Research Roundup: Exchange Premiums; Altering Doctor Practices; Workers’ Preferences

Urban Institute: Marketplace Premium Changes Throughout The United States, 2014-2015
In this paper, we examine marketplace premium changes between 2014 and 2015 in all rating regions in all states and the District of Columbia. We provide premium data on the lowest-cost silver plan within each rating region for a 40-year-old individual who does not use tobacco. We calculate that the population-weighted national average premium increase in the lowest-cost silver plan offered in each year was 2.9 percent. Increases varied considerably both across rating regions within states and across states. The change in the population-weighted average premium in the lowest-cost silver plan offered in each year was 1.8 percent in the Northeast, 3.5 percent in the Midwest, 5.4 percent in the South and 1.4 percent in the West. (Holahan, Blumberg and Wengle, 3/17)

Rand Corp./American Medical Association: Effects Of Health Care Payment Models On Physician Practice In The United States
[The researchers] aimed to describe the effects that alternative health care payment models (i.e., models other than fee-for-service payment) have on physicians and physician practices .... Respondents perceived that alternative payment models have encouraged the development of team approaches .... Market observers and physician practices reported that global capitation and related shared savings models were changing relationships between primary care and subspecialist physicians. ... Alternative payment models had negligible effects on the aggregate income of individual physicians within the sample. ... Alternative payment models have not substantially changed how physicians delivered face-to-face patient care. Additional nonclinical work created significant discontent. (Friedberg et al., 3/19)

The Kaiser Family Foundation/George Washington University: Community Health Centers: A 2013 Profile And Prospects As ACA Implementation Proceeds
In 2013, 1,202 federally funded health centers operating in 9,170 sites provided 61 million medical care visits, 11 million dental visits, 6.6 million visits for behavioral health needs, and 5.1 million visits for enabling services such as case management. In all, health centers provided more than 85 million visits. ... More than 70% of health center patients have income below 100% of the federal poverty level (FPL) .... Over one-third (35%) of health center patients were uninsured in 2013, and 41% were covered by Medicaid. As the ACA is implemented, early evidence suggests that the proportion of insured patients in the health care system will grow substantially. At the same time, however, the uninsured rate among health center patients is expected to remain high. (Shin et al, 3/17)

Brookings: High Value Health IT: Policy Reforms For Better Care And Lower Costs
[T]he Office of the National Coordinator (ONC) for Health IT recently announced a ten-year “Interoperability Roadmap” as the next step in its effort to promote more straightforward exchange of electronic health data for a wide range of clinical, administrative and public health purposes. Despite this progress, significant gaps in practical interoperability remain. ... This policy brief details several major challenges with existing health IT policy, and also describes policy recommendations to address these issues. The main goals of these recommendations are: (1) to align health IT efforts directly with other major payment reforms and policies to suppport higher value care and (2) ensure better health outcomes for patients, and (3) implement data standards for the most important information to support care improvement. (Basch, McClellan, Botts and Katikaneni, 3/16)

Employee Benefit Research Institute: Views On Employment-Based Health Benefits: Findings From The 2014 Health And Voluntary Workplace Benefits Survey
[D]ata on worker preferences will be useful toward making informed decisions about the future direction of employment-based health benefits. ... Nearly 70 percent report that they are satisfied with the health benefits they currently receive, while 12 percent say they would trade wages to get more health benefits, and 19 percent say they would surrender some health benefits for higher wages. ... the importance of benefits as criteria in choosing a job remains high, and health insurance in particular continues to be, by far, the most important employee benefit to workers. ... Choice of health plans is important to workers, and they would like more choices, but most workers express confidence that their employers or unions have selected the best available health plan. (Fronstin and Helman, 3/16)

Brookings: Disruptive Entrepreneurship Is Transforming U.S. Health Care
Economists and other experts debate why, in the past few years, health care inflation has abruptly and significantly moderated. ... This paper, however, adds weight to a significant body of evidence suggesting that longer-lasting structural changes are also at work: in particular, changes in economic incentives ... have given rise to an entrepreneurial ... ecosystem. Supporting this ecosystem are four developments: first, changes in public and private payment structures that reward value; second, rapid improvements in information technology; ... third, an influx of creative value-seeking entrepreneurship ...; fourth, an investor infrastructure that is eager to bankroll value-seeking startups. In short, health care is beginning to taste the disruptive culture of Silicon Valley, retailing, and many other American sectors. (Rauch, 3/17)

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

Reuters: Early X-Rays Might Not Help Elderly With New Back Pain
Older people with a new episode of back pain shouldn’t be sent right away for x-rays or other imaging studies, new research suggests. They won’t be any better off, and they’ll end up with bigger bills, the researchers say. “We found that they didn’t have worse or better outcomes, and yet they were certainly getting more things done to them downstream,” said Dr. Jeffrey Jarvik, the study’s lead author from the University of Washington in Seattle. (Doyle, 3/17)

The New York Times: Too Much Cardiac Testing
The electrocardiogram you got at your most recent physical may have been a waste of time and money. A guideline from the American College of Physicians published Monday in The Annals of Internal Medicine concludes that routine cardiac testing of adults without symptoms has not been shown to improve patient outcomes, and can lead to potential harms. There is no evidence that stress tests, electrocardiograms or myocardial perfusion imaging (the so-called nuclear stress test that involves exposure to radiation) have any advantages over routine risk assessment in asymptomatic people. All the tests commonly produce false positives that lead to further unnecessary testing, and all involve extra expense. (Bakalar, 3/16)

The New York Times: Breast Biopsies Leave Room For Doubt, Study Finds
Breast biopsies are good at telling the difference between healthy tissue and cancer, but less reliable for identifying more subtle abnormalities, a new study finds. Because of the uncertainty, women whose results fall into the gray zone between normal and malignant — with diagnoses like “atypia” or “ductal carcinoma in situ” — should seek second opinions on their biopsies, researchers say. Misinterpretation can lead women to have surgery and other treatments they do not need, or to miss out on treatments they do need. (Grady, 3/17)

MinnPost: Income Inequality: What Is Its Toll On Workers' Health?
The rise in income inequality over the past three decades or so is taking a major toll on the general health of American workers — and not just because stagnant or falling wages have made it increasingly difficult for many workers to afford high-quality health care. For, as a commentary published recently in the American Journal of Public Health points out, income inequality has also been accompanied by changes in the workplace that increase workers’ stress in ways that negatively affect their health. (Perry, 3/17)

Bloomberg: Costs Of Obesity Ballooning For Employers, Individuals And U.S.
Obesity is weighing heavily on the U.S. economy. As a panel of scientists considers ways to help Americans trim down, unpublished research shows medical expenses linked to being extremely overweight have skyrocketed. Experts say the damage is augmented by reduced productivity, wider gender and income inequality and even higher transportation costs. (Stilwell, 3/16)

Reuters: Experts Call For Transparency On Insulin Pump Problems
When diabetic patients report problems with their insulin pumps, the pump manufacturers collect that information – but there’s no easy way for researchers to analyze the data independently, a new paper says. In a joint statement, experts from the American Diabetes Association and the European Association for the Study of Diabetes say regulatory agencies should work together to create standards that apply to all pump manufacturers. People who use these devices shouldn’t be alarmed, however. (Doyle, 3/17)