Research roundup: Caring for dual eligibles; Antitrust policy and the health law

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

PLoS ONE: Geographic And Racial Variation In Premature Mortality In The U.S.: Analyzing The Disparities -- Using data from the Centers for Disease Control and Prevention (CDC), this report notes a systematic difference in life expectancy across region and race. "Within in each sex-race group, there are striking geographical differences in the probability of survival to age 70. ... These differences are larger for males than females within each race and larger for blacks than whites within each sex" (Cullen, Cummins and Fuchs, 4/17).

Urban Institute/Robert Wood Johnson Foundation: ACA Implementation-Monitoring And Tracking: Colorado Site Visit Report -- This report looks at how the state of Colorado created bipartisan health reform. The authors note that "stakeholders have largely worked collaboratively to begin putting various required policies and structures in place. Adopting a 'Colorado-specific' version of health reform has been critical for state policymakers in responding to the ACA, and was a key factor in the successful passage of exchange legislation. Strong leadership, bipartisan political support, and continued aggressive action will be needed for Colorado to succeed in implementing reform on time" (Hill, Courtot, Bovbjerg and Adams, 4/12).

Kaiser Commission on Medicaid and the Uninsured: Massachusetts' Proposed Demonstration To Integrate Care For Dual Eligibles -- The author writes: "This brief examines Massachusetts' proposal to CMS to create an integrated service delivery and payment model in that state. Massachusetts is the first state to submit such a proposal as a part of a nationwide effort guided by the Centers for Medicare and Medicaid Services (CMS). Beginning in January, 2013, CMS will implement a three-year multi-state demonstration to test new service delivery and payment models for people dually eligible for Medicare and Medicaid. These demonstrations will enroll full dual eligibles in managed fee-for-service or capitated managed care plans that seek to integrate benefits and align financial incentives between the two programs" (Musumeci, 4/18).

Government Accountability Office: Federal Antitrust Policy: Stakeholders' Perspectives Differed On The Adequacy Of Guidance For Collaboration Among Health Care Providers -- This report explores how the possibility of creating a collaborative arrangement in the health care system would be received by stakeholders -- "health care industry groups and experts in antitrust law." These collaborative arrangements could include a hospital cooperating with a group of health plans and physicians, for example. The authors write: "The use of exclusive arrangements has the potential to improve or reduce competition, depending on the circumstances. Four of the experts said that the agencies' guidance on exclusive arrangements was reasonable, while three industry groups stated that the agencies should permit greater use of exclusive arrangements" (4/16). 

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

MedPage Today: HIV Prevention Pill's Value Varies by Target
The pill-a-day approach to HIV prevention can be cost-effective in men who have sex with men, but only in those at high risk for infection, researchers reported. In a complex mathematical model, so-called pre-exposure prophylaxis, or PrEP, was found to prevent a large number of infections over a 20-year period, according to Jessie Juusola, MS, and colleagues at Stanford University in Palo Alto, Calif. But the best bang for the buck came when PrEP was aimed mainly at men who have more than five sex partners a year, Juusola and colleagues reported in the April 17 issue of Annals of Internal Medicine (Smith, 4/16).

Reuters/Chicago Tribune: Interpreters In ER May Limit Medical Errors: Study
The study, conducted at two pediatric ERs and published in the Annals of Emergency Medicine, found that mistakes which could have "clinical consequences," like giving the wrong medication dose, were about twice as likely if there were no interpreters or if the translator was an amateur (4/17).

KQED's State of Health blog: Smoking Or Schools: Which Is More Important To Your Health?
Too often, we confuse health with health care. ... health comes from many places we don't normally think of as health at all -; things like good schools, safe neighborhoods and access to a variety of jobs. In other words, if you live in places without those things, you have a lower likelihood of enjoying good health. Today, a new study from researchers at Stanford's School of Medicine confirms that health disparities across the country have more to do with social factors than the color of your skin or where you live (Aliferis, 4/17).

MedPage Today: Cheaper Lung Screen May Help in CT Quandary 
A less expensive alternative to CT might help identify patients with suspicious lung lesions that require further evaluation, initial data from an ongoing study showed. ... In the recent National Lung Screening Trial (NLST), screening high-risk patients with chest CT led to a 20% reduction in lung cancer-specific mortality and a 7% reduction in overall mortality compared with conventional chest x-rays. However, CT costs substantially more than chest x-rays do, and increased radiation exposure with CT remains a concern, even with low-dose protocols, said Bertolaccini (Bankhead, 4/19).