Research roundup: Lessons from Medicare Part D; Evaluating medical homes; Insuring young adults

Health Affairs: Lessons Learned: Who Didn't Enroll In Medicare Drug Coverage In 2006, And Why? - With data from the 2005 and 2006 Medicare Current Beneficiary Survey, this study examines enrollment of those who were previously without either public or private sources of prescription drug coverage. The authors report "63 percent of all eligible seniors and 69 percent of low-income beneficiaries were enrolled in Part D in 2006. However, only 29 percent of low-income beneficiaries were enrolled in the subsidy program, leaving millions without coverage." 

"Although the passage of the Patient Protection and Affordable Care Act of 2010 will have far-reaching effects on extending insurance coverage, it could have mixed effects on Part D enrollment. ... [B]ecause these provisions will ultimately raise Part D premiums, albeit for improved coverage, they may have the perverse impact of reducing applications for nonsubsidized Part D plans and may affect applications for the low-income subsidy for beneficiaries with incomes of 135-150 percent of the federal poverty level" (Davidoff et al., 5/13).

Health Affairs: Health Reform's Changes In Medicare -- "The new health reform law includes numerous Medicare provisions that will take effect over the next five years. Within several years, for example, some payments to Medicare Advantage plans will be cut, but those plans will be eligible for bonuses if they can show that they provide high-quality health care." The brief outlines "many other provisions [that] take effect as soon as this year" (Cassidy, 5/20).

Commonwealth Fund: Rite Of Passage: Young Adults And The Affordable Care Act Of 2010 - "As of 2008, the number of uninsured young adults between the ages of 19 and 29 was nearing 14 million, representing three of every 10 uninsured persons in the United States," write the authors about provisions in the Patient Protection and Affordable Care Act of 2010. After reviewing historical data and detailing the new law, authors of the brief conclude: "Young adults will benefit substantially from the ability to remain on their parent's health plans, an unprecedented expansion in the Medicaid program, new insurance market regulations including bans on lifetime limits and rating based on health status, subsidized private health insurance with comprehensive benefits package through the new insurance exchanges, and employer penalties for not offering health insurance" (Collins and Nicholson, 5/21).

Kaiser Family Foundation: How Will Health Reform Impact Young Adults? -- "In 2014, most uninsured young adults will either qualify for Medicaid or will be eligible for subsidies for coverage they purchase in a health insurance Exchange. The high cost of coverage is currently a major hurdle for young adults looking for coverage, and the expansion of Medicaid and the subsidies in the Exchanges are designed to make affordable coverage available to more uninsured young adults in 2014. ... Gaining health insurance will extend medical care and provide additional financial security to young adults as they begin their adult lives" (Schwartz and Schwartz, 5/13).

Journal Of General Internal Medicine: A Nationwide Survey Of Patient-Centered Medical Home Demonstration Projects - This study characterizes 26 patient-centered medical home (PCMH) pilot projects across the country, including structure and payment models, as described by the leaders of the projects during in-depth interviews and found a "wide spectrum" of types of plans. "The heterogeneity in program design suggests an urgent need to incorporate evaluation in all programs' designs. Less than half of the programs had well-specified evaluation plans that were designed in conjunction with the pilot," the researchers report. "In most cases, although evaluation is considered important, the evaluation designs had not been pre-specified, thus necessitating a reliance on existing data, and funding had not been secured to support a robust evaluation. Furthermore, many of the pilots do not identify adequate control groups against which to compare the intervention practices" (Bitton, Martin and Landon, 5/14).

Vermont State Legislature/Commonwealth Fund: The Vermont Accountable Care Organization Pilot: A Community Health System To Control Total Medical Costs And Improve Population Health - This report details the efforts of Vermont's ACO pilot program and highlights lessons drawn from the experience. Although some "large integrated care systems have the scale and resources to work concurrently at practice, community, and regional/state levels to support ACOs ... most small and medium-sized communities and care systems will need state and/or national support for defining a common financial framework for all payers, supporting the development and expansion of primary care medical homes, information technology (IT) support, technical support, and training and start-up funding," the authors write.

"ACO growth in Vermont and elsewhere must be coordinated with the broader payment and delivery system reforms included in the recently enacted health reform bill," they conclude (Hester, Lewis and McKethan, 5/14). 

Annals Of Internal Medicine: The Effect Of Different Attribution Rules On Individual Physician Cost Profiles - "Health plan administrators and government payers use cost profiles of individual physicians, which compare a physician with his or her peers in terms of expenditures incurred, for various applications ..." write the authors of this study, who "applied 12 different attribution rules ... to an aggregated database of claims submitted to 4 commercial health plans in Massachusetts," and found that "compared with the most commonly used rule, 17% to 61% of physicians would be assigned a different category under and alternate attribution rule." 

"Our analyses emphasize that the choice of attribution rule affects how costs are assigned to physicians and that moving from one rule to another can make a difference in the cost category to which physicians are assigned," the authors conclude. "It is critical for health plans and others who create physician cost profiles to be transparent about how they assign costs to a physician" (Mehrotra et al., 5/18).