Research Roundup: ‘Pharmacy Deserts’; Marketplace Premiums; Narrow Networks

Health Affairs: ‘Pharmacy Deserts’ Are Prevalent In Chicago’s Predominantly Minority Communities, Raising Medication Access Concerns
Attempts to explain and address disparities in the use of prescription medications have focused almost exclusively on their affordability. However, the segregation of residential neighborhoods by race or ethnicity also may influence access to the pharmacies .... We found that throughout the period 2000–2012 the number of pharmacies [in Chicago] was lower in segregated minority communities than in segregated white communities and integrated communities. In 2012 there were disproportionately more pharmacy deserts in segregated black communities, as well as in low-income communities and federally designated Medically Underserved Areas. (Qato et al., 11/3)

Health Affairs: Hennepin Health: A Safety-Net Accountable Care Organization For The Expanded Medicaid Population
We describe how Hennepin Health—a county-based safety-net accountable care organization in Minnesota—has forged ... a partnership to redesign the health care workforce and improve the coordination of the physical, behavioral, social, and economic dimensions of care for an expanded community of Medicaid beneficiaries. Early outcomes suggest that the program has had an impact in shifting care from hospitals to outpatient settings. For example, emergency department visits decreased 9.1 percent between 2012 and 2013, while outpatient visits increased 3.3 percent. ... Hennepin Health has realized savings and reinvested them in future improvements. (Sandberg et al., 11/3)

Health Affairs: The 340B Discount Program: Outpatient Prescription Dispensing Patterns Through Contract Pharmacies In 2012
Section 340B of the Public Health Service Act provides qualified organizations serving vulnerable populations with deep discounts for some outpatient medications. ... We used 2012 data from Walgreens, the national leader in 340B contract pharmacies. Medications used to treat chronic conditions such as diabetes, high cholesterol levels, asthma, and depression accounted for an overwhelming majority of all prescriptions dispensed at Walgreens as part of the 340B program. ... The majority of 340B prescriptions dispensed at Walgreens originated at tuberculosis clinics, consolidated health centers, disproportionate-share hospitals, and Ryan White clinics. Our results suggest that 340B contract pharmacies ... disproportionately dispense medications used by key vulnerable populations targeted by the program. (Clark, 11/3)

The Urban Institute/Robert Wood Johnson Foundation: Marketplace Insurance Premiums In Early Approval States: Most Markets Will Have Reductions Or Small Increases In 2015
[W]e present data on how premiums are changing between 2014 and 2015 in nongroup marketplace plans; we focus on 17 states and the District of Columbia, which were the first to complete their rate review and approval processes. ... Many of the small increases or reductions in 2015 premiums will occur in large cities .... Larger premium increases are more likely to occur in rural areas. ... As a result, the lowest cost silver option available to consumers in 16 of the rating regions will be lower in 2015 than in 2014. Those changes reflect that many of the lowest cost carriers in 2014 have fairly low premiums and believe that they can increase those rates, while other carriers are responding to competitive pressure. (Holahan et al., 11/6)

NORC at the University of Chicago/Commonwealth Fund: Premiums Unchanged In Rhode Island, Modestly Higher In Nevada, And Significantly Higher In District Of Columbia
This is the fourth in a series of blog posts reporting premium and benefit changes for the individual market from 2014 to 2015. The states reviewed are the District of Columbia, Nevada, and Rhode Island. ... From 2014 to 2015, average premiums increased substantially in D.C., modestly in Nevada, and held steady in Rhode Island. In Rhode Island and Nevada, the number of carriers participating in the market and the number of plans offered rose. In D.C., the number of plans offered declined slightly. (Gabel et al., 10/31)

The Kaiser Family Foundation: Data Note: Gearing Up For Round 2 of Open Enrollment: Some Lessons From Round 1
Two Kaiser Family Foundation surveys conducted last spring after the first open enrollment came to a close explored the shopping experience among two key groups impacted by the ACA: non-group health insurance purchasers and the previously uninsured in California, the state with the largest number of uninsured in the country prior to the ACA. ... Four key takeaways emerge from these surveys: 1. The websites were just one way people got information and enrolled in health plans – many also got help in person or over the phone. 2. Costs, including the monthly premiums, deductible, and copays, were important factors in plan choice. 3. Outreach efforts that reached individuals directly helped to boost enrollment. 4. Both those who successfully enrolled in coverage as well as those who remained uninsured expressed some trouble with the process. (Norton, DiJulio and Brodie, 11/4)

The Urban Institute/Robert Wood Johnson Foundation: Narrow Networks, Access To Hospitals And Premiums
In this first year of ACA implementation, many insurers negotiated new hospital network arrangements for Marketplace products. In some cases, providers or facilities that have historically been “in-network” for a given insurer may not be included in that insurer’s new Marketplace plans. ... The ACA includes strict network adequacy requirements, but there remains considerable variation in the breadth of acceptable hospital networks and the options available in each. In this brief, we investigate which hospitals are included in Marketplace plans in major cities in six states. ... We conclude that almost all insurers offer plans that include in their networks access to many highly ranked hospitals. Moreover, all hospitals in the cities we examined were in at least one Marketplace plan’s networks. Finally, the size of networks was not necessarily tied to premiums. (Peters and Holahan, 10/31)

Manhattan Institute for Policy Research: Health Savings Accounts Under The Affordable Care Act: Challenges And Opportunities For Consumer-Directed Health Plans
The ACA implemented a number of important new regulations on health-insurance products, many of which potentially boded ill for HDHPs [high-deductible health plans]. Indeed, many advocates of these types of health plans believed that the administration would implement ACA insurance regulations in a way that would disadvantage consumer-driven products .... Initial skepticism from HSA advocates was understandable; but based on our current research, it appears that the Obama administration was true to its word and that HSAs (at least for the moment) remain widely accessible on public exchanges. ... high-deductible plans are widely available—98 percent of uninsured Americans have access to at least one HSA-eligible plan. Moreover, these plans also make up about 25 percent of total offerings on Obamacare exchanges (Howard and Feyman, October, 2014)

The Commonwealth Fund: What Will Be The Impact Of The Employer Mandate On The U.S. Workforce?
The Affordable Care Act’s employer mandate requires large firms to pay penalties unless they offer affordable health insurance coverage to full-time employees, raising concerns that employers might lay off workers or reduce hours. In this brief, we estimate the number of workers potentially at risk of losing their jobs or having hours reduced. Most workers near the thresholds—those in firms with around 50 full-time-equivalent employees or those working near 30 hours per week—are already insured or have been offered coverage. There are 100,000 full-time workers at the firm-size threshold and 296,000 at the hourly threshold who are uninsured. Fewer than 10 percent, less than 0.03 percent of the U.S. labor force, might see reductions in employment or hours in the short run. Over time, employment patterns might change, leading to fewer firm sizes and work schedules near the thresholds, potentially affecting up to 0.5 percent of the workforce. (Glied and Solis-Roman, 10/28)

Mathematica/The Kaiser Family Foundation: What Do We Know About Health Care Access And Quality In Medicare Advantage Versus The Traditional Medicare Program?
This literature review synthesizes the findings of studies that focus specifically on Medicare and have been published between the year 2000 and early 2014. ... On the one hand, the evidence indicates that Medicare HMOs tend to perform better than traditional Medicare in providing preventive services and using resources more conservatively, at least through 2009. These are metrics where HMOs have historically been strong. On the other hand, beneficiaries continue to rate traditional Medicare more favorably than Medicare Advantage plans in terms of quality and access, such as overall care and plan rating, though one study suggests that the difference may be narrowing .... Among beneficiaries who are sick, the differential between traditional Medicare and Medicare Advantage is particularly large ... favoring traditional Medicare. (Gold and Casillas, 11/6)

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

Medscape: Low-Risk Cesarean Delivery Rates Dropping In US
Low-risk cesarean delivery rates have declined in the United States, going from a high of 28.1% in 2009 to 26.9% in 2013, according to a report published November 5 in the National Vital Statistics Reports. The low-risk cesarean delivery rate was at its lowest, at 18.4%, in 1997 and rose steadily after that, note Michelle J.K. Osterman, MHS, from the Division of Vital Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, and colleagues. (Brown, 11/5)

Medscape: Better Handoffs Cut Medical Errors 30% In Multicenter Trial
The I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) system of bundled communication and training tools for handoff of patient care between providers reduced injuries caused by medical errors by 30%, according to a multicenter study. The improvements in patient safety and quality of care occurred without significantly burdening clinical workflows, researchers report in an article published in the November 6 issue of the New England Journal of Medicine. (Barclay, 11/6)

HealthDay/Philadelphia Inquirer: Lung Cancer Screening Can Be Cost Effective, Study Reports
Lung cancer screening with CT scans can be cost-effective while saving lives, a new study suggests. But, there are two caveats to that finding -- the procedure has to be performed by skilled professionals and the screening must be done on a very specific set of long-time smokers, the researchers noted. Results from the National Lung Screening Trial (NLST) showed four years ago that annual CT scans can reduce lung cancer deaths by 20 percent in older, long-time smokers. The new study, which uses data gathered during that national trial, concludes that screening for lung cancer would cost $81,000 for each year of quality life gained -- lower than the generally accepted $100,000-per-year threshold for cost effectiveness. ... The results are published in the Nov. 6 issue of the New England Journal of Medicine. (Thompson, 11/5)

NBC News: Missing Out: 8 Million U.S. Women Skip Cervical Cancer Screening
As many as 8 million adult women who should be screened for cervical cancer haven’t had that checkup in the past five years, and they’re missing a chance to prevent or treat the disease before it could kill them, federal health officials said Wednesday. More than half of women diagnosed with cervical cancer cases had never or rarely been screened, the Centers for Disease Control and Prevention said. A Pap smear or a test for the human papillomavirus (HPV) that causes cervical cancer can catch it early, while it’s still curable, or even prevent cancer. (Fox, 11/5)

Medscape: Bariatric Surgery Cuts Costs For Diabetes, Cardiac Drugs
A new study based on national insurance claims in the United States has found that obese patients who had contemporary bariatric surgery went on to use fewer drugs for conditions such as type 2 diabetes, thus lowering healthcare costs. Specifically, costs for prescription medications among 2700 patients who underwent laparoscopic gastric banding or bypass surgery were $8411 in the 4 years following the operation vs $9900 for 2700 matched patients who did not have this surgery — a saving of 22.4%. (Busko, 11/6)