2011 Potpourri XXXXVI

High-deductible health plans are spreading rapidly.  Research in the American Journal of Managed Care looks at their longer term effects on health care utilization.  The data come from a single health plan in Massachusetts and analyze utilization after the first year of enrollment in an HDPD, comparing it to that for people in traditional health plans.  In the first year both emergency room visits and hospitalizations declined, but in the second year, hospitalizations no longer showed a decrease, although ER visits were still down.  The ER visits avoided were largely for non-emergent needs.  The data suggest that any long-term health spending reductions, as opposed to just cost-shifting to consumers, may only come from ER spending.   (AJMC Article)

A report from the Kaiser Family Foundation estimates how much CMS will pay out in bonuses to Medicare Advantage plans in 2012.  The 2012 payments are based on 2011 performance under the Star system, which covers 53 performance measures and rates plans on a one to five star scale.  About a fourth of Medicare Advantage enrollees are in plans with four or five stars, most are in plans with average ratings of 3 or so.  About 91% of plans are estimated to receive a bonus, with the total amount being about $3.1 billion.  These bonuses make up about half the reduction in payments scheduled for Medicare Advantage plans under the reform law in 2012.  The average bonus is about $281 per enrollee, although there is wide variation.  Not-for-profit plans generally have better ratings than for-profit ones and therefore will get more of the bonus payouts.   (KFF Report)

Research published in the New England Journal of Medicine finds that among the elderly, problems arising from use of relatively common drugs account for a significant number of hospitalizations.  According to the authors, there were about 100,000 hospitalizations a year for adults over 65 that were due to drug complications and half of those were in people over 80.  Two-thirds of these hospitalizations were caused by unintentional overdoses.  And two-thirds were accounted for by common drugs like warfarin, insulin, anti-platelet factors and hypoglycemic agents.  Drugs considered high-risk were linked to only about 1% of the hospitalizations.   (NEJM Article)

An Employee Benefits Market Survey from the Council of Insurance Agents & Brokers finds that while many employers are still seeing significant premium increases in 2011, those increases have moderated from last year.  For small groups, 39% saw hikes of 11% or more, for medium size groups of 51-500 employees, 69% had increases of 6-15% and for large groups 61% had increases under 10%.  The reform act was perceived as adding 2-3% to premiums.  Interest in high-deductible plans and wellness efforts was reported to be very high and employers are reducing plan options for employees.    (CIAB Release) 

A note on the Kaiser Family Foundation website discusses trends in physician office visits.  In the early 2000s these visits were running at about 140 million per quarter for privately insured patients.  Around 2005 they jumped to about 160 million, where they stayed until the recession, then dropping to as low as about 130 million.  As the author notes, this is probably due to people losing coverage and to more high-deductible, high copayment plans.  It may also be due to the greater use of retail clinics we noted in a post earlier this week and to use of onsite workplace clinics.  The uncertainty about the number of visits complicates insurer rate-setting, especially in a controlled MLR environment.  (KFF Notes)

Many pay-for-performance programs have a significant patient satisfaction component.  A new study in the British Medical Journal; Quality & Safety suggests that there is a lack of understanding of patient expectations that likely inhibits creation of better patient satisfaction.  The authors surveyed clinicians in four countries, including the US, and found that while 90% of clinicians think it is important to ask patients about their expectations, only 16% actually ask.  Only 20% of respondents thought they had adequate training to understand and handle patient expectations.  Overall, not surprisingly, 88% of the clinicians thought they and their organizations had a low awareness of patient expectations.   (BMJQS Article)