Research Roundup: Suicide Ideation; Medicaid Expansion; And Premium Changes

Pediatrics: Hospitalization For Suicide Ideation Or Attempt: 2008–2015
Encounters for SI and SA at US children’s hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children’s hospitals and health care delivery systems. (Plemmons et al, 6/1)

The Commonwealth Fund: Complex Needs Medicaid Expansion Enrollees Low Incomes
Early Medicaid expansion enrollees in urban Minnesota were largely nonwhite, male, and unmarried and had low educational attainment. In this very poor population, rates of homelessness, substance use, and mental illness were very high. More than 25 percent of adults dealt with two or more of these challenges, while 10 percent experienced all three. Providing access to a range of highly integrated health and social services may be the best way to help these individuals. (Shippee and Vickery, 5/31)

The Henry J. Kaiser Family Foundation: Tracking 2019 Premium Changes On ACA Exchanges
Insurers submit filings every year to state regulators detailing their plans to participate in the Affordable Care Act marketplaces (also called exchanges). These filings include information on the premiums insurers plan to charge in the coming year and which areas they plan to serve. Each state or the federal government reviews premiums to ensure they are accurate and justifiable before the rate goes into effect, though regulators have varying types of authority and states make varying amounts of rate review information public. This analysis looks at preliminary lowest-cost bronze and second lowest-cost silver premiums in the 50 states and the District of Columbia. (Kamal, Cox, Long, Semanskee and Levitt, 6/6)

Brookings: How Did The Individual Mandate Affect Insurance Coverage?
The ACA’s individual mandate appears to have meaningfully increased insurance coverage among people with family incomes above 400 percent of FPL. While extrapolating this estimate to the non-elderly population as a whole introduces considerable uncertainty, the estimates presented in this paper suggest that the individual mandate increased the number of people with insurance coverage by at least several million in 2016. (Matthew Fielder, 5/31)

Employee Benefit Research Institute: The Impact of Length of Time Enrolled in a Health Plan on Consumer Engagement and Health Plan Satisfaction
The survey found that engagement and satisfaction for the most part do not change with the length of time an individual has been enrolled in their health plan. What appears to be disengagement among individuals with the longest enrollment length may merely reflect their familiarity with various options available to them. Plan sponsors and employers may need to think about different ways to engage plan members with different lengths of plan tenure. (Frontin, Dretzka, Greenwald et al., 5/22)

JAMA Internal Medicine: An Advance Care Planning Video Decision Support Tool For Nursing Home Residents With Advanced Dementia: A Cluster Randomized Clinical Trial
In this cluster randomized clinical trial of 402 patients with advanced dementia, do-not-hospitalize directives, care preferences, and burdensome treatments did not significantly differ between trial arms. In intervention facilities, residents were more likely to have directives to withhold tube-feeding, and, when comfort care was preferred, to have do-not-hospitalize and no tube-feeding directives. (Mitchell et al, 6/4)

Annals of Internal Medicine: Association Between Prescription Drug Monitoring Programs and Nonfatal and Fatal Drug Overdoses
Evidence that PDMP implementation either increases or decreases nonfatal or fatal overdoses is largely insufficient, as is evidence regarding positive associations between specific administrative features and successful programs. Some evidence showed unintended consequences. Research is needed to identify a set of “best practices” and complementary initiatives to address these consequences. (Fink et al., 6/5)

Urban Institute: Changes To Title X Funding Could Affect Access To Health Care For Millions Of Women
On May 22, the department of Health and Human Services released proposed regulations, supported by the White House, that would place new restrictions on the use of Title X family planning program funding. Title X provides $286 million a year to safety net family planning clinics like Planned Parenthood and state public health departments to provide birth control services, pregnancy tests, screenings, and general medical care. Federal funds currently cannot be used to pay for abortion except in cases of rape, incest, or endangerment of a woman's life. The proposed rule would withhold all federal funds from family planning clinics and providers that perform or refer patients to abortion services. (Johnston and Shartzer, 5/23)

Health Affairs: Balancing Affordability And Access: Lessons From New Cholesterol-Lowering Drugs
The lessons learned from PCSK9Is can inform the design of more effective approaches to balancing budget affordability and appropriate access for future beneficial but expensive specialty drugs for broad populations. First, we have learned that blunt one-size-fits-all and highly burdensome PA requirements and processes that reward administrative competence instead of fast-tracking clinical urgency are likely to stand in the way of value-based care and allow high-risk patients to fall through the cracks. Second, we have learned that payers and manufacturers can work together and meet halfway in an attempt to improve access through innovative payment arrangements. (Doshi et al., 6/5)

JAMA Internal Medicine: Effect Of Increased Inpatient Attending Physician Supervision On Medical Errors, Patient Safety, And Resident Education: A Randomized Clinical Trial
Increased direct attending physician supervision did not significantly reduce the medical error rate. In designing morning work rounds, residency programs should reconsider their balance of patient safety, learning needs, and resident autonomy. (Finn, Metlay and Chang, 6/4)