A paper from the National Bureau of Economic Research explores the extent to which medical malpractice liability may affect health care quality, finding only a minor relationship.
Every now and then an interesting health-related article is found in an unusual venue. A recent edition of The Atlantic, written by a distinguished health policy wonk, contains an article addressing the use more home care for the chronically ill elderly population. (Atlantic Article) As the population ages, an increasing portion of our total health spending is going for a relatively small number of chronically ill older Americans. Many of these people wind up in nursing homes, where they often make repeated trips to emergency rooms or hospitals for flare-ups of one or another of their health conditions. As their health slides down toward the last year of life, their spending goes up rapidly, usually due to a cycle of repeated and ineffective hospitalizations. Those who live at home also tend to have high rates of ER and hospital use. In addition to their health problems, they tend to have a syndrome of other issues, such as inadequate income, poor health literacy and non-existent social support. They often engage in poor health behaviors and make poor health care decisions.
The article describes a new approach reflected in a number of programs across the country to create intensive, multi-disciplinary, home-based care and support for these patients, in the hopes of improving their health and quality of life and potentially reducing overall health spending on them. One underlying premise is that the health conditions can be treated most effectively if the other issues in a person’s life are also addressed. Another premise is that care in a home setting is almost always less expensive than that rendered in a hospital or nursing home or ER. Focusing on one program in California, the author suggests it may offer a model for the country. Social workers are key members of the program’s team and are able to address issues that exacerbate health problems. A barrier to these programs, as usual, is the fickle and random nature of Medicare reimbursement, which pays a lot for hospitalizations and ER care, but not much if anything for this kind of team-based care coordination, much less for social work. The programs must scramble to find grants or other funding. Medicare Advantage plans are better able to be creative since they can choose to spend the money CMS pays them how they wish. And many of these people are dual eligibles and many Medicaid programs are more flexible than CMS. It is very, very unclear that these programs will save money. But just as clearly, they likely make patients’ lives much better, and that is itself a worthy goal.
The socioeconomic makeup of a Part D plan’s enrollees may affect it’s scores on performance measures, which can have important downstream effects, according to research published in Health Affairs.
Having continuous health insurance for a number of years before becoming a Medicare beneficiary is associated with lower Medicare spending according to a recent Government Accounting Office report, but only for limited categories and, for obvious methodological reasons, once again we see that association or correlation is not the same as causation.
A Congressional Budget Office report tackles the difficult subject of growing military health spending, providing options to reduce the rate of increase.
The IMS Institute for Healthcare Informatics issues a report describing the efforts of pharmaceutical manufacturers to use social media to engage patients.
Research published in the New England Journal of Medicine finds that having surgery for a knee meniscus tear has no better outcomes than fake surgery.
The Massachusetts Health Policy Commission issues its annual report on cost trends, finding that almost a decade after reform was initiated in the state, costs are still high, not well-controlled and much spending is wasted.
Under the current Medicare Advantage plan payment methodology, plans receive more for sicker enrollees, but research in the Journal of Health Economics finds no evidence plans are selecting for these less healthy beneficiaries in order to get higher reimbursement.
Research published in Health Affairs studies a long-running wellness effort at PepsiCo, finding that the disease management component appears to save on health costs but the lifestyle modification portion does not.
A consumer survey from the Altarum Institute gives insight into decision-making and attitudes about health and health care coverage.
Legendary strategist Michael Porter has fixed his sights on health care and his latest missive in the Harvard Business Review lays out a vision which unfortunately is based on a number of inaccurate perceptions of the current health system.
Medication therapy management has become more common, especially for the elderly. A review from the Agency for Healthcare Research and Quality finds little evidence to date that it improves most outcomes.
Medigap insurance is purchased by many Medicare beneficiaries to cover cost-sharing. A new paper confirms that having this insurance leads to higher Medicare spending.
The Pharmacy Benefit Management Institute has released its 2013/14 prescription drug benefit report.