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1.
Crit Care Med ; 48(12): e1164-e1170, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33003081

RESUMO

OBJECTIVES: Deliver a novel interdisciplinary care process for ICU survivor care and their primary family caregivers, and assess mortality, readmission rates, and economic impact compared with usual care. DESIGN: Population health quality improvement comparative study with retrospective data analysis. SETTING: A single tertiary care rural hospital with medical/surgical, neuroscience, trauma, and cardiac ICUs. PATIENTS: ICU survivors. INTERVENTIONS: Reorganization of existing post discharge health care delivery resources to form an ICU survivor clinic care process and compare this new process to post discharge usual care process. MEASUREMENTS AND MAIN RESULTS: Demographic data, Acute Physiology and Chronic Health Evaluation IV scores, and Charlson Comorbidity Index scores were extracted from the electronic health record. Additional data was extracted from the care manager database. Economic data were extracted from the Geisinger Health Plan database and analyzed by a health economist. During 13-month period analyzed, patients in the ICU survivor care had reduced mortality compared with usual care, as determined by the Kaplan-Meier method (ICU survivor care 0.89 vs usual care 0.71; log-rank p = 0.0108) and risk-adjusted stabilized inverse probability of treatment weighting (hazard ratio, 0.157; 95% CI, 0.058-0.427). Readmission for ICU survivor care versus usual care: at 30 days (10.4% vs 26.3%; stabilized inverse probability of treatment weighting hazard ratio, 0.539; 95% CI, 0.224-1.297) and at 60 days (16.7% vs 34.7%; stabilized inverse probability of treatment weighting hazard ratio, 0.525; 95% CI, 0.240-1.145). Financial data analysis indicates estimated annual cost savings to Geisinger Health Plan ranges from $247,052 to $424,846 during the time period analyzed. CONCLUSIONS: Our ICU survivor care process results in decreased mortality and a net annual cost savings to the insurer compared with usual care processes. There was no statistically significant difference in readmission rates.


Assuntos
Assistência ao Convalescente , Unidades de Terapia Intensiva , Melhoria de Qualidade , Assistência ao Convalescente/economia , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Custos Hospitalares/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/normas , Estimativa de Kaplan-Meier , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Análise de Sobrevida , Sobreviventes
2.
Popul Health Manag ; 21(4): 303-308, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29135368

RESUMO

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.


Assuntos
Planos de Assistência de Saúde para Empregados , Promoção da Saúde , Saúde Ocupacional , Assistência Ambulatorial , Custos e Análise de Custo , Serviço Hospitalar de Emergência , Humanos , Estudos Retrospectivos
3.
Popul Health Manag ; 20(6): 435-441, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28338416

RESUMO

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.


Assuntos
Assistência Integral à Saúde/economia , Atenção à Saúde/economia , Adolescente , Adulto , Transtorno Autístico/economia , Transtorno Autístico/terapia , Cuidados Críticos/economia , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Medicaid , Disrafismo Espinal/economia , Disrafismo Espinal/terapia , Estados Unidos , Adulto Jovem
4.
Risk Manag Healthc Policy ; 9: 67-74, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27307773

RESUMO

The impact of a patient-centered medical home (PCMH) in reducing total cost of care remains a subject of debate, particularly among the non-elderly adult population. This study examines a 6-year experience of a large integrated regional health care delivery system in the US implementing PCMH among its commercially insured population. A regional health plan's claims data from 2008 through 2013 among its commercially insured members were obtained and analyzed. Over the 6-year period, the PCMH implementation beyond the first 6 months of exposure was associated with a lower total cost of care of ∼9% (P<0.05). The largest reduction was observed in outpatient costs (12%; P<0.05). This study suggests that PCMH implementation among the non-elderly adult population can potentially lead to cost savings. Future studies are necessary to identify the drivers of the cost savings and examine if similar results can be replicated elsewhere by other health care delivery systems.

5.
Popul Health Manag ; 19(4): 257-63, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26565693

RESUMO

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).


Assuntos
Prestação Integrada de Cuidados de Saúde , Programas de Assistência Gerenciada , Medicaid , Adolescente , Adulto , Criança , Pré-Escolar , Redução de Custos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Estudos de Casos Organizacionais , Estados Unidos , Adulto Jovem
6.
Popul Health Manag ; 18(3): 203-8, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25248037

RESUMO

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.


Assuntos
Cobertura do Seguro/economia , Manejo da Dor/economia , Modalidades de Fisioterapia/economia , Dor nas Costas/etiologia , Dor nas Costas/reabilitação , Dedutíveis e Cosseguros , Pesquisa sobre Serviços de Saúde , Nível de Saúde , Humanos , Cobertura do Seguro/organização & administração , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente
7.
Popul Health Manag ; 17(6): 340-4, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24865986

RESUMO

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.


Assuntos
Custos Diretos de Serviços/tendências , Insuficiência Cardíaca , Hospitalização/economia , Hospitalização/tendências , Monitorização Fisiológica/economia , Telemedicina/economia , Idoso , Idoso de 80 Anos ou mais , Controle de Custos , Feminino , Humanos , Masculino , Monitorização Fisiológica/métodos , Readmissão do Paciente/tendências , Análise de Regressão
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