Research Roundups: Health IT progress; Telecare and cancer pain; State exchanges; Adults with no medical care

Jul 17 2010

eHealth/Commonwealth Fund: National Progress Report On eHealth - This extensive report examines changes in the adoption and use of health information technology (HIT) since 2007, as assessed by a group of more than 100 experts. "Sixty-one percent [of the stakeholders involved in assessing HIT progress] agreed or strongly agreed that significant progress has been made in the successful adoption and use of health IT since 2007, but most (67%) felt that outreach to educate consumers about the value of electronic health records and health information exchanges is not effective," according to a Commonwealth Fund description of the project, which adds: "To realize the goal of using health IT adoption to improve quality in care delivery, the report recommends implementing policies and programs that take into consideration all sectors of the health care community, including consumers, and promoting further education on the new privacy and security laws and regulations" (Marotta, Jessee, Bordenick and Jones with multiple co-chairs, 7/13).

Journal of the American Medical Association: Effect of Telecare Management on Pain and Depression in Patients With Cancer - "Pain and depression are 2 of the most prevalent and treatable cancer-related symptoms, yet they frequently go unrecognized, undertreated, or both," write the authors of this study which examined "16 community-based urban and rural oncology practices involved in the Indiana Cancer Pain and Depression (INCPAD) trial. ... participating patients had depression," cancer-related pain or both.  Patients were randomly assigned to receive either "usual care" or "centralized telecare management by a nurse-physician specialist team coupled with automated home-based symptom monitoring by interactive voice recording or Internet."  The authors conclude that "telecare management intervention resulted in significant improvements in both pain and depression. ... it is feasible to provide telephone-based centralized symptom management across multiple geographically dispersed community-based practices in both urban and rural areas ... collaborative care intervention can cover several conditions, both physical and psychological" (Kroenke, 7/14).

Kaiser Family Foundation: Chronic Disease And Co-Morbidity Among Dual Eligibles: Implications For Patterns Of Medicaid And Medicare Service Use And Spending - "The health reform law contains provisions that aim to improve the delivery and coordination of services for persons enrolled in both Medicaid and Medicare, known as the dual eligibles. This population includes individuals with some of the most severely disabling chronic conditions. While the higher costs associated with services to dual eligibles is well-known, information on how spending is distributed across these programs is less understood."

The authors of this brief analyze Medicare and Medicaid data and report, "Three in five dual eligibles have multiple chronic physical conditions and 20 percent have more than one mental/cognitive condition," which result in a high use of services and require care coordination across both programs. "In contrast, roughly half of all other Medicare beneficiaries have more than one chronic physical condition and only 5 percent have more than one mental/cognitive condition. Almost 2 in 5 dual eligibles have both a physical and mental disease or condition compared to only 17 percent of all other Medicare beneficiaries" (Kasper, O'Malley Watts and Lyons, July 2010).

Kaiser Family Foundation: Uninsured And Untreated: A Look At Uninsured Adults Who Received No Medical Care For Two Years - "When Medicaid expands to reach all adults at or below 133% [of the Federal Poverty Level] in 2014, the program will be enrolling a diverse population of individuals who differ from the current Medicaid population," according to this brief, which is based on an analysis of data from the 2006-2007 Medical Expenditure Panel Survey. 

The authors note: "Among adults at or below 133% FPL who were uninsured for at least two years, almost four-in-ten (38%) received no medical care during the two years when they lacked coverage" and roughly 40 percent report being in good, fair of poor physical health. "By comparison, just 7% of adults in the same income range who had Medicaid coverage received no medical care over a two year period. ... Reaching adults who currently have little or no interaction with the health care system will require strategies geared specifically towards this population. Successfully enrolling these uninsured adults in Medicaid and linking them to the health care system has the potential to improve their access to care and contribute to a decrease in the number of uninsured" (Schwartz and Damico, 7/9).

Robert Wood Johnson Foundation: Recognizing Destabilization In The Individual Health Insurance Market - "As health reform moves forward, the medical loss ratio (MLR), designed to indicate how much of the premiums collected from consumers actually pay for health care services and clinical quality, will take on new significance for plans competing in health insurance markets," writes the author of this issue brief that examines MLR standards in the individual insurance market. The brief addresses potential warning signs of market destabilization as well as several approaches states have taken to help protect consumers (Bernstein, 7/8).

Commonwealth Fund: Health Insurance Exchanges And The Affordable Care Act: Key Policy Issues - "Health insurance exchanges are the centerpiece of the private health insurance reforms of the Patient Protection and Affordable Care Act of 2010," writes the author of this brief examining some of the lessons learned from previous attempts at state-level health insurance exchanges. The report identifies 13 issues "must be resolved for the exchanges to succeed."

For example, "It is absolutely necessary that exchanges be protected against adverse selection ... Provisions of the [health law] should help, but if small-group and nongroup insurance plans are available outside the exchange, the possibility of adverse selection remains open. … Exchanges must be employer-friendly if they are to succeed. Thus, while the [law] offers little guidance to exchanges on how to interact with employers, this relationship must be a major focus of implementation efforts" (Jost, 7/15).