Research roundup: 'Shared decision making' can reduce costs, improve care; Effects of mental health parity

Feb 10 2013

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Enhanced Support For Shared Decision Making Reduced Costs Of Care For Patients With Preference-Sensitive Conditions – With shared decision making, patients and their clinicians collaboratively review the risks and benefits of available treatments options while also considering the patients' preferences and values. The authors write: "We examined data obtained from a yearlong randomized investigation. The study compared the effects on patients of receiving a usual level of support in making a medical treatment decision with the effects of receiving enhanced support, which included more contact with trained health coaches through telephone, mail, e-mail, and the Internet. We found that patients who received enhanced support had 5.3 percent lower overall medical costs than patients who received the usual level of support." Patients with enhanced support also had fewer hospital admissions and surgeries for conditions such as angina, arthritis, back pain and early stage prostate cancer, conditions that "come with substantial trade-offs between benefits and risks to the patient." The conclusion: "These findings indicate that support for shared decision making can generate savings" (Veroff, Marr and Wennberg, 2/1).

Health Affairs: Patients With Mental Health Needs Are Engaged In Asking Questions, But Physicians' Responses Vary – According to the authors, primary care doctors see and treat more than half of all cases of mental illness in the United States. Compared to other patients, however, those with mental health needs may be less likely to engage in that care and less willing to ask questions. Researchers analyzed more than 300 audio recordings of interactions between primary care providers and patients and found that "patients asked many questions-;a median of fifteen per visit-;but that they were more likely to ask about biomedical topics, such as diabetes, than about mental health topics. Patients received highly varied responses from physicians. Our findings suggest that efforts aimed at improving patient engagement should move beyond simply encouraging patients to ask questions. The goal should also be to support physicians in recognizing patients' concerns and providing the most responsive answers" (Tai-Seale, Foo, and Stults, 2/1).

American Journal Of Psychiatry: The Effects Of Mental Health Parity On Spending And Utilization For Bipolar, Major Depression, And Adjustment Disorders – The 2010 Mental Health Parity and Addiction Equity Act requires many private health insurance plans to provide coverage for mental conditions in the same manner as they do for general health services. Researchers compared the 1999 behavioral health treatment use and spending in the Federal Employees Health Benefits plan, which had implemented a parity program, and privately insured patients unaffected by parity. They report: "Total spending was unchanged among enrollees with bipolar disorder and major depression but decreased for those with adjustment disorder. Out-of-pocket spending decreased for all three groups ... Total annual utilization ... remained unchanged across all diagnoses," and conclude: "Parity implemented under managed care improved financial protection and differentially affected spending and psychotherapy utilization across groups. There was some evidence that resources were preferentially preserved for diagnoses that are typically more severe or chronic and reduced for diagnoses expected to be less so" (Busch et al., 2/1). 

Journal Of Health Care For The Poor And Underserved: Reducing Disparities In Access To Primary Care And Patient Satisfaction With Care: The Role Of Health Centers – The authors note that federally supported health centers (HC) provide accessible and affordable health care services, such as primary and dental care, to people living in medically underserved areas. With data from two 2009 national surveys, researchers compared the primary care experiences of patients receiving their care at HCs to other patients. They found that "Health center patients were more racially and ethnically diverse than national patients, and health center patients were more likely than national patients to be uninsured or publicly insured. No significant health care disparities in access to care existed among patients from different racial/ethnic and insurance groups among health centers, unlike low-income patients nationwide or the U.S. population in general. Additional focus on the uninsured, in health centers and other health care settings nationwide, is needed to enhance satisfaction with care among these patients" (Shi et al., 2/2013).

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

Reuters: Longer Span Between Mammograms Okay For Older Women
Screening women over 65 each year for breast cancer doesn't catch any more early tumors -- but it does lead to more false positives -- than screening every other year, according to a new study. The findings are based on more than 140,000 older women included in five mammography registries across the United States. "This study clearly tells us that screening every two years may be more appropriate than screening women every year," said Dr. Otis Brawley, chief medical officer of the American Cancer Society (ACS) (Pittman, 2/7).

MedPage Today: 'Smarter Testing' May Resolve PSA Debate
More efficient prostate cancer screening might result from strategies that employ higher PSA thresholds for older men and longer screening intervals for low-risk patients, a computer modeling study suggested. Raising the threshold of biopsy referral for older men increased the risk of prostate cancer death by less than 0.1% versus a reference strategy but reduced the likelihood of overdiagnosis by a full percentage point, reported Ruth Etzioni, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and colleagues (Bankhead, 2/5).

Reuters: Uninsured Less Likely To Get Heart Meds
Uninsured Americans were less likely to get the best treatment for heart troubles than those with insurance in a new study that hints the blame may lie with the quality of physicians who typically treat the uninsured. ... The researchers, who published their findings in the Journal of the American College of Cardiology, looked to see which patients received the recommended medications for their heart conditions and whether the treatment they got was linked to their insurance status (Seaman, 2/1).

MedPage Today: More Insurance Claims Filed Electronically
Healthcare providers continue to file more insurance claims electronically and submit claims more quickly, a report from the leading health insurance industry group showed. In 2011, 94% of claims were submitted electronically, up from 82% in 2009, according to America's Health Insurance Plans (Pittman, 2/7). 

MedPage Today: Out-of-Network Charges Out Of Line With Medicare
Out-of-network doctors sometimes charge several times more -- often thousands of dollars more -- than Medicare pays for the same service in the same area, according to a report from the leading health insurance industry group. "Our survey ... indicated that health plans and their members routinely receive bills from physicians that are 10 to 20 or sometimes nearly 100 times higher than Medicare would allow," America's Health Insurance Plans (AHIP) found in its survey, "A Hidden Threat to Affordability" (Pittman, 2/6). 

Medscape: Stimulant Use Exceptionally High Among Medical Students
Medical students are significantly more likely to use prescription stimulant medications to boost academic performance compared with other college students, new research suggests. A survey conducted in third-year medical students at a single school in the United States showed a lifetime use prevalence of about 20%, a figure that is "distinctly higher" than the average of 6.9% among college students (Cassels, 2/6).