5 Findings From the April 2019 Issue of AJMC®

The April issue of The American Journal of Managed Care^® featured research on deaths in opioid users, colorectal cancer screening, and health system competition. Here are 5 findings from research published in the issue.

1. Reporting quality metrics was not associated with increased competition among clinics

After clinics in Minnesota began publicly reporting their performance on diabetes care measures, the hope was that clinics would compete to improve their quality. However, this analysis found that health systems did not improve the performance of their clinics that performed worse than competitors.

Diabetes care performance did improve overall within the study period, but low-performing clinics fell further behind high-performing clinics, indicating that competition-based strategies to improve care quality may have a limited effect. The authors suggested that the health systems that performed worse may have lacked the resources to implement quality improvement interventions to keep up with their competitors.

2. Patient characteristics affect time to return colorectal cancer screening test

Fecal immunochemical tests (FITs) present a less invasive way to screen for colorectal cancer, but they are only effective if patients complete and return them. In a cohort study of health plan members, researchers discovered that older members and Asian members completed the FIT 4 days earlier than younger and white members, respectively. There were also decreases in FIT completion associated with having more comorbidities or being a woman, younger, or overweight.

These findings of disparities could help health systems tailor outreach programs to encourage adherence to screening recommendations. “Targeted interventions, beyond mailed kits, and clinic workflows to improve return of FITs should be investigated as potential means to increase overall return rates and address disparities by patient characteristics such as obesity and age,” the authors wrote.

3. Links found between opioid prescribing practices and deaths in Georgia Medicaid

As the opioid crisis continues, this retrospective pharmacy claims data analysis looked at instances of potentially inappropriate opioid prescribing and all-cause deaths among opioid users in the Georgia Medicaid program. The inappropriate prescribing indicators included high-dose opioid prescriptions or overlapping opioid and benzodiazepine prescriptions.

There was a higher death rate among the opioid users who received these inappropriate prescriptions than among those who did not. The rates of both inappropriate prescribing and death were higher among fee-for-service enrollees than managed care enrollees. According to the authors, this could indicate that structural differences in payment systems are affecting opioid use. They suggested further research into strategies to curb inappropriate opioid prescribing within fee-for-service insurance plans.

4. Providing positive learning experiences can help recruit graduating health professionals

Healthcare systems that offer clinical education want to know how best to recruit their trainees to work in those systems after graduation, and this multisite pre—post study offered some insights into what factors make trainees more “recruitable.” The study conducted in the Department of Veterans Affairs found that ratings of clinical learning environment, personal experiences, and culture of psychological safety were each associated with changes in recruitability.

These data confirm that mere exposure to a teaching facility is not enough to make trainees decide to work there in the future—the students must also have positive perceptions of those important domains. The researchers advised academic medical centers to “invest in their training mission in order to improve trainee clinical, working, learning, and cultural experiences.”

5. Opportunities to improve well-being abound in a health plan population

When the health plan HealthPartners could not find a set of measures that would help it improve its population health performance, it devised its own measures: a current health score, a future health score, and a well-being score. Results of an analysis to calculate these scores in the plan’s member population revealed the conditions most responsible for worsening current health and the greatest opportunity for improving future health.

The data showed that 44% of the loss to current health score is attributable to musculoskeletal, psychosocial, and neurologic conditions, and there is most potential to improve the future health score by increasing healthy diets of fruits and vegetables. The researchers also noted that members with Medicaid or low educational attainment had the lowest levels of well-being. More data on these measures could help to develop regional and national interventions to improve population health, they wrote.