Research Roundup: Veterans Health Care; Hospital Acquired Infections; And Exchange Enrollment

Health Affairs: Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access
Aiming to increase care access, the national Primary Care–Mental Health Integration (PC-MHI) initiative of the Veterans Health Administration (VHA) embedded specialists, care managers, or both in primary care clinics to collaboratively care for veterans with psychiatric illness. The initiative’s effects on health care use and cost patterns were examined among 5.4 million primary care patients in 396 VHA clinics in 2013–16. The median rate of patients who saw a PC-MHI provider was 6.3 percent. Each percentage-point increase in the proportion of clinic patients seen by these providers was associated with 11 percent more mental health and 40 percent more primary care visits but also with 9 percent higher average total costs per patient per year. At the mean, 2.5 integrated care visits substituted for each specialty-based mental health visit that did not occur. PC-MHI was associated with improved access to outpatient care, albeit at increased total cost to the VHA. Successful implementation of integrated care necessitates significant investment and multidisciplinary partnership within health systems. (Leung et al, 8/1)

JAMA Internal Medicine: Time-Series Analysis Of Health Care–Associated Infections In A New Hospital With All Private Rooms
In this time-series analysis of a move from a 417-bed hospital with ward-type rooms to a 350-bed facility with solely private rooms, the move was associated with reductions in the incidence of nosocomial vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus colonization and vancomycin-resistant Enterococcus infection. However, no change in nosocomial Clostridioides difficile or methicillin-resistant Staphylococcus aureus infections was noted. (McDonald et al, 8/19)

The Henry J. Kaiser Family Foundation: Enrollment In Individual Market Dips Slightly In Early 2019 After Repeal Of Individual Mandate Penalty
A new KFF analysis finds that overall enrollment in the individual market fell 5% to 13.7 million in the first quarter of 2019 following the repeal of the Affordable Care Act’s individual mandate penalty. The analysis provides an early look at how the market is working following recent policy changes that some argued would spark dramatic upheaval among consumers who buy their own health insurance either through the Affordable Care Act’s marketplaces or through off-exchange plans. (8/21)

Urban Institute: State Variation In Medicaid Prescriptions For Opioid Use Disorder From 2011 To 2018
Expanding access to effective treatment for opioid use disorder (OUD) is essential to staunching the opioid epidemic. Access to these treatments is particularly important in Medicaid, which covers a disproportionately large share of people with OUD (MACPAC 2017). Despite strong evidence supporting the effectiveness of pharmacotherapy for OUD (sometimes called medication-assisted treatment), research indicates that most people with OUD do not receive treatment (Clemans-Cope, Lynch, et al. 2019; Saloner and Karthikeyan 2015). Three medications—buprenorphine, methadone, and naltrexone—are approved by the Food and Drug Administration (FDA) for OUD treatment and have well-documented benefits. This brief uses Medicaid State Drug Utilization Data (SDUD) to assess buprenorphine maintenance treatment in Medicaid. We estimated trends from 2011 to 2018 and patterns across states and the District of Columbia, which we consider a state for this analysis. (Clemans-Cope, Lunch, Winiski and Epstein, 8/21)

Commonwealth Fund: What Is Your State Doing To Affect Access To Health Insurance
Select a state on the map and an action above to learn what the individual insurance market stabilization strategies states may be pursuing. (8/12)

The New York Times: Flavonoids In Plants May Help Protect Against Major Killers
Consuming flavonoids, a large class of nutrients found in plant foods, may reduce the risk for cancer and cardiovascular death. Researchers used data on 56,048 Danes, following their diet and health prospectively for 23 years. During that time, 14,083 of them died. The study is in Nature Communications. After controlling for smoking, hypertension, cholesterol and many other health and dietary factors, they found that compared with people in the lowest one-fifth for flavonoid intake, those in the highest one-fifth had a 17 percent reduced risk for all-cause mortality, a 15 percent reduced risk for cardiovascular disease death, and a 20 percent reduced risk for cancer mortality. (Bakalar, 8/19)

Urban Institute: What Happens When We Forgive Debt From Child Support Payments?
In California, 70 percent of child support payments don't go to parents to support their children, but to reimburse the government for public assistance their children have received. If parents miss a payment or don’t pay the full amount due, they accrue  “public assistance payback debt” with 10 percent interest. Most parents who owe this debt earn under $15,000 a year. This public assistance payback policy involves additional stiff penalties: parents’ driver’s and professional licenses can be suspended, up to 65 percent of their paycheck can be garnished, and they can be jailed. (Hahn and Kuehn, 8/20)