Research Roundup: Medical Homes And Preventive Services; Medicaid Expansion Waivers

JAMA Internal Medicine: Patient-Centered Medical Home Implementation And Use Of Preventive Services
The patient-centered medical home (PCMH) model of primary care is being implemented in a wide variety of socioeconomic contexts, yet there has been little research on whether its effects differ by context. Clinical preventive service use, including cancer screening, is an important outcome to assess the effectiveness of the PCMH .... A longitudinal study spanning July 1, 2009, through June 30, 2012, using data from the Blue Cross Blue Shield of Michigan Physician Group Incentive Program was conducted. ... The implementation of a PCMH was associated with higher breast, cervical, and colorectal cancer screening rates .... PCMH implementation was associated with larger increases in screening in lower socioeconomic practice settings. (Markovitz et al., 2/17)

JAMA Ophthalmology: Outcomes Of An Inner-City Vision Outreach Program
[Researchers sought to] characterize the demographic characteristics and ophthalmic conditions in children attending Give Kids Sight Day (GKSD), an outreach ophthalmic care program held annually in Philadelphia .... We studied 924 children ... coming from 584 families who attended GKSD 2012, of whom 27% were uninsured and 10% were not aware of their insurance status. Forty-two percent ... had public insurance, which covered vision care and glasses, but 35% did not know their benefits and did not realize vision care was covered. Forty-nine percent of children attended because they failed community vision screening. Provision of free glasses and failure of previous vision screening were the most common reasons families elected to attend GKSD. (Dotan et al., 2/13)

The Kaiser Family Foundation: The ACA And Medicaid Expansion Waivers
As of February 2015, 29 states including DC are implementing the [Medicaid] expansion. Nearly all states (24 of 29) are implementing the expansion as set forth by law, but a limited number of states have obtained or are seeking approval through Section 1115 waivers to implement the expansion in ways that extend beyond the flexibility provided by the law .... This brief provides an overview of the role of Section 1115 waivers in expanding coverage since the enactment of the ACA. The brief also highlights key themes in these waivers including implementing the Medicaid expansion through a premium assistance model, charging premiums, eliminating certain required benefits (most notably non-emergency medical transportation), and using healthy behavior incentives. (Rudowitz, Artiga and Musumeci, 2/17)

The Kaiser Family Foundation: Are Uninsured Adults Who Could Gain Medicaid Coverage Working?
As additional states consider whether to implement the [Medicaid] expansion, some have raised pursuing waiver authority to tie Medicaid eligibility for adults under the expansion to work requirements. This fact sheet profiles uninsured adults who could gain Medicaid coverage under the ACA by their relationship to the workforce and job-based coverage. ... Nearly three out of four (72%) of the uninsured adults who could gain Medicaid coverage live in a family with at least one full-time or a part time worker and more than half (57%) are working full or parttime themselves. ... Most uninsured adults who would be eligible for the Medicaid expansion work in firms and industries that often have limited employer-based coverage options. (2/13)

The Urban Institute: Certificates Of Public Advantage Can They Address Provider Market Power?
A key problem [in health spending] is provider pricing power in increasingly concentrated health delivery markets. The growth of pricing power follows recent waves of hospital mergers, the emergence of “must-have” hospitals, and increasing integration with physicians. Antitrust law alone has done little to maintain competitive pricing. One alternative is the use of Certificates of Public Advantage (COPAs) to oversee merged hospitals. COPAs are seldom used, but one has operated in Western North Carolina for nearly 20 years. ... We conclude that this application of the COPA model has some successes, and with modifications a COPA-like approach could provide a useful complement to antitrust enforcement in addressing market power. (Bovbjerg and Berenson, 2/18)

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

Reuters: Racial Gaps In Diabetes Not Tied To Social, Economic Status
Social and economic status does not explain the racial gaps in the care and outcomes of kids with type 1 diabetes, according to a new study. The finding suggests researchers look to other factors that may explain the racial gap in type 1 diabetes care, such as the perceptions of doctors and families, write the researchers in the journal Pediatrics February 16. (Doyle, 2/16)

Reuters: Kids With Type 1 Diabetes At Risk For Mental Health Issues
In a new Swedish study, kids diagnosed with type 1 diabetes were more likely than their healthy siblings to develop a psychiatric disorder or to attempt suicide. (Doyle, 2/18)

Reuters: U.S. Cancer Survival Rates Improving
The proportion of people surviving years after a cancer diagnosis is improving, according to a new analysis. Men and women ages 50 to 64, who were diagnosed in 2005 to 2009 with a variety of cancer types, were 39 to 68 percent more likely to be alive five years later, compared to people of the same age diagnosed in 1990 to 1994, researchers found. Seaman, 2/19)

Reuters: Disabled Elderly Decline Sharply After ICU
Seniors admitted to the hospital intensive care unit (ICU) were more likely to die or sharply decline soon after their release depending on how well they functioned beforehand, according to a new study. ... Those who had mild to moderate disability before ICU admission were twice as likely as the minimally disabled to die within one year of ICU admission, and those with severe disability were three times as likely to die. Those who started out minimally disabled had much better outcomes, and should be targeted for aggressive rehabilitation since they have a good chance of recovering all of their pre-ICU function, Ferrante said. (Doyle, 2/12)

Los Angeles Times: Vaccine That Targets 9 Strains Of HPV Boosts Cancer Protection, Study Says
When it comes to HPV vaccines, more protection is better. A new version of the vaccine that fights nine strains of human papillomavirus offered greater cancer protection for women than the earlier one that targets only four, researchers reported Wednesday. (Kaplan, 2/18)