Research Roundup: Medicare Drug Plans; ACA Patient Losses; Hospital Readmissions

Health Affairs: Medicare Prescription Drug Plan Enrollees Report Less Positive Experiences Than Their Medicare Advantage Counterparts
[W]e compared beneficiaries’ assessments of Medicare prescription drug coverage when provided by standalone plans or integrated into [a Medicare Advantage] plan. Beneficiaries in standalone plans consistently reported less positive experiences with prescription drug plans (ease of getting medications, getting coverage information, and getting cost information) than their MA counterparts. Because MA plans are responsible for overall health care costs, they might have more integrated systems and greater incentives than standalone prescription drug plans to provide enrollees medications and information effectively. (Elliott et al., 3/7)

Health Affairs: Patient Population Loss At A Large Pioneer Accountable Care Organization And Implications For Refining The Program
There is an ongoing move toward payment models that hold providers increasingly accountable for the care of their patients. The success of these new models depends in part on the stability of patient populations. We investigated the amount of population turnover in a large Medicare Pioneer accountable care organization (ACO) in the period 2012–14. We found that substantial numbers of beneficiaries became part of or left the ACO .... For example, nearly one-third of beneficiaries who entered in 2012 left before 2014. ... We recommend policy changes to increase the stability of ACO beneficiary populations, such as permitting lower cost sharing for care received within an ACO and requiring all beneficiaries to identify their primary care physician before being linked to an ACO. (Hsu et al., 3/7)

JAMA Internal Medicine: Preventability And Causes Of Readmissions In A National Cohort Of General Medicine Patients
[F]ew programs have incorporated viewpoints of patients and health care professionals to determine readmission preventability .... An observational study was conducted of 1000 general medicine patients readmitted within 30 days of discharge to 12 US academic medical centers between April 1, 2012, and March 31, 2013. ... Approximately one-quarter of readmissions are potentially preventable when assessed using multiple perspectives. High-priority areas for improvement efforts include improved communication among health care teams and between health care professionals and patients, greater attention to patients’ readiness for discharge, enhanced disease monitoring, and better support for patient self-management. (Auerbach et al., 3/7)

Health Affairs: Meaningful Use Of EHRs Among Hospitals Ineligible For Incentives Lags Behind That Of Other Hospitals, 2009–13
The Centers for Medicare and Medicaid Services’ meaningful-use incentive program aims to promote the adoption and use of electronic health records (EHRs) throughout health care settings in the United States. However, psychiatric, long-term care, and rehabilitation hospitals are ineligible for these incentive payments. Using national data from the period 2009–13, we compared eligible and ineligible hospitals’ rates of EHR adoption. All three types of ineligible hospitals had significantly lower rates of adoption than eligible hospitals did, yet both groups experienced similar growth rates. This growth has widened the gap in adoption of health information technology between eligible and ineligible hospitals, which could stymie efforts to lower costs and improve quality across the health care continuum. (Walker et al., 3/7)

The Kaiser Family Foundation: Assessing ACA Marketplace Enrollment
Marketplace enrollment under the ACA is lower than projected, though signups continue to grow and the program appears sustainable overall. ... Judging by the experience of the top performing states, there is considerable room for enrollment growth over the next several years. However, even if all states signed people up at the rate of the top 10 states, enrollment would still fall well short of projections by CBO, suggesting that those forecasts may have been unrealistic. ... There are signs that marketplace coverage could continue to grow modestly in the years ahead. But, absent a substantial boost in outreach or changes to the subsidies to make insurance more affordable, substantial increases in marketplace enrollment are unlikely. (Leavitt et al., 3/4)

The Kaiser Family Foundation: Outreach And Enrollment Strategies For Reaching The Medicaid Eligible But Uninsured Population
Three years into implementation of the ACA, ... 8.8 million individuals are eligible for Medicaid or CHIP but remain uninsured. Reaching and enrolling these individuals will be important for achieving continued coverage gains .... State experiences to date point to an array of effective outreach and enrollment strategies .... These strategies include implementing broad marketing and outreach campaigns, promoting the expansion through strong leadership and collaboration, establishing a coordinated and diverse network of assisters, developing effective eligibility and enrollment systems that coordinate with Marketplace coverage, and planning ahead to translate coverage gains into improved access to care. (Artiga, Rudowitz and Tolbert, 3/2)

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

The Columbus Dispatch: Results Of Clinical Trials Often Kept Secret, Despite Taxpayer Funding
Scientific advances often take root in clinical trials. Too often, though, researchers at U.S. academic medical centers aren’t sharing their taxpayer-funded work publicly, potentially placing blinders and biases on what we know about health and illness. That’s the conclusion of a new study published in the medical journal formerly known as the British Medical Journal, now simply called BMJ. (Sutherly, 3/7)

Reuters: Telling Docs They Overprescribe Addicting Drugs Doesn't Make Them Stop
Government letters informing doctors they're prescribing vastly more addictive drugs than their peers fall on deaf ears, according to a new study. The doctors in the study were all writing far more prescriptions for drugs like opioid painkillers than doctors in similar specialties practicing nearby -- but the letters didn't lead to changes in prescribing. Still, the study's lead author said the results will help researchers who are studying ways to get doctors to pay attention. (Seaman, 3/7)

Reuters: No Paid Sick Leave Means Workers Skip Medical Care
U.S. workers without paid sick leave are more likely to keep going to work when they’re sick and to forgo medical care for themselves and their families, compared to workers who do get paid for sick days, according to a new study. Not only are workers with paid sick leave more likely to stay home to care for themselves or family when needed, but “more importantly, (paid sick leave) enables workers to ‘self-quarantine’ when necessary, without the worries of losing their job or income while also not spreading illness to others,” which is especially important in the food service, healthcare and child care industries, said lead author LeaAnne DeRigne of Florida Atlantic University in Boca Raton in email to Reuters Health. (Doyle, 3/8)

Los Angeles Times: Diet Drug Contrave Kicks Up A Tempest Amid Uncertainty About Heart Attack And Stroke Effects
Researchers have a gentle warning for patients on the receiving end of 765,000 prescriptions for the weight-loss drug Contrave: The cardiovascular safety of this treatment "remains uncertain," they write in a newly published study. As for claims by the drug's maker that it dramatically drives down heart attacks, strokes and deaths? Those, says the lead author of the new study, are premature at best. (Healy, 3/8)