Cigna Creates Online Initiative To Drive Patient-Provider Conversations Regarding Pain and Opioid Prescriptions

MedicalResearch.com Interview with:

Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna

Dr. Lustig

Dr. Stuart Lustig, M.D., M.P.H
National Medical Executive for Behavioral Health
Cigna

Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic.

MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study?

Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention.

The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.

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For Your Surgeon, Do You Want Younger Hands or More Experience?

MedicalResearch.com Interview with:
“Untitled” by Marcin Wichary is licensed under CC BY 2.0
Yusuke Tsugawa, MD, MPH, PhD
Assistant professor
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine at UCL
Los Angeles, CA 

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

Response: We studied whether patients’ mortality rate differ based on age and sex of surgeons who performed surgical procedures. Using a nationally representative data of Medicare beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries, we found that patients treated by older surgeons have lower mortality than those cared for by younger surgeons, whereas there was no difference in patient mortality between male and female surgeons. When we studied age and sex together, we found that female surgeons at their 50s had the lowest patient mortality across all groups.

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Maryland’s Global Budget Plan Did Not Change Hospital or Primary Care Usage

MedicalResearch.com Interview with:

Eric T. Roberts, PhD Assistant Professor of Health Policy & Management University of Pittsburgh Graduate School of Public Health Pittsburgh, PA 15261

Dr. Roberts

Eric T. Roberts, PhD
Assistant Professor of Health Policy & Management
University of Pittsburgh Graduate School of Public Health
Pittsburgh, PA 15261

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

Response: There is considerable interest nationally in reforming how we pay health care providers and in shifting from fee-for-service to value-based payment models, in which providers assume some economic risk for their patients’ costs and outcomes of care.  One new payment model that has garnered interest among policy makers is the global budget, which in 2010 Maryland adopted for rural hospitals.  Maryland subsequently expanded the model to urban and suburban hospitals in 2014.  Maryland’s global budget model encompasses payments to hospitals for inpatient, emergency department, and hospital outpatient department services from all payers, including Medicare, Medicaid, and commercial insurers.  The intuition behind this payment model is that, when a hospital is given a fixed budget to care for the entire population it serves, it will have an incentive to avoid costly admissions and focus on treating patients outside of the hospital (e.g., in primary care practices).  Until recently, there has been little rigorous evidence about whether Maryland’s hospital global budget model met policy makers’ goals of reducing hospital use and strengthening primary care.

Our Health Affairs study evaluated how the 2010 implementation of global budgets in rural Maryland hospitals affected hospital utilization among Medicare beneficiaries.  This study complements work our research group published in JAMA Internal Medicine (January 16, 2018) that examined the impact of the statewide program on hospital and primary care use, also among Medicare beneficiaries.

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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

Seniors Entering Old Age Will Increasingly Have Multiple Complicated Health Conditions

MedicalResearch.com Interview with:

Prof. Carol Jagger AXA Professor of Epidemiology of Ageing and Deputy Director of the Newcastle University Institute for Ageing (NUIA) Institute of Health & Society Campus for Ageing and Vitality Newcastle

Prof. Jagger

Prof. Carol Jagger
AXA Professor of Epidemiology of Ageing and
Deputy Director of the Newcastle University Institute for Ageing (NUIA)
Institute of Health & Society
Campus for Ageing and Vitality
Newcastle 

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

Response: As part of a larger study (MODEM – modelling outcome and cost impacts of interventions for dementia) we have developed a microsimulation model called PACSim which forecasts the number of older people aged 65 years and over along with their health and lifestyle factors as they age over the next 20 years. Crucially these are the first projections that include the health and lifestyle profiles of younger people as they age into to older population, rather than just assuming they have the same health profiles as existing young-old.

Other studies have already reported that the proportion of older people with multimorbidity (two or more concurrent diseases) has increased. Our study shows that not only will this continue but that the largest increase over the next 20 years will be for complex multimorbidity (four or more diseases). Much of the gain in life expectancy over the next 20 year for a 65 year old will be years spent with complex multimorbidity. And more importantly the future cohorts of young-old entering the older population will have successively more multimorbidity. Continue reading

Anesthesia, Sterility Measures Contribute To Large Carbon Footprint of Health Care Systems

MedicalResearch.com Interview with:
 <a href="https://www.flickr.com/photos/armymedicine/6127836005">“surgery”</a> by <i> <a href="https://www.flickr.com/people/armymedicine/">Army Medicine</a> </i> is licensed under <a href="https://creativecommons.org/licenses/by/2.0"> CC BY 2.0</a>Andrea MacNeill MD MSc FRCSC

Surgical Oncologist & General Surgeon
University of British Columbia
Vancouver General Hospital
BC Cancer Agency

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

Response: Climate change is one of the most pressing public health issues of the present era, responsible for 140,000 deaths annually.  Somewhat paradoxically, the health sector itself has a considerable carbon footprint, as well as other detrimental environmental impacts.  Within the health sector, operating rooms are known to be one of the most resource-intensive areas and have thus been identified as a strategic target for emissions reductions.

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Most Adolescents Not Receiving Important Health Care Preventive Services

MedicalResearch.com Interview with:

Sally H. Adams, PhD, RN Specialist, Division of Adolescent and Young Adult  Medicine Adolescent and Young Adult Health National Resource Center University of California, San Francisco Benioff Children’s Hospital San Francisco, CA 94118

Dr. Adams

Sally H. Adams, PhD, RN
Specialist, Division of Adolescent and Young Adult  Medicine
Adolescent and Young Adult Health National Resource Center
University of California, San Francisco
Benioff Children’s Hospital
San Francisco, CA 94118

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

Response: Major causes of adolescent illness and mortality are preventable. To address this, in the 1990s, professional medical organizations developed healthcare provider guidelines for the delivery of adolescent preventive healthcare. These include the receipt of anticipatory guidance and risk screening services in the effort to promote healthy behaviors and avoid risky behaviors that are intended to be covered within a preventive care visit, but could be addressed in other healthcare visits.

The adolescent developmental period is an important time for adolescents to be engaged with the healthcare system. Transitioning from childhood to adulthood, adolescents are becoming increasingly independent – having more responsibility and freedom for decision making in many areas, including healthy choices in behaviors and activities. While families and community settings (schools, churches) play strong roles in this process, the healthcare system also plays an important role.

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Trends in Opioid-Related Inpatient Stays Shifted After Switch to ICD-10 Coding

MedicalResearch.com Interview with:

Anne Elixhauser, Ph.D. Senior Research Scientist Agency for Healthcare Research and Quality Rockville MD 20857

Dr. Elixhauser

Anne Elixhauser, Ph.D.
Senior Research Scientist
Agency for Healthcare Research and Quality
Rockville MD 20857

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

Response: Hospital inpatient data began using ICD-10-CM (I-10) codes on October 1, 2015.  We have been doing analysis using the new codeset to determine to what extent we can follow trends crossing the ICD transition—do the trends look consistent when we switch from I-9 to I-10?  Tracking the opioid epidemic is a high priority so we made this one of our first detailed analyses.  We were surprised to find that hospital stays jumped 14% across the transition, compared to a 5% quarterly increase before the transition (under I-9) and a 3.5% quarterly increase after the transition (under I-10).  The largest increase (63.2%) was for adverse effects in therapeutic use (side effects of legal drugs), whereas stays involving opioid abuse decreased 21% and opioid poisoning (overdose) decreased 12.4%.

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Nearly Half of All US Medical Care is Delivered by Emergency Departments

MedicalResearch.com Interview with:

David Marcozzi, MD, MHS-CL, FACEP Associate Professor  Director of Population Health Department of Emergency Medicine Adjunct Associate Professor Co-Director of the Program in Health Disparities and Population Health Department of Epidemiology and Public Health University of Maryland School of Medicine Assistant Chief Medical Officer for Acute Care University of Maryland Medical Center

Dr. Marcozzi

David Marcozzi, MD, MHS-CL, FACEP
Associate Professor
Director of Population Health
Department of Emergency Medicine
Adjunct Associate Professor
Co-Director of the Program in Health Disparities and Population Health
Department of Epidemiology and Public Health
University of Maryland School of Medicine
Assistant Chief Medical Officer for Acute Care
University of Maryland Medical Center

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

Response: Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by emergency departments has grown. The study highlights what many experts argue is a major flaw in American health care: the use of emergency care in non-urgent cases, where clinics and doctor’s offices would be more appropriate.

“I was shocked by this result. This really helps us understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system, particularly for Americans who have no access to care.” said David Marcozzi, MD, MHS-CL, FACEP, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care delivered in emergency departments for many reasons, and we need to face this fact this is a significant segment of healthcare and actually it may be delivering the type of care that individuals want and need—24/7, 365 days.”  Although he now focuses on population health and hospital throughput, Dr. Marcozzi is an emergency room doctor himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.

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Patients With Social Risks Are More Expensive and Require Greater Medicaid Resources

MedicalResearch.com Interview with:

Dr-arlene-S-Ash.jpg

Dr. Ash

Arlene S. Ash, PhD
Department of Quantitative Health Sciences
University of Massachusetts Medical School
Worcester 

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

Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score.

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