Health policy research roundup

Nov 7 2009

Health Affairs: Enrollment Is Driving Medicaid Costs—But Two Targets Can Yield Savings - "Although Medicaid spending has grown faster than the rate of increase in national health spending, much of this is explained by increased enrollment," write the authors of this paper, who present data showing that "[p]er enrollee, Medicaid spending actually compares favorably to increases in medical care prices and gross domestic product." The authors examine Medicaid's "relative success" at cost containment, which they attribute to "limits on provider payment rates, expansion of managed care, limits on the use and pricing of prescription drugs, and expansion of community-based long-term care programs." The paper suggests future cost containment strategies (Holahan and Yemane, Sept./Oct. 2009).

Robert Wood Johnson Foundation: Can Accountable Care Organizations Improve The Value of Health Care By Solving The Cost And Quality Quandaries? - This policy brief provides a comprehensive look at accountable care organizations (ACOs), which have been proposed as a way to slow health care spending while improving the delivery of care. "ACOs will not be a real game changer in the short run but are definitely worth a concerted try, given long-standing problems with the [fee-for-service] FFS provider payment and delivery systems that impede health care cost control and quality improvement," the authors write. "ACOs can help overcome the impasse of where to start first—provider payment or delivery system reform—by coupling and coevolving them over time" (Devers and Berenson, 10/29).

Related KHN story: ACOs, A Quick Primer (Galewitz, 7/19)

Annals of Internal Medicine: Much Cheaper, Almost as Good: Decrementally Cost-Effective Medical Innovation - "Under conditions of constrained resources, cost-saving innovations may improve overall outcomes, even when they are slightly less effective than available options, by permitting more efficient reallocation of resources," write the authors of this study that looked at "cost- and quality-decreasing medical innovations that might offer favorable 'decrementally' cost-effective tradeoffs—defined as saving at least $100 000 per quality-adjusted life-year lost." Of 2,128 cost-effectiveness ratios the authors pulled from "887 publications, only 9 comparisons (0.4% of total) described 8 innovations that were deemed to be decrementally cost-effective. ... On a per-patient basis, these innovations yielded savings from $122 to almost $12,000 but losses of 0.001 to 0.021 quality-adjusted life-years (approximately 8 hours to 1 week)," according to this literature-review study (Nelson, Cohen, Greenberg and Kent, 11/3).

Kaiser Family Foundation: Putting Children On The Express Lane To Health Insurance: Streamlining Enrollment And Renewal Of Children In Medicaid And CHIP Through Express Lane Eligibility - These briefs offer an overview of Express Lane Eligibility (ELE) - a new tool that allows states to reach and enroll eligible yet uninsured low-income children into Medicaid and CHIP - and issues related to implementing an ELE initiative (Kaiser Commission on Medicaid and the Uninsured, 10/30).

Annals of Family Medicine: Children's Receipt Of Health Care Services And Family Health Insurance Patterns - This study examines how the insurance coverage of parents relates to the access children have to health care and preventive medical services. The study found that even when children had insurance, if their parents were uninsured, the children "had higher odds of an insurance coverage gap, no usual source of care, unmet health care needs, and [were] not receiving at least one preventive counseling service compared with insured children with insured parents. ... The vulnerability of children in this study ... is due not only to their own coverage instabilities but also the lack of reliable coverage for parents. … [It] highlights the need to look beyond child-only insurance models in the longer term," the study authors write (DeVoe, Tillotson and Wallace, Sept./Oct. 2009).

Health Affairs: Adverse Selection In The Medicare Prescription Drug Program -"Medicare enrollees with high prescription drug costs have strong incentives  to enroll in Part D, especially in plans with more comprehensive coverage. To measure this potential problem of 'adverse selection,' which could threaten plans' finances," the authors compared baseline characteristics among groups of beneficiaries with various drug coverage arrangements in 2006 and found "some significant differences."

Among other things, the researchers found "average baseline drug costs for Part D plan enrollees to be lower than those for respondents with retiree subsidies or other drug coverage, which is not consistent with the Part D plan enrollees' poorer health and higher risk scores." In addition, the authors report that enrollees in stand-alone plans, especially those that offer benefits that help cover the "doughnut hole" gap in prescription drug treatment, "had higher baseline drug costs and worse health than enrollees in Medicare Advantage prescription drug plans. Although risk-adjusted payments and other measures have been put in place to account for selection, these patterns could adversely affect future Medicare costs and should be watched carefully," the authors (all from CMS) write in this study which was originally presented at AcademyHealth Annual Research Meeting, June 2008 (Riley, Levy and Montgomery, Nov./Dec. 2009).

Kaiser Family Foundation: Setting Medicare Payment Policy: Is There A Role For An Independent Entity? - "The Obama Administration and some Congressional leaders have proposed establishing a new independent entity that would be given authority to recommend changes in Medicare policy to be implemented by the Administration, subject to Congressional review. This concept represents a significant departure from current practices. This issue brief considers questions associated with the establishment of a new entity to set Medicare payment policy and the implications for beneficiaries, other stakeholders, and program spending" (10/29).

Commonwealth Fund/Health Affairs: A Survey Of Primary Care Physicians In 11 Countries, 2009: Perspectives On Care, Costs, And Experiences - This study examines the reported experiences and perspectives of physicians from 11 countries (Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States), based on a survey of more than 10,000 primary care physicians. It finds "the United States lags far behind in terms of access to care, the use of financial incentives to improve the quality of care, and the use of health information technology. In other countries, national policies have sped the adoption of such innovations" (Schoen, Osborn, Doty, Squires, Peugh, and Applebaum, 11/5).