Research Roundup: Medicaid Flexibility, Drug Price Transparency and Hospital Quality

JAMA Forum:
State Flexibility For Medicaid: How Much?

President Trump’s budget proposal and the recent House health legislation included substantial reductions in Medicaid. Understandably, those cuts have focused attention on the potential effect on coverage for lower-income individuals. But there’s another important and related conversation that needs attention: how much flexibility should states have in redesigning the federal-state Medicaid program? (Butler, 6/14)

Brookings:
Would Price Transparency For Generic Drugs Lower Costs For Payers And Patients?

In “Would price transparency for generic drugs lower costs for payers and patients?“, the authors provide background information on generic prescription drug pricing and outline a proposed policy to generate information on actual average prices paid by retail pharmacies to acquire generic drugs. The proposed policy would make actual average generic drug price information selectively available to third-party payers and would analyze the likely effects of limited price disclosure on competition and efficiency. The authors estimate additional information would cut health spending $4 billion for every $1 reduction in the average reimbursement to retail and mail-order pharmacies for a generic prescription. (Lieberman and Ginsburg, 7/14)

NEJM:
Changes in Hospital Quality Associated with Hospital Value-Based Purchasing

Starting in fiscal year 2013, the Hospital Value-Based Purchasing program introduced quality performance based adjustments of up to 1% to Medicare reimbursements for acute care hospitals. The authors evaluated whether quality improved more in acute care hospitals that were exposed to HVBP than in control hospitals. The authors found HVBP was not associated with improvements in measures of clinical process or patient experience and was not associated with significant reductions in two of three mortality measures. (Ryan, Krinsky, Maurer and Dimick, 6/15)

The Kaiser Family Foundation:
The Effects Of Premiums And Cost Sharing On Low-Income Populations: Updated Review Of Research Findings

This brief reviews research from 65 papers published between 2000 and March 2017 on the effects of premiums and cost sharing on low-income populations in Medicaid and CHIP. … Together, the research finds: Premiums serve as a barrier to obtaining and maintaining Medicaid and CHIP coverage among low-income individuals. … Even relatively small levels of cost sharing in the range of $1 to $5 are associated with reduced use of care, including necessary services. … State savings from premiums and cost sharing in Medicaid and CHIP are limited. (Artiga, Ubri and Zur, 6/1)

Urban Institute:
The Evidence On Recent Health Care Spending Growth And The Impact Of The Affordable Care Act 

National health expenditures have been growing in recent years at about the rate of increase in gross domestic product (GDP) plus 1 percent, following decades of growth at GDP plus 2.5 percent. In this brief the authors discuss a number of reasons for the slowdown, including contributions made by the ACA. The authors also discuss reasons for the growth in marketplace premiums, finding that states with rapid growth rates typically have little insurer or provider competition. Large numbers of states have seen relatively modest premium increases. Finally, the authors conclude with evidence on Medicaid spending growth, arguing that enrollment increases have played a major role, with growth in spending per enrollee below that of other payers. This largely reflects the cost containment efforts of states. (Holahan et. al, 5/24)