scholarly journals Maximizing Potentially Avoidable Hospitalizations and Cost Savings Beyond Targeting the Most Costly Patients (Preprint)

2018 ◽  
Author(s):  
Mariana Simons ◽  
Sara Golas ◽  
Stephen Agboola ◽  
Jorn op den Buijs ◽  
Jennifer Felsted ◽  
...  
Keyword(s):  
Health Care ◽  
Older Patients ◽  
Health Care Organizations ◽  
Health Care Cost ◽  
Cost Savings ◽  
Categorical Variables ◽  
Care Utilization ◽  
Potential Cost ◽  
Great Opportunity ◽  
Avoidable Hospitalizations

BACKGROUND Many health care organizations use value-based care strategies that include population health management programs and data analytics to stratify their population and identify high-risk and high-cost patients. Most of these programs target the top 5% most expensive patients. However, little is known about these patients prior to reaching the top 5% of cost, or how their characteristics change over time. To address these gaps, we analyzed the differences in characteristics of patients from 3 different cost segments over 5 years (2011-2015). OBJECTIVE To evaluate potentially avoidable hospitalizations and associated savings in the health care cost of older patients using Personal Emergency Response Service (PERS). METHODS We conducted a retrospective, longitudinal, multicenter study to evaluate potentially avoidable hospitalizations of 2643 older patients over 5 years (2011-2015). All patients had at least one inpatient and/or outpatient encounter, and at least one episode of home health care during the study period. Additionally, all patients used PERS at home anytime during the study period. We ranked patients by their annual health care cost and then grouped them into the following segments for each respective year: T-segment constitutes the top 5% most expensive patients; M-segment comprises the middle 45% of patients; B-segment includes the bottom 50% least expensive patients. We then evaluated differences in the characteristics of patients in the B-, M- and T-cost segments in each study year. Continuous variables were compared by t test (two-tailed) for normally distributed variables and Kruskal-Wallis Rank Sum test for skewed variables. The chi-square test was used for categorical variables. RESULTS The three cost segments differed significantly each year (P<.05) with respect to: demographics (age, education), PERS utilization (Incidents, ER transport), health care utilization (hospitalizations, length of stay, 30-, 90-, and 180-day readmissions, outpatient encounters) and medical conditions (number of conditions, Charlson Comorbidity Index). Further, we analyzed the number of potentially avoidable hospitalizations (as defined by CMS) and associated cost savings in each segment. All hospitalizations occurred among patients in the T- and M-segments while the B-segment was hospitalization-free each year. The percentage of avoidable hospitalizations in the M-segment compared with the T-segment was 3 times greater (75% vs 25%, P<.001). While the potential cost saving from avoidable hospitalizations in the entire population increased from $3.0M to $8.2M (2011-2015), the majority of these cost savings were in the M-segment compared with the T-segment (60% vs 40%, P<.001). CONCLUSIONS Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis suggests there is untapped potential to control costs and improve care beyond focusing on the highest cost patients. Namely, targeting patients in the middle cost segment may offer great opportunity for population management programs to maximize both potentially avoidable hospitalizations and cost savings.

scholarly journals Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study (Preprint)

2018 ◽  
Author(s):  
Stephen Agboola ◽  
Mariana Simons ◽  
Sara Golas ◽  
Jorn op den Buijs ◽  
Jennifer Felsted ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Annual Cost ◽  
Older Patients ◽  
Health Care Organizations ◽  
Health Care Cost ◽  
Cost Savings ◽  
Study Population ◽  
The Cost ◽  
Care Costs

BACKGROUND Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years. OBJECTIVE To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures. METHODS This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains. RESULTS Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%. CONCLUSIONS Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services.

Access to Health Care and Nonemergency Medical Transportation

2005 ◽  
Vol 1924 (1) ◽  
pp. 76-84 ◽  
Author(s):  
Richard Wallace ◽  
Paul Hughes-Cromwick ◽  
Hillary Mull ◽  
Snehamay Khasnabis
Keyword(s):  
Health Care ◽  
National Health ◽  
Rural Areas ◽  
Urban Areas ◽  
Access To Health Care ◽  
Health Care Cost ◽  
Minority Group ◽  
Cost Savings ◽  
Great Opportunity ◽  
National Health Care

Although lack of access to nonemergency medical transportation (NEMT) is a barrier to health care, national transportation and health care surveys have not comprehensively addressed that link. Nationally representative studies have not investigated the magnitude of the access problem or the characteristics of the population that experiences access problems. The current study, relying primarily on national health care studies, seeks to address both of those shortcomings. Results indicate that about 3.6 million Americans do not obtain medical care because of a lack of transportation in a given year. On average, they are disproportionately female, poorer, and older; have less education; and are more likely to be members of a minority group than those who obtain care. Although such adults are spread across urban and rural areas much like the general population, children lacking transportation are more concentrated in urban areas. In addition, these 3.6 million experience multiple conditions at a much higher rate than do their peers. Many conditions that they face, however, can be managed if appropriate care is made available. For some conditions, this care is cost-effective and results in health care cost savings that outweigh added transportation costs. Thus, it is found that great opportunity exists to achieve net societal benefits and to improve the quality of life of this population by increasing its access to NEMT. Furthermore, modifications to national health care and transportation data sets are recommended to allow more direct assessment of this problem.

scholarly journals Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study

JMIR Aging ◽  
10.2196/10254 ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. e10254 ◽  
Author(s):  
Stephen Agboola ◽  
Mariana Simons ◽  
Sara Golas ◽  
Jorn op den Buijs ◽  
Jennifer Felsted ◽  
...  
Keyword(s):  
Health Care ◽  
Retrospective Study ◽  
Older Patients ◽  
Health Care Cost ◽  
Cost Savings ◽  
Cost Analyses

scholarly journals Incremental Cost of Prematurity by Week of Gestational Age

2019 ◽  
Vol 09 (01) ◽  
pp. e76-e83 ◽  
Author(s):  
Eileen Walsh ◽  
Sherian Li ◽  
Libby Black ◽  
Michael Kuzniewicz
Keyword(s):  
Health Care ◽  
Gestational Age ◽  
Cost Savings ◽  
Care Utilization ◽  
Potential Cost ◽  
Term Infants ◽  
Cross Sectional ◽  
Very Preterm Infants ◽  
Hospitalization Costs ◽  
Cost Differences

Objective This study was aimed to compare health care costs and utilization at birth through 1 year, between preterm and term infants, by week of gestation. Methods A cross-sectional study of infants born at ≥ 23 weeks of gestational age (GA) at Kaiser Permanente Northern California facilities between 2000 and 2011, using outcomes data from an internal neonatal registry and cost estimates from an internal cost management database. Adjusted models yielded estimates for cost differences for each GA group. Results Infants born at 25 to 37 weeks incur significantly higher birth hospitalization costs and experience significantly more health care utilization during the initial year of life, increasing progressively for each decreasing week of gestation, when compared with term infants. Among all very preterm infants (≤ 32 weeks), each 1-week decrease in GA is associated with incrementally higher rates of mortality and major morbidities. Conclusion We provide estimates of potential cost savings that could be attributable to interventions that delay or prevent preterm delivery. Cost differences were most extreme at the lower range of gestation (≤ 30 weeks); however, infants born moderately preterm (31–36 weeks) also contribute substantially to the burden, as they represent a higher proportion of total births.

Frailty and Health Care Utilization among Community-Dwelling Older Patients with Diabetes Mellitus

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1468-P
Author(s):  
SHIVANI PRIYADARSHNI ◽  
SRUTHI NELLURI ◽  
ZUBAIR RAHAMAN ◽  
MICHAEL J. MINTZER ◽  
STUTI DANG ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Health Care ◽  
Health Care Utilization ◽  
Older Patients ◽  
Community Dwelling ◽  
Care Utilization ◽  
Patients With Diabetes

The Effects of Doctor-Patient Portal Use on Health Care Utilization Rates and Cost Savings

2017 ◽  
Author(s):  
Daeho Kim ◽  
John H. Kagel ◽  
Neeraj Tayal ◽  
Seuli Bose-Brill ◽  
Albert Lai
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cost Savings ◽  
Care Utilization ◽  
Patient Portal

scholarly journals Health care utilization and end-of-life care for older patients with acute myeloid leukemia

Cancer ◽  
2015 ◽  
Vol 121 (16) ◽  
pp. 2840-2848 ◽  
Author(s):  
Areej R. El-Jawahri ◽  
Gregory A. Abel ◽  
David P. Steensma ◽  
Thomas W. LeBlanc ◽  
Amir T. Fathi ◽  
...  
Keyword(s):  
Health Care ◽  
Acute Myeloid Leukemia ◽  
Health Care Utilization ◽  
End Of Life ◽  
End Of Life Care ◽  
Older Patients ◽  
Myeloid Leukemia ◽  
Care Utilization ◽  
Life Care ◽  
Acute Myeloid

Acute care reliance among patients with advanced cancer with or without nurse navigation.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18303-e18303 ◽  
Author(s):  
Marc Kowalkowski ◽  
Kris Blackley ◽  
Carol J. Farhangfar
Keyword(s):  
Health Care ◽  
Acute Care ◽  
Advanced Cancer ◽  
Health Care Cost ◽  
Survival Duration ◽  
Care Utilization ◽  
Hospital Inpatient ◽  
Cancer Type ◽  
Inverse Association

e18303 Background: Acute care utilization is a key component of health care cost among oncology patients, particularly at advanced stages. Oncology nurse navigation (NN) was developed to improve access to quality cancer care but little is known about the impact of NN on acute care reliance (ACR) among patients with advanced cancer. Methods: A cohort study was conducted among adults (≥18) diagnosed with advanced-stage (III/IV) first primary solid tumor (10 most common solid tumors by annual incidence - bladder, breast, colon, kidney, lung, melanoma, pancreas, prostate, thyroid, uterus) from January 2013-December 2015. For inclusion, NN patients had to initiate NN services ≤30 days after diagnosis and all patients must have had ≥30 days of follow-up. The primary outcome was ACR, defined as the proportion of total health care utilization received in an acute care setting (hospital inpatient/observation, emergency department), from diagnosis through 1 year, calculated per 30-day interval to adjust for follow-up variance. To assess the effect of NN receipt on ACR, generalized linear models were fit specifying a gamma distribution and a log-link function, adjusted for patient and clinical characteristics at diagnosis. Subgroup analyses were conducted in patients surviving < 6 and ≥6 months. Results: 2950 patients with advanced cancer were followed (NN = 970 [33%]). Lung (37%), prostate (13%) and breast (12%) cancers were most common. 944 (32%) patients died during the 1-year interval. Patients averaged 1.7 health care encounters per 30-day interval. Those who received NN had lower mean ACR than patients who did not, overall (0.18 vs 0.30; p < 0.001) and in each individual cancer type (p < 0.05) except melanoma (p = 0.4). In multivariable models, NN receipt was associated with decreased ACR (RR = 0.65 95%CI = 0.60-0.70). The effect of NN on ACR was consistent in subgroups defined by survival duration. Conclusions: Patients with advanced cancer who received NN were less reliant on acute care than patients who did not receive NN. Given the role of acute care in driving health care cost and the inverse association between increased ACR and health care quality, our findings may have important implications for improving value in oncology care.

Race, Psychiatric Diagnosis, and Mental Health Care Utilization in Older Patients

2000 ◽  
Vol 8 (4) ◽  
pp. 301-309 ◽  
Author(s):  
Helen C. Kales ◽  
Frederic C. Blow ◽  
C. Raymond Bingham ◽  
Jeffrey Scott Roberts ◽  
Laurel A. Copeland ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Utilization ◽  
Mental Health Care ◽  
Psychiatric Diagnosis ◽  
Older Patients ◽  
Care Utilization ◽  
Mental Health Care Utilization
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