Research roundup: Cutting speciality care by raising co-payments; Asthma diagnosis and insurance coverage; GAO on early retirees

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs.

Health Affairs: Mayo Clinic Employees Responded To New Requirements For Cost Sharing By Reducing Possibly Unneeded Health Services Use -- Researchers at the Mayo Clinic examined the effects of changes in the clinic's self-funded health plan "to decrease the use of potentially inappropriate health care services and foster a deliver system centered on primary care." In 2004, the Mayo Clinic added a $25 co-payment in its high option health plan for speciality care and increased beneficiaries' cost sharing by 10 or 20 percent for some other services, such as imaging and some outpatient procedures. The plan also removed cost sharing for visits to primary care providers and for preventive services. The researchers found plan members cut back on office visits to specialists and "did not make greater use" of primary care. They also reported "large decreases in the use of diagnostic testing and outpatient procedures that were sustained for four years, and an immediate decrease in the use of imaging that later rebounded" (Shaw et al., 11/7).

New England Journal of Medicine: Results Of The Medicare Health Support Disease-Management Pilot Program -- This large study looks at eight commercial diseases management programs that serve Medicare beneficiaries through the use of nurse-based call centers. The researchers looked at the effects of such services on patients with heart failure, diabetes, or both. They found that these disease management programs did not reduce hospital admissions or emergency room visits, and write: "We observed only 14 significant improvements in process-of-care measures out of 40 comparisons. These modest improvements came at substantial cost to the Medicare program in fees paid to the disease-management companies ($400 million), with no demonstrable savings in Medicare expenditures" (McCall and Cromwell, 11/3).

Government Accountability Office: Implementation Of The Early Retiree Reinsurance Program -- This report examines the provision in the health law that provided reimbursements to employer plans for health costs for retirees under the age of 65 and not yet eligible for Medicare.  The GAO found that since the start of the program the Obama administration approved more than $2.7 billion in reimbursements, 54 percent of the $5 billion allotted to the entire program. The biggest portion of this reimbursement went to government entities, "which is consistent with the provision of retiree health benefits in the marketplace" since government entitites "are more likely than other types of employers to provide health benefits to their retirees."  GAO also noted "HHS projects that the $5 billion appropriated for ERRP will be expended by the end of fiscal year 2012--before the January 1, 2014, end date for the program" (Dicken et. al, 10/30).

Health Services Research: Lack Of Insurance Linked To Fewer Asthma Diagnoses In Children -- This study "tests the hypothesis that an asthma diagnosis is more prevalent among insured rather than uninsured children and that insurance-based differences have an effect on the disease." Using federal data, the researchers found that children with insurance "increases only the likelihood that a child with intermittent, not persistent, asthma symptoms will receive an asthma diagnosis and control medication, and it may not reduce acute care utilization. Although universal insurance may increase detection and management of undiagnosed childhood asthma, theorized cost savings from reduced acute care utilization might not materialize (Coker, Kaplan and Chung, 10/27).

Kaiser Commission on Medicaid and the Uninsured/Health Outreach Partners: Connecting Eligible Immigrant Families To Health Coverage And Care: Key Lessons From Outreach And Enrollment Workers -- This report looks at the experiences of outreach workers who serve immigrant communities to see what kind of role Medicaid and the Children's Health Insurance Program (CHIP) could have for them. It also identifies key barriers to coverage and the strategies for giving the low-income immigrant populations in California, Washington, D.C., and Florida access to health care. Some of the biggest obstacles workers encountered included language barriers, "burdensome and confusing application processes and difficulty meeting documentation requirements," a lack of access to care for the immigrants and a fear in the community of deportation for using care.  Among the strategies offered in the brief were to improve and increase outreach to immigrant families, provide translation assistance and aide them in the application process to get Medicaid and/or CHIP (Gomez, Day and Artiga, 10/27).

The Urban Institute: The Role Of Prevention In Bending The Cost Curve -- This brief specifically focuses on a provision in the federal health law to establish the Prevention and Public Health Fund, which will help identify and invest in "effective primary prevention interventions" and targes interventions for tobacco use, obesity, better nutrition and physical activity. "The difference between the cost of care for people with chronic disease and those without can be thought of as the 'excess costs' associated with chronic disease." Funding for diabetes prevention, smoking cessation, community-wide interventions for physical activity and targeting health disparities is "essential if the United States is to remain competitive in the world economy" (Waidmann, Ormond and Bovbjerg, 10/27).

Robert Wood Johnson Foundation/The Urban Institute: Accountable Care Organizations In Medicare And The Private Sector -- This policy paper provides an overview of accountable care organizations (ACOs) as well as concerns about federal regulations that have been set for them. It also explores where ACOs stand on delivering health care through Medicare and private health plans. Experts assessed a key demonstration project and reported that while "ACOs will be able to improve the quality of care they deliver (at least as measured by process-oriented clinical quality measures)," they will have a harder time generating savings (Berenson and Burton, November 2011).