#6things That Happened in Health Policy This Week

6 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research. This week’s edition includes contributions from Stephanie Caty (@stephaniecaty), Yevgeniy Feyman (@YFeyman), and Kim Reimold (@KimReimold).

STAT: US babies born addicted to opioids has tripled in 15 years, CDC says

  • According to a new report from the CDC, the incidence of neonatal abstinence syndrome (NAS), which occurs primarily among opioid-exposed infants, has tripled.
    • Among 28 states, the NAS rate was 1.5 per 1,000 hospital births in 1999. In 2013, that had grown to 6.0.
    • There is wide variation in NAS incidence,  ranging from 0.7 per 1,000 in Hawaii to 33.4 per 1,000 in West Virginia.
    • The CDC notes that these are likely underestimates.
  • State governments will likely play an important role in addressing the issue, as Medicaid funds make up about 80 percent of the total charges for treating neonatal opioid withdrawal in 2012.
  • This report comes on the heels of new guidelines recently issued on opioid prescription, which recommends discussing alternatives to opioids, consideration of the effects on pregnancy, and when starting, to begin with the lowest possible dose.

The Fiscal Times: Your Health Insurance Will Cost More Next Year: Here’s What’s Driving Prices Higher

  • A survey of large employers conducted by the National Business Group on Health finds that employers expect costs to rise by 6% in the coming year.
  • The biggest driver of cost increases is expected to be specialty drugs, with 80% of employers placing it among their top 3 cost-drivers. High-cost claimants (73%) and specific diseases (61%) were number two and three respectively.
  • An increase of 6%, while lower than increases on the ACA exchanges, would be more than double the rate of inflation.
  • The survey also reports on several potentially cost-controlling strategies:
    • 90% of employers will make telehealth services available
    • 84% will offer consumer-directed health plans
    • 85% will use “centers of excellence” for particular surgeries/procedures
    • 80% will offer nurse coaching for care and condition management
    • Additionally, 33% will implement spousal surcharges for spouses with alternative coverage available

JAMA IM: Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance

  • Under the Affordable Care Act, states have the option to expand Medicaid or private insurance. Sommers et al. sought to determine how such expansion has affected utilization and health outcomes in low-income populations.
  • Changes in access, affordability, utilization, management of chronic conditions, and overall health were compared in low-income adults in Kentucky (where Medicaid was expanded), Arkansas (where Medicaid funds were used to buy private insurance), and Texas (where no expansion occurred) from November 2013-December 2015.
  • Compared to nonexpansion, expansion was associated with:
    • A 22.7% reduction in the uninsured rate
    • Increased access to primary care
    • Reduced out-of-pocket spending
    • Reduced likelihood of emergency department visits and increased outpatient visits
    • Increased regular care for chronic conditions
    • Significant increase in the share of adults reporting excellent health.
  • Compared to Medicaid expansion (in Kentucky), the only significant difference in private expansion (in Arkansas) was lower diabetic glucose testing rates.
  • Policy implications:
    • This study can help inform the remaining 19 states that have not accepted ObamaCare’s expansion for Medicaid on whether and how to expand health insurance coverage.

CMS.gov: Medicare Advantage Value-Based Insurance Design Model

  • The Centers for Medicare & Medicaid Services (CMS) announced revisions to the second year of the Medicare Advantage Value-Based Insurance Design (MA-VBID) model.
  • The overall goal of the model is to test whether giving MA plans flexibility to (1) offer supplemental benefits or (2) reduced cost sharing to targeted groups with chronic conditions in order to encourage the use of services that are of highest value to them will lead to higher-quality care.
  • Expected outcomes:
    • Improved beneficiary health
    • Reduced utilization of avoidable high-cost care
    • Reduced costs for plans, beneficiaries, and Medicare program
  • In year one of the MA-VBID, which will begin January 1, 2017, Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee will measure outcomes for enrollees with diabetes, chronic obstructive pulmonary disease, congestive heart failure, stroke, hypertension, coronary artery disease, and mood disorders.
  • Year two revisions will allow for a greater diversity of plans to participate in the model by:
    • Expanding the model to include Alabama, Michigan, and Texas—states that are generally representative of the national MA market, with urban and rural areas and areas with high and low average Medicare expenditures, high and low prevalence of low-income subsidies, and varying level of MA penetration.
    • Adding two new chronic conditions – rheumatoid arthritis and dementia.

New York Times: Obama Administration Set to Remove Barrier to Marijuana Research

  • The Drug Enforcement Administration will soon allow universities to apply to grow marijuana for research purposes, an allowance that previously was only granted to the University of Mississippi.
  • The University of Mississippi’s monopoly over marijuana growth for research purposes had led to other researchers having some difficulties accessing certain strains of marijuana, especially those with high levels of THC that are of particular interest to researchers.
  • 25 states currently allow the use of medical marijuana to treat certain diseases, such as Parkinson’s and Alzheimer’s, even though there is not robust research supporting the efficacy of these treatments.
  • In order for a university to be approved to grow marijuana for research, it must receive approval for the research protocol, have the ability to store marijuana appropriately, and receive approval from the DEA and FDA.
  • Although this is a relaxation of previous marijuana restrictions, the DEA still has not signaled any plans to change the classification of marijuana as a Schedule 1 substance.

Kaiser Health News: Syncing Up Drug Refills: A Way to Get Patients to Take Their Medicine

  • A new Health Affairs study published on Monday finds that within a sample of Medicare Advantage plan members receiving mail-order medications for diabetes, hypertension or cardiac disease, patient adherence to medication increased when refill times were coordinated.
  • The study compared medication adherence rates between a control group of patients who were receiving their medications by mail order on their usual schedule versus a test group of patients whose refill times were aligned.
  • For patients whose refill times were coordinated, medication adherence increased 3-10%, whereas there was an increase of only 1-5% in patients who kept their usual refill schedule.
  • The study did not look specifically at the health implications associated with increased adherence to a drug regimen, however given the efficacy of some of these drugs, increased adherence could yield significant health improvements.
  • While this study was conducted in a small sample of the patient population, non-adherence is problematic for many patients, so this provides a promising jumping off point to further test strategies to increase adherence.

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