Research roundup: Effects of health exchanges; Improving provider performance; Governors' 2013 budgets and Medicaid

Every week, KHN reporter Shefali S. Kulkarni compiles a selection of recently-released health policy studies and briefs.

Urban Institute: The Coverage And Cost Effects Of Implementation Of The Affordable Care Act In New York State -- Authors analyzed the cost and coverage implications of various scenarios of the health insurance exchanges that are called for in the health law. They predicted that about 1 million uninsured people in the state would get insurance through the exchanges and said that premiums in the small group and individual market would be lower than if the health law was not in effect. They added: "The state will reap substantial savings under the ACA due to the higher federal matching rate that it will receive on Medicaid coverage for adult non-parents" (Blavin, Blumberg, Buettgens and Roth, 3/31).

Health Affairs: In A California Program, Quality And Utilization Reports On Reproductive Health Services Spurred Providers To Change -- Researchers examined a statewide family planning and reproductive health program in California to see if performance reports altered providers' behavior. The researchers reported that for "five of the six indicators among private providers and three of the six indicators among public providers, there was a significant change over time. We believe the evidence suggest that providers changed their behavior when they were presented with performance reports that used administrative and claims data to compare them with their peers" (Watts et al., 3/28).

The Kaiser Family Foundation: Governors' Budgets for FY 2013 -- What is Proposed for Medicaid? -- This report notes that state revenues "have not rebounded to pre-recession levels, unemployment rates are still high, and some states continue to face budget shortfalls. ... Governors have proposed a wide range of Medicaid cost containment measures, including significant cuts in eligibility and benefits for some groups, increased use of care management, and greater use of technology to streamline enrollment processes and find efficiencies. At the same time, many states are preparing for the Affordable Care Act coverage expansions and implementation of state Exchanges and are taking advantage of opportunities for federal financial support to make changes" (Snyder, Stephens and Rudowitz, 3/27).

Archives of Pediatric and Adolescent Medicine: Parental Recall Of Doctor Communication Of Weight Status – This study used data from the National Health and Nutrition Examination Survey, 1999 through 2008, and found that the "percentage of parents who reported that a doctor or health professional told them that their child was overweight was relatively unchanged during the 1999-2006 period but increased in the 2007-2008 period." Researchers concluded: "Fewer than one-quarter of parents of overweight children report having been told that their child was overweight. While reports of notification have increased over the last decade (perhaps because of [1] revised definitions of overweight and obesity, [2] increased concern about children with BMIs in the 85th to 95th sex- and age-specific percentiles, or [3] improved recall by parents), further research is necessary to determine where and why communication of weight status breaks down" (Perrin, Skinner and Steiner, April 2012).

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

Kansas Health Institute News: Study: Untreated Mental Illness Costs Kansas More Than $1 Billion Yearly
The financial toll of untreated mental illness in Kansas is $1.17 billion annually, according to new research released today by the Health Care Foundation of Greater Kansas City.  In the KC metro area, the cost is $624 million per year -; about $287 million of which is also included in the statewide Kansas tally. About one in 10 adults in Kansas and Kansas City has at least one of the serious mental illnesses considered in the research: major depression, anxiety disorder, schizophrenia and bipolar disorder, said Jessica Hembree, the foundation's policy officer. About 40 percent of those go untreated, she said (Cauthon, 4/4).

MedPage Today: Lawsuit Defense Still Costly When Doctor Wins
Clinicians spend more money defending themselves when malpractice suits involve a payment to the patient, researchers found, but winning cases remains expensive. Mean defense costs were significantly higher in cases in which indemnity payments were made ($45,070 versus $17,130, P<0.001), Apum Jena, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues reported in a letter to the editor in the New England Journal of Medicine (Fiore, 4/4).

Medscape: Nutrition Report Reflects Race And Sex Differences 
Data from the latest National Health and Nutrition Examination Survey (NHANES), just released by the US Centers for Disease Control and Prevention (CDC), also suggest that ethnicity is a factor in measures of vitamin D deficiency, as well as in measures of heart-healthy polyunsaturated fatty acids at beneficial levels. The Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population states further that iron deficiencies and excesses can be associated with age, ethnicity, and sex (Franklin, 4/4).

MedPage Today: EMR Pop-Ups Can Lead To 'Alert Fatigue'
A VA point-of-care study found that medication alerts generated by the electronic medical record system were frequently frustrating to prescribers because they were numerous, contained extra information, and did not apply to the patient. ... Some alerts don't give enough information and others contradict common clinical practice, according to Alissa Russ, PhD, of the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues. One result may be that practitioners distrust the value of the system, Russ and colleagues argued in the April issue of the International Journal of Medical Informatics (Smith, 4/3).