Research Roundup: Economics Of Chronic Care; State-Run Marketplaces

Annals of Internal Medicine: Medicare Chronic Care Management Payments And Financial Returns To Primary Care Practices--A Modeling Study
Physicians have traditionally been reimbursed for face-to-face visits. A new non–visit-based payment for chronic care management (CCM) of Medicare patients took effect in January 2015. ... If nonphysician staff were to deliver CCM services, net revenue to practices would increase despite opportunity and staffing costs. Practices could expect approximately $332 per enrolled patient per year... if CCM services were delivered by registered nurses (RNs), approximately $372 ... if services were delivered by licensed practical nurses, and approximately $385 ... if services were delivered by medical assistants. ... At a minimum, 131 Medicare patients ... must enroll for practices to recoup the salary and overhead costs of hiring a full-time RN to provide CCM services. (Basu et al., 9/22)

The Commonwealth Fund: The Experiences of State-Run Marketplaces That Use HealthCare.gov
This brief explores the experiences of four states—Idaho, Nevada, New Mexico, and Oregon—that established their own exchanges but have operated them with support from the federal HealthCare.gov eligibility and enrollment platform. Drawing on discussions with policymakers, insurers, and brokers, we examine how these supported state-run marketplaces perform their key functions. We find that this model may offer states the ability to maximize their influence over their insurance markets, while limiting the financial risk of running an exchange. (Giovannelli and Lucia, 9/17)

The Kaiser Family Foundation: Serving Low-Income Seniors Where They Live: Medicaid's Role In Providing Community-Based Long-Term Services And Supports
To better understand the low-income population with [long-term services and supports] LTSS needs, including those covered by Medicaid and those who are not, this issue brief examines the need for LTSS among seniors who live in the community and need LTSS. We use the 2011 National Health and Aging Trends Study (NHATS) to examine rates of need for LTSS and detail the characteristics of seniors who need these services. Throughout the brief, we compare dual eligible beneficiaries to low-income seniors without Medicaid. We also examine a third group, higher income seniors without Medicaid, to understand the role of income. Because LTSS needs increase with age, we also examine differences by age. (Garfield, 9/18)

National Governors Association: Using Data To Better Serve The Most Complex Patients: Highlights From NGA’s Intensive Work With Seven States
[C]omplex care patients, sometimes referred to as super-utilizers, have comorbid and often serious conditions. ... such conditions often span both physical and behavioral health and are often further complicated by social factors, such as housing instability, poverty, or limited education. ... complex care patients represent only a small proportion (5 percent) of [Medicaid] beneficiaries but account for more than half of program costs. ... the National Governors Association has worked with several states to develop statewide [data] initiatives for improving the management of care for super-utilizers .... The following lessons learned can help state leaders ...: Understand the characteristics of complex populations. ... Identify and target specific patients. ... Ensure effective management and evaluation. (Isasi, 9/23)

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

Reuters: Americans Overpaying Hugely For Cancer Drugs - Study
Americans are paying way over the odds for some modern cancer drugs, with pharmaceutical companies charging up to 600 times what the medicines cost to make, according to an independent academic study. The United States also pays more than double the price charged in Europe for these drugs - so-called tyrosine kinase inhibitors (TKIs), a potent class of cancer pills with fewer side effects than chemotherapy. The analysis by pharmacologist Andrew Hill of Britain's University of Liverpool, who will present his findings at the Sept. 25-29 European Cancer Congress in Vienna, is likely to fuel a growing storm over U.S. drug costs. (Hirschler, 9/22)

The Philadelphia Inquirer/Health Day: ERs Often 'Safety Net' Care For People With Schizophrenia: CDC
A new report finds that, too often, under-medicated Americans suffering from schizophrenia end up seeking care in the nation's hospital emergency rooms. The report, issued Wednesday by the U.S. Centers for Disease Control and Prevention, found that between 2009 and 2011, over 382,000 visits to ERs were recorded for people aged 18 to 64 with schizophrenia. (9/23)

Reuters: Weight-Loss Surgery May Not Increase Health Costs For Diabetes
Weight loss surgery may be a cost-effective way of lowering blood sugar for many diabetics, not just those who are severely obese, a Swedish study suggests. Researchers found that for people with diabetes, total healthcare costs did not rise in the years following weight-loss surgery, largely because of overall savings from less use of healthcare and medications. (Rapaport, 9/23)

Reuters: A Text Message A Day May Keep The Doctor Away
Texting patients regular reminders to do things like eat right, exercise more and smoke less may help them make lifestyle changes linked to a lower risk of heart attacks and strokes, an Australian study suggests. Researchers sent four texts a week to about 350 people with heart disease to supplement their regular care with reminders designed to encourage healthier habits. Another group of about 350 patients stuck with their usual care routines but didn’t receive texts. (9/23)

The New York Times: Consumers Are Embracing Full-Fat Foods
Public health authorities have long urged Americans to cut back on foods high in saturated fat like butter, meat and whole milk. But a new report on dietary-fat consumption suggests that the public is increasingly eating more, not less, of these foods. The new report, which was published last week by the Credit Suisse Research Institute, found that sales of butter in the United States rose 14 percent last year and climbed another 6 percent in the first three months of 2015. Sales of whole milk rose 11 percent in the first half of this year, while skim milk purchases fell 14 percent. The report also predicted that consumption of red meat and eggs would climb in the coming years. (O'Connor, 9/23)

Reuters: Telehealth Visits May Be An Option After Surgery
People may happily, and safely, forgo in-person doctors' visits after surgery by opting instead for talking with their surgeons by phone or video, suggests a small study of U.S. veterans. Most patients preferred the virtual visits and the doctors didn't miss any infections that popped up after surgery, the researchers report in JAMA Surgery. (Seaman, 9/23)

Medscape: Many Poor Kids With Mental Illness Miss Out On Benefits
A "sizable" number of US children with mental disorders who are from low-income households do not receive federal benefits under the Social Security Administration's Supplemental Security Income (SSI) program, according to a new report from the National Academies of Sciences, Engineering, and Medicine, in Washington, DC. However, the number of these children who are receiving SSI funds is growing at a pace consistent with the mental health trends in the general population, the report indicates. (Brooks, 9/21)

Medscape: DNR After In-Hospital Cardiac Arrest May Not Match Prognosis
Among patients who had an in-hospital cardiac arrest and successful restoration of spontaneous circulation, do-not-resuscitate (DNR) orders were generally issued quickly and reflected predicted prognosis, a new study reports. However, the study, which was published in the September 22/29, 2015 issue of the Journal of the American Medical Association, also identified room for improvement. (Busko, 9/23)