Research Roundup: Medicare Advantage, Medicaid And Diabetes Coaching

Urban Institute: What Do Patients With Diabetes Think Of Health Coaching?
City Health Works coaches use an evidence-based curriculum and motivational interviewing to educate clients about their chronic disease and help them improve their nutrition, medication adherence, physical activity, stress management, and engagement with primary care providers. Lay coaches are hired locally, receive intensive training, and consult with a registered dietician/diabetes educator and a social worker. The clients we interviewed were usually effusive in their praise, and said coaching helped them better understand and manage their condition. Some credited the trusting friendships they developed with their coach as making them more receptive to their coach’s advice. Coaches focused on teaching clients how to eat healthier, and most clients reported lowered hemoglobin A1c levels and feeling better physically and emotionally. (Burton and Thompson, 2/5)

The Commonwealth Fund: Sustainable Investment Social Interventions In Medicaid 
It is now widely recognized that social factors, such as unstable housing, lack of healthy food, unsafe neighborhoods, and unemployment, have a substantial impact on health care outcomes and spending, particularly with respect to lower-income populations. Moreover, there is an emerging body of research on which interventions are most likely to result in better outcomes and reductions in spending. As the nation’s largest payer for health care services for low-income populations, many of whom have substantial social service needs, Medicaid is front and center when it comes to these issues. State Medicaid agencies are increasingly focusing on how the program can cover and reimburse for nonclinical interventions, particularly in managed care, now the dominant service delivery model in Medicaid. (Bachrach, Guyer, Meier et al, 1/31)

Urban Institute: Why Does Medicare Advantage Work Better Than Marketplaces? 
The Medicare program offers an option called Medicare Advantage in which private insurance plans compete with traditional Medicare. The Affordable Care Act set up marketplaces in which insurers compete for enrollees. Both programs provide government-subsidized health insurance coverage in a regulated market that encourages private plans to compete for market share based on premiums, quality, provider networks, cost-sharing, and benefits. Yet the Medicare Advantage markets are substantially more robust, with higher private insurer participation and lower average premium growth. We assess how structural differences between Medicare Advantage and marketplaces led to these outcomes, and provide recommendations for strengthening the marketplaces. (Holahan, Skopec, Wengle et al, 1/30)

Health Affairs: Association Of A Regional Health Improvement Collaborative With Ambulatory Care–Sensitive Hospitalizations 
Although regional health improvement collaboratives have been adopted nationwide to improve primary care quality, their effects on avoidable hospitalizations and costs remain unclear. We quantified the association of the Better Health Partnership, a primary care–led regional health improvement collaborative operating in Cuyahoga County, Ohio (Cleveland and surrounding suburbs), with hospitalization rates for ambulatory care–sensitive conditions. ... We estimated that 5,746 hospitalizations for ambulatory care–sensitive conditions were averted in 2009–14, leading to cost savings of nearly $40 million. (Tanenbaum, Cebul, Votruba et al, 2/5)