Research roundup: Medicare Part D in 2014; barriers to mental health care; scattered patterns of ACOs

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Kaiser Family Foundation/Georgetown University/NORC: Medicare Part D: A First Look At Plan Offerings In 2014
Medicare Part D continues to be a marketplace with an array of competing plans offered at a wide range of premiums and benefit designs.  In 2014, Medicare beneficiaries will have a choice of 35 stand-alone PDPs, on average, up by four from 2013. ... Beneficiaries receiving Low-Income Subsidies (LIS) will have access to a modestly higher number of plans for no monthly premium in 2014 compared to 2013 ... Notable trends for 2014 include a growing share of PDPs using preferred pharmacy networks and adopting more formulary cost-sharing tiers. For example, a majority of PDPs now use preferred pharmacy networks where cost sharing is lower when enrollees use preferred pharmacies and higher outside the preferred network (Hoadley, Cubanski, Hargrave and Summer, 10/10).  

Health Affairs: Access And Cost Barriers To Mental Health Care, By Insurance Status, 1999–2010 
Although access to specialty care remained relatively stable for people with mental illnesses, cost barriers to care increased among the uninsured and the privately insured who had serious mental illnesses. The rise in cost barriers among those with private insurance suggests that the current financing of care in the private insurance market is insufficient to alleviate cost burdens and has implications for reforms under the Affordable Care Act. People with mental health problems who are newly eligible to purchase private insurance under the act might still encounter high cost barriers to accessing care (Rowan, McAlpine and Blewett, 10/7).

Health Affairs/Rand: Accountable Care Organization Formation Is Associated With Integrated Systems But Not High Medical Spending
Medicare's approximately 250 accountable care organizations (ACOs) care for a growing portion of all fee-for-service beneficiaries across the United States. We examined where ACOs have formed and what regional factors are predictive of ACO formation. ... We found wide variation in ACO formation, with large areas, such as the Northwest, essentially empty of ACOs, and others, such as the Northeast and Midwest, dense with the organizations. Key regional factors associated with ACO formation include a greater fraction of hospital risk sharing (capitation), larger integrated hospital systems, and primary care physicians practicing in large groups. Area income, Medicare per capita spending, Medicare Advantage enrollment rates, and physician density were not associated with ACO formation (Auerbach et al., 10/7). 

Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five
During [2007-2011], per capita spending on employer-sponsored insurance grew at historically slow rates, but still faster than per capita national health expenditures. Total per capita spending for employer-sponsored insurance grew at an average annual rate of 4.9 percent, with prescription spending growing at 3.3 percent and medical spending growing at 5.3 percent. Out-of-pocket medical spending increased at an average annual rate of 8.0 percent, whereas out-of-pocket prescription drug spending growth was flat. Growth in the use of medical services and prescription drugs slowed. Medical price growth accelerated, and prescription price growth decelerated (Herrera et al., 10/7). 

Urban Institute/Robert Wood Johnson Foundation: Eligibility For Assistance And Projected Changes In Coverage
Among states not currently planning to expand Medicaid eligibility, the share of the uninsured eligible for assistance ranges from 34 to 53 percent. In contrast, the share of the uninsured eligible for assistance ranges from 59 to 81 percent among the states that are currently committed to expanding Medicaid under the ACA. Second, we estimate the decrease in the uninsured population under the ACA in each state. Among states not currently expanding Medicaid, we predict the number of uninsured would decrease 28 to 38 percent. Eight states committed to expansion would see the number of uninsured decline by more than half (Buettgens, Kenney, Recht and Lynch, October 2013).

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

Reuters: Are Blood Clots After Surgery A Sign Of Hospital Quality
Some policymakers have suggested using the number of patients that form blood clots after surgery as a measure of a hospital's quality. But a new study questions that idea. Researchers found high-quality hospitals and those that regularly check for the complications tend to have higher rates of blood clots than low-quality hospitals and those that don't look for clots as often (Seaman, 10/7).

Modern Healthcare: ACOs More Likely To Be In Markets With Hospital, Doctor Consolidation, Study Finds
In five markets around the country, accountable care organizations were providing care to more than half the Medicare patients in the traditional fee-for-service program, a new study found. In addition, ACOs were more likely to be found in markets with greater consolidation by hospitals and doctors (Evans, 10/7).

Reuters: Sicker Medicaid, Medicare Emergency Patients Less Profitable
When a patient with private health insurance seeks outpatient care at the emergency room, the sicker he or she is, the more money the hospital stands to make, a new study shows. But the opposite is true for patients with Medicaid or Medicare insurance: the sicker the patient, the less profitable he or she is to the hospital, Dr. Philip Henneman of the Tufts University School of Medicine in Boston and his colleagues report in the Annals of Emergency Medicine (Harding, 10/10).