Health Policy Research: Covering Young Adults, ACOs, Wellness Programs

Robert Wood Johnson Foundation: Dependent Coverage Expansions: Estimating the Impact of Current State Policies – "With an estimated 29.3 percent of Americans age 19 to 29 lacking coverage, young adults are more likely to be uninsured than any other age group," the authors note. They examine efforts taken by 38 states to define and expand health coverage to young adult dependents. The report compares common provisions in state regulations and estimates the impact on the coverage of young adults, based on data from the Current Population Survey. "Preliminary findings based on CPS data through 2008 (reflecting coverage through 2007) found a small increase in coverage of young adults as dependents, but they also showed that this increase was offset by a decline in other sources of coverage, with no impact evident on the likelihood of being uninsured" (Cantor et al., Jan.15).

Health Affairs: Workplace Wellness Programs Can Generate Savings – The authors conducted a critical meta-analysis of the literature on costs and savings associated with wellness programs, and the effects of program interventions on health care costs and absenteeism, finding that medical costs "fall about $3.27 for every dollar spent on wellness programs, and absentee day costs fall by about $2.73 for every dollar spent. ... Our critical review of the existing evidence suggests that employer-based wellness initiatives may not only improve health, but may also result in substantial savings over even short-run horizons. Encouraging (or even subsidizing) such programs also seem to have broad political appeal, perhaps in part because they operate with less direct government oversight and fewer government dollars and in part because they hold the promise of slowing health care cost growth without the specter of rationing care" (Baicker, Cutler and Song, 1/14).

Mathematica Policy Research: Accountable Care Organizations: Will They Deliver? – "In our existing system, fee-for-service (FFS) payments, even when combined with pay-for-performance incentives, provide little impetus for providers to restructure to enhance their performance. ACO proposals aim to change these dynamics by providing financial incentives for broad cost containment and quality performance across multiple sites of care," writes the author of this policy brief that reflects on how the lessons drawn from historical efforts to reform medical practice in the U.S. could be used to enhance the effectiveness of ACOs. ACOs are more likely to succeed if "they are rolled out as part of a multi-component strategy that includes influencing provider training and attitudes, number and mix of providers, and differences in perceptions of health care among providers and patients in different parts of the country," the author concludes (Gold, 2010).

Related KHN story: ACOs, A Quick Primer (Galewitz, 7/17/09)

Journal of General Internal Medicine: The Effects of Guided Care on the Perceived Quality of Health Care for Multi-morbid Older Persons: 18-Month Outcomes from a Cluster-Randomized Controlled Trial – Interviews with over 900 chronically ill older adults revealed that patients who received support from a physician-nurse team, or "Guided Care" (GC), were twice as likely to rate their health care quality as high compared to patients that received the standard care. "Health-care processes that were improved significantly as measured by patient report include goal setting, coordination of care, problem solving, and patient activation" (Boyd et al., Dec. 2009).

Health Affairs: The Economic Burden Of Diabetes – This paper from the Lewin Group provides comprehensive estimates of the U.S. national economic burden of pre-diabetes and diabetes in 2007: "The national economic burden associated with pre-diabetes and diabetes reached an estimated $218 billion in 2007," including "$153 billion in higher medical costs and $65 billion in reduced productivity." The authors continue, "For each American, regardless of diabetes status, this burden represents a cost of approximately $700 annually. For a typical American family in 2007 with three members and a median income of $61,000, this diabetes burden equaled 3.4 percent of earnings" (Dall et al., 1/14).

Commonwealth Fund: Does the Congressional Budget Office Underestimate Savings from Reform? A Review of the Historical Record –  "CBO rules require substantial evidence that a cost-saving initiative has historically achieved savings. Hence, when few historical antecedents exist—be they demonstrations or natural experiments—CBO is likely to score an initiative as yielding no savings. In other words, 'don't know' becomes 'zero,'" writes the author of this issue brief that looks at how CBO scores compared to overall savings in reform measures historically. The author compares the CBO projection of "the prospective payment system for hospitals in the 1980s, the Balanced Budget Act of the 1990s, and the Medicare Modernization Act of 2003," to the actual impact and concludes the CBO "substantially underestimated savings from these reform measures" (Gabel, 1/20).

AARP Public Policy Institute: Resource Tests and Eligibility for Federal Assistance Programs: Effects of Current Rules and Options for Change – "Resource tests (also called asset tests) disqualify many individuals and families whose income would otherwise make them eligible for federal assistance," writes the author of this report that examines how adjustments to resource tests could affect the numbers of people who qualify for such programs as Medicare Savings Programs (MSPs), and the Medicare Part D Low-Income Subsidy (LIS) Program. Some possible changes could include "higher resource limits and different rules for treating specific kinds of assets," such as excluding retirement savings or the cash value of life insurance (Merlis, Jan. 2010).

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