Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder
State mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the number of children diagnosed with the disorder. However, diagnosis rates remain much lower than community estimates, suggesting that many commercially insured children with ASD remain undiagnosed or are insured through public plans.
Primary Care Appointment Availability for Medicaid Patients: Comparing Traditional and Premium Assistance Plans
In 2014, Arkansas and Iowa expanded their Medicaid programs and enrolled many of their adult beneficiaries in commercial Marketplace plans. This study suggests that this “private option” may make it easier for new Medicaid patients to get primary care appointments.
Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment Before and After Implementation of Quality-Related Bonus Payments in 2012
In PLOS ONE, LDI Senior Fellows Pengxiang Li and Jalpa Doshi examine the impact of the Medicare Advantage Presciption Drug Plan star ratings before and after 2012, when they became tied to bonus payments. Does an increase in a plan’s star rating have a direct impact on concurrent year plan enrollment? What’s the indirect impact (via bonus payments) of star ratings on subsequent year plan enrollment?
This Issue Brief discusses treatments for opioid use disorders and summarizes a new systematic review of economic evaluations of these interventions. The review reveals strong evidence that methadone maintenance therapy is an economically advantageous form of treatment; the economic evidence for buprenorphine and naltrexone treatments is more limited.
Click Worthy: Stories Encourage Emergency Physicians to Learn More About Opioid Prescribing Guidelines
New study finds that narrative vignettes outperform standard summaries in promoting engagement with opioid prescription guidelines among a national sample of emergency physicians.
This Issue Brief summarizes evidence of nursing’s effects on NICU outcomes and recommends policies to bolster and support nursing practice in NICUs. Adequate staffing and a supportive work environment are associated with better outcomes for very low birth weight infants.
Overbilling for physician services under Medicare Part B has long been a concern, as some estimates show that fraudulent “upcoding” or “overcharging” might have cost the program tens of billions of dollars per year. Existing methods to detect the prevalence and financial cost of overbilling have various limitations, so the authors developed a novel approach: create estimates of actual hours worked as implied by the medical service codes that providers submit to Medicare. In an NBER Working Paper, LDI Senior Fellow Hanming Fang and co-author Qing Gong examine whether this method can generate a quicker and more robust estimation of overbilling across medical specialties and geographic areas.
In Health Affairs, Charlene Wong and colleagues go shopping on the most recent iteration of ACA marketplaces. They find added features to help consumers browse and pick a health plan, including total cost estimators and provider look-up tools. Marketplaces differ in how they estimate out-of-pocket costs and how they display plan choices, although most continue to present plans in premium order.
High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid Leukemia
Does high cost sharing in Medicare Part D drug plans affect whether and how quickly patients initiate a recommended and life-extending drug treatment? In American Journal of Managed Care, LDI Senior Fellows Jalpa Doshi, Pengxiang Li and colleagues assess whether Medicare patients newly diagnosed with chronic myeloid leukemia (CML) and subject to significant coinsurance, take longer to initiate tyrosine kinase inhibitors (TKI) treatment than low-income (subsidized) Medicare patients subject to a nominal copayment.
How does price transparency affect negotiated prices in business-to-business markets? In the first empirical analysis of its kind, LDI Senior Fellows Ashley Swanson and Matthew Grennan estimate how benchmarking information could be useful to hospital buyers in their negotiations with medical technology companies. They explore two mechanisms for possible savings: first, by reducing “asymmetric information” about seller bargaining parameters (that is, not knowing the lowest price a seller would accept); and second, by helping hospitals solve the “agency problem” with their procurement negotiators (that is, allowing hospitals to monitor negotiator performance and restructure financial incentives). Taking coronary stents as their example, the authors look at whether hospitals that join a price benchmarking database, which contains average pricing based on data submitted by member hospitals, can achieve savings in future negotiations with suppliers.
Changes in Consumer Demand Following Public Reporting of Summary Quality Ratings: An Evaluation in Nursing Homes
A new study by LDI Senior Fellows Rachel Werner and Daniel Polsky and their colleague, R. Tamara Konetzka, find that consumers responded when a nursing home report card converted 12 measures of quality into a simple 5-star system. One-star facilities typically lost 8 percent of their market share and 5-star facilities gained more than 6 percent of their market share. These results support the use of summary measures in report cards.
Adjuvant Chemotherapy Use and Health Care Costs After Introduction of Genomic Testing in Breast Cancer
The promise of personalized genomic testing is that it can reduce unnecessary care and costs by predicting which patients are most likely to benefit from a treatment. In this study of actual treatment patterns, LDI Senior Fellows Andrew Epstein and Peter Groeneveld and colleagues investigate how genomic testing of women with early-stage breast cancer affects subsequent chemotherapy use and medical spending in the year after diagnosis. After surgery, women with early-stage breast cancer face the decision of whether to undergo expensive and potentially toxic chemotherapy to prevent recurrence, although most will not have a recurrence. The 21-gene recurrence score test (RS) was developed in 2004 to predict this risk, and its use in clinical medicine is increasing. Epstein and Groeneveld find that genomic testing is associated with decreased use of chemotherapy and lower costs in younger patients, and slightly increased use of chemotherapy and higher costs in older patients. Genomic testing in actual practice may “rule out” chemotherapy in younger women, and “rule in” chemotherapy in older women.
Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk
In this study, LDI Senior Fellow Jeffrey Silber and colleagues at the Children’s Hospital of Philadelphia and the University of Pennsylvania look at how better nurse working environments influence the “value” of care, which is defined as the quality of care relative to the cost of providing it. Past studies of nurse work environments have looked at their impact on either quality or cost, but not on both. This study asks whether selecting hospitals based solely on excellent nursing environments identifies a set of hospitals that display better outcomes and value, a question most relevant to a patient seeking advice on where to go for care.
Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial
To whom should financial incentives be targeted to achieve a desired clinical or health outcome—physicians or patients? Using insight from behavioral economics, a research team led by LDI Senior Fellows David Asch and Kevin Volpp sought to determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective in promoting medication adherence and reducing cholesterol levels of patients at high risk for cardiovascular disease. Though physician and patient incentives are becoming more common, they are rarely combined, and effectiveness of these approaches is not well-established. This study offers insight into what incentive structure leads to the greatest impact on health promotion.
To reduce financial barriers to receiving recommended preventive care, the Affordable Care Act (ACA) eliminated patient cost sharing for many preventive services. This provision, rolled out between September 2010 and January 2011, applies to all private insurance plans and exempts ‘grandfathered plans’. In this study, LDI Senior Fellow Shivan Mehta and colleagues investigated whether this ACA provision has its intended effect on colonoscopy and mammography rates.