Research Roundup - May 2015

State News

Oregon’s network adequacy rules taking shape

By Tara Bannow, The Bulletin | April 23, 2015

Legislation addressing network adequacy has passed the Oregon House and now awaits hearings in the Senate, where it’s likely to be approved. The new rules, which would take effect Jan. 1, 2017, would require carriers to submit annual reports to the state on their plans to ensure network adequacy and maintain up-to-date lists of in-network providers on their websites. The rules would not apply to large-group plans.

Michigan’s Fee-for-Value Physician Incentive Program Reduces Spending and Improves Quality in Primary Care

By Christy Harris, et al., Health Affairs | April 2015

A new study examines Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program (a fee-for-value organization) and its impact on quality and spending from 2008 to 2011. The authors found a spending reduction of 1.1 percent for adults (5.1% reduction for children) and the same or improved performance on 11 of 14 quality measures.

Recent Reports

The Impact of a Tiered Network on Hospital Choice

The Commonwealth Fund | April 22, 2015

Tiered-network designs that feature large cost differences between tiers are successful at steering patients toward preferred hospitals—those offering lower costs and higher quality—while preserving a greater degree of provider choice than a narrow network design. The authors warn, however, that tiered networks have potential drawbacks. For example, they may transfer risk to patients in the form of higher out-of-pocket payments for lower-tiered providers.

Two reports find that Medicare Pioneer ACOs save money

By Sarah Kliff, Vox | May 4, 2015

New evidence shows that Pioneer Accountable Care Organizationscreated in 2012 to provide financial incentives to doctors who met quality metrics and punish those who did notshowed significant savings to the Medicare program: $384 million over two years. The Obama administration would like to expand the program to other hospitals, but there is uncertainty whether other hospitals would be able to replicate the savings seen by the large, more advanced hospitals systems that took part in the initial phase of the Pioneer ACO program. Additionally, more evidence is needed to show that this program can sustain savings in the long run.

Small Number of Drugs Drives Big Medicare Bill, Spending Data Show

By Joseph Walker and Anna Wilde Mathews, The Wall Street Journal | April 30, 2015

Expensive drugs for diseases such as cancer and multiple sclerosis account for more than a quarter of spending on prescriptions. According to newly released data from Medicare’s prescription-drug program, of nearly 3,500 drugs prescribed in 2013, roughly 400 cost $3,000 or more per beneficiary per year—comprising $26.5 billion in total spending. The data release comes amid a national debate over the costs of new, high-price medications—and who should pay for them. [For more, see the Hub’s Rx Costs: A Primer for Healthcare Advocates]

Family Doctors Who Do More, Save More

By Anders Kelto, NPR | May 2015

A study published in the Annals of Family Medicine suggests that family doctors who provide more care themselves save the health system money. The researchers looked at 3,652 family physicians and 555,165 Medicare patients across the country and found that patients of physicians who provided a wider range of services experienced fewer hospitalizations and incurred lower healthcare costs.The researchers also found that doctors who performed a wider range of services reduced overall patient costs by between 10 and 15 percent. [Link]

Mapping Life Expectancy

VCU Center on Society and Health | April 2015

The Virginia Commonwealth University Center on Society and Health created a series of maps that prominently display life expectancy values along common geographic landmarks. The maps illustrate the vastly different health outcomes experienced by Americans living just a few miles apart and serve as a conversation starter about the social determinants of health.

Anthem Touts Results of Effort to Cut Health Costs

By Anna Wilde Matthews, The Wall Street Journal | April 28, 2015

Anthem, the nation’s second largest health insurer, released the results of a 12-month experimental program of paying providers more if they lowered the cost of patient care and met specific quality measurements. The program helped reduce costs by about 3.3% in participating hospitals. The findings are an early look and haven’t been peer-reviewed.

Measuring Vital Signs: An IOM Report on Core Metrics for Health and Healthcare Progress

The Commonwealth Fund | April 28, 2015

Enthusiasm for performance measurement in both the public and private healthcare sectors has helped to create a serious problem: a massive proliferation of measures that have caused confusion and inefficiency. In response, the IOM has identified a set of standardized measures, along with steps for implementing and refining them. This report highlights the 15 measures identified by the IOM and discusses the need for monitoring and measuring performance and growth in these areas.

Commentary/ News

When Healthcare Transformation Fails

By Stuart Pollack, Health Affairs Blog | April 27, 2015

Creating successful ACOs, medical homes and other coordinated care requires not only a policy change but a culture shift. Pollack argues that disorganized, fee-for-service health systems are struggling to reproduce the results of successful systems (such as Geisinger and Intermountain) by scaling their processes when they should be scaling their cultures and principles instead.

Genetic Testing Moves Into World of Employee Health

By Tom Murphy, Associated Press | April 28, 2015

Workplace wellness programs in large corporations are considering blending genetic testing with coaching on nutrition and exercise to help workers lose weight and improve their health before serious conditions like diabetes or heart disease develop.  Many benefit experts argue that this sort of testing, offered by Aetna and Newtopia, will not likely be used on a widespread basis especially because it requires the sharing of sensitive information.

5 things Atul Gawande learned on his return to McAllen, TX


By Kavita Patel and Frank McStay, Brookings | May 8, 2015

As a follow up the New Yorker articles, “The Cost Conundrum” and “The Cost Conundrum: Redux,” Atul Gawande provides an update on the town of McAllen, Texas, and their healthcare spending problem. Six years ago Atul Gawande went on a fact finding mission to McAllena community with double the average Medicare spending. He found a system in denial and with high rates of hospital admissions, expensive surgeries and outpatient home healthcare. When Gawande returned to McAllen the entire system had vastly improved. Inpatient visits had fallen by 10 percent; home healthcare spending was down 40 percent; ambulance rides were down 40 percent; and cost per beneficiary dropped almost $3,000 resulting in nearly half a billion dollars saved. Find out how!