Detroit Leads in Risky Births

According to a new Kids Count study, babies born in Detroit are sicker and arrive earlier than babies born in other major U.S. cities. The report, which analyzed data over a 15-year period ending in 2005, showed 14.1 percent of babies born in Detroit were less than 5.5 pounds, the worst rank among 50 major cities studied by Kids Count. At 19.8 percent, the city also ranked worst on preterm births, and 73 percent of babies born in the city were born to unmarried women.

Infant mortality is recognized as not only a health problem, but a community wide problem. The low rankings are indicators of the ongoing need for safety net healthcare services, as well as services for the uninsured who will need to access prenatal care and other assistance programs.

A National Study of Chronic Disease Prevalence and Access to Care in Uninsured U.S. Adults

By using data from the National Health and Nutrition Examination Survey (1999–2004), this study estimates that more than 11 million working-age Americans with cardiovascular disease, hypertension, diabetes, dyslipidemia, obstructive lung disease, or previous cancer do not have health insurance. Individuals without health insurance were more likely than those with insurance to report problems with access to health care.The study estimates that roughly one of every three uninsured, working-age adults — about 11 million people — has been diagnosed with a chronic illness. Researchers concluded that many of these patients seldom see primary care doctors, with some relying instead on emergency rooms for their care.

While there are statistics and surveys estimating the number and prevalence of the uninsured, the rates of chronic illness among those without insurance have not been commonly reported. The results of this study are important as they document that many uninsured Americans have health conditions that require ongoing care, and without access to this care they are at high risk for serious health complications.

Physician Groups Earn Performance Payments for Improving Quality of Care for Patients with Chronic Illnesses

The Centers for Medicare & Medicaid Services (CMS) announced that all physician groups participating in the Physician Group Practice (PGP) Demonstration improved the quality of care delivered to patients with congestive heart failure, coronary artery disease, and diabetes during performance year 2 of the demonstration. As a result, the 10 groups earned $16.7 million in incentive payments under the demonstration that rewards health care providers for improving health outcomes and coordinating the overall health care needs of Medicare patients assigned to the groups. Among the groups is the University of Michigan Faculty Group Practice. Five of the physician groups, including the University of Michigan Faculty Group Practice, achieved benchmark quality performance on all 27 quality measures.

Among the results: For patients with diabetes or coronary artery disease, Medicare expenditures grew more slowly for beneficiaries assigned to the physician groups than for beneficiaries in the comparison group with the same conditions. This lower expenditure growth for chronic conditions as well as complex patients treated in the ambulatory and hospital settings contributed to four physician groups sharing in savings for improving the overall efficiency of care they furnish their patients.

The four physician groups — Dartmouth-Hitchcock Clinic, The Everett Clinic, Marshfield Clinic, and the University of Michigan Faculty Group Practice — earned $13.8 million in performance payments for improving the quality and cost-efficiency of care as their share of a total of $17.4 million in Medicare savings. This compares to two physician groups that earned $7.3 million in performance payments under the first year of the demonstration.

These results highlight the importance of working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care.

Safety-Net Providers Balance Margin and Mission in a Profit-Driven Health Care Market

This article is based on the Center for Health System Change's (HSC's) 2007 site visits to 12 nationally representative communities — Boston; Cleveland; Greenville, S.C.; Indianapolis; Lansing, Mich.; Little Rock, Ark.; Miami; northern New Jersey; Orange County, Calif.; Phoenix; Seattle; and Syracuse, N.Y. HSC has been tracking change in these markets since 1995. As private physicians and hospitals shed unprofitable patients and services, safety net providers are balancing their mission to serve the needy with steps to attract higher-paying patients to maintain financial viability.

The study identified the following safety-net provider strategies:

• Limiting exposure to uncompensated care costs
• Managing payer mix
• Upgrading or expanding facilities
• Expanding into more profitable service lines and areas

Effect of PCI on Quality of Life in Patients with Stable Coronary Disease

The study, which appears in the New England Journal of Medicine, finds that the slight lead an angioplasty has over drug treatment at relieving pain in nonemergency cases of chest pain and stable coronary diseases diminishes within six months. In addition, within three years, that advantage disappears completely, contradicting earlier projects that concluded that the advantage provided by an angioplasty lasted five years. The study, whose conclusions come from patient self-reports on how they fared after treatment, did note that patients with more severe chest pain recovered better with an angioplasty.

This study demonstrates that both treatment strategies can have a strong positive effect on patients' health status and suggests complementary roles — optimal medical therapy as first-line therapy, with PCI reserved for patients who do not have a response or who have severe baseline symptoms. It directly supports the importance of encouraging the appropriate and judicious use of cardiac services in patients with stable coronary artery disease.

F as in Fat: How Obesity Policies are Failing in America

According to the fifth annual F as in Fat: How Obesity Policies are Failing in America report from the Trust for America's Health and the Robert Wood Johnson Foundation, adult obesity rates increased in 37 states in the past year, and more than 20% of adults are obese in every state except Colorado. In 1980, the national average of obese adults was 15%, compared with the estimated two-thirds of American adults who are overweight or obese today. The report estimated that 23 million American children are overweight or obese, which means this generation could be the first to live sicker, shorter lives than their parents.

While all 50 states and Washington have passed laws related to physical education or activity in schools, only 13 states have language to enforce those laws. And of those, only four states have sanctions or penalties if the laws are not implemented. The report also said that the U.S. Agriculture Department school meal program-in which an estimated 39 million American schoolchildren receive their meals-has yet to adopt the national 2005 dietary guidelines. The report's statewide obesity ranking showed the least-obese states were Colorado (51), Hawaii (50) and Connecticut (49), while Mississippi came in last (1), with West Virginia and Alabama placing second and third, respectively. Michigan was ranked 10.

This report provides data on obesity rates, but more importantly shows that while local communities have been taking action, the nation as a whole has had a limited response to this problem — highlighting the need for a national priority to prevent and address obesity.

Income, Poverty, and Health Insurance Coverage in the United States: 2007

The nation's poverty rate held steady as median household income edged upward and the number of Americans without health insurance decreased by more than 1 million people last year, according to annual census data. Meanwhile, the number of people without health insurance declined to 45.7 million from last year's record 47 million, the Census report says. Census officials and health insurance advocates attributed the decrease in the number of uninsured to the growing popularity of government-sponsored health insurance, including Medicaid and the State Children's Health Insurance Program (SCHIP). The number of people under 65 who are insured by government-funded health insurance increased by more than 2 million to 48.6 million, according to an analysis by officials at the University of Minnesota.

While the indicators are positive over one year, the trends are less promising when viewed over a longer time frame.