Research roundup: Looking at CHIP to gauge effect of health law on doctors; Insurers' spending on quality improvements

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Medicare & Medicaid Research Review: The Effect Of The Children's Health Insurance Program On Pediatricians' Work Hours – In this study published by the Centers for Medicare & Medicaid Services, researchers analyzed the 1997 Children's Health Insurance Program (CHIP) to evaluate the potential changes in physicians' work hours in response to a large expansion in coverage. According to the authors, CHIP's coverage of almost one in five children is "roughly similar in magnitude to the expansion for adults that will occur under the Affordable Care Act." CHIP shifted millions of children into public coverage and substantially reduced out-of-pocket payments for medical services. The researchers found "that pediatricians in states with larger CHIP expansions substantially reduced their annual work hours relative to pediatricians in states with smaller expansions." They conclude that when trying to assess public insurance expansions, "it is important to not rely on a purely demand-driven model of physician behavior, but also to assess their effects on reimbursement rates and on physicians' work incentives" (He and White, 2013). 

The Commonwealth Fund: Insurers' Medical Loss Ratios And Quality Improvement Spending In 2011 –The federal health law requires insurers to pay out at least 80 percent of premiums for medical claims and quality improvements. If they don't meet that medical loss ratio (MLR), insurers are required to refund the difference to policyholders. The authors of this issue brief examined the spending of 947 health insurers, especially their "investment in quality improvement activities." They report, "In the aggregate, insurers paid less than 1 percent of premiums on either MLR rebates or quality improvement activities in 2011, with amounts varying by insurer type. Publicly traded insurers had significantly lower MLRs in each market seg­ment (individual, small group, and large group), and were more likely to owe a rebate in most segments compared with non–publicly traded insurers." The authors' findings suggest that "current market forces do not strongly reward insurers' investments" in quality improvements. (Hall and McCue, 3/22).

Georgetown University Law Center/The Kaiser Family Foundation: Updating The Ryan White HIV/AIDS Program For A New Era: Key Issues & Questions For The Future –The Ryan White HIV/AIDS program provides care and health services to millions of people – insured or uninsured –affected by HIV. The law is set to expire on Sept. 30, but Congress could reauthorize it  and "discussions about how best to structure the program in this new environment, including the timing of any changes, have already begun," the authors of this report state. They highlight four broad areas of discussion: supporting people in all stages of treatment; building HIV treatment networks in underserved communities; integrating HIV care into mainstream health care; allocating Ryan White resources fairly. (Crowley and Kates, 4/3).

Trust For America's Health/Robert Wood Johnson Foundation: Investing In America's Health: A State-By-State Look At Public Health Funding And Key Health Facts – According to the authors "investing in disease prevention is the most effective, common-sense way to improve health – helping to spare millions of Americans from developing preventable illness, reducing health care costs, and improve the productivity of the American workforce so we can be competitive with the world." The authors say the nation's public health system has remained underfunded for decades and examine funding and key health facts in every state. They highlight several findings including inadequate federal funding for public health; cuts in states and local funding; wide variations in states' disease rates and other health statistics; and wide variations in health statistics within states. They conclude that "a sustained and sufficient level of investment in prevention is essential to improving health in the United States and that differences in disease rates will not be changed unless an adequate level of funding is provided to support public health departments and disease prevention efforts" (Levi, Segal, Laurent, and Lang, 4/2013).

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

Reuters: End-Of-Life Talks Lacking Between Doctors, Patients
Although many older patients in Canada have thought about end-of-life care and discussed it with family members, a new study suggests fewer have spoken with doctors and had their wishes noted accurately in their medical record. Many elderly people prefer to die at home instead of in the hospital - but that's not always the way it works out, researchers said (Pittman, 4/1).

MedPage Today: Kidney Outcomes Worse For Uninsured
Uninsured patients are more likely to progress to kidney failure and die from it than those who are covered by public or private insurance, researchers reported here. In adjusted models, uninsured patients were 82% more likely to die and 72% more likely to have kidney failure compared with insured patients (P<0.001 for both), Claudine Jurkovitz, MD, MPH, of Christiana Care Health System's Value Institute in Delaware, reported at the National Kidney Foundation meeting here (Fiore, 4/3). 

MedPage Today: Group Visits Ease Appointment Overload
A pilot program aimed at streamlining care of kidney stone patients allowed clinicians to see patients as a group and still provide individualized care, researchers reported. The "group visit" cut waiting time for office visits in half, yet the "satisfaction level attained with the shared medical appointments was very high as well," Allan Jhagroo, MD, assistant professor of medicine at the University of Wisconsin, Madison, told MedPage Today (Susman, 4/3).

The Hill: Study: Managed Medicaid Plans Handling More Prescriptions
Medicaid is quickly abandoning the traditional fee-for-service model when it comes to handling patient prescriptions, according to a new study. The IMS Institute for Healthcare Informatics reported Thursday that Medicaid managed care plans handled 19 percent of the program's prescriptions in September 2011 (Viebeck, 4/4).