KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Research Roundup: Examining Comparative Effectiveness Research And Changes In Medicare Part D

Health Affairs: The Potential Impact Of Comparative Effectiveness Research On The Health Of Minority Populations -- This  is part of a collection of reports this month on comparative effectiveness research. Studies that compare how different treatments work is a focus of the new health law because advocates believe it could help hold down costs. This brief focuses on the health care of minorities, who "suffer more frequently and more severely from many diseases than do non-Hispanic whites." The authors examine "whether disparities reflect variations in care or different responses to treatment" and suggest improvements in research to address the needs of minorities (Mullins, et al., 10/5).

Health Affairs: How Medicare Could Use Comparative Effectiveness Research In Deciding On New Coverage And Reimbursement -- "Medicare generally covers any treatment that is deemed 'reasonable and necessary,' regardless of the evidence on the treatment's comparative effectiveness or its cost in relation to other treatments. Likewise, with only very rare exceptions, Medicare does not use comparative effectiveness information to set payment rates." But the authors of this analysis suggest that using a modified reimbursement policy based on comparative analysis could help control Medicare costs. They propose that "when Medicare determined that a service would be covered, it would also need to make a simultaneous determination of the service's comparative effectiveness."

"The model would include higher payments for services demonstrated by adequate evidence to provide superior health benefits compared to alternative options. New services without such evidence would receive usual reimbursement rates for a limited time but then be reevaluated as evidence emerged. ... Were the additional evidence to suggest that the new service was inferior to existing options, Medicare could reevaluate whether the service was reasonable and necessary. … Limiting the time that this higher payment rate was in effect would create a substantial incentive for manufacturers to conduct comparative effectiveness studies" (Pearson and Bach, 10/5)

Kaiser Health News has a roundup of news stories about this study.

Health Affairs: An Evaluation Of Recent Federal Spending On Comparative Effectiveness Research: Priorities, Gaps, And Next Steps -- This study examines how the $1.1 billion that Congress allocated for comparative effectiveness research in the 2009 stimulus bill is being used. "Our analysis of funds allocated in the legislation found that nearly 90 percent of the $1.1 billion will eventually be spent on two main types of activity: developing and synthesizing comparative effectiveness evidence, and improving the capacity to conduct comparative effectiveness research. Based on our analysis, priorities for the new funding should include greater emphasis on experimental research; evaluation of reforms at the health system level; identification of effects on subgroups of patients; inclusion of understudied groups of patients; and dissemination of results" (Benner, et al, 10/5).

Georgetown University/Kaiser Family Foundation/NORC: Medicare Part D Spotlight: Part D Plan Availability in 2011 and Key Changes Since 2006 -- This analysis (.pdf) reports that the average Medicare beneficiary "will have a choice of 33 Part D stand-alone prescription drug plans in 2011, despite a 30 percent reduction in the total number of stand-alone plans available nationwide. Monthly premiums for stand-alone prescription drug plans (PDPs) will rise by 10 percent, on average, to $40.72 in 2011 if beneficiaries stay with their 2010 plans." The authors find that the number of plans being offered next year is the lowest since the program began in 2006, "yet beneficiaries will continue to have a large number of PDPs from which to choose their drug coverage. … The majority of plans offered in 2011 will offer no gap coverage beyond that which is required by the Affordable Care Act of 2010, underscoring the importance of the provision of the health reform law that will gradually phase out the Medicare Part D 'doughnut hole' between 2011 and 2020. (Hoadley, et al., 10/4).

Robert Wood Johnson Foundation: Physicians Slow to E-mail Routinely with Patients -- This survey (.pdf) by the Center for Studying Health System Change found that "6.7 percent of office-based doctors routinely e-mailed patients in 2008, despite indications that many patients want to e-mail their physicians and that e-mailing might foster better communication between patients and doctors" and "only 34 percent of office-based physicians have the capability to e-mail patients." The authors point out that doctors are sometimes hesitant because of "concerns about increased workload without reimbursement, uncertainty about impacts on quality of care, and challenges related to data privacy and security and medical liability. ... Federal policy efforts currently underway to support delivery system reforms may help spur physician adoption and use of e-mail communication with patients indirectly" (Boukus, Grossman and O'Malley, 10/7). 

The Commonwealth Fund: Realizing Health Reform's Potential: Pre-Existing Condition Insurance Plans Created by the Affordable Care Act of 2010 -- The new federal health law created temporary insurance pools called the Pre-Existing Condition Insurance Plan (PCIP) for people with medical problems who had trouble getting traditional coverage. This issue brief (.pdf) surveys the program, examining "eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state." It finds, "The PCIPs provide an important early opportunity for perhaps hundreds of thousands of uninsured individuals with preexisting conditions to acquire health insurance coverage" even though the "their coverage is less comprehensive and more expensive than employer-based insurance" (Hall and Moore, 10/4).


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