Research roundup: Best health care for homeless, new business model for pharma

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

Center for Health Care Strategies/Robert Wood Johnson Foundation: Medicaid-Financed Services In Supportive Housing For High-Need Homeless Beneficiaries: The Business Case -- The cost and coordination of health care for homeless individuals can be a challenge for states. But as this brief describes, establishing supportive housing - which provides social services, usually on site - "can help improve health, increase survival rates, foster mental health recovery, and reduce alcohol and drug use." The authors note funding opportunities under the 2010 health law. While such programs require lots of planning and targeted outreach, they also "could represent a good investment opportunity for states" (Nardone, Cho and Moses, 6/8).

Health Affairs: Acute Care For Elders Units Produced Shorter Hospital Stays At Lower Cost While Maintaining Patients' Functional Status -- In the 1990s, clinicians at the University Hospitals of Cleveland developed a program called "Acute Care for Elders," which puts an emphasis on senior-friendly facilities within the hospital and coordinated, "team" care. This randomized, controlled trial found that patients in the program had shorter hospital stays than the control group, 6.7 vs. 7.3 days, on average. Costs were also significantly lower -- $9,477 versus $10,451 per patient. The researchers suggest that "more widespread implementation of Acute Care for Elders Units could result in major systemwide cost savings while preserving quality of care" (Barnes et al., 6/5).

Rand Corporation: Medicines As A Service -- A New Commercial Model For Big Pharma In The Postblockbuster World -- The pharmaceutical industry is facing an uncertain future as many of its "blockbuster" drugs go off patent. The authors of this paper propose a new business model in which the industry places a greater emphasis on chronic conditions and quality of care. They recommend companies "add patient engagement solutions to medicines, which would promote adherence," and point to some examples, e.g. packaging for birth control pills so users can recall if they have taken the day's dose. The authors encourage tying financial reward to quality of patient care, such as in accountable care organizations, and advocate moving "from selling pills to selling outcomes. The opportunity is clearly there because prescription drugs are underused, and better adherence to evidence-based treatment regimens could both save lives and reduce cost," they write (Mattke, Klautzer and Mengistu, 6/6).

State Health Access Data Assistance Center/Robert Wood Johnson Foundation: The Rural Implications Of Geographic Rating Of Health Insurance Premiums
Beginning in 2014, the health law will allow insurers to vary their premiums based on only a few factors. Among those is the location for a plan, because regions can vary widely on the cost of care. This brief looks at current "geographic rating" practices and finds no clear pattern in pricing, which "suggests that health plans may [currently] use geographic rating for business purposes other than adjusting for underlying cost/price differences." The authors conclude that rating practices "could undermine the intent of the ACA to distribute risk broadly" and ensure affordable coverage (Coburn et al., 6/8).

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

Reuters: Typical Hospital Noises May Disrupt Sleep
Certain hospital sounds, such as electronic alarms, telephones and conversations, can wake people up even at relatively low levels, according to a new study [in the Annals of Internal Medicine]. The results point to ways hospitals can focus on mitigating the most disruptive noises, researchers said. … Nighttime noises are one of the chief complaints among patients who are surveyed about their time in the hospital (Grens, 6/11).

Medscape: Least Serious ED Trips Partly Attributed To Access Hassles
American adults up to age 64 years who visit a hospital emergency department (ED) without being admitted afterward are more likely to cite a lack of access to other providers than the severity of their condition as the reason for the trip, the US Centers for Disease Control and Prevention (CDC) reports. These findings give further credence to the widely embraced notion that extended office hours for physicians, urgent-care centers, and retail clinics can eliminate many costly trips to the ED (Lowes, 6/13).

MedPage Today: Web Effort Helps Control Heart Risk Factors
An Internet-based system to help patients manage vascular risk factors was better than usual care alone, a randomized trial showed. In the unadjusted analysis, those using the nurse-led system combined with usual care had a 14% decline in Framingham heart risk scores, compared with those in the usual care arm, according to Frank Visseren, MD, PhD, of University Medical Center Utrecht in Utrecht, the Netherlands, and colleagues [in BMJ] (Smith, 6/14).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.