Research roundup: Changing unhealthy diets with mobile tech; ACOs for Medicaid

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Archives of Internal Medicine: Multiple Behavior Changes In Diet And Activity -- Mobile technologies have been touted for their potential benefits to health and wellness. Researchers in this study gave 204 individuals a dieting and exercise regimen. They also gave each person a handheld device to record adherence and receive remote coaching. Patients could earn a financial reward for meeting their goals, and many did so after three weeks of treatment and at a five-month follow-up. "This study demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently, and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," the authors write (Spring et al, 5/28).

Journal of General Internal Medicine: Evaluation Of The Effectiveness Of Making Weight Watchers Available To Tennessee Medicaid (TennCare) Recipients -- Since 2006, Tennessee's Medicaid program has offered enrollment in local Weight Watchers programs at a substantially reduced cost. This study looks at nearly 1,200 participants over three years and finds that 21 percent experienced at least a 5 percent loss of body weight, which the authors describe as clinically significant. This benefit came even with poor meeting attendance among some Medicaid beneficiaries, and the researchers conclude that state-private partnerships like this one "may provide a valuable weight management tool" for low-income populations (Mitchell et al, 5/23).

Mathematica Policy Research/Kaiser Family Foundation: Emerging Medicaid Accountable Care Organizations: The Role of Managed Care -- Accountable care organizations, in which doctors and hospitals agree to share responsiblity for the care of patients, are rapidly spreading through both private and federal efforts, including the Medicare pilots initiated by the health law. This brief looks at efforts in some states to establish ACOs in Medicaid programs and finds that "most Medicaid ACOs are currently at an early stage of development, as states engage in relatively lengthy planning and implementation processes." Federal regulations and concerns about how to address Medicaid patients who are also eligible for Medicare have complicated efforts to develop Medicaid ACOs. Five states -- Colorado, Utah, Oregon, Minnesota and New Jersey -- have ACO initiatives and only Colorado has one operating. "Promoting transformation in the way services are delivered in Medicaid is not straightforward, and the time and investment required may run counter to states' fiscal imperatives," the authors write (Gold, Nysenbaum and Streeter, 5/29).

The Urban Institute: Best Practices in SHAP Outreach, Eligibility, and Enrollment Activities
Much of the health law's expansion of insurance coverage will depend on individual states' ability to reach out to communities and enroll people in programs like Medicaid. This brief looks at the efforts of five states -- Colorado, Kansas, Minnesota, New York and Oregon -- that received grants from the State Health Access Program to improve outreach and enrollment processes. States showed success by working with community partners, coordinating with fellow agencies and streamlining online enrollment systems. These "experiences under the SHAP grant offer important insights for other states as they consider how to best prepare for the major coverage expansions that will occur in 2014," the authors conclude (Courtot and Coughlin, 5/23).

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

JAMA: Author Insights: Home Telemonitoring Does Not Reduce Hospitalizations or Emergency Department Visits for Seniors
A telemonitoring device in the home that can measure and transmit information about indicators of health such as blood pressure and oxygen saturation coupled with videoconferencing can allow a health care team to assess a patient's condition remotely and discuss ongoing treatment plans with the patient. Proponents of telemonitoring suggest that it has the potential to improve patient outcomes, but recent studies suggest such optimism may be premature. New findings appearing in the May 28 Archives of Internal Medicine found that telemonitoring of older adults with multiple health issues did not reduce hospitalizations and emergency department visits (Mitka, 5/29).

Reuters: Doctors Sometimes Over-Treat Blood Pressure: Study
A new study suggests veterans hospitals are following guidelines when it comes to treating patients with diabetes and high blood pressure -- but some diabetics with healthy readings may also be getting intensive blood pressure treatment that won't do them much good. … Doctors have gotten very good at making sure everyone at risk gets treated with blood pressure medications, [lead author Eve Kerr] added. But some patients who needed blood pressure medications to begin with might end up not needing them later on (Pittman, 5/29).