The essential scan: Top findings in health policy research

Medical equipment is pictured on the wall of an examination room inside a Kaiser Permanente health clinic located inside a Target retail department store in San Diego

What’s the latest in health policy research? The Essential Scan, produced by the USC-Brookings Schaeffer Initiative for Health Policy, aims to help keep you informed on the latest research and what it means for policymakers. If you’d like to receive the biweekly Essential Scan by email, you can sign up here.

23 Percent of Prescription Claims Analyzed Involved a Copay Overpayment 

Study by: Karen Van Nuys, Geoffrey Joyce, Rocio Ribero, Dana P. Goldman

Patients with prescription drug coverage assume their copayment represents a portion of the total cost of the drug, with their insurer covering the difference. Yet, a new study finds overpayments, a situation in which the copayment is more than the cost of the drug, to be common. The researchers compared National Average Retail Price survey data from CMS from January to June 2013 with a 25 percent random sample of Optum’s Clinformatics Data Mart data from the same period. According to the study, 23 percent of all prescriptions analyzed involved an overpayment. The overpayment rate was higher for generics than brand drugs, 28.17 percent versus 5.95 percent. All-in-all, the average overpayment was $7.69, with 17 percent of overpayments exceeding $10. In a corresponding white paper, the researchers identify the 20 most popular prescription drugs during the study period, finding nine involved overpayments more than 40 percent of the time. These findings may not only have direct implications for overall drug spending but also may contribute to cost-related medication non-adherence which leads to higher medical expenditures and poorer health outcomes. JAMA research letter here and white paper here.

ACA Marketplace Premiums and Competition Among Hospitals and Physician Practices

Study by: Maria Polyakova, M. Kate Bundorf, Daniel P. Kessler, Laurence C. Baker

Studies have documented lower premiums in marketplaces with greater competition among insurers, but the effect of competition among health care providers on premiums has received less attention. New research examines the association between annual premiums for health plans available in Federally Facilitated Marketplaces (FFMs) and the extent of competition and integration among physicians and hospitals, as well as the number of insurers. The authors found insurance premiums offered in the FFMs were higher in markets with greater hospital and physician market concentration and fewer insurers. The average annual premium for the second lowest cost silver plan was $4,330 in the areas with the least concentrated hospital markets, and $5,014 in the areas with the most concentrated hospital markets. In areas with the least concentrated physician markets average annual premiums cost $4,661 as compared to $4,873 in areas with the most concentrated physician markets. Given the current trend towards more coordinated care, this study highlights the unintended financial consequences of care consolidation. Full study here.

Oregon Medicaid Expansion Improves Rates of Depression Diagnosis and Treatment

Study By: Katherine Baicker, Heidi L. Allen, Bill J Wright, et al

Depression, the most common form of mental illness in America, disproportionately affects low-income Americans and has been shown to significantly increase the cost of treating patients for other diseases. Many low-income individuals with depression are uninsured, and are thus unable to receive a clinical diagnosis or access to psychiatric treatments that would significantly improve their quality of life. A new study that takes advantage of the 2008 Oregon Medicaid Lottery analyzes the effect of Medicaid expansion on rates of depression diagnosis and treatment finds that expanding the state’s Medicaid program reduced the prevalence of undiagnosed depression by 50 percent and the prevalence of untreated depression by more than 60 percent. The study also shows that the share of newly insured individuals screening positive for depression dropped by 9.2 percentage points in the post lottery period, with many individuals reporting fewer feelings of hopelessness and less trouble sleeping. These findings provide further evidence that expanding state Medicaid programs provides greater access to physical and mental care to those who would otherwise be uninsured, which can improve both their health and wellbeing. Full study here.

Missed Appointment Rate Not Significantly Different for Medicaid Patients Offered Rideshare-based Transportation Services

Study by: Krisda H. Chaiyachati, Rebecca A. Hubbard, Alyssa Yeager, et al

Although a large percentage of low-income patients report missing outpatient appointments because of unreliable transportation, a new study finds that offering ridesharing services does not decrease missed primary care appointments. Between October 2016 and April 2017, 786 Medicaid beneficiaries who were established primary care patients were allocated to either receiving the intervention (offered a Lyft ride to and/or from the appointment) or receiving usual care. Within the intervention population (394 patients), 288 patients answered the phone call reminding them of their appointment and offering a complementary ridesharing service. Of those, only 26 percent used the service. Furthermore, the researchers found the missed appointment rate was nearly identical between the intervention and control groups: 36.5 percent for those offered Lyft compared to 36.7 percent for those patients who received usual care. These findings point to the reality that for Medicaid patients, missed appointments may occur due to a number of competing social, environmental, and financial factors and simple transportation-based interventions may not solve the problem alone. Full study here.