Demonstrated health care cost savings for women: findings from a community health worker intervention designed to address depression and unmet social needs.

To evaluate the impact of a community health worker intervention (CHW) (referred to as Personalized Support for Progress (PSP)) on all-cause health care utilization and cost of care compared with Enhanced Screening and Referral (ESR) among women with depression. A total of 223 patients (111 in PSP and 112 in ESR randomly assigned) from three women's health clinics with elevated depressive symptoms were enrolled in the study. Their electronic health records were queried to extract all-cause health care encounters along with the corresponding billing information 12 months before and after the intervention, as well as during the first 4-month intervention period. The health care encounters were then grouped into three mutually exclusive categories: high-cost (> US$1000 per encounter), medium-cost (US$201-$999), and low-cost (≤ US$200). A difference-in-difference analysis of mean total charge per patient between PSP and ESR was used to assess cost differences between treatment groups. The results suggest the PSP group was associated with a higher total cost of care at the baseline; taking this baseline difference into account, the PSP group was associated with lower mean total charge amounts (p = 0.008) as well as a reduction in the frequency of high-cost encounters (p < 0.001) relative to the ESR group during the post-intervention period. Patient-centered interventions that address unmet social needs in a high-cost population via CHW may be a cost-effective approach to improve quality of care and patient outcomes.

Impact of primary and specialty care integration via asynchronous communication.

OBJECTIVES: To describe and evaluate the impact of primary and specialty care integration via asynchronous communication at a large integrated healthcare system. STUDY DESIGN: In January 2014, Geisinger's primary care providers (PCPs) were given access to an asynchronous communication tool, Ask-a-Doc (AAD), that enabled direct communication with specialists in 14 medical specialties and 5 surgical specialties. Internal data were collected to assess PCPs' acceptance and use of the tool, as well as satisfaction. Insurance claims data were obtained to assess the impact on healthcare utilization and cost. METHODS: A retrospective analysis of health plan claims data was conducted among those patients who had at least 1 specialist visit with 1 of the participating specialties between January 2014 and December 2016. A set of difference-in-differences multivariate linear regression models with patient fixed effects was estimated, in which those who were not exposed to AAD served as the comparison group. RESULTS: Acceptance and use of AAD among PCPs gradually increased over time but varied by specialty. AAD was associated with an approximately 14% reduction in total cost of care during the first month of follow-up and a 20% reduction (P <.001) during the second month. These reductions in cost of care appeared to be driven by reductions in emergency department visits and physician office visits. CONCLUSIONS: Geisinger's AAD experience suggests that the integration of primary and specialty care via the use of a highly reliable and efficient asynchronous communication system can potentially lead to reductions in avoidable care and more efficient use of specialty care.

Impact of a multidisciplinary pain management program on patient care utilization and cost of care.

OBJECTIVE: Chronic pain is a highly prevalent and costly condition with few proven treatment options. Since 2014, Geisinger's Department of Pain Medicine has implemented the Multidisciplinary Pain Program (MPP), which consists of a 3-day educational seminar followed by 12 months of comprehensive care. This study examines the impact of MPP on care utilization and cost between 2014 and 2016. METHODS: A retrospective health insurance claims data analysis covering a 3-year period between January 2013 and December 2016. Among all patients referred to MPP during the period, a subset of those who were Geisinger Health Plan (GHP) members was identified (113 patients). Those who were GHP members and were referred to MPP after December 2016 served as the contemporaneous comparison group (69 patients). GHP's claims data for the corresponding period were analyzed on a per-member-per-month (PMPM) basis. RESULTS: MPP was associated with US$754 PMPM reduction in total cost of care including prescription drug costs (P=0.014) and US$846 reduction in total medical cost excluding prescription drugs (P=0.006). These cost savings were attributable to reductions in utilization of high-end diagnostic imaging (52 per-1,000 members-per month; P=0.015) and acute inpatient admissions (20 per-1,000 members-per month; P=0.086). CONCLUSION: Patients enrolled in MPP were less likely to use expensive diagnostic imaging and experienced fewer hospitalizations, resulting in total cost of care savings. These findings are consistent with the expectation that MPP improves health outcomes among patients suffering from chronic pain.

Impact of a pharmacist-led diabetes management on outcomes, utilization, and cost.

PURPOSE: Pharmacist-led medication therapy disease management (MTDM) has shown improvement in clinical outcomes in patients with certain chronic diseases. However, only limited data demonstrating the impact on health care utilization and cost of care are available. This study seeks to evaluate the impact of a pharmacist-led MTDM program on clinical surrogate outcomes, care utilization, and cost of care among patients with diabetes mellitus. METHODS: A retrospective cohort study was conducted by utilizing electronic health records and insurance claims data. Patients were identified between February 2011 and December 2014. Data were collected from Geisinger, a large integrated health care system located in Pennsylvania and southern New Jersey. A total of 5,500 patients with diabetes mellitus were identified; 2,750 were enrolled in MTDM and were 1-to-1 propensity score-matched to a comparison cohort not enrolled in a pharmacist-led MTDM program. RESULTS: There were no differences between groups in composite HbA1c, blood pressure, or low-density lipoprotein cholesterol goal attainment at 12 months (12% vs 12%, P=0.53). HbA1c goal was reached more frequently among patients without MTDM compared to those at 12 months (57% vs 51%, P<0.0001). There were no significant differences between the two cohorts in the attainment of blood pressure or low-density lipoprotein cholesterol goals at 12 months. MTDM was associated with reduced all-cause hospitalization rate (-19.6%; P=0.02) as well as increased primary care physician visits (18.5%; P<0.001) and lower average per-member-per-month medical cost (-13%, P=0.027). CONCLUSION: Despite the lack of impact on the clinical surrogate outcomes, MTDM was associated with lower cost of care and fewer hospitalizations, possibly facilitated by increased monitoring (ie, higher primary care utilization).

An Analysis of a Biometric Screening and Premium Incentive-Based Employee Wellness Program: Enrollment Patterns, Cost, and Outcome.

Since 2012, a large health care system has offered an employee wellness program providing premium discounts for those who voluntarily undergo biometric screenings and meet goals. This study evaluates the program impact on care utilization and total cost of care, taking into account employee self-selection into the program. A retrospective claims data analysis of 6453 employees between 2011 and 2015 was conducted, categorizing the sample into 3 mutually exclusive subgroups: Subgroup 1 enrolled and met goals in all years, Subgroup 2 enrolled or met goals in some years but not all, and Subgroup 3 never enrolled. Each subgroup was compared to a cohort of employees in other employer groups (N = 24,061). Using a difference-in-difference method, significant reductions in total medical cost (14.2%; P = 0.014) and emergency department (ED) visits (11.2%; P = 0.058) were observed only among Subgroup 2 in 2015. No significant impact was detected among those in Subgroup 1. Those in Subgroup 1 were less likely to have chronic conditions at baseline. The results indicate that the wellness program enrollment was characterized by self-selection of healthier employees, among whom the program appeared to have no significant impact. Yet, cost savings and reductions in ED visits were observed among the subset of employees who enrolled or met goal in some years but not all, suggesting a potential link between the wellness program and positive behavior changes among certain subsets of the employee population.

Patterns of health care utilization and cost before and after opioid overdose: findings from 10-year longitudinal health plan claims data.

OBJECTIVE: To describe the longitudinal pattern of health care utilization and cost of care before and after opioid overdose (OD) over a 10-year period using health plan claims data. METHODS: Patients who had experienced opioid ODs between April 2005 and March 2015 were identified from Geisinger Health System's electronic health records. Among these patients, a subgroup of patients who were Geisinger Health Plan (GHP) members at any point between January 2006 and December 2015 were also identified. From the corresponding GHP claims data, their all-cause health care utilization (inpatient admissions, emergency department [ED] visits, and physician office visits) and total medical costs, excluding prescription medication cost, were obtained. Per-member-per-month estimates for each month before and after the index date of opioid OD were calculated, adjusting for age, gender, plan type, year, and comorbidity via multivariate regression models. RESULTS: A total of 942 opioid OD patients with an average GHP enrollment period of 41.4 months were identified. ED visit rates rose rapidly starting around 19-24 months prior to the opioid OD date. Acute inpatient admission rates and total medical cost also rose rapidly starting around 12 months prior. After the OD date, the utilization rates and cost declined but tended to remain above those of the pre-OD period. CONCLUSION: Opioid OD is preceded by sharp increases in utilization of acute care and cost well before the actual OD. These findings therefore suggest that early signals of OD may be detected from patterns of acute care utilization, particularly the ED visits.

Impact of a value-based insurance design for physical therapy to treat back pain on care utilization and cost.

OBJECTIVE: To assess the impact of a value-based insurance design providing enhanced access to physical therapy (PT) for treatment of back pain on treatment patterns and cost of care. STUDY DESIGN: A retrospective analysis of claims data obtained from Geisinger Health Plan (GHP). In April 2013, GHP began offering "PT bundle" - i.e., a bundle of up to five PT visits for a single one-time copay that can be renewed for another bundle of five PT visits - for its employer-based plan members with back pain. METHODS: A cohort of GHP members who were preauthorized for the PT bundle were compared against a contemporaneous cohort of GHP members who were preauthorized for PT under the standard per-visit copay arrangement between January 2013 and October 2014. RESULTS: Among the PT bundle cohort, the PT visit rate during the first 9 months since the PT preauthorization date had dramatically increased and then gradually decreased in subsequent months. The PT bundle was also associated with 29%-35% short-term reductions in emergency department visits and with 12%-20% reductions in primary care visits after 6 months. No significant impact on hospitalization or cost was observed. CONCLUSION: Implementation of the PT bundle appears to have led to a change in the treatment pattern of back pain that is more consistent with the recommended guidelines to use more conservative management such as PT as the first-line treatment for back pain.

Synthesis Of Research On Patient-Centered Medical Homes Brings Systematic Differences Into Relief.

The patient-centered medical home (PCMH) model emphasizes comprehensive, coordinated, patient-centered care, with the goals of reducing spending and improving quality. To evaluate the impact of PCMH initiatives on utilization, cost, and quality, we conducted a meta-analysis of methodologically standardized findings from evaluations of eleven major PCMH initiatives. There was significant heterogeneity across individual evaluations in many outcomes. Across evaluations, PCMH initiatives were not associated with changes in the majority of outcomes studied, including primary care, emergency department, and inpatient visits and four quality measures. The initiatives were associated with a 1.5 percent reduction in the use of specialty visits and a 1.2 percent increase in cervical cancer screening among all patients, and a 4.2 percent reduction in total spending (excluding pharmacy spending) and a 1.4 percent increase in breast cancer screening among higher-morbidity patients. These associations were significant. Identification of the components of PCMHs likely to improve outcomes is critical to decisions about investing resources in primary care.

Impact of a Complex Care Management Model on Cost and Utilization Among Adolescents and Young Adults with Special Care and Health Needs.

Adolescents and young adults with special care and health needs in the United States-many of whom have Medicaid coverage-at the transition phase between pediatric and adult care often experience critical care gaps. To address this challenge, a new model-referred to as Comprehensive Care Clinic (CCC)-has been developed and implemented by Geisinger Health System since 2012. CCC comprises a care team, consisting of a generalist physician, advanced practitioner, pharmacist, and a nurse case manager, that develops and closely follows a coordinated care plan. This study examines the CCC impact on total cost of care and utilization by analyzing Geisinger Health Plan claims data obtained from 83 Medicaid patients enrolled in CCC. A set of multivariate regression models with patient fixed effects was estimated to obtain adjusted differences in cost and acute care utilization between the months in which the patients were enrolled and the months not enrolled in CCC. The results indicate that CCC enrollment was associated with a 28% reduction in per-member-per-month total cost ($3931 observed vs. $5451 expected; P = 0.028), driven by reductions in hospitalization and emergency department visits. This finding suggests a clinical redesign focused on adolescent and young adults with complex care needs can potentially reduce total cost and acute care utilization among such patients.

Patterns of Multiple Emergency Department Visits: Do Primary Care Physicians Matter?

CONTEXT: Overutilization and overreliance on Emergency Departments (EDs) as a usual source of care can lead to unnecessarily high costs and undesirable consequences, such as a gap in care coordination and inadequate provision of preventive care. OBJECTIVE: To identify factors associated with multiple ED visits by patients, in particular, the impact of primary care physicians (PCPs) on their patients' multiple ED visit rates. DESIGN: Geisinger Health Plan claims data among adult patients who averaged more than 1 ED visit within a 12-month period between 2013 and 2014 were obtained (N = 20,351). MAIN OUTCOME MEASURES: Rate of ED visits. Three linear regression models using patient characteristics and utilization patterns as covariates along with PCP fixed effects were estimated to explain the variation in the multiple ED visit rates. RESULTS: Multiple ED visits were significantly associated with younger age (18-39 years), having Medicaid insurance, and greater comorbidity. Higher rates of physician office visits and inpatient admissions were also associated with higher rates of multiple ED visits. Accounting for PCP characteristics only marginally improved the explained variation (R2 increased from 0.14 to 0.16). CONCLUSIONS: Multiple ED visit patterns are likely driven by patients' health conditions and care needs rather than by their PCPs. Multiple ED visits also appear to be complementary, rather than substitutionary, to PCP visits, suggesting that PCP-focused interventions aimed at reducing ED use are unlikely to have a major impact.

Patient characteristics and healthcare utilization patterns associated with unused medications among medicare patients.

OBJECTIVE: To examine what patient characteristics and healthcare utilization patterns are associated with the likelihood of having unused medications among elderly Medicare patients. DESIGN: Secondary data analysis combining insurance claims and phone survey data of Medicare Advantage members. SETTING: Regional health plan in Central Pennsylvania. PARTICIPANTS: 528 Medicare Advantage members (age 65 and older), who had Medicare Part D coverage through Geisinger Health Plan as of December 31, 2013, and completed the phone survey in May of 2014. MAIN OUTCOME: Member survey response indicating whether or not the member had any unused medication at the time of the survey. RESULTS: 27% of the patients in the sample (142 out of 528) indicated having one or more unused medications. In a bivariate analysis, these patients had higher prevalence of chronic conditions, utilized more medical care (more emergency department visits and physician office visits), and incurred higher cost of care. In a multivariate analysis, patients who received medications with days' supply greater than 30 (odds ratio (OR) = 1.59; p = 0.03) and utilized more acute care (defined as inpatient admissions or emergency department visits) (OR = 4.2; p = 0.04) were more likely to have unused medications. Moreover, patients who were advised by health care professionals about proper medication disposal were less likely to have unused medications (OR = 0.52; p = 0.04). CONCLUSION: These findings suggest potential ways to develop effective strategies to reduce amounts of unused medications. Such strategies are likely to involve limiting quantities of medications dispensed at each fill, and patient education on proper disposal of unused medications, particularly during care transitions.

Value of primary care diabetes management: long-term cost impacts.

OBJECTIVES: To estimate long-term cost savings associated with patients' exposure to an all-or-none bundle of measures for primary care management of diabetes. STUDY DESIGN: In 2006, Geisinger's primary care clinics implemented an all-or-none diabetes system of care (DSC). Claims data from Geisinger Health Plan were used to identify those who met Healthcare Effectiveness Data and Information Set criteria for diabetes and had 2 or more diabetes-related encounters on different dates before 2006. A cohort of 1875 members exposed to the DSC was then compared against a propensity score matched non-DSC comparison cohort from January 1, 2006, through December 31, 2013. METHODS: A set of generalized linear models with log link and gamma distribution was estimated. The key explanatory variable was each member's bundle exposure measured in months. The dependent variables were inpatient and outpatient facility costs, professional cost, and total medical cost excluding prescription drugs measured on a per-member-per-month basis. RESULTS: Over the study period, the total medical cost saving associated with DSC exposure was approximately 6.9% (P < .05). The main source of the saving was reductions in inpatient facility cost, which showed approximately 28.7% savings (P < .01) over the study period. During the first year of the DSC exposure, however, there were significant increases in outpatient (13%; P < .05) and professional (9.7%; P < .05) costs. CONCLUSIONS: A system of care with an all-or-none bundled measure used in primary care for patients with diabetes may reduce long-term cost of care while improving health outcomes.

The value of value-based insurance design: savings from eliminating drug co-payments.

OBJECTIVES: To estimate the cost impact of a $0 co-pay prescription drug program implemented by a large healthcare employer as a part of its employee wellness program. STUDY DESIGN: A $0 co-pay program that included approximately 200 antihypertensive, antidiabetic, and antilipid medications was offered to Geisinger Health System (GHS) employees covered by Geisinger Health Plan (GHP) in 2007. Claims data from GHP for the years 2005 to 2011 were obtained. The sample was restricted to continuously enrolled members with Geisinger primary care providers throughout the study period. METHODS: The intervention group, defined as 2251 GHS employees receiving any of the drugs eligible for $0 co-pay, was propensity score matched based on 2 years of pre-intervention claims data to a comparison group, which was defined as 3857 non-GHS employees receiving the same eligible drugs at the same time. Generalized linear models were used to estimate differences in terms of per-member-per-month (PMPM) claims amounts related to prescription drugs and medical care. RESULTS: Total healthcare spending (medical plus prescription drug spending) among the GHS employees was lower by $144 PMPM (13%; 95% CI, $38-$250) during the months when they were taking any of the eligible drugs. Considering the drug acquisition cost and the forgone co-pay, the estimated return on investment over a 5-year period was 1.8. CONCLUSIONS: This finding suggests that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to positive cost savings.

Unused medications and disposal patterns at home: Findings from a Medicare patient survey and claims data.

OBJECTIVE: To examine what medications are most frequently left unused by patients, how much is left unused, and how these medications are disposed of among Medicare beneficiaries. DESIGN: Secondary data analysis combining insurance claims and telephone survey data of Medicare Advantage members. SETTING: Regional health plan in Central Pennsylvania. PARTICIPANTS: Seven hundred twenty-one Medicare Advantage members who had Part D coverage through the plan as of December 31, 2013, and completed the telephone survey in May 2014. INTERVENTION: Telephone survey conducted by a survey research center. MAIN OUTCOME MEASURE: Member survey response. RESULTS: Of the 2,994 medications in the dataset, 247 (8%) were reported being left unused by patients. Of the 247, the most common medications were those for pain (15%), hypertension (14%), antibiotics (11%), and psychiatric disorders (9%). Approximately 15% of unused medications were controlled substances. The reasons for being unused varied by drug type. For example, for pain medications, adverse effects and overprescribing were the most commonly cited reasons; for hypertension medications, "dosage changed by doctor" was the most common reason. Most commonly, unused portions accounted for approximately 25% to 50% of the unused medications identified by patients. Approximately 11% of unused medication was disposed of via drug take-back programs, whereas the majority was kept in a cabinet (55%), thrown in the trash (14%), or flushed down the toilet (9%). CONCLUSION: A lack of patient adherence alone does not explain unused medications and their improper disposal. Community-level interventions designed to improve prescription efficiency and patient awareness of appropriate disposal methods-particularly of controlled substances-are necessary to reduce the potentially harmful effects of improper disposal of unused medications.

Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience.

Many states in the United States, including Pennsylvania, have opted to rely on private managed care organizations to provide health insurance coverage for their Medicaid population in recent years. Geisinger Health System has been one such organization since 2013. Based on its existing care management model involving data-driven population management, advanced patient-centered medical homes, and targeted case management, Geisinger's Medicaid management efforts have been redesigned specifically to accommodate those with complex health care issues and social service needs to facilitate early intervention, effective and efficient care support, and ultimately, a positive impact on health care outcomes. An analysis of Geisinger's claims data suggests that during the first 19 months since beginning Medicaid member enrollment, Geisinger's Medicaid members, particularly those eligible for the supplemental security income benefits, have incurred lower inpatient, outpatient, and professional costs of care compared to expected levels. However, the total cost savings were partially offset by the higher prescription drug costs. These early data suggest that an integrated Medicaid care management effort may achieve significant cost of care savings. (Population Health Management 2016;19:257-263).

Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home.

Early evidence suggests that the patient-centered medical home has the potential to improve patient outcomes while reducing the cost of care. However, it is unclear how this care model achieves such desirable results, particularly its impact on cost. We estimated cost savings associated with Geisinger Health System's patient-centered medical home clinics by examining longitudinal clinic-level claims data from elderly Medicare patients attending the clinics over a ninety-month period (2006 through the first half of 2013). We also used these data to deconstruct savings into its main components (inpatient, outpatient, professional, and prescription drugs). During this period, total costs associated with patient-centered medical home exposure declined by approximately 7.9 percent; the largest source of this savings was acute inpatient care ($34, or 19 percent savings per member per month), which accounts for about 64 percent of the total estimated savings. This finding is further supported by the fact that longer exposure was also associated with lower acute inpatient admission rates. The results of this study suggest that patient-centered medical homes can lead to sustainable, long-term improvements in patient health outcomes and the cost of care.

Impact of a value-based insurance design for back pain on health plan member satisfaction and its implications for patient outcomes.

Back pain is one of the most common reasons for seeking care, and physical therapy (PT) can be an effective treatment option. However, PT coverage for back pain varies widely among private health plans, usually requiring high cost sharing, thereby potentially leading to member dissatisfaction and worse outcomes. In this study, a quasi-experimental design was used to estimate the impact of a new value-based insurance design for back pain-related PT on selected Consumer Assessment of Healthcare Providers and Systems survey items. Under this design, eligible members receive a bundle of 5 PT sessions for a 1-time co-payment; if deemed necessary, the bundle is renewable for 1 additional co-payment. The results indicate that the proportion of members reporting the highest satisfaction rating was higher by about 6 to 10 percentage points among those who received the PT bundle. The data also indicate that those PT bundle members who reported the highest satisfaction rating had improvements in their functional status scores that were roughly 3 to 4 times higher than those who reported a lower satisfaction rating. These findings suggest that providing a value-based insurance design for back pain-related PT can potentially improve health plan members' care experiences and their overall satisfaction. Further study is needed to determine its impact on back pain-related medical care utilization and cost of care.

Patient ratings of case managers in a medical home: associations with patient satisfaction and health care utilization.

BACKGROUND: Case managers are employed in medical homes to coordinate care for clinically complex patients. OBJECTIVE: To measure the association of patient perceptions of case manager performance with overall satisfaction and subsequent health care utilization. DESIGN: Retrospective cohort study. SETTING: Integrated health system in Pennsylvania. PATIENTS: Members of the health system-owned health plan who 1) received primary care in the health system's clinics, 2) were exposed to clinic-embedded case managers, and 3) completed a survey of satisfaction with care. MEASUREMENTS: Survey assessment of case manager performance and overall satisfaction with care and claims-based assessment of case manager performance and subsequent hospitalizations or emergency department visits. Survey measures were dichotomized into very good versus less than very good. RESULTS: A total of 1755 patients (44%) completed the survey and 1415 met study criteria. Survey respondents who reported very good ratings of case manager performance across all items had a higher probability of reporting very good overall satisfaction with care (92.2% vs. 62.5%; P < 0.001) and had a lower incidence of subsequent emergency department visits (incidence rate ratio, 0.79 [95% CI, 0.64 to 0.98]; P = 0.029) but not hospitalizations (incidence rate ratio, 0.92 [CI, 0.75 to 1.11]; P = 0.37) up to 2 years after the survey compared with survey respondents who reported less-than-very good case manager performance on 1 or more questions on the survey. LIMITATIONS: Satisfaction data demonstrated substantial ceiling effects. Survey nonresponse may have introduced bias in the results. CONCLUSION: Patients' favorable perceptions of case managers are associated with higher overall satisfaction with care and may lower risk for future acute care use. PRIMARY FUNDING SOURCE: Robert Wood Johnson Foundation and the U.S. Department of Veterans Affairs.

Cost-effectiveness of IL28Β genotype-guided protease inhibitor triple therapy versus standard of care treatment in patients with hepatitis C genotypes 2 or 3 infection.

BACKGROUND/AIMS: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients. METHODS: Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling. RESULTS: For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2 IL28Β variants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed. CONCLUSIONS: Markov modeling revealed that modest increases in SVR rates from IL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.

Can telemonitoring reduce hospitalization and cost of care? A health plan's experience in managing patients with heart failure.

Telemonitoring provides a potentially useful tool for disease and case management of those patients who are likely to benefit from frequent and regular monitoring by health care providers. Since 2008, Geisinger Health Plan (GHP) has implemented a telemonitoring program that specifically targets those members with heart failure. This study assesses the impact of this telemonitoring program by examining claims data of those GHP Medicare Advantage plan members who were enrolled in the program, measuring its impact in terms of all-cause hospital admission rates, readmission rates, and total cost of care. The results indicate significant reductions in probability of all-cause admission (odds ratio [OR] 0.77; P<0.01), 30-day and 90-day readmission (OR 0.56, 0.62; P<0.05), and cost of care (11.3%; P<0.05). The estimated return on investment was 3.3. These findings imply that telemonitoring can be an effective add-on tool for managing elderly patients with heart failure.