5 Findings From the March 2019 Issue of AJMC®

The March issue of The American Journal of Managed Care^® featured research on immuno-oncology costs and Medicare Annual Wellness Visits in addition to studies on the issue’s theme of Medicaid. Here are 5 findings from research published in the issue.

1. Providers swayed by practice capacity, specialist availability when deciding to accept new Medicaid patients

Investigators conducted a statewide survey of primary care providers (PCPs) in Michigan after Medicaid expansion to explore the factors that lead them to accept or reject new Medicaid patients. Nearly 8 in 10 PCPs did currently accept new patients with Medicaid, and the most commonly cited reasons for doing so were practice capacity to accept any new patients, availability of specialists for Medicaid patients, and reimbursement amounts.

“With continued innovation in Medicaid policy at the state and federal levels, identifying provider and practice factors that promote Medicaid acceptance among PCPs will be even more important,” the authors noted. They urged efforts to promote diversity in the PCP workforce and encourage healthcare providers to train in underserved settings.

2. Annual Wellness Visits associated with reduced care spending, receiving more preventive care

Medicare beneficiaries who received an Annual Wellness Visit (AWV) saw benefits including lower utilization and costs and higher rates of preventive services in the year after their visit compared with those who did not have an AWV, according to the findings of this retrospective cohort study. AWVs were associated with significantly reduced spending on hospital acute care and outpatient services, a 5.7% reduction in total healthcare costs, and higher likelihood of receiving screenings for fall risk and depression.

The researchers suggested that these positive outcomes spring from the AWV’s focus on “personalized conversations about risk factors, preventive needs, and a patient’s long-term health goals,” which can help strengthen the patient—provider relationship. They hoped that future studies would explore AWVs’ impact on patient satisfaction, health behaviors, and care continuity.

3. Fragmented care linked to increased risk of emergency visits among Medicaid beneficiaries

Numerous studies’ findings have pointed to an association between fragmented ambulatory care and higher rates of emergency department (ED) visits among Medicare beneficiaries, but this retrospective study conducted in New York indicated that the association exists in Medicaid as well. Having more fragmented care from multiple providers was linked to a modest increase in the hazard of an ED visit, independent of a patient’s chronic conditions.

Because fragmentation can potentially be addressed through interventions at the patient, practice, or payer levels, the study authors wrote that it “could serve as a novel target for improvement.” Efforts to improve quality and cut costs are especially important as Medicaid reimbursement shifts to value-based purchasing, they added.

4. Immuno-oncology costs lower in community practices than hospital-based outpatient setting

Adding to literature showing higher cancer care costs in hospital-based than community-based practices, evidence from this claims analysis shows that this trend also exists among patients receiving immuno-oncology (I-O) therapies. Mean costs for medical and pharmacy claims per member per month were more than $3650 lower for patients treated with I-O therapy in a community- versus hospital-based clinic (P <.001).

Noting that costs were lower in the community clinic cohort regardless of patients’ tumor type, duration of treatment, or I-O agent utilized, the researchers wrote that “as comfort builds and indications expand with these I-O agents, further evaluation of contributors to increased cost with these already costly agents should be explored.”

5. Some states with generous Medicaid policies experienced spillover effects after expanding eligibility

States that had generous Medicaid eligibility levels before expanding Medicaid under the Affordable Care Act are often omitted from analyses of expansion’s effect on coverage, but this study used American Community Survey data to demonstrate that New York experienced nontrivial gains in coverage after expansion and Massachusetts saw gains among certain subgroups, like the working poor.

These spillover effects indicate that aspects of Medicaid expansion, such as a more streamlined enrollment process and increased media coverage, encouraged enrollment among those who were already eligible for Medicaid. Therefore, the study authors suggested that “state Medicaid agencies aiming to increase healthcare coverage of their low-income populations can boost enrollment by simplifying the enrollment process and increasing advertisement, without changing eligibility levels.”