Research roundup: Avoiding readmissions; the future of ACOs

Journal Of The American Medical Association: Implementation Of Medicare Part D And Non-Drug Medical Spending For Elderly Adults With Limited Prior Drug Coverage -- Researchers wondered whether Medicare Part D -- the voluntary prescription drug benefit -- affects health care spending. They used Medicare Part A and B claims from 2004-2007 to examine "Medicare reimbursements, cost-sharing amounts, and payments from other primary payers to approximate the total costs of these services rather than analyzing Medicare spending only." They found that "nondrug medical spending" was significantly reduced "after January 1, 2006, for beneficiaries with limited prior drug coverage," and concluded: "The economic and clinical benefits suggested by these reductions may be enhanced by further expansions in prescription drug coverage for seniors, improvements in benefit designs for drug-sensitive conditions, and policies that integrate Medicare payment and delivery systems across drug and nondrug services" (McWilliams, Zaslavsky and Huskamp, 7/27).  

KHN summarized news coverage of this study: Medicare Part D Ups Patient Compliance, Reduces Hospital Costs (7/27)

National Bureau of Economic Research: Has The Shift To Managed Care Reduced Medicaid Expenditures? Evidence From State And Local Mandates - The authors write: "From 1991 to 2003, the fraction of Medicaid recipients enrolled in HMOs and other forms of Medicaid managed care (MMC) increased from 11 percent to 58 percent. This increase was largely driven by state and local mandates." Authors used data from CMS and from states and conclude: "The findings suggest that shifting Medicaid recipients from fee-for-service into MMC did not reduce Medicaid spending in the typical state. However, the effects of the shift varied significantly across states as a function of the generosity of the state's baseline Medicaid provider reimbursement rates. These results are consistent with recent research on managed care among the privately insured, which finds that HMOs and other forms of managed care achieve their savings largely through reduced prices rather than lower quantities" (Duggan and Hayford, 7/2011).

National Bureau of Economic Research: Gauging The Generosity Of Employer-Sponsored Insurance: Differences Between Households With And Without A Chronic Condition - Researchers developed an empirical method to analyze "the generosity of employer-sponsored insurance across groups within the U.S. population." They collected data on out-of-pocket health care spending and on total health care spending "to assess whether households with a chronically ill member have more or less generous insurance relative to households with no chronically ill members." They found that "the chronically ill have less generous insurance coverage than the non-chronically ill. ... the reason for this less generous coverage is not that households with a chronically ill member are in different, less generous plans, on average. Rather, households with a chronically ill member have higher spending on certain types of medical services (e.g., pharmaceutical drugs) that are covered less generously by insurance" (Abraham, Royalty and DeLeire, 7/2011).

Archives of Internal Medicine: The Care Transitions Of Intervention - As many as 25 percent of Medicare patients discharged from hospitals are readmitted within 30 days. Researchers note that "focusing on good cross-setting communication at the time of hospital discharge can improve health outcomes, decrease health care costs, and support patients in understanding how, when, and where to seek help, should they need it." This study looks at a coaching system, the "Care Transitions Intervention" that improves communication between providers and patients. In a randomized control trial, CTI "reduced 30-day hospital readmissions by 30 percent." This study looked at a "real-world" trial of Medicare patients in six Rhode Island hospitals and found that "[c]ompared with individuals who did not receive any part of the intervention (20.0% readmission rate), 30-day readmissions were fewer for participants who received coaching (12.8%)" (Voss et al., 7/25).

Kaiser Commission on Medicaid and the Uninsured/Kaiser Family Foundation: Establishing Health Insurance Exchanges: An Update On State Efforts -- This issue brief examines the progress states have made in creating their own insurance exchanges as mandated by the health law. That law requires that exchanges be fully operational by 2013. Legislatures in 13 states passed laws to establish exchanges. Two states had created exchanges prior to 2011, but they may have to amend them to meet the law's requirements. "Most exchanges to date have been created with some independence from state government. In all, eight states chose a quasi-governmental structure and two others opted for a non-profit corporation"  (7/27). 

Commonwealth Fund/Catalyst For Payment Reform: Promising Payment Reform: Risk-Sharing With Accountable Care Organizations -- The authors write that "[d]espite the flurry of activity to understand and establish ACOs since the passage of the Affordable Care Act, the development of ACOs and the payment models to support them are still their infancy. ... it is too early to know whether independent providers can or will reorganize themselves to deliver coordinated care."  This report looks at eight private ACOs that use, or are planning to use, "a shared payer-provider risk payment model." The authors note: "Although this research uncovered several key findings about the development of ACOs and the payment models to support them, it is too early to identify which payment models best align incentives for ACOs with high-quality, high-value care" (Delbanco et al., 7/25).

Annals of Family Medicine: Patient-Reported Care Coordination: Associations With Primary Care Continuity and Specialty Care Use -- Researchers studied Medicare beneficiaries with "select chronic conditions" in Washington state to see whether the type of care -- primary or speciality -- mattered in terms of continuity. They concluded: "High use of specialty care may strain the ability of primary care clinicians to coordinate care effectively. Future studies should investigate care coordination interventions that allow for appropriate specialty care referrals without diminishing the ability of primary care physicians to manage overall patient care" (Liss et al., July/Aug. 2011).