Research Roundup: Medicaid Churning; Addiction Coverage; Medicare Advantage Enrollment

Health Affairs: Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective
Medicaid churning—the constant exit and reentry of beneficiaries as their eligibility changes—has long been a problem ... Churning will continue under the Affordable Care Act because, despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options—extending eligibility either to the end of a calendar year or for twelve months after enrollment—would be the most effective methods for reducing churning. (Swartz, Farley Short, Roempke Graefe and Uberoi, 7/7)

Health Affairs: Lessons From Medicaid’s Divergent Paths On Mental Health And Addiction Services
Medicaid has taken divergent paths in financing mental health and addiction treatment. In mental health, Medicaid became the dominant source of funding and had a profound impact on the organization and delivery of services. But it played a much more modest role in addiction treatment. ... the Affordable Care Act is expected to dramatically expand Medicaid’s role in financing addiction services. In this article we ... identify strategic lessons that the addiction treatment system might take from mental health’s experience under Medicaid. These lessons include leveraging optional coverage categories to tailor Medicaid to the unique needs of the addiction treatment system, providing incentives to addiction treatment programs to create and deliver high-quality alternatives to inpatient treatment, and using targeted Medicaid licensure standards to increase the quality of addiction services. (Andrews, Grogan, Brennan and Pollack, 7/7)

The Kaiser Family Foundation: Medicare Advantage 2015 Spotlight: Enrollment Market Update
This Data Spotlight ... analyzes the most recent data on premiums, out-of-pocket limits, Part D cost sharing, and plans’ quality ratings for Medicare Advantage enrollees. ... Medicare Advantage enrollment has continued to grow and increased in virtually all states in 2015. Almost one in three (31 percent) people on Medicare (16.8 million beneficiaries) were enrolled in a Medicare Advantage plan in March 2015 – up by more than one million beneficiaries from 2014. ... enrollment continues to be highly concentrated among large firms .... most enrollees continue to be in HMOs (64% in 2015). ... The share of enrollees in plans with 4 or more stars rose from 37 percent in 2013 to 61 percent in 2015. While growth in premiums has been relatively modest, ... plans provide less financial protection to Medicare enrollees than they have in the past. (Jacobson, Damico, Neuman and Gold, 6/30)

The Kaiser Family Foundation: Renewals In Medicaid And CHIP: Implementation Of Streamlined ACA Policies And The Potential Role Of Managed Care Plans
[T]his brief reviews the new renewal requirements for Medicaid and CHIP that are designed to maintain continuity of coverage for eligible individuals. ... While states have made significant progress implementing new enrollment processes, some aspects of the simplified renewal policies have not yet been fully implemented due to a range of challenges. While many states have been delayed in implementing the streamlined renewal policies, some states, including Washington and Rhode Island, have successfully implemented the new policies and achieved high retention rates with more than nine in ten enrollees successfully renewed. Managed care plans can support renewals by reminding members to renew and providing direct assistance with the renewal process. (Ryan and Artiga, 6/26)

Duke University Journal of Health Politics, Policy and Law: Addressing Pricing Power In Integrated Delivery: The Limits Of Antitrust
The pricing power that hospitals have garnered recently has resulted from consolidated delivery systems and concentrated markets, leading to enhanced negotiating leverage. ... the frame of consolidation leads to unrealistic expectations for what antitrust’s role in addressing pricing power should be, especially because in the wake of two periods of merger “manias” and “frenzies” many markets already lack effective competition. It is particularly challenging for antitrust to address extant monopolies lawfully attained. New payment and delivery models being pioneered in Medicare, especially those built around accountable care organizations (ACOs), offer an opportunity to reduce pricing power, but only if they are implemented with a clear eye on the impact on prices in commercial insurance markets. (Berenson, 6/29)

Journal of the American Medical Informatics Association/Brookings: An Empirical Analysis Of The Financial Benefits Of Health Information Exchange In Emergency Departments
[Researchers sought to] examine the impact of health information exchange (HIE) on reducing laboratory tests and radiology examinations performed in an emergency department (ED). ... The study was conducted in an ED setting in Western New York over a period of 2 months. The care of the patients in the treatment group included an HIE query for every encounter, while the care of other patients in the control group did not include such queries. A group of medical liaisons were hired to query the medical history of patients from an HIE and provide it to the ED clinicians. ... HIE usage is associated with, respectively, 52% and 36% reduction in the expected total number of laboratory tests and radiology examinations ordered per patient at the ED. (Yaraghi, 6/27)

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

The Associated Press: Not Berry Good: US Adults Still Skimp On Fruit And Veggies
Most U.S. adults still aren't eating nearly enough fruits and vegetables. In a large national survey, only 13 percent said they ate the recommended amount of fruit each day. And only 9 percent ate enough vegetables. California — a big produce-growing state — ranked highest for eating both fruits and vegetables. Tennessee was at the bottom of the fruit list, and Mississippi was last in eating vegetables. (Stobbe, 7/9)

Reuters: Overuse Of Nursing Home Antibiotics May Put All Residents At Risk
Some nursing home facilities prescribe antibiotics more often than others, which is tied to increased health risks, even for residents who don’t receive the medications, according to a new study. About two-thirds of nursing home residents receive antibiotic treatment of some kind each year. Prescribing the drugs inappropriately increases the risk of medication reactions, allergies, diarrhea and infections by antibiotic-resistant bacteria, the authors write in JAMA Internal Medicine. (Doyle, 7/1)

NPR: Teens Dying Of Cancer Face Intensive Treatments In The Final Days
In real life, most teenagers and young adults with terminal cancer have to suffer through chemotherapy and other intensive treatments in their final days of life, a study finds. ... For 68 percent of patients, those interventions include chemotherapy, treatment in the intensive care unit or emergency department, or hospitalization in their final month. The study, published in JAMA Oncology on Thursday, is the first of its kind to study end-of-life care for people ages 15 through 39. (Yang, 7/9)

CBS News: Cost Of Childbirth Varies Widely In U.S. Hospitals
Childbirth is the leading cause of hospital admission in the U.S., accounting for approximately four million hospitalizations each year. As standard as this procedure is, the prices that each hospital charges are not. In an effort to understand the huge difference in the cost of having a baby across the U.S., Xiao Xu, assistant professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine and colleagues parsed data on nearly 275,000 low-risk childbirths at 463 hospitals across the country. They found that the cost of maternity stays can vary from as little as $1,200 to as much as $12,000. (Kraft, 7/9)

Reuters: Healthier Meals Do Cost Families More
Shopping for healthier groceries, like whole wheat bread instead of white bread and lean meat instead of fattier cuts, would cost a family of four about $1,500 more a year at their regular stores, according to a new U.S. study. The small survey focused on 23 families of children with type 1 diabetes. Parents are urged to feed kids with diabetes a low-fat diet, but they may need help with problem-solving skills to provide healthy foods without a heavy burden of extra costs or prep time, researchers say. (Doyle, 7/8)

Medscape: States Vary Widely On Who Gets Hep C Drugs Under Medicaid
Two studies published online June 29 in the Annals of Internal Medicine examine how states are deciding which Medicaid patients will get sofosbuvir, the $1000-per-pill treatment for hepatitis C that has a 90% cure rate. The authors of both studies find restrictions vary tremendously across states' Medicaid fee-for-service programs and often differ with guidelines set out by professional associations. One study says the restrictions violate the federal Medicaid law. (Frellick, 7/1)

Medscape: The Doctor Will See You Eventually: Long Wait Times Scrutinized
Across the United States there is large variability in how long Americans wait to see a healthcare professional, ranging from same-day service to several months, according to new report from the Institute of Medicine (IOM) .... Reducing wait times will take "systems-based approaches" akin to those applied successfully in other industries, the report says. (Brooks, 6/29)

Reuters: Overweight U.S. Women Need Better Pre-Pregnancy Counseling: Study
Better care and counseling is needed to teach overweight women hoping to become pregnant about the health dangers of their excess weight and the importance of maintaining a healthy diet, a new U.S. study concludes. Those excess pounds can lead to diabetes and high blood pressure, which increase the chances of pregnancies complicated by gestational diabetes, pre-eclampsia (dangerously high blood pressure and high protein in the urine), cesarean section, stillbirth or congenital abnormalities, lead author Dr. Abbey Berenson and her team write in the Journal of the Academy of Nutrition and Dietetics. (Neumann, 7/3)

Reuters: Treat 'Whole Person' By Bringing Behavioral Health Into Primary Care: Docs
In a new position paper, the American College of Physicians lays out six strategies for bringing mental health and substance abuse care into primary care to better treat each patient as “a whole person.” Mental and behavioral health issues like inappropriate eating behaviors, sedentary lifestyle, and patterns of social isolation, are common, and have been linked to increased physical illness, higher mortality rates, poorer treatment outcomes and higher healthcare costs, the ACP committee writes in the Annals of Internal Medicine. (Doyle, 7/2)

Fox News: Cancer Forecast: Why More People Will Die, Even As Death Rates Fall
Cancer death rates will continue to decline in the United States through 2020, including death rates from some of the most common cancers in both men and women, a new study says. However, because the population is growing and getting older, the total number of cancer deaths will increase during that same period, the researchers said. The increases will be most pronounced among black and white men and black women, they said. (Rettner, 7/7)