Research roundup: Reducing risk in shared savings programs

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

Health Affairs: The Design And Application Of Shared Savings Programs: Lessons From Early Adopters --"Shared savings programs reward providers for holding spending below specific targets, thus introducing a level of financial accountability not present in strictly volume-based payment models, such as fee-for-service," researchers write. They examined samples of these throughout the country to determine the financial risk to consumers, doctors and other health care providers to offer guidelines for establishing these relationships and give an especially detailed description of the Massachusetts Patient-Centered Medical Home Initiative. They conclude: "This investigation has revealed a considerable range of activity and options in the design and implementation of shared savings arrangements-;a key component of many of the innovations being tested" (Weissman et al., 9/4).

Annals of Internal Medicine: Effect of Nonpayment For Hospital-Acquired, Catheter Associated Urinary Tract Infection
Researchers examined the 2007 and 2009 claims from 96 Michigan hospitals of catheter-associated urinary tract infections. Catheters are known to be responsible for the majority of UTIs, but th authors found that "Nonpayment for hospital-acquired CAUTIs reduced payment for 25 of 781 343 (0.003%) hospitalizations in 2009. ... Catheter-associated UTI rates determined by claims data seem to be inaccurate and are much lower than expected from epidemiologic surveillance data. The financial impact of current nonpayment policy for hospital-acquired CAUTI is low. Claims data are currently not valid data sets for comparing hospital-acquired CAUTI rates for the purpose of public reporting or imposing financial incentives or penalties" (Meddings et al., 9/4).

The New England Journal of Medicine: Health Care Reform and the Dynamics of Insurance Coverage -; Lessons from Massachusetts -- "In the postreform period in Massachusetts, half the spells [of uninsurance] concluded within 8 months, a 4-month decrease from the prereform period. However, the percentage of Massachusetts adults who were uninsured for longer than 24 months after the reform (26.7%) was nearly identical to the percentage of long-term uninsured in the other states (27.4%)," the authors write. They conclude that "policies are needed to minimize gaps in coverage that might occur when people transition between Medicaid and subsidized plans or employer-sponsored coverage, and eligibility rules should be changed for low-income people who cannot afford an employer-sponsored plan" (Graves and Swartz, 9/5). 

Health Affairs: In Amenable Mortality – Deaths Avoidable Through Health Care – Progress In The US Lags That Of Three European Countries -- The U.S. spends roughly 17% of its budget on health care – a rate that is significantly higher than most developed countries. But the excess spending doesn't translate to better health care, researchers assert in this study about "deaths that should not occur in the presence of timely and effective health care." Using World Health Organization data from 1999 to 2007, researchers found that these types of deaths declined in the United States, France, Germany and the United Kingdom but the rate of decline in the U.S. was slower than that in France or Germany, and especially slow compared to that in the United Kingdom. Among other reasons for the differences, the authors write that "many Americans failed to obtain recommended treatment for common chronic conditions and to secure regular affordable treatment" (Nolte and McKee, 8/2012).

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

Medpage Today: Some Vaccination Targets Met
Childhood immunization rates for several recommended vaccines exceed the national Healthy People 2020 targets, the CDC reported. And rates with other vaccines continued to rise from 2010 through 2011, the agency reported in the Sept. 7 issue of Morbidity and Mortality Weekly Report. Despite recent increases in cases of whooping cough, stable or increasing vaccination rates among children in the first 2 years of life are reflected in 'historically low levels of most vaccine-preventable diseases' in the U.S., the agency reported (Smith, 9/6). 

Medpage Today Teen Vaccination Rates Better, but Not Great
Adolescent vaccination coverage rates are rising, but they still fall short of federal goals, researchers found. Immunization of teens ages 13 to 17 with the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, the meningococcal conjugate vaccine (MenACWY), the human papillomavirus (HPV) vaccine, and the varicella vaccine increased from 2010 to 2011 (Neale, 8/31).

Medscape: Organic Foods: Less Pesticide Exposure, Same Nutrition
Although eating organic foods may reduce exposure to pesticides and antibiotic-resistant bacteria, there is no conclusive evidence that they are more nutritious than conventional foods, according to a new systematic review. Crystal Smith-Spangler, MD, from the Center for Health Policy and Center for Primary Care and Outcomes Research, Stanford University, California, and colleagues report their results in the September 4 issue of the Annals of Internal Medicine (Garcia, 9/5).