Research roundup: ACA lawsuit primer; ACA strategies in 4 states; competitive plans for those eligible for Medicare and Medicaid

Jul 21 2014

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

National Health Law Program: Health Advocate: ACA Litigation Continues: A Primer of Major Cases
In 2012, the U.S. Supreme Court upheld the constitutionality of the ACA, but that did not end attacks against the law. Since the decision in National Federation of Independent Business v. Sebelius, objecting parties have filed more than 100 cases in federal courts nationwide. With a few exceptions, most of these cases seek to strike specific provisions of the ACA. This issue of the Health Advocate highlights cases filed in federal courts across the country since 2012 (Perkins and Singh, 7/14).

Agency for Healthcare Research and Quality: State Differences In The Cost Of Job-Related Health Insurance, 2013
This Statistical Brief presents state variations from the national average of the cost of job-related health insurance and how these costs are shared by employers and their employees. The Brief specifically examines the average premiums and employee contributions for private-sector establishments in the 10 most populous states in 2013, using the most recent data available from the Insurance Component of the Medical Expenditure Panel Survey. ... Among the 10 largest States, the percentage of employees opting for single coverage ranged from 44.6 percent in Michigan to 56.4 percent in North Carolina, for employee-plus-one coverage from 18.1 percent in California to 21.0 percent in Michigan, and for family coverage from 23.9 percent in North Carolina to 34.4 percent in Michigan. Nationwide, average premiums were $5,571 for single coverage, $10,990 for employee-plus-one coverage, and $16,029 for family coverage (Karen E. Davis, 7/14).

The Kaiser Family Foundation: What Worked And What's Next? Strategies In Four States Leading ACA Enrollment Efforts
This brief highlights the experiences of four states-;Colorado, Connecticut, Kentucky, and Washington-;that established a State-based Marketplace (SBM), implemented the ACA's Medicaid expansion, and achieved success enrolling eligible individuals into coverage. Based on interviews with key stakeholders in each state, it identifies effective strategies that contributed to enrollment and current priorities looking forward. Key themes are summarized ... Broad marketing campaigns by the SBMs in all four states raised public awareness of new coverage options. ... local level outreach and enrollment efforts played a pivotal role in educating consumers and encouraging them to enroll into coverage. ... one of the most important elements of enrolling people into coverage is one-on-one assistance provided through trusted individuals in the community (Artiga, Stephens, Rudowitz and Perry, 7/16).

Heritage Foundation: How Competitive Private Plans Can Improve Care For Dual-Eligible Beneficiaries Of Medicare And Medicaid
Competitive health plans provide high-quality care for some of America's poorest and most challenging patients. Real Medicare reform based on expanded choice and competition can translate that achievement into better care for 9 million patients known as dual-eligible beneficiaries. "Dual eligibles," low-income patients covered under both Medicare and Medicaid, are an expensive and complex patient population. These patients already greatly benefit from competing private health plans in Medicare Part D, the competitive prescription drug program, and Medicare Advantage, Medicare's competitive private insurance program. Policymakers can build on these successes by including these patients in a flexible Medicare defined-contribution ("premium support") financing system where dual eligibles, with assistance from their families or counselors, can take advantage of care coordination provided by competing health plans (Jonathan Crowe, 7/10).

Annals Of Internal Medicine: Changes in Office Visit Use Associated With Electronic Messaging And Telephone Encounters Among Patients With Diabetes In The PCMH [Patient Centered Medical Home]
Telephone- and Internet-based communication are increasingly common in primary care, yet there is uncertainty about how these forms of communication affect demand for in-person office visits. We assessed whether use of copay-free secure messaging and telephone encounters was associated with office visit use in a population with diabetes. ... Before and after a medical home redesign, proportional increases in secure messaging and telephone encounters were associated with additional primary care office visits for individuals with diabetes (Liss, July-August 2014).

American Journal Of Preventive Medicine: Impact of the National Breast and Cervical Cancer Early Detection Program on Cervical Cancer Mortality Among Uninsured Low-Income Women in the U.S., 1991–2007
Past studies have demonstrated that poor, uninsured, and underinsured women receive less screening than affluent women. To reduce disparities in cervical cancer incidence and mortality, the U.S. Congress [passed a law which] authorized the establishment of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach underserved women. ... The impact of the Program on life expectancy in uninsured low-income women was estimated using a previously published and validated model ... These estimates suggest that NBCCEDP cervical cancer screening has reduced mortality among medically underserved low-income women who participated (Ekwueme et al., 7/7). 

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

Minnesota Public Radio: Study: Collaboration Between Docs, Insurers Lowers Cost Of Cancer Care
A UnitedHealth Group study found the cost of cancer care dropped when doctors were paid a lump sum per case and were showed how they compared with others treating the same cancers. The Minnetonka-based company says even with an increase in drug costs, total costs went down by a third. The study tracked not only costs but also 60 quality of care measures. The study's lead author, UnitedHealth Senior Vice President Lee Newcomer, says the collaboration between doctors and the insurer made a major difference (Stawicki, 7/12).

Reuters: Doctors Characteristics May Influence Prostate Cancer Treatment
Whether a man's low-risk prostate cancer gets treated with surveillance, surgery or another method may have more to do with his doctor than his health, according to a new study. Urologists who had been practicing for more years and those who treated more advanced cases of the disease were less likely to use a wait-and-see approach to manage low-risk prostate cancer, researchers found (Seaman, 7/14).

The New York Times: Study Discounts Testosterone Therapy For Early Prostate Cancer
For decades, millions of men with early prostate cancer have been placed on drug therapy to suppress their production of testosterone, despite such significant side effects as impotence, diabetes and bone loss. Now a large new analysis has concluded that so-called androgen deprivation therapy does not extend the lives of these patients. "There are so many side effects associated with this therapy, and really little evidence to support its use," said Dr. Grace L. Lu-Yao, a researcher at the Rutgers Cancer Institute of New Jersey and the lead author of the report, published on Monday in JAMA Internal Medicine. "I would say that for the majority of patients with localized prostate cancer, this is not a good option" (O'Connor, 7/14).

Modern Healthcare: Digital Mammography Costlier, Shows No Detection-Rate Advantages: Study
Despite a nearly $300 million increase in Medicare spending linked to a sharp rise in the use of newer, more-sensitive breast-cancer screening technologies, no changes were seen in early detection rates, a study in the Journal of the National Cancer Institute found. Healthcare dollars may be wasted, some experts say, when widespread adoption of a new test precedes evidence of its meaningful clinical benefit (Rice, 7/16). 

Medscape: Telecare Intervention Improves Chronic Pain For VA Patients
A telecare intervention using basic telephone technology and collaborative care management resulted in clinically meaningful improvements in chronic musculoskeletal pain compared with usual care, according to an article published online July 15 in JAMA. Kurt Kroenke, MD, from the Veterans Administration (VA) Center for Health Information and Communication, Roudebush VA Medical Center, Indianapolis, Indiana, and colleagues conducted a randomized trial involving 250 patients from 5 primary care clinics within the center between June 2010 and May 2012 (Hand, 7/15).

Reuters: Some Kidney Donors Struggle To Buy Life Insurance: Study
Although people who have donated a kidney have passed a rigorous battery of tests and tend to be healthier than the average person, many report difficulty getting or changing health or life insurance policies after the surgery, according to a new study. "These are the healthiest people in the nation, they've undergone more health screening scrutiny than anybody else for any process," said senior author Dr. Dorry L. Segev. "We only allow the healthiest people to do this." Segev is an abdominal transplant surgeon at Johns Hopkins University School of Medicine in Baltimore, Maryland, where the study took place (Doyle, 7/16).