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The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would ... improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. ... During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. ... Midway through this 4-year intervention, practices ... have reported progress in transforming the delivery of primary care. However, ... these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Dale et al., 6/16)

In the Medicare Shared Savings Program (MSSP), accountable care organizations (ACOs) have financial incentives to lower spending and improve quality. ... Using Medicare claims from 2009 through 2013 and a difference-in-differences design, we compared changes in spending and in performance on quality measures from before the start of ACO contracts to after the start of the contracts between beneficiaries served by the 220 ACOs entering the MSSP in mid-2012 (2012 ACO cohort) or January 2013 (2013 ACO cohort) and those served by non-ACO providers (control group). ... The first full year of MSSP contracts was associated with early reductions in Medicare spending among 2012 entrants but not among 2013 entrants. Savings were greater in independent primary care groups than in hospital-integrated groups. (McWilliams et al., 6/16)

[Researchers sought to] estimate the prevalence of physical, verbal, and sexual R-REM [Resident-to-resident elder mistreatment] in nursing home residents and subgroups. ... 2011 residents in 10 facilities [were] randomly selected on the basis of size and location; 83% of facilities and 84% of eligible residents participated. ... 407 of 2011 residents experienced at least 1 R-REM event; the total 1-month prevalence was 20.2% .... The most common forms were verbal (9.1% ...), other (such as invasion of privacy or menacing gestures) (5.3% ...), physical (5.2% ...), and sexual (0.6% ...). Several clinical and contextual factors (for example, lower versus severe levels of cognitive impairment, residing on a dementia unit, and higher nurse aide caseload) were associated with higher estimated rates of R-REM. (Lachs et al, 6/14)

The assumption that health care spending skyrockets at the end of life might suggest that policy makers should target the last few months of life to control costs. However, spending patterns leading up to death have not been fully examined. ... we identified four unique spending trajectories among decedents: 48.7 percent had high persistent spending, 29.0 percent had moderate persistent spending, 10.2 percent had progressive spending, and 12.1 percent had late rise spending. High spending throughout the full year before death (approximately half of all decedents) was associated with having multiple chronic conditions but not any specific diseases. These findings suggest that spending at the end of life is a marker of general spending patterns often set in motion long before death. (Davis, 6/15)

This brief provides an overview of Medicaid payments for hospitals and explores the implications of the ACA Medicaid expansion as well as payment policy changes on hospital finances. ... Overall, hospitals have benefitted financially from the ACA coverage expansions and the increase in Medicaid payments .... data for 2013 and 2014 shows overall declines in uncompensated care from $34.9 billion to $28.9 billion in 2014 nationwide. Nearly all of this decline occurred in expansion states .... Despite the decrease in uncompensated care, other changes to Medicaid payment policy (such as required reductions to disproportionate share hospital (DSH) payments and policy changes to limit the use of other supplemental payments) are likely to have a more substantial effect on Medicaid hospital payment and overall hospital financial performance in the future. (Cunningham et al, 6/9)

One effect of the Affordable Care Act’s “Cadillac tax” (now delayed until 2020) is to undo part of the existing federal tax preference for employer-sponsored insurance. The specific features of this tax on high-cost health plans—notably, the inclusion of tax-favored savings vehicles such as health savings accounts (HSAs) in the formula for determining who is subject to the tax—are designed primarily to maximize revenue and minimize coverage disruptions, not to reduce health spending. Thus, at least initially, these savings accounts, rather than enrollee cost-sharing or other plan features, are likely to be affected most by the tax as employers act to limit their HSA contributions. Because high earners are the ones benefiting most from tax-preferred accounts, the high-cost plan tax will probably be more progressive than prior analyses have suggested, while having only a modest impact on total health spending. (Glied and Striar, 6/8)

After years of declines, the pharmaceutical industry is experiencing a greater rate of success with its clinical trials in recent years, according to a new analysis. Between 2012 and 2014, more than 11 percent of clinical trials succeeded, which meant compounds being tested survived the arduous journey from the laboratory to the pharmacy counter. This reversed a downward trend seen over the past 20 years, according to executives at McKinsey & Co., the consulting firm that conducted the analysis and does consulting work for drug makers. (Silverman, 6/13)

A third of people worldwide are either undernourished or overweight, driving increasing rates of disease and piling pressure on health services, a global report showed on Tuesday. Rates of obese or overweight people are rising in every region of the world, and in nearly every country, according to the 2016 Global Nutrition Report - an annual independent stock take of the state of the world's nutrition. (Kelland, 6/14)