A Call for Greater Flexibility in High-Deductible Plans
In a March 11 post on the new Health Affairs Blog, researchers in the U-M Center for Value-Based Insurance Design addressed the complexities of some of the nation's fastest-growing health plans—health savings account–eligible high-deductible health insurance plans (HSA-HDHPS). Specifically, the authors, including V-BID Director and U-M SPH Professor Mark Fendrick, called for increased flexibility for coverage for high-value services, such as those used in chronic-disease management. Currently, HSA-HDHPS require the deductible to be met before such coverage begins.
Noting that high-deductible plans must provide certain preventive services at no cost to asymptomatic patients, V-BID researchers say it's inconsistent with clinical guidelines, cost-ineffective in the long run, and potentially harmful to patients to impose cost barriers to evidenced-based services to treat existing conditions, such as diabetes, mental illness, HIV, or cancer.
"While we agree that there is value in evidence-based preventive services for asymptomatic people," the researchers wrote, "we feel it is important to recognize that the prevailing focus on primary prevention tilts the system against services often of much greater value: those that prevent adverse consequences associated with diagnosed disease." The V-BID blog post is part of a larger initiative to modify Internal Revenue Service guidelines to allow HSA-HDHPs greater flexibility in plan design, so that ultimately consumer engagement is enhanced, quality of care improved, and health care costs lowered.
U-M a Leader in Health Systems Research
Using data from the Web of Science database, knowledge-visualization techniques, and scientometric methods (a technique by which the state of science and technology is observed through the overall production of scientific literature at a given level of specialization), a team of researchers from China has evaluated both global scientific production and emerging trends in health systems research (HSR) from 1900 to 2012. U-M ranked among the top four academic institutions for HSR publications, with U-M SPH Professor John Piette, U-M SPH alumna (and U-M faculty member) Marcia Valenstein, U-M SPH alumnus John McCarthy, and U-M faculty member Frederic Blow among the world's top 10 most productive authors in this area.
Black Women at Higher Risk for Lupus
Young black women have the highest rate of developing lupus and are more likely to be diagnosed at a younger age than whites and during childbearing years, according to a study by Emily Somers, associate professor of environmental health sciences, medicine, and OB/GYN at U-M. In addition to experiencing the disease earlier in life—which can mean living with the condition over more years—black females with lupus also face a higher degree of serious health complications, such as kidney failure requiring dialysis or a transplant. "We found lupus to be up to three times more common than previously thought," said Somers. "And by establishing the magnitude of the disease in specific populations, we're better able to identify the resources we need to put toward the problem from a health care perspective."
Mental Health Program Resonates with U-M Student-Athletes
Research shows that one in three college students experiences significant symptoms of depression, anxiety, or other mental health conditions—yet only about 30 percent of those students seek help. The number goes down to only 10 percent for student athletes. That's partly because the core traits of athletes, including the need to "be tough," often lead them to ignore their mental health needs, says Daniel Eisenberg, associate professor of health management and policy at U-M SPH.
Eisenberg leads the research component of Athletes Connected, a new program led by SPH, the U-M Depression Center, and the U-M Department of Athletics, with support from the NCAA. Aimed at developing and evaluating mental health initiatives for student-athletes, the program has to date funded the creation of two videos featuring testimonies from former athletes about their struggles with mental illness and two videos on coping skills, as well as presentations to all U-M athletic teams and the development of biweekly support groups for ongoing help.
More than 90 percent of U-M's 900-plus student-athletes took part in the program last fall. Of those participating, 96 percent said they were likely to use what they learned, either to help themselves or others, and 40 students indicated they would like an appointment with a counselor to address an immediate concern.
Why Health Equity Matters
Years ago, while working in the U.S. Senate for the Health, Education, Labor and Pensions Committee and the Children and Families Subcommittee, Carmen R. Green found herself thinking about the concept of health equity. What exactly did it mean—not only for policymakers, but for ordinary Americans?
She's still pondering the question. Two years ago, Green, a professor of health management and policy at U-M SPH and professor of anesthesiology and obstetrics and gynecology at the U-M Medical School, launched "The Health Equity Campaign," which asks patients, physicians, nurses, and students to describe, in eight words or less, their idea of health equity. To date the researchers have received over 6,000 responses, mostly from the U-M community.
It's important for health care providers to understand how different constituencies regard health equity and inclusion because it affects quality of care, says Green, whose research focuses on pain-management outcomes, physician decision-making, and access to care. "An example would be if I have a patient who is dying of breast cancer, and I think I know what she wants, based on my clinical experiences, but it's not what the patient wants."
Studies show that poverty is the biggest risk factor for decreased quality of care, but racial, ethnic, gender, and other disparities are also factors. For example, after controlling for economic status, Green has found that high-income minorities have decreased access to pain medications, as compared to low-income whites. "So this is a health equity issue," she says. HMP student Kisha McPherson, who is part of Green's research team, presented a poster on the health equity study at a recent Health Disparities Summit sponsored by the U.S. Department of Health and Human Services. For more visit healthyconversations.org.