Research roundup: Obesity treatment for low-income patients; Medicare vs. private plans

Apr 16 2012

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Archives Of Internal Medicine: Obesity Treatment For Socioeconomically Disadvantaged Patients In Primary Care Practice – Low-income patients are underrepresented in clinical trials and are disproportionately prone to obesity and the related problems of high blood pressure and heart disease. Researchers conducted a 24-month trial of more than 300 low-income, obese patients from various Boston community health centers, randomizing participants "to usual care or a behavioral intervention that promoted weight loss and hypertension self-management using eHealth components. The intervention included tailored behavior change goals, self-monitoring, and skills training, available via a website or interactive voice response." The intervention resulted in "modest weight losses, improved blood pressure control and slowed systolic blood pressure" (Bennett et al., 4/9).

Kaiser Family Foundation: How Does The Benefit Value Of Medicare Compare To The Benefit Of Typical Large Employer Plans? A 2012 Update -- This study, updated from 2008, found that "Medicare remains less generous on average than typical large employer health plans, even after recent improvements in the program's drug coverage. Overall, Medicare would cover $11,930 on average of the $14,890 in estimated annual spending for an individual age 65 and older, less than would be covered under either the federal employee plan ($12,260) or the typical PPO comparison plan ($12,800) for an individual age 65 and older. The gap was narrower in 2011 than it was in 2007, largely due to provisions in the Affordable Care Act that provide discounts on brand-name drugs purchased in the Medicare drug benefit's coverage gap, or "doughnut hole" (McArdle, Levinson, Stark and Neuman, 4/4).

The Heritage Foundation: Saving The American Dream: Comparing Medicare Reform Plans – The Heritage Foundation has proposed a premium support plan for Medicare as part of a comprehensive defict reduction package. This backgrounder looks at that proposal and five other plans that offer such supports. In a plan with a premium support, sometimes called a voucher, the government makes a fixed payment to Medicare beneficiaries, who then can shop for appropriate health insurance.  The author writes that, while details vary, each requires "traditional Medicare to compete with private plans, using competitive bidding to determine market-based payments to health plans, requiring upper-income retirees to pay more for their benefits, providing extra assistance to lower-income enrollees, and adding a risk-adjustment mechanism to guarantee market stability and security for older and sicker retirees. The breadth of the consensus on key policy components could be the basis for a strong bipartisan agreement" (Moffit, 4/4).

Here is a selection of news coverage of other recent research:

KQED's State of Health blog: Who Will Care for the Caregivers?
Some people who care for vulnerable older adults are in dire economic straits, according to a new study from the UCLA Center of Health Policy Research. Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from Medi-Cal. ... At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average (Menghrajani, 4/12). 

MedPageToday: Insurers Dodged Billions In Rebate Payments
If the Affordable Care Act's requirement that insurers spend at least 80% on patient care had come into effect a year early, policyholders would have received about $2 billion in rebates from insurance companies, according to a new report from the Commonwealth Fund. ... If that MLR provision had been in effect in 2010, 5.3 million people insured through the individual market -- or about half of everyone with individual coverage -- would have split $1 billion in rebates. Another $1 billion would have gone to about 10 million people with small- and large-group policies (Walker, 4/9).

Medscape: Should Statins Be Used in Primary Prevention? JAMA Gets in on the Debate
For Drs Rita Redberg and William Katz (University of San Francisco, California), who argue that healthy men should not take statins, there are other effective means to reduce cardiovascular risk, including dietary changes, weight loss, and increased exercise.  ... In their counterpoint, Drs Michael Blaha, Khurram Nasir, and Roger Blumenthal (Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD) agree that the cornerstone of treatment for patients with elevated cholesterol levels will always be diet and exercise but that statins can be a "critical adjunct for those identified to be at increased coronary heart disease risk" (O'Riordan, 4/10).