Research Roundup: Depression And Medicaid Spending; Chronic Care Costs

Every week, Kaiser Health News reporter Shefali S. Kulkarni compiles a selection of recently released health policy studies and briefs. 

Archives Of General Psychiatry: Ten-Year Trends In Quality Of Care And Spending For Depression
The researchers looked at treatment of depression in Medicaid enrollees in Florida from 1996-2006. They found a 29 percent increase in spending "despite decreases in inpatient costs." They attributed much of the increase to the growing use of antipsychotic drugs. They concluded that "spending for Medicaid enrollees with depression increased substantially, with minimal improvements in quality of care" (Fullerton, et al., 12/5).

UCLA Center For Health Policy Research: Independence at Risk: Older Californians With Disabilities Struggle To Remain At Home As Public Supports Shrink
The authors write: "This policy brief presents findings from a year-long study that closely followed a small but typical set of older Californians with disabilities who depend on fragile arrangements of paid public programs and unpaid help to live safely and independently at home. ... Most display resilience and fortitude, and all share a common determination to maintain their independence at almost any cost. ... Policy recommendations include consolidating long-term care programs and enhancing support for caregivers" (Kietzman, et al., 12/7).

Kaiser Family Foundation: Money Follows the Person: A 2011 Survey of Transitions, Services and Costs
This report notes that a total of "43 states and the District of Columbia have received federal grant money under the [Money Follows the Person] program to transition Medicaid individuals living in institutions back into their homes or the community. ... As states embrace rebalancing their long-term services and supports delivery systems, MFP will remain a critical program helping to change the way long-term services and supports are delivered" (O'Malley Watts, 12/8).

Urban Institute: The Potential Savings From Enhanced Chronic Care Management Policies
The authors of this report write that care for "the chronically ill and disabled account for an estimated $635 billion, or 30 percent, of total U.S. health care spending as of 2010."  They call for an expansion of recent "innovative chronic care management programs that have shown considerable promise in reducing hospital admissions, readmissions, specialty care and prescription drug use." Such programs could save the U.S. $331 billion over 10 years. "In this paper, we argue that this should primarily be a Medicare initiative because most of the current expenditures and savings from these programs would accrue to Medicare" (Holahan, Schoen and McMorrow, 11/30).

Government Accountability Office: Mental Health And Substance Use: Employers’ Insurance Coverage Maintained Or Enhanced Since Parity Act, But Effect Of Coverage On Enrollees Varied
The 2008 mental health parity legislation requires that mental health and substance use coverage, when offered, "is no more restrictive than that offered for medical and surgical conditions." Of the employers responding to this GAO survey, 96 percent "offered coverage of MH/SU for the current plan year and for 2008, before MHPAEA was passed. Approximately 2 percent of employers reported offering coverage for only mental health conditions but not substance use disorders for the current plan year and for 2008." The GAO noted that "[r]esearch examining the effect of health insurance coverage for MH/SU on enrollee expenditures generally found that the implementation of parity requirements reduced enrollee expenditures" (11/30).

Robert Wood Johnson Foundation: Physicians Highlight Overlooked Connection Between Social Needs And Health
In this national poll of 1,000 physicians, 85 percent say that “unmet social needs — things like access to nutritious food, reliable transportation and adequate housing — are leading directly to worse health for all Americans. Furthermore, 4 in 5 physicians do not feel confident in their capacity to meet their patients’ social needs, and they believe this impedes their ability to provide quality care." The authors suggest that a new model of health care is required, one which empowers "health care providers to help remove the social barriers that keep people from taking the actions they need to be healthy" (12/8).

Journal Of Community Health: Factors Associated With Program Utilization Of Radiation Therapy Treatment For VHA And Medicare Dually Enrolled Patients
This study looks at the various factors that dictate where and how often veterans get radiotherapy treatments for cancer. Medicare and VHA medical records, financial data and ZIP codes show that location, health care coverage and geographic access play a role in how often patients’ got these cancer treatments. Of the 45,914 dually-enrolled (Medicare and VA) patients in 2008, more than 75 percent used Medicare to cover their radiotherapy (French et. al.,12/3).

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