Research roundup: 'Welcome-mat' effect of Medicaid expansion; Setting up shops; California's transition to Medicaid managed care

Jul 2 2013

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

Health Affairs: Medicaid 'Welcome-Mat' Effect Of Affordable Care Act Implementation Could Be Substantial – The number of people eligible for Medicaid who remain uninsured varies from state to state, according to the authors. But the federal health law is likely to increase the rate of enrollment for this group. The potential impact of this increase in Medicaid enrollment, also known as the 'welcome-mat' effect, is unclear. Analyzing low-income parents in Massachusetts who had been eligible but did not join Medicaid until the state implemented it own health overhaul in 2006, researchers from the University of Minnesota  sought to predict that impact nationally.  They found that the state's overall Medicaid participation increased more than 19 percentage points and the "enrollment rate among previously eligible low-income parents in Massachusetts increased by 16.3 percentage points." They add, however, the experiences of other states are likely to differ from the effects they observed in Massachusetts and will also depend on various factors such as current enrollment rates and outreach efforts (Sonier, Boudreaux and Blewett, 6/26).

The Urban Institute/Robert Wood Johnson Foundation: Implementation Of Small Business Exchanges In Six States – Under the federal health law, the Small Businesses Health Options Program, also known as the SHOP exchange, aims to provide small employers with an opportunity to pool their purchasing power to get more affordable health coverage options and to provide administrative relief for them in offering more options to workers. SHOP will exist in both federally and state-run health exchanges, and this report provides an overview of the program and its development in New York, Oregon, Rhode Island, Colorado, Maryland and New Mexico. "Policy decision-making varied state to state and appears to be rooted in specific market dynamics that exist in each individual state," the authors found. Their report also highlights several other major findings including the role of brokers in educating small employers about the new market places (Blumberg and Rifkin, 6/27).

The Kaiser Family Foundation/University of California, Berkeley/University of California, Los Angeles: Transitioning Beneficiaries With Complex Care Needs To Medicaid Managed Care: Insights From California – According to the report, California's Medicaid program for low-income individuals, known as Medi-Cal, transitioned close to 240,000 seniors and people with disabilities into Medicaid Managed Care between June 2011 and May 2012. This transition from a fee-for-service to managed care program, the authors add, did not include seniors and people with disabilities who were dually eligible for both Medi-Cal and Medicare, the federal health program for those 65 years and older. The researchers examined how health service providers, plan administrators and community-based organizations in Contra Costa, Kern, and Los Angeles Counties handled this transition. "Even when steps are taken to mitigate anticipated issues and concerns prior to the transition, as was the case with California, unanticipated challenges are likely to arise," the authors write. Their findings, the authors highlight in this report, may serve as guide to inform similar transitions elsewhere (Graham et al., 6/25).

The Center Of Excellence In Public Health Workforce Studies/Robert Wood Johnson Foundation: Enumeration And Characterization Of The Public Health Nurse Workforce – Although public health nurses play a vital role in health care, "little is known about the size, composition, and educational/training background" of this workforce, the authors write.  They analyzed survey and local- and state-level data to assess the current workforce. Among many of the findings highlighted in this report is the lack of racial and ethnic diversity among public health nurses in local and state departments and the need to strengthen the workforce's education and training. The findings highlight "the need for ongoing systematic monitoring of the workforce in order to better address issues of supply and demand, inform competency compliance and credentialing efforts, permit better alignment of academic resources with workforce needs, and allow for a better understanding between workforce infrastructure and its relationship to specific health outcomes," the report's authors conclude (Boulton and Beck, 6/26).

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

Medscape Today: Image Test Orders Shaped By Patient And Visit Factors
Physician-level factors do not appear to greatly affect the use of low- and high-cost imaging modalities in the emergency department (ED), according to the findings of a retrospective cohort study. Hannah J. Wong, PhD, from York University in Toronto, Ontario, Canada, and colleagues published their findings online June 25 in Radiology (Barber, 6/26).

Medscape Today: Cancer Clinics Closing: Community Oncology 'Near Crisis'
The community cancer care landscape in the United States continues to evolve, and not for the better, according to a report released by the Community Oncology Alliance (COA). Since their previous report, issued in April 2012, there has been a 20% increase in clinic closings and in consolidation into hospitals. "Community oncology is very much under fire. With the coming of the budget cuts that were made to Medicare," said Ted Okon, executive director of COA, "we are nearing crisis" (Nelson, 6/27).

Medscape Today: Pediatric Scan Rates High Despite Risk
One quarter of children presenting with isolated headache undergo at least a single computed tomography (CT) scan, according to the results of a study published online June 24 in Pediatrics. "Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk," write Andrea DeVries, PhD, from HealthCore Inc, Wilmington, Delaware, and colleagues, noting that less than 1% of pediatric brain abnormalities present with headache as the only symptom (Waknine, 6/27).

Reuters: New Labels Tied To Fewer Child Poisonings By OTC Meds
Fewer small children have been sickened or died from accidentally taking cough and cold medicines meant only for older ages, according to a new study of the effects of recent label changes on these over the counter products. High doses of antihistamines can cause coma, seizure and abnormal heart rhythms in kids, and an overdose of the pain reliever acetaminophen can cause liver failure, according to the study's lead author Dr. Maryann Mazer-Amirshahi of the department of emergency medicine at The George Washington University in Washington, D.C. (Doyle, 6/28).

Reuters: Many Cancer Patients Expect Palliative Care To Cure
In a survey of patients with terminal lung cancer, nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. Among the nationwide sample of patients with advanced lung cancers, four out of five thought the radiation would help them live longer and two in five believed it might cure their cancers (Doyle, 6/26).

Medicare Newsgroup: Traditional Medicare Makes Gains But Lags Behind Medicare Advantage in Chronic Illness Treatment -- On television, older Americans look healthy. We see them in commercials riding bicycles, jogging and playing basketball with their grandchildren. Sometimes they're even surfing. The doctor's office tells a different story. Dana E. King, MD, a family physician at the Sleeth Family Medicine Center, said he's seeing an increasing burden of chronic illnesses such as diabetes obesity and hypertension in younger, baby boom-aged patients. … Turns out that baby boomers, the 78 million Americans born from 1946 through 1964, were more chronically ill, more disabled and had lower self-rated health than the previous generation did at the same age, according to their study, published in JAMA Internal Medicine. More than half of baby boomers reported no regular physical activity (Sjoerdsma, 6/27).

Medpage: ACA Coverage Affected By DOMA Ruling
Legally married same-sex couples will now be considered a family in calculating federal medical benefits after Wednesday's landmark Supreme Court ruling striking down part of the Defense of Marriage Act (DOMA). The ruling in United States v. Windsor forces the federal government to recognize same-sex marriages that have taken place in 12 states and the District of Columbia -- jurisdictions in which such marriages are legal. That means gay and lesbian spouses will now be counted as couples for such things as tax credits to purchase insurance under the Affordable Care Act (ACA) (Pittman, 6/27).