Research roundup: Oral health; details of Medicare's IPAB

Every Friday, Jennifer Evans compiles this selection of recently released health policy studies and briefs:

Dartmouth Institute: Trends And Variation In End-Of-Life Care For Medicare Beneficiaries With Severe Chronic Illness - This report explores the shifts in the use of medical resources to treat Medicare beneficiaries at the end of life between 2003 and 2007. It finds that "the percentage of chronically ill Medicare patients dying in hospitals and the average number of days they spent in the hospital before their deaths declined in most regions of the country and at most academic medical centers." However, "other indicators of the intensity of care increased, including a rise in the number of ICU days in the last six months of life. There were particularly sharp increases in the amount of physician labor used per patient in the last two years of life (measured as physician clinical full-time-equivalents) and in the number of patients who saw ten or more physicians during their last six months of life," the authors report. The report also documents the rise in the use of hospice care between 2003 and 2007 (Goodman et al., 4/12).

Center for Studying Health System Change/National Institute for Health Care Reform: Geographic Variation In Health Care: Changing Policy Directions - This policy analysis looks at Miami, Indianapolis and Seattle to highlight several factors that contribute to geographic variations, including population characteristics and local health system organization. "Consistent with an emerging consensus in the research community, the analysis points to the need for a policy shift away from narrowly targeting specific geographic areas toward system-wide payment reforms and oversight to encourage greater efficiency in the health care system overall," the authors write (Bernstein, Reschovsky and White, April 2011).

Institute of Medicine: Advancing Oral Health In America - This brief describes the IOM's recent recommendations to the Department of Health and Human Services to improve oral health and several priority areas for the New Oral Health Initiative (NOHI). The IOM committee urged HHS "to have consistent messaging within its own organization that oral health is a priority. HHS has the opportunity and responsibility to bring together different sectors to effect change in oral health care. There are many reasons that HHS should seize this opportunity. However, most important is that in spite of improvement, the American people continue to suffer, often silently, from avoidable and treatable oral diseases" (4/8).

Health Policy Alternatives/Kaiser Family Foundation: The Independent Payment Advisory Board: A New Approach Controlling Medicare Spending - The Patient Protection and Affordable Care Act (ACA) "establishes a new Independent Payment Advisory Board (IPAB) with authority to issue recommendations to reduce the growth in Medicare spending, and provides for the Board's recommendations to be considered by Congress and implemented by the Administration on a fast-track basis." This brief explains how the IPAB will be structured, the process and timelines for IPAB to make recommendations to achieve Medicare savings and the scope of its recommendations. It also explores issues and questions that have been raised about IPAB, its implementation, and its workings in practice. Finally, the report describes the various policy options that could be considered to modify the role of IPAB in the future" (Ebeler, Neuman and Cubanski, 4/13). 

Kaiser Family Foundation: What The Actuarial Values In The Affordable Care Act Mean - The health law "establishes four levels of coverage based on the concept of 'actuarial value,' which represents the share of health care expenses the plan covers for a typical group of enrollees. As plans increase in actuarial value - bronze, silver, gold, and platinum - they would cover a greater share of enrollees' medical expenses overall, though the details could vary across plans. ... an actuarial value is not as intuitive for people as specific deductibles and other out-of-pocket costs." The authors of this brief conclude that "significant variation in plan designs could make it more difficult for consumers to compare plans and dampen how much competition over price emerges in the insurance market" (Levitt and Claxton, 4/14).

Urban Institute: Multi-State Health Insurance Exchanges - This brief describes the potential gains and drawbacks for states if they join together to offer regional or multi-state exchanges. For instance, such exchanges might "promote pooling across state lines" and "create the necessary critical mass of insured persons to establish stable risk pools."  However, "the fact that cross-state risk-sharing would lead to one state's population effectively subsidizing another state's population and create a complex environment for decision-making, multistate exchanges are likely to focus on shared administrative structures and efficiencies as opposed to risk-sharing," the author concludes (Blumberg, April 2011).

Commonwealth Fund: High Performance Accountable Care: Building On Success And Learning From Experience - "While the prospect of participating in [accountable care organizations] has generated a groundswell of interest and activity among providers, many issues need to be addressed about the methods that will be used to determine how that accountability is to be achieved, assessed, and rewarded," according to this report that describes three organizational models that could serve to inform ACOs. The report also includes several policy recommendations for CMS to support the successful implementation and growth of ACOs (Guterman et al., 4/14).