American Journal of Managed Care: Guided Care and the Cost of Complex Healthcare: A Preliminary Report – The authors of this report present the preliminary findings of an ongoing study analyzing the health service utilization and costs associated with Guided Care (GC), physician-nurse teams for people living with chronic health conditions. By comparing the health services used by patients who received GC to patients who did not receive care during the first eight months of the study, researchers found, on average, GC patients experience 24 percent fewer hospital days, 37 percent fewer skilled nursing facility days, 15 percent fewer emergency department visits, 29 percent fewer home health care episodes and 9 percent more specialist visits – a difference, "[b]ased on current Medicare payment rates and GC costs" that "represent[s] an annual net savings of $75,000 per nurse, or $1,364 per patient" (8/7).
Commonwealth Fund: High-Deductible Health Insurance Plans: Efforts to Sharpen a Blunt Instrument – In this Health Affairs study, researchers surveyed 1,515 members of Kaiser Permanente California, an integrated delivery system, to assess their knowledge of their health plan's benefit structure and how often out-of-pocket costs affected decision making regarding trips to the emergency room, office visits and medical tests. In addition to finding that "consumers have limited knowledge of their deductible plans, including which medical services were exempt from the deductible," the survey revealed "[a] greater percentage of consumers with deductibles than those without reported changing their care-seeking behavior because of costs." For instance, the authors found "an estimated 39 percent of respondents with deductibles reported that they had altered how they sought care from the [emergency department] because of out-of-pocket expenses, compared to 27 percent of members without deductibles" (8/6).
American Journal of Respiratory and Critical Care Medicine: Are Physicians' Recommendations to Limit Life Support Beneficial or Burdensome? – This study of one hundred and sixty-nine caregivers recruited from four ICUs at the University of California San Francisco found that they are "are virtually split when it comes to how much guidance they want to receive from physicians in making end-of-life medical choices on behalf of critically ill patients," according to an American Thoracic Society description of the study. The themes influencing a surrogates' preference for recommendations included: "the surrogates' perceptions of physicians' appropriate role in life or death decisions and their perceptions of the positive or negative consequences of a recommendation on the physician–surrogate relationship, on the decision-making process, and on long-term regret for the family" (8/15).
Health Affairs: The Unhealthy State Of Health Policy Research – This commentary paper examines the poor study design of health policy research and the resulting confusion it creates among policy makers and the public. To illustrate their point, the study authors pick apart the design of studies commonly pointed to for arguments in favor of pay-for-performance, cost-sharing and health information technology before offering suggestions on how to improve health policy research (8/11).