Research roundup: Limited savings found from ACOs; Examining men's health racial disparities

Oct 6 2012

Each week KHN reporter Ankita Rao compiles a selection of recently-released health policy studies and briefs.

Health Affairs: A Simulation Shows Limited Savings From Meeting Quality Targets Under The Medicare Shared Savings Program -- The health law rewards accountable care organizations (ACOs), groups of health care providers working together to save money and increase quality. Those providers then share in the savings. Using CMS guidelines, researchers simulated an ACO targeting Type 2 diabetes Medicare patients. They concluded that a 10 percentage point improvement in performance would prevent up to 4.1 percent of adverse events, such as cardiovascular complications. But they note that would reduce Medicare costs only "by up to about 1 percent. After the costs of performance improvement, such as additional tests or visits, are accounted for, the savings would decrease or become cost increases." To save more, they say, ACOs would "have to lower costs by other means, such as through improved use of information technology and care coordination" (Eddy and Shaw, 10/3).

The New England Journal Of Medicine: The Prevention And Treatment Of Missing Data In Clinical Trials -- Despite FDA regulations, missing data in clinical trials is a "serious problem that undermines the scientific credibility of causal conclusions." They note that a key cause of missing data is when study participants discontinue their treatment which can result in researchers simply inflating "the required sample size in the absence of missing data to achieve the same sample size under the anticipated dropout rate, estimated from similar trials." The authors suggested improvements for limiting missing data, such as allowing a flexible treatment regimen and shortening the follow-up period. (Little et. al., 10/4).

The Kaiser Family Foundation:  Putting Men's Health Care Disparities On The Map: Examining Racial and Ethnic Disparities at the State Level – The authors write that "men of color in almost every state continue to fare worse than white men on a variety of measures of health, health care access and other social determinants of health. ... the persistence of such disparities between white men and men of color -- and among different groups within men of color -- [were found] on 22 indicators of health and well-being, including rates of diseases such as AIDS, cancer, heart disease and diabetes, as well as insurance coverage and health screenings." The authors also link to an earlier, companion report about women (James, Salganicoff, Ranji, Goodwin and Duckett, 9/27).

Health Affairs: The Supreme Court And Health Reform -- This policy brief explores the implications of the Supreme Court ruling on the federal health law, especially the decision to limit the law's mandated Medicaid expansion which "dealt a blow to a major element of the government's strategy to expand health insurance coverage to millions of uninsured Americans. It is unclear how many states will now move forward with the expansion, or what options they have to undertake partial expansions." The brief also notes: "The Supreme Court's decision upholding the Affordable Care Act makes moot almost all of the trial and appellate court cases that had been moving through the judicial system" (Goldman, 9/27).

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

Reuters: Drop In Hospital Visits Seen With Lower Drug Copay
After Pitney Bowes Inc cut copayments for two essential heart drugs, employees at the Stamford, Connecticut-based company began filling their prescriptions more regularly, according to a new report. They also were less likely to visit the doctor, end up in the ER or be admitted to a hospital, slashing their out-of-pocket expenses beyond the copay reductions, researchers found (Joelving, 10/3).

Medscape: Makers of Antipsychotics Targeting Medicaid Psychiatrists
Manufacturers of antipsychotic medications are targeting high levels of their marketing dollars toward psychiatrists in the Washington, DC, area, with a special emphasis on those who are Medicaid prescribers, new research suggests. The study was conducted by researchers from the George Washington University School of Public Health and Health Services (SPHHS), with results released in a report by the DC Department of Health (DOH). The investigators found that in 2010, more than $25 million was spent on marketing antipsychotics in the DC area (Brauser, 10/3).

Medscape/Reuters: Race Influences Surgical Residency Experience
Compared with white general surgery residents who responded to a recent survey, minority residents reported feeling less positive about their fit with the program and their relationships with faculty and peers. "We believe that residency programs should establish mentorship between faculty and trainees based on shared interests, culture and background, if possible," Dr. Julie A. Sosa from Yale School of Medicine, New Haven, Connecticut, who led the study, told Reuters Health. "Since the number of minority faculty is small, programs should commit to fostering cultural competence among all its faculty and trainees..." (Boggs, 10/1).