Research Roundup: Marketplace Plan Information; Kids’ Mental Health; Drug Costs
Each week, KHN compiles a selection of recently released health policy studies and briefs.
Health Affairs:
Summarized Costs, Placement Of Quality Stars, And Other Online Displays Can Help Consumers Select High-Value Health Plans
Starting in 2017, all state and federal health insurance exchanges will present quality data on health plans in addition to cost information. We analyzed variations in the current design of information on state exchanges to identify presentation approaches that encourage consumers to take quality as well as cost into account .... Using an online sample of 1,025 adults, we randomly assigned participants to view the same comparative information on health plans, displayed in different ways. We found that consumers were much more likely to select a high-value plan when cost information was summarized instead of detailed, when quality stars were displayed adjacent to cost information, when consumers understood that quality stars signified the quality of medical care, and when high-value plans were highlighted with a check mark or blue ribbon. (Greene, Hibbard and Sacks, 4/4)
Health Affairs:
Use Of Nursing Home Compare Website Appears Limited By Lack Of Awareness And Initial Mistrust Of The Data
In December 2008 the Centers for Medicare and Medicaid Services (CMS) launched a five-star rating system of nursing homes as part of Nursing Home Compare, a web-based report card detailing quality of care .... We used a qualitative assessment of how consumers select nursing homes and of the role of information about quality, using semistructured interviews of people who recently placed a family member or friend in a nursing home. We found that consumers were receptive to using Internet-based information about quality ... but that choice was limited by the need for specialized services, proximity to family or health care providers, and availability of Medicaid beds. Consumers had a positive reaction when shown Nursing Home Compare; however, its use appeared to be limited. (Konetzka and Perraillon, 4/4)
Pediatrics:
Variations In Mental Health Diagnosis And Prescribing Across Pediatric Primary Care Practices
This retrospective review of electronic heath records from 43 US primary care practices included children aged 4 to 18 years with ≥1 office visit from January 1, 2009, to June 30, 2014. .... Among 294 748 children, 40 932 (15%) received a mental health diagnosis and 39 695 (14%) were prescribed psychotropic medication. Attention deficit/hyperactivity disorder was most commonly diagnosed (1%–16% per practice). The proportion of children receiving any psychotropic medication (4%-26%) and the proportion receiving ≥2 medication classes (1%-12%) varied across practices. Prescribing of specific medication classes also varied .... Variability was partially explained by community availability of psychiatrists (significantly higher odds of a diagnosis or prescription when not available) but not by colocation of mental health professionals or percentage of children in foster care. (Mayne et al., 4/1)
JAMA/Kaiser Family Foundation:
Recent Trends In Prescription Drug Costs
Prescription drug spending rose sharply in 2014, driven by growth in expenditures on specialty drugs, including medications to treat cancer and hepatitis C. Medicare’s spending on prescription pharmaceuticals also has risen: between 2004 and 2014, the program’s share of US drug expenditures increased from 2% of $193 billion to 29% percent of $298 billion. ... The majority of the public favors 4 policy actions to hold drug prices in check: requiring pharmaceutical companies to publicly release information on how they set prices; allowing Medicare to negotiate medication prices; limiting charges for high-cost drugs; and allowing people in the United States to buy drugs imported from Canada. (Cox et al., 4/5)
The Kaiser Family Foundation:
Traditional Medicare…Disadvantaged?
Under federal law and in many states, [Medigap] insurers are not required to participate in an annual open enrollment period, and are only required to sell a policy under specific circumstances, such as when applicants first enroll in Medicare at age 65 or within a year of trying a Medicare Advantage plan. In other words, consumer protections, such as an annual open enrollment period without pre-existing condition exclusions, do not apply to the Medigap market as they do for Marketplace and Medicare Advantage plans. This means that seniors who opt for a Medicare Advantage plan when they first go on Medicare can forever be locked out of the Medigap market. ... [if seniors] choose Medicare Advantage from the start, as more and more Boomers are doing, they may be making an irrevocable decision by giving up their right to purchase supplemental insurance later in life. (Neuman, 3/31)
Georgetown University Health Policy Institute/Robert Wood Johnson Foundation/Urban Institute:
Can Telemedicine Help Address Concerns With Network Adequacy? Opportunities And Challenges In Six States
[I]nsurers generally do not appear to be using telemedicine to fill gaps in plan networks or to meet state network adequacy standards. There is uncertainty about how state and federal regulators would assess the use of telemedicine, particularly where telemedicine encounters could be perceived as replacing, rather than supplementing, face-to-face access to a physician. In addition, the lack of payer and provider investment in the necessary technology, as well as concerns from organized medicine, has led to a lack of infrastructure and integration into medical practice. Specifically, some respondents question the cost efficiency of using telemedicine within provider practices because of the need for resources to support both the technology and the patient with a telemedicine visit. (Ahn, Corlette and Lucia, 4/6)
Here is a selection of news coverage of other recent research:
JAMA:
Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It
[T]he US Centers for Disease Control and Prevention (CDC) hasn’t funded research into gun violence prevention for 2 decades, ever since Congress included these 3 lines—named the Dickey Amendment for then-representative Jay Dickey (R, Ark), who introduced it—on page 245 of the 750-page Omnibus Consolidated Appropriations Act of 1997: “None of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.” The amendment was in response to a CDC-funded study that concluded having a gun in the home was associated with a higher risk of homicide by a family member or intimate acquaintance. ... the same language has also applied to the National Institutes of Health (NIH). However, as part of a funding opportunity for violence research announced in 2013, the NIH awarded Wintemute a total of about $850 000, from May 2015 through April 2017, to study whether gun owners with a history of alcohol and drug convictions are more likely to commit violence than gun owners without such a criminal history. Why the 2 federal agencies have interpreted the same rider so differently is not clear. (Rubin, 4/6)
Reuters:
World's Obese Population Hits 641 Million, Global Study Finds
More than 640 million people globally now weigh in as obese and the world has more overweight than underweight people, according to an analysis of global trends in body mass index (BMI). A startling increase in rates of obesity in the past 40 years means the number of people with a BMI of more than 30 has risen from 105 million in 1975 to 641 million in 2014, the study found. More than one in 10 men and one in seven women are obese. (Kelland, 3/31)
Reuters:
Baby Boomers Often Unaware They Need Hepatitis C Screening
Many baby boomers may be unaware they need screening for the hepatitis C virus, a small study suggests. In a survey of 81 emergency room patients born during the “baby boom” from 1945 to 1965, only 29 percent of participants knew their risk for the virus was higher than for people born in earlier or later generations, the study found. (Rapaport, 4/6)
Medscape:
Family Docs, Internists Least Likely To Pick Specialty Again
Family physicians and internists were the most likely among specialists to choose medicine as a career again (73% and 71%, respectively), but were the least likely to choose their own specialty (29% and 25%, respectively), according to the latest Medscape Physician Compensation Report. Again this year, the two disciplines had nearly the lowest pay among specialists in the survey, but satisfaction with compensation ranked in the middle for both. (Frellick, 4/7)
Reuters:
Longer Night Fasting Tied To Reduced Breast Cancer Reccurence
For breast cancer survivors, the risk of recurrence may be tied to how many hours they fast at night, a new study suggests. Women in the study were more likely to have their breast cancer come back if they fasted overnight for less than 13 hours, researchers found. (Seaman, 3/31)
Reuters:
U.S. Hispanics Have High Risk Of Heart Pumping Problems
Hispanic and Latino people in the U.S. have a high risk of heart pumping problems that can lead to heart failure, but most who have these disorders don’t know it, a recent study suggests. (Rapaport, 4/6)