The Effect of Usual Source of Care on the Association of Annual Healthcare Expenditure with Patients' Age and Chronic Disease Duration

Along with rapid population aging, the importance of chronic disease management increases with high growth of national healthcare expenditures, and efficient spending on healthcare is required to reduce unnecessary utilizations. For that reason, this study examined the association of annual healthcare expenditure with age and disease duration of chronic patients. Furthermore, the study investigated the effect of usual source of care (USOC) to suggest directions for preventive management of chronic disease. Using Korean Health Panel Study data, this study selected 1481 outpatients, who had out-of-pocket costs for hypertension or diabetes, and their total healthcare and chronic disease management (CDM) costs were examined. With patient aging, CDM cost decreased while the total healthcare cost increased, but longer duration of hypertension or diabetes resulted in increases in both CDM and total healthcare costs. In addition, the moderating effect of USOC indicated that elderly patients had increased CDM costs when they had a regular site for healthcare. In contrast, patients with longer duration had reductions in both CDM and total healthcare costs while having a regular doctor increased CDM cost. The results of this study could be an evidence for future policies to suggest proper preventive management plans for specific subjects.

Population Health Management for Older Adults: Review of Interventions for Promoting Successful Aging Across the Health Continuum

Background: The older adult population is expanding, living longer, with multiple chronic conditions. Understanding and managing their needs over time is an integral part of defining successful aging. Population health is used to describe the measurement and health outcomes of a population. Objectives: To define population health as applied to older adults, summarize lessons learned from current research, and identify potential interventions designed to promote successful aging and improved health for this population. Method: Online search engines were utilized to identify research on population health and health interventions for older adults. Results: Population health management (PHM) is one strategy to promote the health and well-being of target populations. Interventions promoting health across a continuum tend to be disease, risk, or health behavior specific rather than encompassing a global concept of health. Conclusion: Many existing interventions for older adults are simply research based with limited generalizability; as such, further work in this area is warranted.

Comparative effectiveness of total population versus disease-specific neural network models in predicting medical costs

The objective of this research was to compare the accuracy of two types of neural networks in identifying individuals at risk for high medical costs for three chronic conditions. Two neural network models-a population model and three disease-specific models-were compared regarding effectiveness predicting high costs. Subjects included 33,908 health plan members with diabetes, 19,264 with asthma, and 2,605 with cardiac conditions. For model development/ testing, only members with 24 months of continuous enrollment were included. Models were developed to predict probability of high costs in 2000 (top 15% of distribution) based on 1999 claims factors. After validation, models were applied to 2000 claims factors to predict probability of high 2001 costs. Each member received two scores-population model score applied to cohort and disease model score. Receiver Operating Characteristic (ROC) curves compared sensitivity, specificity, and total performance of population model and three disease models. Diabetes-specific model accuracy, C = 0.786 (95%CI = 0.779-0.794), was greater than that of population model applied to diabetic cohort, C = 0.767 (0.759-0.775). Asthma-specific model accuracy, C = 0.835 (0.825-0.844), was no different from that of population model applied to asthma cohort, C = 0.844 (0.835-0.853). Cardiac-specific model accuracy, C = 0.651 (0.620-0.683), was lower than that of population model applied to cardiac cohort, C = 0.726 (0.697-0.756). The population model predictive power, compared to the disease model predictive power, varied by disease; in general, the larger the cohort, the greater the advantage in predictive power of the disease model compared to the population model. Given these findings, disease management program staff should test multiple approaches before implementing predictive models.

The impact of a multidisciplinary, integrated approach on improving the health and quality of care for individuals dealing with multiple chronic conditions

This study examined the effects of using a multidisciplinary, integrated, whole-person, team advocate approach to educate and empower participants with multiple chronic illnesses and coordinate, monitor, and support their health care process. Individuals (N = 39) from Midwest hospitals participated and completed self-report instruments. Changes in participants' functioning were also measured with diagnostic measures completed by the team advocates. The results indicate that the participants' perceptions of physical functioning, physical well-being, control, self-efficacy, and life satisfaction increased. Additionally, health-related behavior changes were reported, and short-term costs were significantly lower than projected costs. Finally, the participants rated their health care services in the program as more effective than previous health care services.