J. Willke

  55 shared

• Jill R. Horwitz

  Center for Effective Philanthropy

  53 shared

• Neal F. Kassell

  Focused Ultrasound Foundation

  50 shared

• Wayne M. Alves

  50 shared

• Sean Nicholson

  Policy Analysis (United States)

  41 shared

• Rachel M. Werner

  41 shared

Labs

• Daniel E. Polsky LabPI