A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign

2017 ◽  
Vol 20 (4) ◽  
pp. 309-317
Author(s):  
Dale E. Green ◽  
Bruce H. Hamory ◽  
Grace E. Terrell ◽  
Jasmine O'Connell
Keyword(s):  
Health Care ◽  
Case Report ◽  
Cost Of Care ◽  
Care Model ◽  
Total Cost ◽  
Population Segmentation

Cost analysis of a randomized trial of early palliative care (PC) in patients with metastatic non-small cell lung cancer (NSCLC).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Joseph A. Greer ◽  
Angela Tramontano ◽  
Pamela M McMahon ◽  
Areej El-Jawahri ◽  
Ravi Bharat Parikh ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Health Care Costs ◽  
Standard Care ◽  
Secondary Analysis ◽  
Cost Of Care ◽  
Average Total Cost ◽  
Total Cost ◽  
Metastatic Nsclc ◽  
Care Costs

4 Background: Several randomized, controlled trials have shown that early, integrated palliative and oncology care improves quality of life, mood, and symptom burden in patients with advanced cancers. However, the degree to which early involvement of specialty PC in the ambulatory care setting impacts the cost of care remains unknown. We investigated the health care costs for patients with metastatic NSCLC enrolled in a clinical trial of early PC. Methods: For this secondary analysis, we examined data from a randomized trial of 151 patients with newly-diagnosed metastatic NSCLC from 06/2006 to 07/2009. Patients received either early PC integrated with standard care or standard care (SC) alone. We abstracted costs for emergency and inpatient care, outpatient visits, intravenous chemotherapy, and physician services from the hospital’s accounting system. Oral chemotherapy costs were estimated based on actual drug charges for patients. To estimate hospice costs, we used Medicare reimbursement rates. For each participant, we calculated the average total cost of care per day for the entire study period as well as the total cost of care for the final 30 days prior to death. Costs differences between groups were examined with the Wilcoxon Rank-Sum Test. Results: We analyzed health care costs of the 138 patients who died by 07/15/2013 (early PC N=68; SC N=70). The mean number of days on study was longer for patients assigned to early PC (M=397, SD=360) versus SC (M=299, SD=266). Over the study period, early PC was associated with a lower average total cost per day of $117 (SD=$436) compared to SC (p=.09). In the final 30 days of life, patients in the early PC group incurred higher total costs for hospice care (Mean difference=$1,053, SD=$3,162, p=.11), while expenses for chemotherapy were less (Mean difference=$757, SD=$2,143, p=.06). No cost differences between groups met the threshold for statistical significance. Conclusions: Although this secondary analysis was inconclusive due to the lack of statistical power to examine differences in cost outcomes, the delivery of early PC for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life. Clinical trial information: NCT01038271.

Pharmacy cost in cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18358-e18358
Author(s):  
Surbhi Shah ◽  
Nathan Rubin
Keyword(s):  
Health Care ◽  
Drug Cost ◽  
Economic Burden ◽  
Cancer Care ◽  
Cost Of Care ◽  
Pharmacy Cost ◽  
Health Care Spending ◽  
Total Cost ◽  
The Cost ◽  
Active Cancer

e18358 Background: Health care spending in US is highest in the developed world and contributes to up to 1/5 of the GDP. The price escalation is steep and contribution from cancer care is soaring. The cost of medications is deemed to be the leading cause of increased health care spending. In this era of precision medicine, with more effective and better tolerated drugs, patients are using them for longer periods of time, adding to the ever mounting health care spending. Methods: We used a large claims based data set US database MarketScan to explore the economic burden of drug cost in cancer care. Between January 1, 2013 and September 30, 2015 we identified 195,290 enrollees with active cancer. We analyzed the economic burden of medications for overall cancer care by exploring the total cost of care and the pharmacy expenditure by various classes of drugs for these patients. The perspective was that of the health care system as the costs included payments by the insurer and the patient. Results: There were 195,290 active cancer patients in this analysis. Mean age was 61 years, 55% were females. Breast cancer was the most common diagnosis. Mean total cost of care and total drug cost per patient over the study period was $141,415 and $13,579, respectively. The total pharmacy expenditure across all study patients was ~2.5B. Antineoplastic drugs make up the largest portion of the total pharmacy expenditure at 39%. Cost contribution based on drug categories were anti-infective (6%), cardiovascular (6%), central nervous system (including opiates, anti-nausea medications and antidepressants) (7%), blood formulations (including anticoagulants) (8%), hormones (8%) and gastrointestinal drugs (4%) respectively. Conclusions: Based on the real world information from a large insurance claims database, this study quantifies the contribution of various drug classes to the cost of cancer care. Antineoplastic contribute to > 1/3rd of the total pharmacy spending. With increasing trend for immunotherapy and combination therapy drug costs are bound to go up even more steeply. Unless drug prices are regulated, we are looking towards an unsustainable level of growth in the health care spending in cancer care.

The Oncology Care Model: A Critique

2016 ◽  
pp. e109-e114 ◽  
Author(s):  
Christian A. Thomas ◽  
Jeffrey C. Ward
Keyword(s):  
Health Care ◽  
Health Care Expenditures ◽  
Critical Discussion ◽  
Cost Of Care ◽  
Fee For Service ◽  
Care Model ◽  
Patient Admissions ◽  
Pilot Model ◽  
Oncology Care ◽  
The Cost

Rapidly increasing national health care expenditures are a major area of concern as threats to the integrity of the health care system. Significant increases in the cost of care for patients with cancer are driven by numerous factors, most importantly the cost of hospital care and escalating pharmaceutical costs. The current fee-for-service system (FFS) has been identified as a potential driver of the increasing cost of care, and multiple stakeholders are interested in replacing FFS with a system that improves the quality of care while at the same time reducing cost. Several models have been piloted, including a Center for Medicare & Medicaid Innovation (CMMI)–sponsored medical home model (COME HOME) for patients with solid tumors that was able to generate savings by integrating a phone triage system, pathways, and seamless patient care 7 days a week to reduce overall cost of care, mostly by decreasing patient admissions to hospitals and referrals to emergency departments. CMMI is now launching a new pilot model, the Oncology Care Model (OCM), which differs from COME HOME in several important ways. It does not abolish FFS but provides an additional payment in 6-month increments for each patient on active cancer treatment. It also allows practices to participate in savings if they can decrease the overall cost of care, to include all chemotherapy and supportive care drugs, and fulfill certain quality metrics. A critical discussion of the proposed model, which is scheduled to start in 2016, will be provided at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting with practicing oncologists and a Centers for Medicare & Medicaid Services (CMS) representative.

Maryland Total Cost of Care Model

JAMA ◽  
2019 ◽  
Vol 321 (10) ◽  
pp. 939 ◽  
Author(s):  
Katherine J. Sapra ◽  
Katie Wunderlich ◽  
Howard Haft
Keyword(s):  
Cost Of Care ◽  
Care Model ◽  
Total Cost

Impact Of Health Care Delivery System Innovations On Total Cost Of Care

2017 ◽  
Vol 36 (3) ◽  
pp. 509-515 ◽  
Author(s):  
Kevin W. Smith ◽  
Anupa Bir ◽  
Nikki L. B. Freeman ◽  
Benjamin C. Koethe ◽  
Julia Cohen ◽  
...  
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Cost Of Care ◽  
Total Cost

Development of a Comprehensive, Nonsurgical Joint Health Program for People With Osteoarthritis: A Pilot Case Report

2019 ◽  
Author(s):  
Morven R Malay ◽  
Trevor A Lentz ◽  
Jonathan O’Donnell ◽  
Theresa Coles ◽  
Richard Chad Mather ◽  
...  
Keyword(s):  
Health Care ◽  
Case Report ◽  
Health Program ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Comprehensive Care ◽  
Care Providers ◽  
Care Model ◽  
Care Models ◽  
Joint Health

Abstract Background and Purpose Existing osteoarthritis (OA) care models often fall short in addressing the many biological, psychological, social and behavioral characteristics that contribute to disability. As US health care shifts towards value-based payment, there is an increasing need to develop and test scalable, cost-effective, and multi-modal OA care models. This administrative case report will describe the development and pilot of a new, value-based comprehensive care model for OA. Case description The Joint Health Program (JHP) is a physical therapist-led conservative care model for individuals with hip and knee OA. In the JHP, physical therapists with specialized training in cognitive behavioral-theory based strategy function as the central care provider (i.e., the Primary Osteoarthritis Provider, or POP) that delivers evidence-based, psychologically-informed interventions and coordinates care within a multi-disciplinary network of dietitians, behavioral health specialists and orthopedic providers. The JHP is focused on enhancing patient engagement, shared decision making, self-management and multi-modal patient interaction, and long-term follow-up. Outcomes A value-based, comprehensive care program for OA led by physical therapists demonstrated feasibility and acceptability within a large, academic health care system, which has led to its early growth. Barriers to development and integration of the program were addressed through effective collaboration among health care providers, program and health system administrators, and executive leadership. Discussion The JHP serves as a model for future physical therapist-led, value-based care models that could be developed in other health care systems for OA and other chronic conditions. Future work will identify characteristics that predict program response and compare the effectiveness of this program to existing models of care.

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