Research Roundup: Insurance Churning; Hospital Readmission Rates; Teen HPV Vaccinations

Health Affairs: Insurance Churning Rates For Low-Income Adults Under Health Reform: Lower Than Expected But Still Harmful For Many
Changes in insurance coverage over time, or “churning,” may have adverse consequences, but there has been little evidence on churning since implementation of the major coverage expansions in the Affordable Care Act (ACA) in 2014. We [surveyed] 3,011 low-income adults in Kentucky, which used a traditional expansion of Medicaid; Arkansas, which chose a “private option” expansion that enrolled beneficiaries in private Marketplace plans; and Texas, which opted not to expand. We also compared 2015 churning rates in these states to survey data from 2013, before the coverage expansions. Nearly 25 percent of respondents in 2015 changed coverage during the previous twelve months—a rate lower than some previous predictions. We did not find significantly different churning rates in the three states over time. (Sommers et al., 10/4)

Health Affairs: Rethinking Thirty-Day Hospital Readmissions: Shorter Intervals Might Be Better Indicators Of Quality Of Care
We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control. (Chin et al., 10/4)

Pediatrics: Achieving High Adolescent HPV Vaccination Coverage
Despite national recommendations for adolescent human papillomavirus (HPV) vaccination, rates have lagged behind those of other adolescent vaccines. ... Denver Health is an integrated urban safety net health system serving >17 000 adolescents annually. The process for achieving high vaccination rates in our health system includes “bundling” of vaccines, offering vaccines at every visit, and standard orders. ... In 2013, HPV coverage of ≥1 dose was 89.8% (female subjects) and 89.3% (male subjects), compared with national rates of 57.3% and 34.6%. Rates of HPV coverage (≥3 doses) were 66.0% for female subjects and 52.5% for male subjects, versus 37.6% and 13.9% nationally. ... Female subjects, Hispanic subjects, non-English speakers, and teenagers <200% below the federal poverty level were more likely to have received 3 doses of HPV. (Farmer et al., 10/5)

The New England Journal of Medicine: The Health Effects Of Electronic Cigarettes
It is clear that the use of e-cigarettes has biologic effects and possibly health-related effects on persons who do not smoke conventional tobacco products. Although some studies suggest that smoking e-cigarettes may be less dangerous than smoking conventional cigarettes, more needs to be learned. A particular challenge in this regard is the striking diversity of the flavorings in e-cigarette liquids, since the effects on health of the aerosol constituents produced by these flavorings are unknown. At present, it is impossible to reach a consensus on the safety of e-cigarettes except perhaps to say that they may be safer than conventional cigarettes but are also likely to pose risks to health that are not present when neither product is used. ... e-cigarette use is growing among minors and young adults and may promote nicotine addiction in these age groups. (Dinakar and O’Connor, 10/6)

Annals of Internal Medicine: Trends In Prevalence Of Chronic Kidney Disease In The United States
The unadjusted prevalence of stage 3 and 4 [chronic kidney disease] CKD increased from the late 1990s to the early 2000s. Since 2003 to 2004, however, the overall prevalence has largely stabilized (for example, 6.9% prevalence in 2003 to 2004 and in 2011 to 2012). There was little difference in adjusted prevalence of stage 3 and 4 CKD overall in 2003 to 2004 versus 2011 to 2012 after age, sex, race/ethnicity, and diabetes mellitus status were controlled for (P = 0.26). Lack of increase in CKD prevalence since the early 2000s was observed in most subgroups and with an expanded definition of CKD. (Murphy et al., 10/4)

Urban Institute: Designing A Medicare Buy-In And A Public Plan Marketplace Option: Policy Options And Considerations
Presidential candidate Hillary Clinton has indicated interest in a Medicare buy-in option for those ages 55 to 64 and a public plan option for the Affordable Care Act’s Marketplaces as mechanisms for increasing the affordability of insurance outside employer-sponsored insurance. Medicare is an attractive basis for developing insurance alternatives (either a direct buy-in or a public option based in Medicare rates) since the program generally has lower provider payment rates and lower administrative costs than private insurers. This paper explores the design issues raised by these proposals and their implications for costs and benefits to different age groups. (Blumberg and Holahan, 9/29)

The Kaiser Family Foundation: The Gap In Medigap
Medicare provides coverage for a wide array of medical and drug benefits, but, with its deductibles, cost-sharing requirements, and lack of an annual out-of-pocket spending limit, many people on Medicare purchase Medigap supplemental insurance to help cover their out-of-pocket costs. ... Thanks to a 1990 federal law, people age 65 and older are able to buy a Medigap policy when they sign up for Medicare, but younger Medicare beneficiaries with disabilities are not granted the same right unless they live in a state that requires it. Today, Medicare covers 9 million people under 65 with disabilities. ... a much smaller share of beneficiaries under 65 with disabilities than seniors have a Medigap policy (2% versus 17%, respectively), and a much higher share have no supplemental coverage whatsoever (21% versus 12%). (Neuman and Cubanski, 9/27)

And one news outlet's report on recent research --

The Hill: Study: ObamaCare Enrollees More Likely To Have Checkups 
People who gained ObamaCare coverage in 2014 were more likely to have a regular doctor and an annual checkup than people who remained uninsured, a new study finds. The study, published in Health Affairs, finds that 27 percent of people who were uninsured in 2013 and gained coverage through ObamaCare’s marketplaces in 2014 went from not having a usual source of care to having one. That is significantly higher than the 11 percent of people who remained uninsured who gained a regular doctor. (Sullivan, 10/5)