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Suh M, Movva N, Jiang X, Reichert H, Pastula ST, Sacks NC, Frankenfeld C, Fryzek JP, Simões EAF. Healthcare Utilization Among Infants Covered by Medicaid and Newly Diagnosed With Respiratory Syncytial Virus. Open Forum Infect Dis 2024; 11:ofae174. [PMID: 38595954 PMCID: PMC11002947 DOI: 10.1093/ofid/ofae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/19/2024] [Indexed: 04/11/2024] Open
Abstract
Background Infants covered by Medicaid have higher respiratory syncytial virus (RSV) hospitalization rates than those with commercial insurance, but findings are limited to the inpatient setting. This birth cohort study describes healthcare encounters for RSV across all settings among infants covered by Medicaid and the Children's Health Insurance Program. Methods Medicaid claims for infants born and residing in Arizona (AZ), California (CA), Florida (FL), Michigan (MI), North Carolina (NC), New York (NY), and Texas (TX) were analyzed for first diagnosis of RSV in 2016-2018 using International Classification of Diseases, Tenth Revision codes. Encounters on the day of first diagnosis were examined by setting in 7 states and by setting and race in CA, FL, and NC. Results A total of 80 945 infants were diagnosed with RSV in 7 states in 2016-2018. The highest encounter rates for first RSV diagnosis were in the emergency department (ED) in 5 states (11.0-33.4 per 1000 in AZ, CA, FL, MI, and NY) and outpatient setting in 2 states (54.8 and 68.5 per 1000 in TX and NC). Significantly higher outpatient encounter rates were found in CA and NC for White infants compared to non-White infants. In NC, ED encounter rates were significantly higher for non-White infants than White infants, whereas in CA, the rates were comparable. In these 2 states, hospitalization rates were similar across groups. In FL, compared with White infants, non-White infants had significantly higher encounter rates in each setting on the day of first RSV diagnosis. Conclusions This is the first study to describe the burden of RSV by setting and race. Medicaid infants who are newly diagnosed with RSV have the highest burden in ED and outpatient settings.
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Affiliation(s)
- Mina Suh
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naimisha Movva
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Xiaohui Jiang
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Heidi Reichert
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Susan T Pastula
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Naomi C Sacks
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Cara Frankenfeld
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Jon P Fryzek
- EpidStrategies, a division of ToxStrategies, LLC, Rockville, Maryland, USA
| | - Eric A F Simões
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
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Gillinov SM, Kim DN, Islam W, Lee MS, Moran J, Fong S, Mahatme RJ, McLaughlin WM, Maldonado DR, Medvecky MJ, Grauer JN, Jimenez AE. Medicaid Insurance Is Associated With More Complications and Emergency Department Visits but Equivalent 5-Year Secondary Surgery Rate After Primary Hip Arthroscopy. Arthroscopy 2024; 40:1117-1125. [PMID: 37597701 DOI: 10.1016/j.arthro.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE To compare 90-day complications, 30-day emergency department (ED) visits, and 5-year rate of secondary surgeries for patients with Medicaid vs commercial insurance undergoing primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) and/or labral tears using a large national database. METHODS The PearlDiver Mariner151 database was used to identify patients with International Classification of Diseases, Tenth Revision diagnosis codes for FAIS and/or labral tear who underwent primary hip arthroscopy with femoroplasty, acetabuloplasty, and/or labral repair between 2015 and 2021. Patients with Medicaid were matched 1:4 to a control group of commercially insured patients based on age, sex, body mass index, and Elixhauser Comorbidity Index. Rates of 90-day complications and 30-day ED visits were compared using multivariate regression models. Five-year rates of secondary surgeries-revision arthroscopy or total hip arthroplasty-were compared between cohorts by Kaplan-Meier analysis. RESULTS A total of 2,033 Medicaid patients were matched with 8,056 commercially insured patients. Rates of adverse events were low; however, Medicaid patients were significantly more likely than commercially insured patients to experience any 90-day complication (2.12% vs 1.43%; odds ratio [OR], 1.2; P = .02). Medicaid patients also experienced more 30-day ED visits than commercially insured patients (8.61% vs 4.28%), and on multivariate logistic regression, insurance status was the strongest determinant of 30-day ED visits (relative to commercial, Medicaid OR, 2.02; P < .001). Despite these differences, 5-year rates of secondary surgeries were comparable between groups (6.1% vs 6.0%; P = .6). CONCLUSIONS In this large national database study, Medicaid patients undergoing primary hip arthroscopy showed significantly greater odds of experiencing 90-day postoperative complications and 30-day ED visits compared to commercially insured patients. Nevertheless, both groups had similar survivorship rates at 5-year follow-up, similar to prior estimates irrespective of insurance. These results document encouraging secondary surgery rates in Medicaid patients.
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Affiliation(s)
- Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA.
| | - David N Kim
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jay Moran
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Scott Fong
- Advanced Orthopedics and Sports Medicine, San Francisco, California, USA
| | - Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - William M McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - David R Maldonado
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Rahman TM, Hennekes M, Mehaidli A, Shaw JH, Silverton CD. Marital Status, Race, Insurance Type, and Socioeconomic Status-Assessment of Social Predictors for Outcomes After Total Knee Arthroplasty. J Am Acad Orthop Surg 2024; 32:169-177. [PMID: 38100772 DOI: 10.5435/jaaos-d-23-00368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of various social determinants of health on outcomes and dispositions after total knee arthroplasty (TKA). METHODS A retrospective review was conducted on 14,462 consecutive TKA procedures between 2013 and 2021 at a multicenter hospital system. Data abstraction was done by inquiry to the Michigan Arthroplasty Registry Collaborative Quality Initiative. Data points requested included basic demographics, marital status, race, insurance status, socioeconomic status measured by the Area of Deprivation Index, perioperative course, and incidence of emergency department (ED) visits and readmissions within 3 months of surgery. Subsequent multivariate analyses were conducted. RESULTS Unmarried patients required markedly greater lengths of hospital stay and had an increased rate of discharge to skilled nursing facilities and a higher likelihood of any purpose ED visit within 90 days of surgery compared with married patients, who had a significantly greater rate of same-day discharge ( P < 0.001). Race did not markedly correlate with outcomes. Medicare patients showed a greater rate of same-day discharge, nonhome discharge, and 90-day ED visits compared with privately insured patients ( P < 0.001). Medicaid patients were more likely than privately insured patients to have a 90-day ED visit ( P < 0.001). Socioeconomic status had a minimal clinical effect on all studied outcomes. CONCLUSION Social factors are important considerations in understanding outcomes after TKA. Additional investigations are indicated in identifying at-risk patients and subsequent optimization of these patients.
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Affiliation(s)
- Tahsin M Rahman
- From the Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, MI
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Teigland C, Mohammadi I, Agatep BC, Boskovic DH, Sajatovic M. Relationship between social determinants of health and hospitalizations and costs among patients with bipolar disorder 1. J Manag Care Spec Pharm 2024; 30:72-85. [PMID: 38153860 PMCID: PMC10775779 DOI: 10.18553/jmcp.2024.30.1.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
BACKGROUND Bipolar disorder type 1 (BD-1) is a serious episodic mental illness whose severity can be impacted by social determinants of health (SDOH). To date the relationship of social and economic factors with health care utilization has not been formally analyzed using real-world data. OBJECTIVE To describe patient characteristics and assess the influence of SDOH on hospitalizations and costs in patients with BD-1 insured with commercial and managed Medicaid health plans. METHODS This retrospective observational study used data from the Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry to identify patients aged 18 years and older with evidence of BD-1 between July 1, 2016, and December 31, 2018. SDOH were linked to patients at the "near neighborhood" level (based on ZIP9 area). Multivariable models assessed the relationship between patient characteristics and hospitalizations (incidence rate ratios [95% CI]) and costs (cost ratios [95% CI]). RESULTS Of 243,286 patients with BD-1, 62,148 were covered by commercial insurance and 181,138 by Medicaid. Mean ages [±SD] were similar (commercial 39.8 [±14.8]; Medicaid 40.1 [±13.6]), with more female patients in both cohorts (commercial 59.8%; Medicaid 65.4%). All-cause hospitalization rates were 21.6% for commercial and 35.1% for Medicaid patients; emergency department visits were 39.7% and 64.3%, respectively. All-cause costs were $15,379 [±$27,929] for commercial and $21,474 [±$37,600] for Medicaid. Older age was a significant predictor of fewer hospitalizations compared with those aged younger than 30 years, particularly ages 40-49 for both commercial (0.60 [0.57-0.64]) and Medicaid (0.82 [0.80-0.85]). Increasing age was associated with significantly higher costs, especially age 65 and older (commercial 1.37 [1.31-1.44]); (Medicaid 1.43 [1.38-1.49]). Initial treatment with antipsychotics plus antianxiety medications was a significant predictor of higher hospitalizations (commercial 2.12 [1.98-2.27]; Medicaid 1.62 [1.57-1.68]) and higher costs (commercial 1.86 [1.80-1.92]); Medicaid 1.80 [1.76-1.84]). Household income was inversely associated with hospitalizations for Medicaid (<$30,000 [1.16 (1.12-1.19)]; $30,000-$39,999 [1.11 (1.07-1.15)]; $40,000-$49,999 [1.08 (1.05-1.12)]; $50,000-$74,999 [1.06 (1.02-1.09)]). Not speaking English well or at all was associated with 90% higher hospitalizations for commercial patients (1.93 [1.36-2.76]) but 40% fewer hospitalizations for Medicaid patients (0.59 [0.53-0.67]). Low English language proficiency was associated with significantly higher costs for commercial patients (2.22 [1.86-2.64]) but lower costs for Medicaid patients (0.57 [0.53-0.61]). CONCLUSIONS Medicaid patients with BD-1 had high SDOH burden, hospitalizations, and costs. The association of lower English proficiency with fewer hospitalizations and lower costs in Medicaid patients suggests a potential disparity in access to care. These findings highlight the importance of addressing social risk factors to advance health equity in treatment of mental illness.
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Bakare O, Akintujoye IA, Gbemudu PE, Mbaezue RN, Akinbolade AO, Olopade S. Medicaid Coverage and Emergency Department Utilization in Southeastern Pennsylvania. Cureus 2023; 15:e45464. [PMID: 37859924 PMCID: PMC10584275 DOI: 10.7759/cureus.45464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Overutilization of the emergency department (ED) is a significant problem in the United States (US), characterized mainly by patients with non-emergent conditions seeking care in a setting designed specifically for acute care. This has significantly increased healthcare costs in the US, a country with one of the most expensive healthcare systems in the world. ED overutilization was also found to be high among people with Medicaid coverage, especially since the Affordable Care Act was enacted with an expansion in Medicaid coverage. Using the 2018 South Eastern Pennsylvania (SEPA) Household Health Survey, we identified a significant bivariate relationship between emergency department visits and the following predictor variables: sex, race, education, employment status, 150% poverty level, and Medicaid recipient. Using a multivariable logistic regression model, Medicaid recipients had higher odds of presenting to the ED than non-Medicaid recipients [odds ratio (OR): 2.863, 95% confidence interval (CI): 2.164, 3.788]. Black people (OR: 1.647, 95% CI: 1.411, 1.923) and Native Americans (OR: 2.985, 95% CI: 1.536, 5.800) had higher odds than Whites. Respondents without a high school diploma had higher odds than college graduates (OR: 1.647, 95% CI: 1.96, 2.273). Respondents below the 150% poverty line had higher odds than those at or above the 150% poverty level (OR: 1.651, 95% CI: 1.386, 1.968). Unemployed respondents had higher odds than full-time employed respondents (OR: 1.703, 95% CI: 1.488, 1.953) or part-time (OR: 1.259, 95% CI: 1.036, 1.529). No difference was observed between the sexes. Addressing ED overutilization should take a multi-faceted approach with the ultimate goal of improving access to primary care.
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Affiliation(s)
- Olusegun Bakare
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | - Paul E Gbemudu
- Internal Medicine-Pediatrics, Tulane University School of Medicine, New Orleans, USA
| | | | | | - Segun Olopade
- Medicine and Surgery, Igbinedion University Teaching Hospital, Okada, NGA
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Lewis A, Howland RE, Horwitz LI, Desai SM. Medicaid Value-Based Payments and Health Care Use for Patients With Mental Illness. JAMA HEALTH FORUM 2023; 4:e233197. [PMID: 37738064 PMCID: PMC10517380 DOI: 10.1001/jamahealthforum.2023.3197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/29/2023] [Indexed: 09/23/2023] Open
Abstract
Importance Medicaid patients with mental illness comprise one of the most high-need and complex patient populations. Value-based reforms aim to improve care, but their efficacy in the Medicaid program is unclear. Objective To investigate if New York state's Medicaid value-based payment reform was associated with improved utilization patterns for patients with mental illness. Design, Setting, and Participants This retrospective cohort study used a difference-in-differences analysis to compare changes in utilization between Medicaid beneficiaries whose outpatient practices participated in value-based payment reform and beneficiaries whose practices did not participate from before (July 1, 2013-June 30, 2015) to after reform (July 1, 2015-June 30, 2019). Participants were Medicaid beneficiaries in New York state aged 18 to 64 years with major depression disorder, bipolar disorder, and/or schizophrenia. Data analysis was performed from April 2021 to July 2023. Exposure Beneficiaries were exposed to value-based payment reforms if their attributed outpatient practice participated in value-based payment reform at baseline (July 1, 2015). Main Outcomes and Measures Primary outcomes were the number of outpatient primary care visits and the number of behavioral health visits per year. Secondary outcomes were the number of mental health emergency department visits and hospitalizations per year. Results The analytic population comprised 306 290 individuals with depression (67.4% female; mean [SD] age, 38.6 [11.9] years), 85 105 patients with bipolar disorder (59.6% female; mean [SD] age, 38.0 [11.6] years), and 71 299 patients with schizophrenia (45.1% female; mean [SD] age, 40.3 [12.2] years). After adjustment, analyses estimated a statistically significant, positive association between value-based payments and behavioral health visits for patients with depression (0.91 visits; 95% CI, 0.51-1.30) and bipolar disorder (1.01 visits; 95% CI, 0.22-1.79). There was no statistically significant changes to primary care visits for patients with depression and bipolar disorder, but value-based payments were associated with reductions in primary care visits for patients with schizophrenia (-1.31 visits; 95% CI, -2.51 to -0.12). In every diagnostic population, value-based payment was associated with significant reductions in mental health emergency department visits (population with depression: -0.01 visits [95% CI, -0.02 to -0.002]; population with bipolar disorder: -0.02 visits [95% CI, -0.05 to -0.001]; population with schizophrenia: -0.04 visits [95% CI, -0.07 to -0.01]). Conclusions and Relevance In this cohort study, Medicaid value-based payment reform was statistically significantly associated with an increase in behavioral health visits and a reduction in mental health emergency department visits for patients with mental illness. Medicaid value-based payment may be effective at altering health care utilization in patients with mental illness.
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Affiliation(s)
- Ashley Lewis
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Renata E. Howland
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Leora I. Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU School of Medicine, New York, New York
| | - Sunita M. Desai
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Smith J, Liu C, Beck A, Fei L, Brokamp C, Meryum S, Whaley KG, Minar P, Hellmann J, Denson LA, Margolis P, Dhaliwal J. Racial Disparities in Pediatric Inflammatory Bowel Disease Care: Differences in Outcomes and Health Service Utilization Between Black and White Children. J Pediatr 2023; 260:113522. [PMID: 37244575 PMCID: PMC10894641 DOI: 10.1016/j.jpeds.2023.113522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe racial inequities in pediatric inflammatory bowel disease care and explore potential drivers. METHODS We undertook a single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients with inflammatory bowel disease, aged <21 years, from January 2013 through 2020. Primary outcome was corticosteroid-free remission (CSFR) at 1 year. Other longitudinal outcomes included sustained CSFR, time to anti-tumor necrosis factor therapy, and evaluation of health service utilization. RESULTS Among 519 children (89% White, 11% Black), 73% presented with Crohn's disease and 27% with ulcerative colitis. Disease phenotype did not differ by race. More patients from Black families had public insurance (58% vs 30%, P < .001). Black patients were less likely to achieve CSFR 1-year post diagnosis (OR: 0.52, 95% CI:0.3-0.9) and less likely to achieve sustained CSFR (OR: 0.48, 95% CI: 0.25-0.92). When adjusted by insurance type, differences by race to 1-year CSFR were no longer significant (aOR: 0.58; 95% CI: 0.33, 1.04; P = .07). Black patients were more likely to transition from remission to a worsened state, and less likely to transition to remission. We found no differences in biologic therapy utilization or surgical outcomes by race. Black patients had fewer gastroenterology clinic visits and 2-fold increased odds for emergency department visits. CONCLUSIONS We observed no differences by race in phenotypic presentation and medication usage. Black patients had half the odds of achieving clinical remission, but a degree of this was mediated by insurance status. Understanding the cause of such differences will require further exploration of social determinants of health.
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Affiliation(s)
- Julia Smith
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew Beck
- Division of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Syeda Meryum
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kaitlin G Whaley
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Phillip Minar
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Jennifer Hellmann
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Lee A Denson
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Peter Margolis
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Jasbir Dhaliwal
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
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Ku L. Still no differences in the length or scope of primary and ambulatory care for Medicaid and commercial patients. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad027. [PMID: 38756244 PMCID: PMC10986203 DOI: 10.1093/haschl/qxad027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/30/2023] [Accepted: 07/12/2023] [Indexed: 05/18/2024]
Abstract
Many seek to improve the quality of primary care in the United States, particularly for Medicaid patients. This paper revisits the question of whether Medicaid patients receive less primary care, such as the length or scope of services per visit, than commercial patients. Analyses of 2016-2019 National Ambulatory Medical Care Survey data, the most recent available, find there were no significant differences in the average length of ambulatory care visits, or of primary care visits in particular, between Medicaid and commercial care, nor differences in the scope, based on the number of diagnostic and treatment services, health education topics covered, or the number of medications prescribed in the visit. Only small differences were found for uninsured patients. The duration and scope of ambulatory and primary care visits were primarily related to the characteristics of patients, visits, and the physicians' practices. To improve primary and ambulatory care for disadvantaged patients, it may be more important to focus on increasing access to care by reducing insurance and cost-related barriers and on broad-based efforts to improve quality.
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Affiliation(s)
- Leighton Ku
- Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC 20052, United States
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Herrera CN, Oblath R, Duncan A. Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2321798. [PMID: 37410466 PMCID: PMC10326644 DOI: 10.1001/jamanetworkopen.2023.21798] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 07/07/2023] Open
Abstract
Importance Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. Objective To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. Design, Setting, and Participants This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Main Outcomes and Measures Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Results Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). Conclusions and Relevance In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.
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Affiliation(s)
- Carolina-Nicole Herrera
- Department of Health, Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Rachel Oblath
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
| | - Alison Duncan
- Department of Psychiatry, Boston Medical Center, Boston, Massachusetts
- Boston Emergency Services Team Partnership for Behavioral Health, Racial, and Social Justice, Boston Medical Center, Boston, Massachusetts
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
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10
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Jimenez AE, Mukherjee D. High-Value Care Outcomes of Meningiomas. Neurosurg Clin N Am 2023; 34:493-504. [DOI: 10.1016/j.nec.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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11
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Ninety-Day Emergency Department Visits After Ankle Fracture Surgery. J Am Acad Orthop Surg 2023; 31:e51-e57. [PMID: 36548157 DOI: 10.5435/jaaos-d-22-00484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/04/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Emergency department (ED) visits after orthopaedic procedures such as ankle fracture open reduction and internal fixation (ORIF) have received less attention than other outcomes. This study analyzed 90-day ED visits after ankle fracture surgery in a national database to better characterize the incidence, timing, risk factors, and reasons. METHODS Ankle fractures undergoing ORIF were extracted from the PearlDiver M91Ortho 2010 to 2020Q3 data set. Patients were excluded for age younger than 18 years, presence of concomitant fractures, and <90 days of database follow-up. Patient age, sex, Elixhauser Comorbidity Index score, region of the country, and insurance plan were analyzed as predictors for 90-day ED utilization using multivariate logistic regression. Incidence of readmissions and incidence, timing, risk factors, and reasons for ED visits were determined. RESULTS Of 87,662 ankle fracture ORIF patients identified, ED visits were noted within 90 days of surgery for 10,087 (11.5%) while 4,030 (4.6%) were readmitted. One ED visit was noted for 6,102 patients, two visits for 2,654, three visits for 787, and more than three visits for 544. The greatest weekly incidence of ED visits was observed in weeks 1 and 2, with 2.9% and 3.1% of the entire cohort visiting in each week respectively. Factors independently associated with 90-day ED utilization included younger age (odds ratio [OR] 1.21 per decade decrease, P < 0.001), greater Elixhauser Comorbidity Index score (OR 1.40 per two-point increase, P < 0.001), and Medicaid insurance (OR 1.92, P < 0.001). In the first two postoperative weeks, 71% of ED visits were attributed to issues directly involving the surgical site while in subsequent weeks, most visits did not involve the surgical site (65%). DISCUSSION Many patients visit the ED after ankle fracture surgery. The greatest ED utilization was during the first two postoperative weeks, and reasons for visits were defined. These findings have implications for optimizing care pathways and targeting resource allocation.
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Giuliani E, Townsel CD, Jiang L, Leplatte-Ogini DJ, Caldwell MT, Marsh EE. Emergency Department Utilization for Substance Use Disorder During Pregnancy and Postpartum in the United States (2006-2016). Womens Health Issues 2022; 32:586-594. [PMID: 35660347 DOI: 10.1016/j.whi.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We aimed to better understand emergency department (ED) use, admission patterns, and demographics for substance use disorder in pregnancy and postpartum (SUDPP). METHODS In this longitudinal study, the United States Nationwide Emergency Department Sample was queried for all ED visits by 15- to 50-year-old women with a primary diagnosis defined by International Classification of Diseases, 9th or 10th edition Clinical Modification, codes of SUDPP between 2006 and 2016. Patterns of ED visit counts, rates, admissions, and ED charges were analyzed. RESULTS Annual national estimated ED visits for SUDPP increased from 2,919 to 9,497 between 2006 and 2016 (a 12.4% annual average percentage change), whereas admission rates decreased (from 41.9% to 32.0%). ED visits were more frequent among women who were 20-29 years old, using Medicaid insurance, in the lowest income quartile, living in the South, and in metropolitan areas. Compared with the proportion of ED visits, 15- to 19-year-olds had significantly lower admission rates, whereas women with Medicaid and in the lowest income quartile had higher admission rates (p < .001). Opioid use, tobacco use, and mental health disorders were most commonly associated with SUDPP. The ED average inflation-adjusted charges for SUDPP increased from $1,486 to $3,085 between 2006 and 2016 (7.1% annual average percentage change; p < .001), yielding total annual charges of $4.02 million and $28.53 million. CONCLUSIONS Despite the decrease in admissions, the number and charges for ED visits for SUDPP increased substantially between 2006 and 2016. These increasing numbers suggest a continuous need to implement preventive public health measures and provide adequate outpatient care for this condition in this population specifically.
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Affiliation(s)
- Emma Giuliani
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Courtney D Townsel
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | - Li Jiang
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | | | - Martina T Caldwell
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, Michigan
| | - Erica E Marsh
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Kammien AJ, Galivanche AR, Gouzoulis MJ, Moore HG, Mercier MR, Grauer JN. Emergency department visits within 90 days of single-level anterior cervical discectomy and fusion. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100122. [PMID: 35637647 PMCID: PMC9144013 DOI: 10.1016/j.xnsj.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 05/05/2022] [Indexed: 10/28/2022]
Abstract
Background Postoperative readmissions are a commonly used metric for quality-of-care initiatives, but emergency department (ED) visits have received far less attention despite their substantial impact on patient satisfaction and healthcare spending. The current study described the incidence and timing of ED visits following single-level ACDF, determined predictive factors and reasons for ED utilization, and compared reimbursement for patients with and without ED use. Methods Single-level ACDF procedures from 2010-2020 were identified in PearlDiver using CPT codes. Patients' age, sex, Elixhauser comorbidity index (ECI) score, region of the country, and insurance coverage were extracted. The incidence, timing, and primary diagnoses for 90-day ED visits and readmissions were determined, as well as total 90-day reimbursement. Variables were compared using univariate analysis and multivariate logistic regression. Results Out of 90,298 patients, 90-day ED visits were identified for 10,701 (11.9%), with the greatest incidence in postoperative weeks 1-2. Readmissions were identified for 3,325 (3.7%) patients. Independent predictors of ED utilization included younger age (OR 1.25 per 10-year decrease, p<0.001), greater ECI score (OR 1.40 per 2-point increase, p<0.001), and insurance type (relative to Medicare, Medicaid [OR 2.15, p<0.001] and commercial plans [OR 1.14, p=0.004]). In postoperative weeks 1-2, 51% of primary ED diagnoses involved the surgical site, while 23% involved the surgical site in weeks 3-13. Compared to patients without ED visits, those who visited the ED had 65% greater mean 90-day reimbursement (p<0.001). Conclusions More than three times as many patients in the current study were found to present to the ED than be readmitted within ninety days of surgery. The identified predictive factors and reasons for ED visits can direct attention to high-risk patients and common postoperative issues. Additional postoperative counseling and integrated care pathways may reduce ED visits, thereby improving patient care and reducing healthcare spending.
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Affiliation(s)
- Alexander J. Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Anoop R. Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Michael J. Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | | | - Michael R. Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA
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Kammien AJ, Zhu JR, Gouzoulis MJ, Moore HG, Galivanche AR, Medvecky MJ, Grauer JN. Emergency Department Visits Within 90 Days of Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083586. [PMID: 35340726 PMCID: PMC8941698 DOI: 10.1177/23259671221083586] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Emergency department (ED) visits after orthopaedic surgery such as anterior
cruciate ligament reconstruction (ACLR) affect patients and health care
systems and should be better understood. Purpose: To determine the incidence, predictors, and reasons for ED visits within 90
days after ACLR. Study Design: Descriptive epidemiologic study. Methods: Patients who had undergone ACLR between 2010 and 2020 were identified in a
national database, and 90-day ED visits, readmissions, risk factors, and
primary diagnoses for visits were determined. One-year postoperative data
were used to establish baseline weekly ED visits for the cohort. Patient
age, sex, Elixhauser comorbidity index, region of the country (Northeast,
Midwest, West, South), and insurance coverage (Medicare, Medicaid, and
commercial) were extracted, and these variables were compared using
univariate analysis and multivariate logistic regression. Results: Out of 81,179 patients, ED visits were identified for 6764 (8.3%), and
readmissions were identified for 592 (0.7%). Overall, 5300 patients had 1 ED
visit, 1020 patients had 2 visits, 275 patients had 3 visits, and 169
patients had ≥4 or more visits; visits occurred within 2 weeks of surgery
38% of the time. Notably, weekly visits returned to baseline at week 3.
Independent predictors of ED utilization from multivariate analysis were
insurance type (relative to commercial insurance: Medicaid [odds ratio [OR],
2.41; 95% CI, 2.23-2.60] and Medicare [OR, 1.38; 95% CI, 1.19-1.60]), higher
Elixhauser comorbidity index (per 2-point increase: OR, 2.24; 95% CI,
2.18-2.29), younger age (per 10-year decrease: OR, 1.23; 95% CI, 1.21-1.24),
female sex (OR, 1.05; 95% CI, 1.02-1.08), and region of the country
(relative to the West: Midwest [OR, 1.33; 95% CI, 1.26-1.39], Northeast [OR,
1.24; 95% CI, 1.18-1.30], and South [OR, 1.17; 95% CI, 1.12-1.23]). In the
first 2 weeks, 67.5% of ED visits were for issues involving the surgical
site, most commonly surgical-site pain (29% of all visits). In the total
90-day period, 39.4% of visits involved the surgical site. Conclusion: Within 90 days of ACLR, >8% of patients visited the ED, while 0.7% were
readmitted. ED visits increased in the first 2 postoperative weeks and
returned to baseline rates around week 3. Within the first 2 weeks,
two-thirds of visits involved the surgical site. Younger patients, patients
with greater comorbidity burden, those in certain regions of the country,
and those with Medicaid had greater odds of ED utilization.
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Affiliation(s)
- Alexander J Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Justin R Zhu
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J Gouzoulis
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Anoop R Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael J Medvecky
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, USA
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Brom H, Anusiewicz CV, Udoeyo I, Chittams J, Brooks Carthon JM. Access to post-acute care services reduces emergency department utilisation among individuals insured by Medicaid: An observational study. J Clin Nurs 2022; 31:726-732. [PMID: 34240494 PMCID: PMC8741822 DOI: 10.1111/jocn.15932] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/25/2021] [Accepted: 06/07/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES We examined whether access to post-acute care services differed between individuals insured by Medicaid and commercial insurers and whether those differences explained emergency department utilisation 30 days post-hospitalisation. BACKGROUND Timely follow-up to community-based providers is a strategy to improve post-hospitalisation outcomes. However, little is known regarding the influence of post-acute care services on the likelihood of emergency department use post-hospitalisation for individuals insured by Medicaid. DESIGN We conducted a retrospective observational study of electronic health record data from an academic medical centre in a large northeastern urban setting. The STROBE checklist was used in reporting this observational study. METHODS Our analysis included adults insured by Medicaid or commercial insurers who were discharged from medical services between 1 August-31 October 2017 (n = 785). Logistic regression models were used to examine the effects of post-acute care services (primary care, home health, specialty care) on the odds of an emergency department visit. RESULTS Post-hospitalisation, 12% (n = 59) of individuals insured by Medicaid experienced an emergency department visit compared to 4.2% (n = 13) of individuals commercially insured. Having Medicaid insurance was associated with higher odds of emergency department visits post-hospitalisation (OR = 3.24). Having a home care visit or specialty care visit within 30 days post-discharge were significant predictors of lower odds of emergency department visits. Specific to specialty care visits, Medicaid was no longer a significant predictor of emergency department visits with specialty care being more influential (OR = 0.01). CONCLUSIONS Improving connections to appropriate post-acute care services, specifically specialty care, may improve outcomes among individuals insured by Medicaid. RELEVANCE TO CLINICAL PRACTICE Hospital-based nurses, including those in direct care, case management and discharge planning, play an important role in facilitating referrals and scheduling appointments prior to discharge. Individuals insured by Medicaid may require additional support in accessing these services and nurses are well-positioned to facilitate care continuity.
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Affiliation(s)
- Heather Brom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Colleen V. Anusiewicz
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Danville, PA, USA
| | | | - Jesse Chittams
- BECCA Lab, University of Pennsylvania, Philadelphia, PA, USA
| | - J. Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Danville, PA, USA
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Austin S, Clarke M, Zhang Y, Qu H, Pisu M. Health care utilization among beneficiaries with diabetes from federally qualified health centers: Analysis from a Medicaid managed care organization. Health Mark Q 2021; 39:74-87. [PMID: 34705595 DOI: 10.1080/07359683.2021.1995638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined health care utilization among federally qualified health center (FQHCs) users from a Medicaid managed care organization based on 2016 administrative claims data (n = 8,402). FQHC users had fewer primary care visits (Adjusted Incidence Rate Ratios (aIRR): 0.82; 95% CI: 0.76-0.88) compared with non-FQHC users. Statistically significant differences were not observed in emergency department visits (aIRR: 1.19; 95% CI: 0.98-1.46) and hospitalizations (aIRR: 1.03; 95% CI: 0.80-1.34). FQHCs provide comprehensive primary care to Medicaid managed care beneficiaries with diabetes in fewer PCP visits. Results provide evidence to health policy experts and MCOs to increase provider network contracting with FQHCs.
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Affiliation(s)
- Shamly Austin
- Research, Development & Analytics Department, Gateway Health, Pittsburgh, PA, USA
| | - Meredith Clarke
- Research, Development & Analytics Department, Gateway Health, Pittsburgh, PA, USA
| | - Yuan Zhang
- Research, Development & Analytics Department, Gateway Health, Pittsburgh, PA, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Maria Pisu
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Velez FF, Colman S, Kauffman L, Anastassopoulos K, Murphy S, Maricich Y. Real-world changes in US health system hospital-based services following treatment with a prescription digital therapeutic for opioid use disorder. Hosp Pract (1995) 2021; 49:341-347. [PMID: 34275401 DOI: 10.1080/21548331.2021.1956256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outcomes associated with buprenorphine therapy for the treatment of opioid use disorder (OUD) are suboptimal. reSET-O is an FDA-authorized prescription digital therapeutic (PDT) delivering neurobehavioral therapy via mobile devices to patients with OUD treated with buprenorphine. This analysis evaluated the net impact of reSET-O on medical costs among actively-engaged reSET-O patients using real-world observations. This real-world retrospective analysis of health care claims between October 2018 and October 2019 evaluated health care resource utilization up to 6 months before and 6 months after the initiation of a reSET-O prescription after accounting for the subset of patients not continuing on therapy after week 1 (non-engaged patients). Repeated-measures negative binomial models compared incidences of hospital-based encounters/procedures adjusted for days in each period as well as associated costs. The number needed to treat (NNT) to avoid an inpatient visit was calculated. Of the 351 patients who were prescribed reSET-O, 321 met the criteria of active engagement. Treatment with reSET-O was associated with a substantial reduction in medical costs of -$765,450 (-$2,385/patient, $235/patient greater than a previous analysis in which non-engaged patients were included) in the 6-month period after initiation. The gross reSET-O prescription cost of $584,415 ($1,665/patient) was substantially offset by $49,950 ($142.31/patient) in refunds to payers. The medical cost reduction in engaged patients offset the cost of the therapeutic resulting in an overall cost reduction of -$230,985 in this cohort (net savings of -$720 per patient). The number needed to treat to avoid an inpatient visit was 4.8. Engagement and continued treatment with reSET-O in patients with OUD treated with buprenorphine is associated with substantial real-world reductions in medical costs in the 6-month period following the initiation of the reSET-O prescription.
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Affiliation(s)
- Fulton F Velez
- Pear Therapeutics Inc, Health Economics and Real-World Evidence, Boston, MA, USA
| | | | | | | | - Sean Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, USA
| | - Yuri Maricich
- Pear Therapeutics Inc, Health Economics and Real-World Evidence, Boston, MA, USA
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Mupfudze TG, Preussler JM, Sees JA, SanCartier M, Arnold SD, Devine S. A Qualitative Analysis of State Medicaid Coverage Benefits for Allogeneic Hematopoietic Cell Transplantation (alloHCT) for Patients with Sickle Cell Disease (SCD). Transplant Cell Ther 2021; 27:345-351. [PMID: 33836889 DOI: 10.1016/j.jtct.2021.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/05/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited hemoglobin disorder, affecting approximately 100,000 people in the United States. Allogeneic hematopoietic cell transplantation (alloHCT), also known as bone marrow transplant (BMT), is currently the only established curative option for SCD. However, alloHCT is an optional benefit under Medicaid. This study of alloHCT coverage for patients with SCD aims to understand the scope of state Medicaid coverage benefits and BMT financial coordinators' experience working with their state Medicaid programs. States estimated to have more than 50 newborns diagnosed with SCD in 2016 and at least one active BMT Clinical Trials Network (1503 [STRIDE 2], NCT02766465) transplant center (TC) were eligible to participate in this study. Qualitative, semi-structured interviews 30 to 60 minutes in length were conducted with BMT financial coordinators via telephone between May and October 2019. A total of 10 BMT financial coordinators from 10 TCs representing eight states (Florida, Georgia, Illinois, Michigan, New York, Pennsylvania, Texas, and Virginia) participated in the semi-structured interviews. Coordinators in all of the included states reported that alloHCT in children with SCD with a human leukocyte antigen-matched sibling donor was covered by their state Medicaid programs. However, only two states (Florida and Texas) had legislative policies mandating coverage of routine medical costs for patients in clinical trials. TCs in two states (Illinois and Pennsylvania) reported accepting out-of-state Medicaid insurance, but only one state (Michigan) covered both travel and lodging for the patient and one caregiver. Four themes emerged when coordinators were asked about their perspectives and experiences working with their corresponding state Medicaid programs: (1) state Medicaid eligibility criteria based on disability were perceived as being restrictive, and Medicaid reimbursement rates were reported to be low; (2) Medicaid fee-for-service plans were perceived as being more comprehensive and easier to navigate compared to comprehensive managed care (CMC) plans; (3) there is a need to address caregiver and financial assistance beyond the health care costs; and (4) completing the insurance authorization process leading up to alloHCT is critical, including peer-to-peer reviews. There is limited legislative policy to help ensure access to clinical trials and provide out-of-state benefits and travel and lodging for Medicaid enrollees with SCD. These data provide insight into potential areas that could influence changes in policy to enhance access to curative therapy for SCD.
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Affiliation(s)
- Tatenda G Mupfudze
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia.
| | - Jaime M Preussler
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Jennifer A Sees
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Michelle SanCartier
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
| | - Staci D Arnold
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Emory University Hospital, Atlanta, Georgia
| | - Steven Devine
- National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota; Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Division of Hematology/Oncology/BMT, Emory University School of Medicine, Atlanta, Georgia
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Cheng V, Billups SJ, Saseen JJ. Prescribing practices of migraine-specific pharmacotherapy associated with emergency department use for migraine. Headache 2020; 61:455-461. [PMID: 33377525 DOI: 10.1111/head.14029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study compared migraine medication prescribing between patients with a migraine diagnosis who used versus did not use the emergency department (ED) for migraine. BACKGROUND Headache is the fifth most common chief complaint for ED visits nationwide and the third most common potentially avoidable ED diagnosis in the University of Colorado Health system. The reasons some patients use the ED for migraine management while others do not and whether some ED admissions might be preventable remain unclear. METHODS This retrospective cohort study identified adults with migraine-related diagnoses within 1 year before the index date of July 1, 2018 and compared patient characteristics and migraine medication prescribing patterns between those who did or did not have a subsequent migraine-related ED encounter the following year. ED admission notes were manually reviewed to identify potentially preventable circumstances that led to the ED visit. The primary outcome was the proportion of patients with an active triptan prescription at the index date. RESULTS Of the 3843 patients identified, 35 patients (0.9%) had a migraine-related ED encounter. Of these, 17/35 (49%) had an active triptan prescription compared to 1360/3808 (36%) of non-ED utilizers (p = 0.114), OR 1.22 (95% CI 0.61-2.45). More ED utilizers had an active prescription for opioids (11/35 [31%] vs. 663/3808 [17%], p = 0.030) and migraine preventive therapy (19/35 [54%] vs. 1149/3808 [30%], p = 0.002), and neurology referrals (20/35 [57%] vs. 654/3808 [17%], p < 0.001) compared to non-ED utilizers. The most common circumstance for migraine-related ED visits was nonresponse to migraine abortive medications administered at home. CONCLUSIONS Triptan prescribing did not differ between ED utilizers and non-ED utilizers for migraine. Overall, less than half of the total patient population had a triptan prescribed. More ED utilizers had neurology referrals, prescriptions for opioids and preventive therapies, and a history of previous ED visit for any reason, which may be markers for higher disease severity or behavior patterns. Future research and interventions to reduce migraine-related ED use could target high-risk patients such as those with previous ED visits for any indication and neurology referrals.
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Affiliation(s)
- Vivian Cheng
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Sarah J Billups
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | - Joseph J Saseen
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA.,Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Effects of variations in access to care for children with atopic dermatitis. BMC DERMATOLOGY 2020; 20:24. [PMID: 33341118 PMCID: PMC7749983 DOI: 10.1186/s12895-020-00114-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/09/2020] [Indexed: 12/31/2022]
Abstract
Background An estimated 50% of children in the US are Medicaid-insured. Some of these patients have poor health literacy and limited access to medications and specialty care. These factors affect treatment utilization for pediatric patients with atopic dermatitis (AD), the most common inflammatory skin disease in children. This study assesses and compares treatment patterns and healthcare resource utilization (HCRU) between large cohorts of Medicaid and commercially insured children with AD. Methods Pediatric patients with AD were identified from 2 large US healthcare claims databases (2011–2016). Included patients had continuous health plan eligibility for ≥6 months before and ≥12 months after the first AD diagnosis (index date). Patients with an autoimmune disease diagnosis within 6 months of the index date were excluded. Treatment patterns and all-cause and AD-related HCRU during the observation period were compared between commercially and Medicaid-insured children. Results A minority of children were evaluated by a dermatology or allergy/immunology specialist. Several significant differences were observed between commercially and Medicaid-insured children with AD. Disparities detected for Medicaid-insured children included: comparatively fewer received specialist care, emergency department and urgent care center utilization was higher, a greater proportion had asthma and non-atopic morbidities, high- potency topical corticosteroids and calcineurin inhibitors were less often prescribed, and prescriptions for antihistamines were more than three times higher, despite similar rates of comorbid asthma and allergies among antihistamine users. Treatment patterns also varied substantially across physician specialties. Conclusions Results suggest barriers in accessing specialty care for all children with AD and significant differences in management between commercially and Medicaid-insured children. These disparities in treatment and access to specialty care may contribute to poor AD control, especially in Medicaid-insured patients. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12895-020-00114-x.
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Hauser BM, Gupta S, Xu E, Wu K, Bernstock JD, Chua M, Khawaja AM, Smith TR, Dunn IF, Bergmark RW, Bi WL. Impact of insurance on hospital course and readmission after resection of benign meningioma. J Neurooncol 2020; 149:131-140. [PMID: 32654076 DOI: 10.1007/s11060-020-03581-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/02/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgical outcomes and healthcare utilization have been shown to vary based on patient insurance status. We analyzed whether patients' insurance affects case urgency for and readmission after craniotomy for meningioma resection, using benign meningioma as a model system to minimize confounding from the disease-related characteristics of other neurosurgical pathologies. METHODS We analyzed 90-day readmission for patients who underwent resection of a benign meningioma in the Nationwide Readmission Database from 2014-2015. RESULTS A total of 9783 meningioma patients with private insurance (46%), Medicare (39%), Medicaid (10%), self-pay (2%), or another scheme (3%) were analyzed. 72% of all cases were elective; with 78% of cases in privately insured patients being elective compared to 71% of Medicare (p > 0.05), 59% of Medicaid patients (OR 2.3, p < 0.001), and 49% of self-pay patients (OR 3.4, p < 0.001). Medicare (OR 1.5, p = 0.002) and Medicaid (OR 1.4, p = 0.035) were both associated with higher likelihood of 90-day readmission compared to private insurance. In comparison, 30-day analyses did not unveil this discrepancy between Medicaid and privately insured, highlighting the merit for longer-term outcomes analyses in value-based care. Patients readmitted within 30 days versus those with later readmissions possessed different characteristics. CONCLUSIONS Compared to patients with private insurance coverage, Medicaid and self-pay patients were significantly more likely to undergo non-elective resection of benign meningioma. Medicaid and Medicare insurance were associated with a higher likelihood of 90-day readmission; only Medicare was significant at 30 days. Both 30 and 90-day outcomes merit consideration given differences in readmitted populations.
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Affiliation(s)
| | - Saksham Gupta
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Edward Xu
- Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kyle Wu
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Joshua D Bernstock
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Melissa Chua
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA
| | - Ayaz M Khawaja
- Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Timothy R Smith
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Computational Neurosurgical Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Regan W Bergmark
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Wenya Linda Bi
- Center for Skull Base and Pituitary Surgery, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA, 02115, USA.
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Are There Nationwide Socioeconomic and Demographic Disparities in the Use of Outpatient Orthopaedic Services? Clin Orthop Relat Res 2020; 478:979-989. [PMID: 32310622 PMCID: PMC7170672 DOI: 10.1097/corr.0000000000001168] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although disparities in the use of healthcare services in the United States have been well-documented, information examining sociodemographic disparities in the use of healthcare services (for example, office-based and emergency department [ED] care) for nonemergent musculoskeletal conditions is limited. QUESTIONS/PURPOSES This study was designed to answer two important questions: (1) Are there identifiable nationwide sociodemographic disparities in the use of either office-based orthopaedic care or ED care for common, nonemergent musculoskeletal conditions? (2) Is there a meaningful difference in expenditures associated with these same conditions when care is provided in the office rather than the ED? METHODS This study analyzed data from the 2007 to 2015 Medical Expenditure Panel Survey (MEPS). The MEPS is a nationally representative database administered by the Agency for Healthcare Research and Quality that tracks patient interactions with the healthcare system and expenditures associated with each visit, making it an ideal data source for our study. Differences in the use of office-based and ED care were assessed across different socioeconomic and demographic groups. Healthcare expenditures associated with office-based and ED care were tabulated for each of the musculoskeletal conditions included in this study. The MEPS database defines expenditures as direct payments, including out-of-pocket payments and payments from insurances. In all, 63,514 participants were included in our study. Fifty-one percent (32,177 of 63,514) of patients were aged 35 to 64 years and 29% were older than 65 years (18,445 of 63,514). Women comprised 58% (37,031 of 63,514) of our population, while men comprised 42% (26,483 of 63,514). Our study was limited to the following eight categories of common, nonemergent musculoskeletal conditions: osteoarthritis (40%, 25,200 of 63,514), joint derangement (0.5%, 285 of 63,514), other joint conditions (43%, 27,499 of 63,514), muscle or ligament conditions (6%, 3726 of 63,514), bone or cartilage conditions (8%, 5035 of 63,514), foot conditions (1%, 585 of 63,514), fractures (7%, 4189 of 63,514), and sprains or strains (18%, 11,387 of 63,514). Multivariable logistic regression was used to ascertain which demographic, socioeconomic, and health-related factors were independently associated with differences in the use of office-based orthopaedic services and ED care for musculoskeletal conditions. Furthermore, expenditures over the course of our study period for each of our musculoskeletal categories were calculated per visit in both the outpatient and the ED settings, and adjusted for inflation. RESULTS After controlling for covariates like age, gender, region, insurance status, income, education level, and self-reported health status, we found substantially lower use of outpatient musculoskeletal care among patients who were Hispanic (odds ratio 0.79 [95% confidence interval 0.72 to 0.86]; p < 0.001), non-Hispanic black (OR 0.77 [95% CI 0.70 to 0.84]; p < 0.001), lesser-educated (OR 0.72 [95% CI 0.65 to 0.81]; p < 0.001), lower-income (OR 0.80 [95% CI 0.73 to 0.88]; p < 0.001), and nonprivately-insured (OR 0.85 [95% CI 0.79 to 0.91]; p < 0.001). Public insurance status (OR 1.30 [95% CI 1.17 to 1.44]; p < 0.001), lower income (OR 1.53 [95% CI 1.28 to 1.82]; p < 0.001), and lesser education status (OR 1.35 [95% CI 1.14 to 1.60]; p = 0.001) were also associated with greater use of musculoskeletal care in the ED. Healthcare expenditures associated with care for musculoskeletal conditions was substantially greater in the ED than in the office-based orthopaedic setting. CONCLUSIONS There are substantial sociodemographic disparities in the use of office-based orthopaedic care and ED care for common, nonemergent musculoskeletal conditions. Because of the lower expenditures associated with office-based orthopaedic care, orthopaedic surgeons should make a concerted effort to improve access to outpatient care for these populations. This may be achieved through collaboration with policymakers, greater initiatives to provide care specific to minority populations, and targeted efforts to improve healthcare literacy. LEVEL OF EVIDENCE Level III, therapeutic study.
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Desai NR, Reed P, Alvarez PJ, Fogli J, Woods SD, Owens MK. The Economic Implications of Hyperkalemia in a Medicaid Managed Care Population. AMERICAN HEALTH & DRUG BENEFITS 2019; 12:352-361. [PMID: 32055283 PMCID: PMC6996620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hyperkalemia, defined as a serum potassium level >5 mEq/L that results from multiple mechanisms, is a serious medical condition that can lead to life-threatening arrhythmias and sudden cardiac death. The coexistence of cardiac and renal diseases (ie, cardiorenal syndrome) significantly increases the complexity of care, but its economic impact is not well-characterized in this understudied Medicaid managed care population with hyperkalemia. OBJECTIVE To calculate the economic impact of hyperkalemia on patients with cardiorenal syndrome in a Medicaid managed care population in the United States using real-world data. METHODS In this retrospective cohort study, we used a proprietary Medicaid managed care database from 1 southern state. The total study population included 3563 patients, including 973 patients with hyperkalemia and 2590 controls (without hyperkalemia), who were matched based on age, comorbidities, and Medicaid eligibility status and duration, during a 30-month period between 2013 and 2016. The inclusion criteria for the hyperkalemia cohort were age ≥18 years, Medicaid-only insurance status, coded cardiorenal diagnosis, and a claim for hyperkalemia during the study period. The cost was determined using paid claims data. RESULTS The mean healthcare costs (medical and pharmacy per member per year [PMPY] for patients with hyperkalemia was higher than that for the control cohort without hyperkalemia ($56,002 vs $23,653, respectively). These cost differences were driven by medical costs accrued in the hyperkalemia and in the control cohorts ($49,648 and $18,399 PMPY, respectively). Two of the largest drivers of the medical cost variance were inpatient costs ($33,116 vs $10,629 PMPY for the hyperkalemia and control cohorts, respectively) and dialysis costs ($2716 vs $810 PMPY, respectively). The medical loss ratios were 552% for the hyperkalemia cohort and 260% for the control cohort. Both cohorts had revenue deficits to the health plan, but the hyperkalemia cohort had double the medical loss ratio compared with the control cohort. CONCLUSIONS The findings from this Medicaid managed care population suggest that hyperkalemia increases healthcare utilization and costs, which were primarily driven by the costs associated with inpatient care and dialysis. Our findings demonstrate that the Medicaid beneficiaries who have cardiorenal comorbidities accrue high costs to the Medicaid health plan, and these costs are even higher if a hyperkalemia diagnosis is present. The very high medical loss ratio for the hyperkalemia cohort in our analysis indicates that enhanced monitoring and management of patients with hyperkalemia should be considered.
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Affiliation(s)
- Nihar R Desai
- Assistant Professor of Medicine, Yale School of Medicine, New Haven, CT
| | - Pamala Reed
- Senior Director, Outcomes Research and Analysis, Intelligent Health Analytics, Tallahassee, FL
| | - Paula J Alvarez
- Senior Director, Managed Care Health Outcomes, Relypsa, a Vifor Pharma Group Company, Redwood City, CA
| | - Jeanene Fogli
- Executive Director, Medical Affairs, Relypsa, a Vifor Pharma Group Company, Redwood City, CA
| | - Steven D Woods
- Senior Director, Managed Care Health Outcomes, Relypsa, a Vifor Pharma Group Company, Redwood City, CA
| | - Mary Kay Owens
- President and Chief Executive Officer, Intelligent Health Analytics
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Pisu M, Rocque GB, Jackson BE, Kenzik KM, Sharma P, Williams CP, Kvale EA, Taylor RA, Williams GR, Azuero A, Li Y, Acemgil A, Martin MY, Demark-Wahnefried W, Turkman Y, Fouad M, Rocconi RP, Sullivan M, Cantuaria G, Partridge EE, Meneses K. Lay navigation across the cancer continuum for older cancer survivors: Equally beneficial for Black and White survivors? J Geriatr Oncol 2019; 10:779-786. [PMID: 30389494 DOI: 10.1016/j.jgo.2018.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/01/2018] [Accepted: 10/18/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The Patient Care Connect Program (PCCP), through lay navigators' distress assessments and assistance, was shown to lower healthcare utilization and costs in older cancer survivors. PCCP benefits and assistance needs for disadvantaged minorities (e.g., Black) vs. Whites are unknown. MATERIALS AND METHODS We examined the PCCP impact with retrospective analyses of Medicare claims (2012-2015). Outcomes were quarterly costs and utilization (emergency room (ER), hospitalizations) for navigated and matched survivors. Repeated measures generalized linear models with normal (costs), and Poisson (utilization) distributions assessed differences in trends overall and separately for Blacks and Whites. With distress data for navigated survivors, we assessed high distress (score > 3), ≥1 distress cause (overall, by domain), and ≥ 1 assistance request by minority group. RESULTS Beneficiaries were: 772 Black and 5350 White navigated, and 770 Black and 5348 White matched survivors. Impact was: i) costs: -$557.5 Blacks (p < .001), -$813.4 Whites (p < .001); ii) ER: Incidence Rate Ratio (IRR) 0.97 Blacks (NS), 0.93 Whites (p < .001); iii) hospitalizations: IRR 0.97 Blacks (NS), 0.91 Whites (p < .001). There was no significant difference in impact across minority groups. No significant differences were found in high distress (29% Black, 25.1% White), ≥1 distress cause (61.6% Black, 57.8% White), or ≥ 1 assistance request (64.5% Black, 59.1% White). Blacks were more likely to have ≥1 distress cause in the Practical domain. CONCLUSION The PCCP may benefit both Black and White older cancer survivors. Programs should consider the proportion of older survivors with high distress, and the specific needs of minorities.
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Affiliation(s)
- Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), United States; Comprehensive Cancer Center, UAB., United States.
| | - Gabrielle B Rocque
- Comprehensive Cancer Center, UAB., United States; Division of Hematology Oncology, UAB., United States; Division of Gerontology, Geriatrics, and Palliative Care, UAB, United States
| | - Bradford E Jackson
- Center for Outcomes Research, John Peter Smith Health Network, United States
| | - Kelly M Kenzik
- Comprehensive Cancer Center, UAB., United States; Division of Hematology Oncology, UAB., United States; Institute for Cancer Outcomes and Survivorship, UAB, United States
| | | | | | - Elizabeth A Kvale
- Comprehensive Cancer Center, UAB., United States; Division of Gerontology, Geriatrics, and Palliative Care, UAB, United States
| | | | - Grant R Williams
- Comprehensive Cancer Center, UAB., United States; Division of Hematology Oncology, UAB., United States; Institute for Cancer Outcomes and Survivorship, UAB, United States
| | | | - Yufeng Li
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), United States; Comprehensive Cancer Center, UAB., United States
| | - Aras Acemgil
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), United States
| | - Michelle Y Martin
- Center for Innovation in Health Equity Research (CIHER), Department of Preventive Medicine, University of Tennessee Health Science Center, United States
| | - Wendy Demark-Wahnefried
- Comprehensive Cancer Center, UAB., United States; Department of Nutrition Science, UAB, United States
| | - Yasemin Turkman
- Comprehensive Cancer Center, UAB., United States; School of Nursing, UAB, United States
| | - Mona Fouad
- Division of Preventive Medicine, University of Alabama at Birmingham (UAB), United States; Comprehensive Cancer Center, UAB., United States
| | - Rodney P Rocconi
- University of South Alabama, Mitchell Cancer Institute, Mobile, AL, United States
| | - Margaret Sullivan
- University of South Alabama, Mitchell Cancer Institute, Mobile, AL, United States
| | - Guilherme Cantuaria
- Division of Gynecologic Oncology, Northside Hospital, Atlanta, GA, United States
| | - Edward E Partridge
- Comprehensive Cancer Center, UAB., United States; Division of Gynecologic Oncology, UAB, United States
| | - Karen Meneses
- Comprehensive Cancer Center, UAB., United States; School of Nursing, UAB, United States
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Li T, Johnson ST, Koester MC, Hommel A, Norcross MF. The impact of high school athletic trainer services on medical payments and utilizations: a microsimulation analysis on medical claims. Inj Epidemiol 2019; 6:15. [PMID: 31245264 PMCID: PMC6582695 DOI: 10.1186/s40621-019-0194-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/21/2019] [Indexed: 06/13/2024] Open
Abstract
Background Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children’s health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision. Methods We obtained medical claims of patients aged 14 to 18 years from the 2011–2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT’s scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either “AT group” or “non-AT group”. We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools. Results Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients. Conclusions Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children’s wellbeing while containing avoidable medical cost.
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Affiliation(s)
- Tao Li
- 1Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Samuel T Johnson
- 2Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Michael C Koester
- 3Slocum Center for Orthopedics and Sports Medicine, Eugene, Oregon USA
| | - Annie Hommel
- 1Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
| | - Marc F Norcross
- 2Kinesiology Program, School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon USA
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Ojinnaka CO, Heflin C. Supplemental Nutrition Assistance Program size and timing and hypertension-related emergency department claims among Medicaid enrollees. ACTA ACUST UNITED AC 2018; 12:e27-e34. [PMID: 30425017 DOI: 10.1016/j.jash.2018.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 09/26/2018] [Accepted: 10/04/2018] [Indexed: 01/12/2023]
Abstract
The Supplemental Nutrition Assistance Program (SNAP) is a public policy program that aims to reduce food insecurity-a social determinant of health that has been associated with suboptimal blood pressure control in the United States. The aim of the article was to explore the association between SNAP benefit timing and size and probability of hypertension-related emergency department (ED) claims. This study used the SNAP data from the Missouri's Department of Social Services for January 2010 to December 2013 linked to Medicaid ED claims data. The dependent variable was probability of hypertension-related and hypertensive emergency ED claims. The independent variables of interest were week of calendar and SNAP benefit months and SNAP benefit amount. Probit regression analyses were conducted. Average marginal effects are reported.In a sample of 6,013,951 Medicaid-insured SNAP beneficiaries, 11,709 hypertension-related claims were submitted for every 100,000 claims. The average marginal effect of SNAP benefit amount on hypertension-related ED claims was -0.0000638 (P < .001); thus, a $100 increase in SNAP benefits will reduce hypertension-related claims by 638 claims per 100,000 claim. The reduction in ED claims was higher for lower SNAP benefit amounts than at higher SNAP benefit amounts. There was no statistically significant association between week of calendar month in which SNAP benefit was received and probability of hypertension-related ED claims. Higher SNAP benefit amount was associated with a decreased probability of hypertension-related ED claims. The impact of an additional dollar of SNAP benefits was larger at lower SNAP benefit amounts.
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Affiliation(s)
- Chinedum O Ojinnaka
- Biomedical Informatics Program, College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
| | - Colleen Heflin
- Department of Public Administration and International Affairs, The Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, NY, USA
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McCormick B, Hill PS, Redding S. Comparative morbidities and the share of emergencies in hospital admissions in deprived areas: a method and evidence from English administrative data. BMJ Open 2018; 8:e022573. [PMID: 30127052 PMCID: PMC6104760 DOI: 10.1136/bmjopen-2018-022573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Various studies find that the share of emergencies in hospital admissions is higher in deprived areas, but both the explanation and policy implications are unclear. We estimate the extent to which this finding is due to a different disease mix in deprived areas, rather than other explanations such as patient behaviour and general practitioner effectiveness. DESIGN Secondary analysis using English Hospital Episode Statistics data, with disease for elective and emergency admissions in 2008/2009 coded at 186 blocks or 1230 categories and aggregated to lower layer super output area of residence. It is then linked to an appropriate measure of deprivation. OUTCOME MEASURES The difference in the share of emergencies in hospital admissions between communities in the highest and lowest deciles of deprivation; and the percentage of this difference that is explained if areas in the least deprived decile have the same disease mix as those in the most deprived decile. RESULTS Using the finest disease classification scheme (1230 categories), 71% of the higher share of admissions that were emergencies in decile 1 areas relative to decile 10, is explained by the "adverse" case mix (CM) in deprived areas. The remainder reflects the higher relative use of emergency care in deprived areas for the same conditions. Higher incidence of respiratory and circulatory diseases in deprived areas explains about 30% of the CM contribution. Diseases of the digestive system and abdomen have a high relative use of emergency care in deprived areas. CONCLUSIONS The higher use of emergency care in deprived areas is primarily a symptom of the higher prevalence of diseases which have high national rates of emergency to elective care-especially respiratory diseases-rather than an indication of less effective primary care. Nevertheless, there is a higher share of emergency care in admissions in deprived areas for several diseases, most notably of the digestive system.
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Affiliation(s)
- Barry McCormick
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter-Sam Hill
- Education Portfolio, Oxford Policy Management, Oxford, UK
| | - Stuart Redding
- Centre for Health Service Economics & Organisation, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Kirkham HS, Staskon F, Hira N, McLane D, Kilgore KM, Parente A, Kim S, Sawicki GS. Outcome evaluation of a pharmacy-based therapy management program for patients with cystic fibrosis. Pediatr Pulmonol 2018; 53. [PMID: 29512893 PMCID: PMC6001460 DOI: 10.1002/ppul.23978] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy-based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations. METHODS This retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled aztreonam, ivacaftor, or dornase alfa from 6/2/2014-5/31/2015. Adherence was measured as proportion of days covered (PDC). Propensity score matching and multivariable regression techniques were used to compare outcomes in program participants to matched controls. RESULTS Of the 236 intervention and 724 control patients meeting selection criteria, 202 were propensity-matched from each cohort. Relative to the control cohort, program patients had 23% higher mean PDC for tobramycin (IRR = 1.23, P = 0.01) and were twice as likely to be adherent to tobramycin (PDC ≥ 80%) than matched controls (OR = 2.14, P = 0.04). Program patients had fewer ER visits (IRR = 0.52, P < 0.01) and slightly lower ER costs (IRR = 0.66, P = 0.06) than the control patients. CONCLUSION A pharmacy-based therapy management program for CF patients was associated with higher adherence to inhaled tobramycin and lower ER rates. Pharmacies that provide therapy management can support effective CF care management.
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Affiliation(s)
| | | | - Nishita Hira
- AllianceRx Walgreens Prime, Pittsburgh, Pennsylvania
| | - Darren McLane
- AllianceRx Walgreens Prime, Pittsburgh, Pennsylvania
| | | | | | - Seung Kim
- Avalere Health-an Inovalon Company, Bowie, Maryland
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