Blocking insurance mergers, habits drive overuse, and a talk therapy study

July 28, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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The Justice Department filed a preliminary injunction last week to block the proposed mergers of health insurers Aetna with Humana, and Anthem with Cigna, citing antitrust violations. The mergers would lead to higher premiums for individuals and fewer options as well, according to U.S. Attorney General Loretta Lynch, as reported in U.S. News & World Report. “If allowed to proceed, these mergers would fundamentally reshape the health insurance industry,” she said. “They would leave much of the multi-trillion-dollar health insurance industry in the hands of three mammoth insurance companies and restrict competition in key markets.” The editorial board of The New York Times reports one study has found that over an eight-year period, consolidation in the health insurance industry raised premiums by 7 percent, or $34 billion a year. Consolidation on the provider side has also led to rising prices, which insurers have found increasingly difficult to combat. In cities where hospitals are merging and buying up clinician practices, the prices they are able to command from private insurers also have skyrocketed. Not surprisingly, hospitals and doctor groups funded opposition to the proposed mergers, according to USA Today, because they would have less bargaining power when negotiating payments. Once again, patients and the American public are left on the sidelines, watching the behemoths duke it out over dollars.

It’s not just the money that’s driving health care providers to order excessive tests and treatments for patients. That’s what Peter Ubel, MD, writes last week in his Forbes column, titled Out of Control Physicians: Too Many Doctors Are Doing Too Many Things to Too Many Patients.  Ubel examines results from three JAMA IM studies, documenting the harms of certain tests. The studies he reviewed are: carotid artery imaging in seniors when there is no evidence that the test will benefit them; aggressive testing and treatments for carotid artery disease before patients undergo non-heart related surgeries; and PSA tests for men with limited life expectancy. In one VA study, Ubel found that 40 percent of older physicians were more likely to order PSA tests for this group, compared with 25 percent of trainees. Habit, he asserts, is one reason senior physicians continue ordering unnecessary tests and treatments. That — and not knowing or not believing the evidence. “It’s hard to get physicians to stop doing what they’ve gotten used to doing,” he said.

Talk therapy is as effective as cognitive behavioral therapy for treating depression in adults, according to a study published in Lancet this week. Research conducted by the University of Exeter in England included hundreds of patients with depression who were assigned to receive talk therapy, also known as behavioral activation therapy (BA), or cognitive behavioral therapy. About two-thirds of the patients remaining in both groups after a year had 50 percent fewer symptoms of depression. Costs for talk therapy are 20 percent lower, and talk therapy can be provided by mental health clinicians with less training, broadening access for patients. In the United States, it’s estimated that only a quarter of depressed patients have received any form of treatment at all in the last year. Untreated depression is expected to cost the global economy $5.36 trillion between 2011 and 2030, the researchers concluded. In a companion piece, Jonathan Kanter, PhD, from the University of Washington and Ajeng Puspitasari, PhD, from Indiana University, write, “Now that we have support for BA as a treatment that is clinically effective and cost-effective, we can shift our efforts to focus on what is necessary to produce sustainable large-scale BA implementation across diverse geographical and cultural settings.”





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