Research Roundup: Unnecessary Care; Medicaid And Marijuana; Workplace Wellness Programs

JAMA Internal Medicine:
Association Of Primary Care Practice Location And Ownership With The Provision Of Low-Value Care In The United States

Question: What is the influence of practice location and ownership on the provision of low-value care? Findings: In this nationally representative sample of primary care visits, hospital-based outpatient practices used more low-value computed tomography and magnetic resonance imaging, radiographs, and specialty referrals for common conditions than community-based office practices, particularly during hospital-based visits with someone other than the patient’s primary care provider. Hospital-owned community-based practices made more specialty referrals than physician-owned community-based practices but were otherwise similar. (Mafi et al., 4/10)

JAMA Internal Medicine:
Low-Value Medical Services In The Safety-Net Population

Question: How often do patients with Medicaid or without insurance receive low-value care compared with privately insured patients; are there any differences related to the physicians treating these patient groups? Findings: Analyses of nationally representative survey data from 2005 to 2013 show that low-value care was delivered in nearly 1 in 5 visits, with no overall difference between Medicaid or uninsured patients vs privately insured patients. Rates of low-value care were similar between safety-net physicians and non–safety-net physicians. Meaning: Overuse of low-value care is just as common among patients with Medicaid or without insurance as among privately insured patients. (Barnett et al., 4/10)

Health Affairs:
Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees

In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of prescription drugs in fee-for-service Medicaid was lower in states with medical marijuana laws than in states without such laws in five of the nine broad clinical areas we studied. If all states had had a medical marijuana law in 2014, we estimated that total savings for fee-for-service Medicaid could have been $1.01 billion. (Bradford and Bradford, 4/12)

Avalere:
Medicaid Funding Reform: Impact On Dual Eligible Beneficiaries

New modeling from Avalere finds that proposals to limit per capita federal Medicaid funding growth based on medical inflation could lead to a $44 billion spending cut for dual eligible beneficiaries—or people who qualify for both Medicaid and Medicare—over the next 10 years. (Pearson and Meyer, 4/20)

The Kaiser Family Foundation:
Changing Rules For Workplace Wellness Programs: Implications For Sensitive Health Conditions

The Affordable Care Act (ACA) sets standards for a certain type of wellness program, called health contingent programs …. Health contingent wellness programs vary health plan premiums or cost sharing based on whether a person achieves a biometric target, such as for blood pressure. … Two other laws – the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) – govern all workplace wellness programs that ask workers and their family members to disclose health information, including genetic information. … Under [legislation pending in Congress], any wellness program in compliance with ACA requirements would be deemed compliant with ADA and GINA wellness program standards. As a result, for the vast majority of workplace wellness programs today, there would be no limit on inducements that could be used to encourage workers and their family members to provide personal health information. (Pollitz and Rae, 4/7)

Urban Institute:
Urban Blight And Public Health

The health impacts from blighted properties—substandard housing, abandoned buildings, and vacant lots—are often not immediately visible or felt. This report—Urban Blight and Public Health—synthesizes recent studies on the complexities of how blight affects the health of individuals and neighborhoods while offering a blend of policy and program recommendations to help guide communities in taking a more holistic and coordinated approach, such as expanding the use of health impact assessments, tracking health outcomes, and infusing public health into housing policies, codes and practices. (de Leon and Schilling, 4/11)

Heritage Foundation:
Assessing The American Health Care Act: Moving Toward A Fair Federal Tax Treatment Of Health Insurance

If congressional leaders are serious about controlling the growth of health care costs, and thus making insurance premiums more affordable for millions of Americans, they must reform the health insurance markets. Congress cannot accomplish that goal effectively, and lay the groundwork for a genuine consumer-driven market in health insurance and health care, unless it reforms the tax treatment of health insurance. That begins with capping the exclusion, and creating an equitable system of individual tax relief. (Robert Moffit, 4/18)