Patients With Multiple Chronic Diseases Incur High Out-of-Pocket Expenses

MedicalResearch.com Interview with:

Dr Grace Sum Chi-En National University of Singapore

Dr Grace Sum    Chi-En

Dr Grace Sum Chi-En
National University of Singapore

MedicalResearch.com: What is the background for this study?

Response: Chronic diseases are conditions that are not infectious and are usually long-term, such as diabetes, hypertension, cancer, chronic lung disease, asthma, arthritis, stroke, obesity, and depression. They are also known as non-communicable diseases (NCDs). Multimorbidity, is a term we use in our field, to mean the presence of two or more NCDs. Multimorbidity is a costly and complex challenge for health systems globally. With the ageing population, more people in the world will suffer from multiple chronic diseases.

Patients with multimorbidity tend to need many medicines, and this incurs high levels of out-of-pocket expenditures, simply known as cost not covered by insurance. Even the United Nations and World Health organisation are recognising NCDs as being an important issue.

Governments will meet in New York for the United Nations 3rd high-level meeting on chronic diseases in 2018. Global leaders need to work towards reducing the burden of having multiple chronic conditions and providing financial protection to those suffering multimorbidity.

Our research aimed to conduct a high-quality systematic review on multimorbidity and out-of-pocket expenditure on medicines.  Continue reading

ACA Pay-For-Performance Programs Not Living Up To Expectations

MedicalResearch.com Interview with:

Dr. Igna Bonfrer PhD Post-Doctoral Research Fellow Harvard T.H. Chan School of Public Health 

Dr. Bonfrer

Dr. Igna Bonfrer PhD
Post-Doctoral Research Fellow
Harvard T.H. Chan School of Public Health  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: One of the two main elements of the Affordable Care Act, generally known as Obama Care, is the implementation of value based payments through so called “pay-for-performance” initiatives. The aim of pay-for-performance (P4P) is to reward health care providers for high-quality care and to penalize them for low-quality care.

We studied the effects of the P4P program in US hospitals and found that the impact of the program as currently implemented has been limited.

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Medicaid Work Requirements May Have Unintended Consequences on Costs and Enrollees

MedicalResearch.com Interview with:

Renuka Tipirneni, MD, MSc Clinical Lecturer in Internal Medicine University of Michigan Department of Internal Medicine, Division of General Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI

Dr. Tipirneni

Renuka Tipirneni, MD, MSc
Clinical Lecturer in Internal Medicine
University of Michigan Department of Internal Medicine, Division of General Medicine, and
Institute for Healthcare Policy & Innovation
Ann Arbor, MI

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several states have submitted proposals to require Medicaid expansion enrollees to work, actively seek work or volunteer, or risk losing Medicaid coverage. The current federal administration has signaled a willingness to approve the waivers states need to enact such requirements.

In our survey of over 4000 Medicaid expansion enrollees in Michigan, we found that nearly half of enrollees have jobs, another 11 percent can’t work, likely due to serious physical or mental health conditions, and another 27% are out of work but also are much more likely to be in poor health.

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LA’s Housing Program Reduced Overall Costs For Homeless Services

MedicalResearch.com Interview with:
“Homeless” by Sonny Abesamis is licensed under CC BY 2.0
Sarah Hunter, PhD
Senior Behavioral Scientist, RAND Corporation
Professor, Pardee RAND Graduate School
Santa Monica, CA 90401-3028

MedicalResearch.com: What is the background for this study?

Response: In 2014, RAND was contracted by Brilliant Corners in collaboration with the Conrad N. Hilton Foundation and Los Angeles County Department of Health Services to conduct an evaluation of the Los Angeles County Department of Health Services’ Housing for Health (HFH) program.  The HFH program began in 2012 with the goal of providing permanent supportive housing for frequent utilizers of county health services who were experiencing homelessness.  Continue reading

Price Transparency Not Keeping Up With High-Deductible Health Care Plans

MedicalResearch.com Interview with:
“Health Insurance” by Pictures of Money is licensed under CC BY 2.0
Allison Kratka
MD Candidate 2018
Duke University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: As there are increasing numbers of high-deductible plans and those with high rates of co-insurance, patients are increasingly expected to help contain the cost of their health care by being savvy health care consumers. We set out to determine how easy or hard it is to find healthcare prices online.

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How Much Non-Invasive Testing Is Necessary In ER To Rule Out Heart Attack?

MedicalResearch.com Interview with:

David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110

Dr. Brown

David L. Brown, MD, FACC
Professor of Medicine
Cardiovascular Division
Washington University School of Medicine
St. Louis, MO 63110

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain.

The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test.

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HIV PreExposure Prophylaxis -PrEP- For MSM Found To Be Effective and Cost Saving

MedicalResearch.com Interview with:

Dr Valentina Cambiano PhD Institute for Global Health University College London London UK

Dr. Cambiano

Dr Valentina Cambiano PhD
Institute for Global Health
University College London
London UK

MedicalResearch.com: What is the background for this study?

Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost.

When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people.

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Maryland All-Payer Model Produced Outpatient and ER Medicare Savings

MedicalResearch.com Interview with:
Susan G. Haber, Sc.D.

Director, Health Coverage for Low-Income and Uninsured Populations
RTI International
Waltham, MA

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In 2014, the state of Maryland and the federal Centers for Medicare and Medicaid Services (CMS) began testing an alternative payment structure for inpatient and outpatient hospital services. Known as the All-Payer Model, the new system limits hospitals’ revenues from Medicare, Medicaid, and private insurers to a global budget for the year. This builds on Maryland’s hospital rate-setting system that had operated since the 1970s, where all payers pay the same rates. CMS wanted to test whether global budgets could help Maryland limit cost growth and reduce avoidable hospital use. The goal of the model is to limit per capita total hospital cost growth for both Medicare and all payers and to generate $330 million in Medicare savings over 5 years.

RTI researchers studied the impact of hospital global budgets on Medicare beneficiary expenditures and utilization, using Medicare claims data to compare changes in Maryland before and after adoption of global budgets with changes in matched comparison areas outside of the state. Our report found Maryland has reduced total Medicare expenditures by approximately $293 million and total hospital expenditures by about $200 million in its first two years of operation. The reduction in overall expenditures indicates that “squeezing the balloon” on hospital expenditures did not simply produce a cost-shift to other health care sectors. Hospital expenditure savings for Medicare were achieved by reducing expenditures for outpatient emergency department and other hospital outpatient department services. Although inpatient admissions declined, there were no savings in Medicare expenditures for inpatient hospital services because the payment per admission increased. Maryland hospitals reduced avoidable utilization, including admissions for ambulatory care sensitive conditions, and readmissions and emergency department visits following hospital discharge. Despite the success in reducing expenditures, interviews with senior leaders at Maryland hospitals and focus group discussions with physicians and nurses suggest that many hospitals had not yet made fundamental changes in how they operate or developed partnerships with community physicians to divert care from the hospital, although there was variation in how hospitals responded.

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Low-Cost, High-Volume Services Add Billions To US Health Care Tab

MedicalResearch.com Interview with:

John N. Mafi MPH Assistant Professor of Medicine David Geffen School of Medicine University of California, Los Angeles Natural scientist in Health Policy RAND Corporation Santa Monica, California

Dr. Mafi

John N. Mafi MD MPH
Assistant Professor of Medicine
David Geffen School of Medicine
University of California, Los Angeles
Natural scientist in Health Policy
RAND Corporation
Santa Monica, California

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Of the 3 trillion dollars the U.S. spends annually on health care, an estimated 10-30% consists of “low-value care”, or patient care that provides no net benefit in specific clinical scenarios (think antibiotics given for the common cold virus). Determining where and why this waste occurs is critical to efforts to safely reducing healthcare spending. Little is known, however, about the distribution of costs among such “low-value” services. In this context, we used the Virginia All Payer Claims Database in order to assess the quantity and total costs of 44 low-value services in 2014 among 5.5 million beneficiaries.

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Financial Incentives to Physicians Did Not Increase Hospital Discharge Follow-Up Visits

MedicalResearch.com Interview with:

Dr. Lauren Lapointe-Shaw, MD Physician at University Health Network Department of Medicine University of Toronto 

Dr. Lapointe-Shaw

Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto 

MedicalResearch.com: What is the background for this study?

Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.

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