Research Roundup: Helping Insurers; Vaccinating Pregnant Women; Malpractice Claims

Health Affairs: Risk Adjustment, Reinsurance Improved Financial Outcomes For Individual Market Insurers With The Highest Claims
Because insurers can no longer vary their offers of coverage based on applicants’ health status, the [Affordable Care Act] established a risk adjustment program to equalize health-related cost differences across plans. The ACA also established a temporary reinsurance program to subsidize high-cost claims. ... we compared revenues to claims costs for insurers in the individual market during the first two years of ACA implementation (2014 and 2015), before and after the inclusion of risk adjustment and reinsurance payments. Before these payments were included, for the 30 percent of insurers with the highest claims costs, claims (not including administrative expenses) exceeded premium revenues by $90–$397 per enrollee per month. The effect was reversed after these payments were included, with revenues exceeding claims costs by $0–$49 per month. (Jacobs, Cohen and Keenan, 3/29)

The New England Journal of Medicine: Maternal Immunization
Vaccines have been one of the most useful tools for achieving substantial reductions in childhood mortality. However, progress in reducing deaths has been slower for infants too young to be vaccinated than for infants and children old enough to receive vaccines. ... This vulnerability of infants who are too young to be vaccinated can be addressed by means of maternal vaccination. Moreover, several infections, such as influenza and hepatitis E, are considered to be associated with increased morbidity and mortality during pregnancy. ... This article synthesizes the evidence for current maternal immunization recommendations, reviews new developments in this rapidly evolving field, and outlines critical areas for future research that will provide a framework for a comprehensive maternal immunization platform. (Omer, 3/30)

JAMA Internal Medicine: Rates And Characteristics Of Paid Malpractice Claims Among US Physicians By Specialty, 1992-2014
This database study linked National Practitioner Data Bank claims data with physician specialty and found that the overall rate of claims paid on behalf of physicians deceased by 55.7% from 1992 to 2014. Mean compensation amounts and the percentage of payments exceeding $1 million increased during that time, with wide differences in rates and characteristics across specialties. ... The increases ranged from $17 431 in general practice ... to $114 410 in gastroenterology ... and $138 708 in pathology. (Schaffer et al., 3/27)

JAMA/The Kaiser Family Foundation: US Public Opinion On Health Care Reform, 2017
This Visualizing Health Policy infographic spotlights public opinion on health reform in the United States as of 2017. The largest percentage of Democrats and Republicans give top priority to lowering out-of-pocket costs for health care. However, other priorities vary by political party: 63% of Republicans vs 21% of Democrats view Affordable Care Act (ACA) repeal as a top priority, while 67% of Democrats vs 55% of Republicans view lowering the cost of prescription drugs as a top priority. (Kirzinger et al., 3/29)

Morbidity and Mortality Weekly Report/CDC: Methadone Prescribing And Overdose And The Association With Medicaid Preferred Drug List Policies — United States, 2007–2014
Methadone accounted for approximately 1% of all opioids prescribed for pain but accounted for approximately 23% of all prescription opioid deaths in 2014. State drug management practices and reimbursement policies can affect methadone prescribing practices and, in turn, might reduce methadone overdose rates within a state. ... Drug utilization management policies that reduce the use of risky opioids such as methadone might reduce opioid-related morbidity and mortality. This evidence of decreases in methadone overdoses and use of preferred drug list policies could serve as a model for future decreases in other specific opioid drug-related mortality. (Faul, Bohm and Alexander, 3/30)

JAMA Ophthalmology: Economic Evaluation Of A Home-Based Age-Related Macular Degeneration Monitoring System
Findings: In this economic analysis using a simulation model, home telemonitoring was considered to be cost-effective in developed countries for patients at high risk for the neovascular form of age-related macular degeneration ($35 663 per quality-adjusted life-year gained). Home monitoring for age-related macular degeneration currently would cost society $907 and be cost saving for patients, incurring $1312 in government expenditures during 10 years. Meaning: This simluation model suggests that supplementing usual care with home telemonitoring for patients at high risk for developing neovascular age-related macular degeneration not only reduces risk of vision loss but also is cost-effective, although incurring net costs for Medicare. (Wittenborn et al., 3/30)

Health Affairs: Implementing MACRA
President Barack Obama signed the Medicare Access and CHIP Reauthorization Act (MACRA) into law on April 16, 2015. The law, passed by a strong bipartisan majority in both chambers of Congress, replaced a controversial existing Medicare physician payment system in effect since 1999. The new law makes fundamental changes in the government's approach to physician payment. ... This policy brief focuses primarily on the context in which these changes are taking place, implementation challenges, and the debate over the law and the concepts that underlie it. (Findlay, 3/27)

The Kaiser Family Foundation: Impact Of Cost Sharing Reductions On Deductibles And Out-Of-Pocket Limits
This note briefly describes the cost-sharing reductions in current law and illustrates their impact by looking at how these provisions affect average deductibles and out-of-pocket maximum limits in benchmark silver plans in 2017 in states using the federally facilitated marketplace. (Rae, Claxton and Levitt, 3/22)