Research roundup: Health providers' growing clout; The surprising bargain in Part D costs

May 11 2012

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Health Affairs: The Growing Power Of Some Providers To Win Steep Payment Increases From Insurers Suggests Policy Remedies May Be Needed -- Concerns have grown that the consolidation of hospitals and physician groups has increased their ability to raise prices, which increases costs for insurers and patients. Study authors interviewed health care leaders in 12 major metropolitan areas across the country. Aside from consolidation, they said, factors like provider reputation, specialized services, and avoidance of limited provider choice have diminished insurers' negotiating power. The authors recommend looking beyond the health law's scrutiny of insurer rate increases and pursuing "a range of other market and regulatory approaches," such as rate setting by states (Berenson, Ginsburg, Christianson and Yee, 5/7).

National Institute for Health Care Reform/Center for Studying Health System Change: Addressing Hospital Pricing Leverage Through Regulation: State Rate Setting -- During the 1970s and 80s, several states established rate setting programs for hospitals, but now only two states -- Maryland  and West Virginia -- continue to use this cost containment approach. In this policy analysis, the authors discuss several potential issues for states that might now consider a rate setting program -- from determining which outpatient services to regulate to providing incentives for quality of care. "Over the long run," the authors add, "decisions about governance and leadership may be more critical to the success of rate setting than the technical details of payment formulas" (Sommers, White and Ginsburg, 5/8).

Kaiser Family Foundation/Georgetown University: Medicare Part D Spending Trends: Understanding Key Drivers And The Role Of Competition -- Spending on Medicare Part D prescription drug benefit has been about 30 percent less than the Congressional Budget Office estimated in 2003, when the program began, according to recent estimates, and the author of this brief writes that "claims that spending is lower because the program was designed around competing private plans seem overstated." Instead, he argues, the price difference is a combination of factors including lower-than-expected Part D enrollment and greater use of generic drugs. As Congress considers further Medicare reforms, "caution is warranted in making claims about consumer behavior in a competitive environment" (Hoadley, 5/8).

Kaiser Family Foundation: Prescription Drug Procurement And The Federal Budget -- Prescription drugs are an area for potentially significant cost savings, but this brief argues that "competition is quite limited" in several key areas for driving down prices for the federal government. Those areas include drugs provided in Part D plans to beneficiaries with low-income subsidies and specialty drugs. The author describes three strategies for better managing the market: using Medicaid prices for low-income beneficiaries of Medicare Part D, shortening the time before generic biologics can enter the market, and allowing the government to determine the price of unique drugs in certain cases. Together, "these ideas offer the potential for well over $100 billion in savings over 10 years and continued growth in savings thereafter" (Frank, 5/8).

Archives of General Psychiatry: Cost-Effectiveness Of A Multicondition Collaborative Care Intervention -- Coordinating care for individuals with multiple chronic and complex conditions is expected to improve health and save money. In this study, researchers used a team model of care to better serve patients with depression and heart disease or diabetes. The two-year intervention showed, at times, improved management of blood pressure and other symptoms. Compared to a control group, patients also had three to four more months of depression-free days. Cost savings were unclear, but an analysis of quality of life suggested that team-based care was "a high-value intervention" (Katon et al., 5/7).

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

Medpage Today: Limit PSA Tests to Younger Men, These Docs Say
Healthy younger men should be screened regularly for prostate cancer using prostate-specific antigen (PSA) testing, but older men in poor health should not be, researchers suggested. ... In their analysis, the investigators acknowledged that "screening is not for everyone [but] there is evidence that younger men have the most to gain from treatment." They also noted that screening was not worthwhile in "elderly men with multiple comorbidities and limited life expectancy"  (Pal, 5/7).

NPR's SHOTS blog: Moms Often Overlook Toddlers' Weight Problems
How good are mothers at recognizing whether their toddlers are overweight, underweight or just right? Not very. More than two-thirds of the mothers participating in a recent study were inaccurate in their assessments. ... Researchers asked 281 mothers recruited from two clinics (one in Baltimore and another in a nearby suburb) that serve mainly low-income mothers to find out. Seventy-one percent of the participants were African-American. The researchers picked those clinics because children in low-income families are at higher risk of becoming overweight or obese. ... The results appear in the latest Archives of Pediatrics and Adolescent Medicine (Hensley, 5/7).

MedPage Today: Outcomes Worse for Inhospital Stent Thrombosis
Among patients who underwent primary percutaneous coronary intervention (PCI) for an ST-segment elevation MI (STEMI), outcomes were worse if stent thrombosis occurred in rather than out of the hospital, researchers found. Patients whose event occurred in the hospital were more likely to die within 1 year compared with those whose event occurred outside of the hospital..., according to George Dangas, MD, PhD, of Mount Sinai Medical Center in New York City, and colleagues. Those with an inhospital stent thrombosis also had a higher rate of non-CABG-related major bleeding (21.2% versus 6%,>

St. Louis Beacon: Exercise And Nutrition Don't Appear To Help Control Type 2 Diabetes Among The Young
Frequent exercise, good nutrition and often a single medication have turned out to be an ideal regimen for helping many adults control their type 2 diabetes. But what works for adults has turned out to be less effective in children, according to results of the first major national study of treatment options for type 2 diabetes among young people. The ongoing study sponsored by the National Institutes of Health involves 699 youngsters. ... The findings [were] reported recently in the New England Journal of Medicine (Joiner, 5/8).