The Rundown | Week of 7.22.2019

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Primary Care Could Reduce ED Visits, Save $32 Billion

In 2018, the 18 million unnecessary emergency department (ED) visits — many of which could be avoided by primary care visits — accounted for $32 billion in healthcare spending. Researchers at UnitedHealth Group calculated that for 10 common conditions treatable by primary care (e.g., bronchitis, flu, strep throat, nausea), the costs of hospital treatment were more than 1,100 percent more expensive. “Two-thirds of hospital ED visits annually by privately insured individuals … are avoidable,” researchers concluded. “These patients can be treated safely and effectively in [a] high-quality, low-cost primary care setting.”
>> Read More: 18 Million Avoidable Hospital Emergency Department Visits Add $32 Billion in Costs to the Health Care System Each Year

ACA Not Linked to Increased Hospital Use

A recent report found that the Affordable Care Act (ACA) and the consequent expansion of insurance resulted in “little or no change in society-wide hospital use.” However, researchers did observe a drop in usage by “younger and higher-income persons” that was offset by an increase in usage by elderly and “those with low incomes.” The lack of change may suggest “bed supply limited increases in use.” Researchers concluded that reductions in coverage “merely shift care toward wealthier and healthier persons.” Furthermore, “universal coverage is unlikely to cause a surge in hospital use if growth in hospital capacity is carefully constrained.”
>> Read More: The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States

Plant-Based Diets May Prevent Type 2 Diabetes

A recent study published in JAMA Internal Medicine indicates plant-based diets may decrease one’s chance of type 2 diabetes. Researchers conducted a meta-analysis of observational studies “assessing the association between plant-based dietary patterns and risk of type 2 diabetes among adults.” Plant-based foods include “such as fruits, vegetables, whole grains, legumes, and nuts.” The nine studies analyzed included 307,099 participants to test plant-based dietary patterns’ effect on type 2 diabetes independent of “body weight, glycemic control, and cardiovascular risk factors.” Qi Sun, MD, the study’s corresponding author, noted: “We found that eating plant-based diets was associated with, on average, 23 percent reduction in diabetes risk.”
>> Read More: Association Between Plant-Based Dietary Patterns and Risk of Type 2 Diabetes

Secretary Azar and OIG Assess Medicare Costs

The Office of Inspector General (OIG) for the Department of Health and Human Services (HHS) recently issued a report estimating that Medicare spending will “exceed $1.5 trillion by 2028, more than double the $708 billion in spending 2017.” The report addressed strategies to curb costs, such as “working to increase cost awareness in ACO physicians, engaging beneficiaries to improve their own health, and managing beneficiaries with costly or complex care needs to improve their health outcomes.” Further strategies include controlling costs and improving quality in skilled nursing and home healthcare. HHS Secretary Alex Azar echoed these points at the Better Medicare Alliance’s summit this week, noting: “We can also enhance value through payments in Medicare Advantage … including creative value-based insurance design arrangements, moving care to the home and community, and new ways for MA plans to improve a patients’ health over the long term.”
>> Read More: ACOs’ Strategies for Transitioning to Value-Based Care: Lessons From the Medicare Shared Savings Program

BMI Associated with Decreased Cognitive Ability

A new study links a higher midlife body mass index (BMI) with gray matter in the brain later in life. The cross-sectional study published in Neurology noted these findings were especially pronounced in participants younger than 65. Furthermore, obese participants more likely to exhibit “smaller cortical thickness.” Researchers also measured waist-to-hip ratio, as BMI increasingly discredited as a precise measure of health. In fact, a recent study published in JAMA Network Open suggests that, regardless of weight, certain body types have an “increased risk of overall, cardiovascular, and cancer mortality.”
>> Read More: Measures of Obesity are Associated with MRI Markers of Brain Aging