Research roundup: More spending can lead to better care; Calif. exchange lessons; high-volume hospitals

Shefali S. Kulkarni compiled this selection of recently released health policy studies and briefs.

Health Services Research: Medical Spending And The Health Of The Elderly -- Does more medical spending lead to better health care for people over age 64? To answer that question, "researchers from George Mason University and the Urban Institute used data of 17,438 elderly who entered the Medicare Current Beneficiary Survey in the fall of each year from 1991 to 1999, and conducted multiple interviews over three years," according to one description of the study. "The average total medical spending for the three years of observation was $27,092 per person ... The researchers found that a 10 percent higher level of medical spending was associated with a 1.9 percent increase in a person's health score and a 1.5 percent greater survival probability," and concluded: "On average, greater medical spending is associated with better health status of Medicare beneficiaries, implying that across-the-board reductions in Medicare spending may result in poorer health for some beneficiaries" (Hadley, Waidmann, Zuckerman and Berenson, 5/24).  

New England Journal of Medicine: Trends in Hospital Volume and Operative Mortality for High-Risk Surgery  -- Authors "used data from national Medicare claims to evaluate trends in the use of high-volume hospitals for major cancer resections and cardiovascular surgery. We also examined concurrent trends in operative mortality rates associated with these procedures and the extent to which decreases in mortality could be associated with a concentration of surgical care in high-volume hospitals." They note that there are "wide variations" in outcomes across hospitals, and conclude: "For a small number of procedures associated with particularly strong direct volume-outcome relationships, such as pancreatectomy and esophagectomy, referral to high-volume centers should continue to be encouraged. For most high-risk procedures, however, strategies such as operating-room checklists, outcomes-measurement and feedback programs, and collaborative quality-improvement initiatives are likely to be more effective than volume-based referral" (Finks, Osborne and Berkmeyer, 6/1).

The Commonwealth Fund: State-Based Coverage Solutions: The California Health Benefit Exchange -- This brief looks at the decisions health officials in California made while establishing the state's health insurance exchange program. California was the first state to implement a health care exchange after the federal health law was passed and its decisions may help guide other states. Several factors played a role in creating the state's exchange, the authors write, including: "minimizing adverse selection, promoting cost-conscious consumer choice, and seamlessly coordinating with public programs." But the brief suggests that "each state will have to design solutions tailored to its own political, demographic, and market characteristics. There are technical decisions each state will have to make" (Weinberg and Haase, 5/31).

Kaiser Commission On Medicaid and the Uninsured/Kaiser Family Foundation: Medicaid Financing Issues: Provider Taxes -"Current law allows states to use revenue from provider taxes to help fund the state share of spending on Medicaid, a program that is jointly financed by the states and the federal government. Almost all states have at least one provider tax in place. This issue brief reviews the use of provider taxes by states as a mechanism for financing the state share of Medicaid spending. It also explores the implications of recent proposed changes in the federal rules that govern how states may design their provider tax structures," according to the authors (5/31).

Urban Institute: Addressing Coverage Challenges For Children Under The Affordable Care Act -- This brief examines how the 2010 health care law will affect insurance options for children who have complex coverage or family situations. "Roughly 20 million children live in situations that create particular challenges in accessing insurance coverage due to within-family variation in eligibility for different types of coverage. For example, some parents have employer-sponsored insurance (ESI) for which their children are not eligible, while some children are eligible for Medicaid or the Children's Health Insurance Program (CHIP), but their parents are not." the authors write. They identify five groups to whom policymakers should to pay special attention (McMorrow, Kenney and Coyer, 5/31).

Robert Wood Johnson Foundation/The George Washington University School of Public Health and Health Services: Lessons Learned In Public Reporting: Crossing The Cost And Efficiency Frontier -- This brief examines the way select communities that are part of the Aligning Forces for Quality program are collecting data to effectively measure the cost and value of health care delivered by hospitals and physicians. For example, the Memphis Alliance "hosted community meetings presenting health care cost trends for the county and facilitating discussions with national experts in cost and efficiency." The Puget Sound Health Alliance provides information on Medicaid beneficiaries, "allowing comparisons across privately and publicly insured populations on performance measures related to asthma, depression, diabetes and heart disease." The South Central Pennsylvania group measured quality of "hospital and ambulatory care with a particular focus on diabetes and coronary heart disease" (May 2011).

Health Affairs: How Intermountain Trimmed Health Care Costs Through Robust Quality Improvement Efforts -- Intermountain Health Care System, a integrated health care system in Utah and Idaho, has been able to contain costs "through measuring, understanding, and managing variation among clinicians in providing care. Intermountain created data systems and management structures that increased accountability, drove improvement, and produced savings," according to the authors, from Intermountain's Institute for Health Care Delivery Research. This brief defined "organized care" as that "whose hallmarks include rich clinical and financial data that inform the decisions of clinical teams at the bedside; and clinical teams that employ patient-centered care processes leading to improved population health." The authors write that "one protocol saves an estimated $50 million in Utah each year. If applied nationally, it would save about $3.5 billion" (James and Savitz, 5/19).