Research Roundup - June 2017


Minnesota Nurses Association Will Give Debt Relief to Needy Patients

By Jeremy Olson | Minneapolis Star Tribune | June 15, 2017

The Minnesota Nurses Association announced that it will pay off approximately 1,800 patients’ debts on the anniversary of its strike against five Allina Health hospitals in the Twin Cities, according to the Star Tribune

Report Reveals the Cost of ‘Low-Value’ Care in Minnesota

By Christopher Snowbeck | Minneapolis Star Tribune | June 3, 2017

A new report from the Minnesota Department of health showed the state spent $54.9 million on low-value healthcare services in 2014, according to the Star Tribune. The report reviewed claims data for 1.46 million patients and evaluated the use of 28 low-value services as defined by the Choosing Wisely campaign.


Nevada Takes on PBMs and Pharma in Broad Drug-Pricing Transparency Bill

By Eric Sagonowsky | Fierce Pharma | June 6, 2017

Nevada’s prior drug-pricing bill that targeted manufacturers of diabetes drugs didn’t make it past the governor’s veto pen, but state lawmakers renewed their efforts with a new bill that not only zeroes in on pharma, but pharmacy benefit managers, too, according to Fierce Pharma. In addition to forcing drugmakers to justify price hikes on diabetes medications, the new bipartisan bill will require PBMs to disclose rebate information. It also forbids them to punish pharmacists for “selling a less expensive alternative drug” to patients. 


Focus on Social Determinants of Health Pushes Caregivers into New Terrain

By Courtney Sherwood | The Lund Report | June 7, 2017

Oregon’s Medicaid Coordinated Care Organizations held a sold-out Social Determinants of Health Conference that explored the diverse ways in which organizations are providing services that go beyond the scope of traditional medical care, according to The Lund Report. Programs profiled included a recent $21 million partnership that will fund the construction of 382 housing units in Portland. 


Governor Signs Legislation to Expand Telemedicine in Vermont

By Erin Mansfield | VT Digger | June 7, 2017

Vermont Governor Phil Scott signed legislation aimed at increasing the use of telemedicine technology in the state, according to VT Digger. The law goes into effect Oct. 1, 2017, and requires Medicaid and private insurers to reimburse doctors for services provided to patients through video conferencing technology. Previously, insurers only had to cover such services if they were provided through a medical facility such as a hospital.


Doctor’s Fees in Milwaukee Area 41% Higher than National average, Study Says

By Guy Boulton | Milwaukee Journal Sentinel | May 15, 2017

The Health Care Cost Institute recently completed a study suggesting that fees for physician services paid to doctors by employers’ health plans ranged from 41-63 percent higher than the national average throughout much of eastern Wisconsin, according to the Milwaukee Journal Sentinel. Although the study did not take utilization into account, the prevalence of health system-employed physician practices may play a role in higher fees. 

Recent Reports

For Selected Services, Blacks and Hispanics More Likely to Receive Low-Value Care than Whites

By William Schpero, et al. | Health Affairs | June 2017

Medicare beneficiaries of color are more likely to receive unnecessary and even potentially harmful medical services than white beneficiaries, according to a study in Health Affairs. Although African Americans and Hispanics were equally likely to receive low-value care, the types of low-value care received differed between the two minority groups. Quality improvement efforts such as the use of payer performance metrics should take racial and ethnic disparities into account, however it is likely that a number of interventions will be required to correct this issue. 

Balance Billing by Healthcare Providers: Assessing Consumer Protections Across States

By Kevin Lucia, Jack Hoadley and Ashley Williams | Commonwealth Fund | June 2017

Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing, according to this Commonwealth Fund report. Most states do not have laws that directly protect consumers from balance billing by an out-of-network provider for care delivered in an emergency department or in-network hospital. Of the 21 states offering protections, only six have a comprehensive approach to safeguarding consumers in both settings, and gaps remain even in these states. Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers. 

Changes in Hospital Quality Associated with Hospital Value-Based Purchasing

By Andrew Ryan, et al. | New England Journal of Medicine | June 15, 2017

Starting in fiscal year 2013, the Hospital Value-Based Purchasing (HVBP) program introduced quality performance based adjustments of up to 1 percent to Medicare reimbursements for acute care hospitals, according to this NEJM article. The authors evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals. The authors found HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures.

The Evidence on Recent Healthcare Spending Growth and the Impact of the Affordable Care Act

By John Holahan, et al. | Urban Institute | May 24, 2017

National health expenditures have been growing in recent years at about the rate of increase in gross domestic product (GDP) plus 1 percent, following decades of growth at GDP plus 2.5 percent. According to this brief from the Urban Institute, the authors discuss a number of reasons for the slowdown, including contributions made by the ACA. The authors also discuss reasons for the growth in marketplace premiums, finding that states with rapid growth rates typically have little insurer or provider competition. Large numbers of states have seen relatively modest premium increases. Finally, the authors conclude with evidence on Medicaid spending growth, arguing that enrollment increases have played a major role, with growth in spending per enrollee below that of other payers. This largely reflects the cost containment efforts of states. 

The Impact of Ambulance Diversion: Black Patients with Acute Myocardial Infarction had Higher Mortality than Whites

By Renee Hsia, Nandita Sarkar and Yu-Chu Shen | Health Affairs | June 2017

Using a non-public database of patients in California with acute myocardial infarction and hospital level data on ambulance diversion between 2001 and 2011, researchers found that hospitals treating a high share of black patients were more likely to experience diversion, and black patients faced worse outcomes when compared to white patients, according to research published in Health Affairs. Interventions are needed that address diversion for hospitals serving a higher volume of blacks to reduce these disparities.

Racial and Ethnic Disparities at Veterans Health Administration Patient-Centered Medical Homes

By Donna Washington, et al. | Health Affairs | June 2017

In 2010, the Veterans Health Administration began implementing patient-centered medical homes as part of an initiative to achieve better patient outcomes. Significant disparities in hypertension or diabetes control were present for most racial/ethnic groups compared to whites in 2009. In 2014, racial and ethnic disparities persisted for most racial groups, according to research published in Health Affairs. Researchers found that the benefits offered by the patient-centered medical homes were offset by multifactorial external, health system, provider, and patient factors.

Role of Nonprofit Hospitals in Addressing and Identifying Health Inequities in Cities

By Amy Carroll-Scott, et al. | Health Affairs | June 2017

A community health needs assessment is required for nonprofit hospitals to maintain their tax-exempt status under the Affordable Care Act. Researchers conducted an analysis of 179 hospitals in 28 cities between August and December 2016. Of the needs assessments analyzed, 65 percent included one health equity term and 35 percent of the implementation strategies included a health equity term, but only 9 percent included an explicit strategy to promote health equity, according to Health Affairs. Hospitals should continue to invest in strategies that address the underlying social and economic conditions that cause health inequities.


How Two Common Medications Became One $455 Million Specialty Pill

By Marshall Allen | ProPublica | June 20, 2017

After the author of this article was prescribed a brand-name drug he didn’t need and given a coupon to cover the out-of-pocket costs, he discovered another reason Americans pay too much for healthcare. In this ProPublica article, he describes his encounter with a new healthcare market waste stream: overpriced drugs whose actual costs are hidden from doctors and patients.

Private Sector Can Lead in Delivery System and Payment Reform

By Chris Jennings and James Capretta | Health Affairs Blog | June 8, 2017

Today, more than half of all Americans receive their health care insurance through employer sponsored plans, according to Health Affairs Blog. Changes made in the private sector could significantly influence the broader healthcare market. There are many promising private-sector approaches to lowering costs and improving quality, including harnessing data as Geisinger does and the use of reference pricing in the California Public Employees Retirement System (CalPers).

Community Health Centers Venture into Value-Based Care to Increase Access, Decrease Costs

By Maria Castellucci | Modern Healthcare | June 2017

The 1,400 federally qualified health centers across the U.S. are an essential source of primary-care services for approximately 24.3 million low-income individuals, but their current reimbursement model does not cover non-traditional care approaches. According to this Modern Healthcare article, this inefficient payment model has encouraged several states to create new reimbursement models that ensure health centers are reimbursed for valuable but non-traditional services, such as at-home visits, transportation services and telehealth. The new model requires health centers to be innovative in the way they engage their patient population and reduce costs. It has been successful in Oregon with cost savings of $240 million over two years. 

How Healthcare and Community-Based Human Services Organizations are Partnering for Better Health Outcomes

By Quiana Lewis | Health Affairs Blog | June 29, 2017

Social determinants of health—such as access to healthy food, safe housing, education, and employment—play a crucial role in individuals’ health and well-being. Increasingly, healthcare and community-based organizations are partnering to address social issues to improve health outcomes and reduce costs. Many of these partnerships have led to the more efficient use of resources, increased communication, and trust. However, they often lack a common language by which to articulate goals and identify needs, according to a recent post on the Health Affairs Blog.

The Flow of Funds in the Pharmaceutical Distribution System

By Neeraj Sood, et al. | Health Affairs Blog | June 13, 2017

Ten percent of all healthcare spending is on prescription drugs and this number is growing rapidly. This increase in spending has been accompanied with calls for more government intervention to regulate drug prices and control their rapid increase. According to Health Affairs Blog post, $1 out of every $5 spent on prescription drugs goes towards profits in the pharmaceutical distribution system. Pricing policies should be more scrutinized and increased competition throughout the distribution system is warranted.