The Efficiency Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits

Objective: The study aim was to compare major bleeding risk and health care costs after initiating oral anticoagulants (OACs) for treatment-naïve non-valvular atrial fibrillation (NVAF) patients. Methods: Patients in the Medicare advantage population prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from the Optum Research Database 01JAN2013-31DEC2014. The first OAC prescription date was designated as the index date. Patients were required to have a NVAF diagnosis, continuous health plan enrollment for 6 months and no OAC claims before the index date. Patients were classified into four cohorts based on their index OAC prescription. Major bleeding events, identified by the Cunningham algorithm plus additional bleeding sites, were compared using a Cox proportional hazards model. Health care costs were calculated per patient per month and compared using generalized linear models. Results: The study included 36,260 patients: 3,762 apixaban, 2,677 dabigatran, 8,740 rivaroxaban, and 21,081 warfarin patients. CHA2DS2-VASc score was higher in apixaban patients (4.2) compared to dabigatran and rivaroxaban (both 4.0; p<0.001), but lower than in warfarin patients (4.3; p<0.001). After adjusting for baseline characteristics, apixaban patients were significantly less likely to have a major-bleeding event within one year of treatment initiation compared to rivaroxaban (HR=0.69; 95% CI=0.59-0.81) and warfarin (HR=0.71; 95% CI=0.61-0.82) patients and trended towards numerically lower major bleeding compared to dabigatran patients (HR=0.87; 95% CI=0.72-1.06). Major bleeding-related medical costs were lower in apixaban patients ($53) compared to rivaroxaban ($111) and warfarin ($138) patients (p<0.001) and similar to dabigatran patients ($44, p=0.370). Furthermore, apixaban patients incurred lower all-cause medical costs ($1,646) compared to dabigatran ($1,974, p=0.02), rivaroxaban ($1,909, p=0.002) and warfarin ($2,162, p<0.001) patients. Conclusion: In a large national Medicare advantage population, treatment-naïve NVAF patients treated with apixaban were significantly less likely to have a major-bleeding event compared to those prescribed rivaroxaban or warfarin and had significantly lower medical costs.

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Heterogeneity of health care costs among medicare advantage patients with type 1 diabetes

Value in Health ◽

10.1016/j.jval.2014.03.1434 ◽

2014 ◽

Vol 17 (3) ◽

pp. A246

Author(s):

G.S. Clore ◽

S.L. Slabaugh ◽

B.H. Curtis ◽

H. Fu ◽

D.P. Schuster

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Health Care Costs ◽

Medicare Advantage ◽

Care Costs

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The Consequences of Health Care Privatization: Evidence from Medicare Advantage Exits

American Economic Journal Economic Policy ◽

10.1257/pol.20160068 ◽

2018 ◽

Vol 10 (1) ◽

pp. 153-186 ◽

Cited By ~ 11

Author(s):

Mark Duggan ◽

Jonathan Gruber ◽

Boris Vabson

Keyword(s):

New York ◽

Hospital Inpatient ◽

Fee For Service ◽

Medicare Advantage ◽

Exogenous Shocks ◽

Inpatient Utilization ◽

Medicare Program ◽

Considerable Controversy ◽

Health Care Privatization ◽

Managed Care Organizations

There is considerable controversy over the use of private insurers to deliver public health insurance benefits. We investigate the consequences of patients enrolling in Medicare Advantage (MA), privately managed care organizations that compete with the traditional fee-for-service Medicare program. We use exogenous shocks to MA enrollment arising from plan exits from New York counties in the early 2000s and utilize unique data that links hospital inpatient utilization to Medicare enrollment records. We find that individuals who were forced out of MA plans due to plan exit saw very large increases in hospital utilization. These increases appear to arise through plans both limiting access to nearby hospitals and reducing elective admissions, yet they are not associated with any measurable reduction in hospital quality or patient mortality. (JEL G22, I11, I12, I13, I18)

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Abstract 112: 12-Month Healthcare Utilization and Expenditures in Medicare Advantage Patients With Mitral Regurgitation From the Medical Outcomes Research for Effectiveness and Economics Registry

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.11.suppl_1.112 ◽

2018 ◽

Vol 11 (suppl_1) ◽

Author(s):

David Cork ◽

Emilie Kottenmeier ◽

Sarah Mollenkopf ◽

Candace Gunnarsson ◽

Patrick Verta ◽

...

Keyword(s):

Heart Failure ◽

Health Care ◽

Mitral Regurgitation ◽

Healthcare Utilization ◽

Outcomes Research ◽

Treatment Options ◽

Mitral Valve Surgery ◽

Medicare Advantage ◽

Medical Outcomes ◽

Utilization Patterns

Background: Mitral Regurgitation (MR) is associated with significant health care costs. This study aims to quantify the financial healthcare burden of Medicare Advantage (MA) patients across all MR patients from the Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry. Methods: MA patients with a minimum of 1 inpatient or 2 outpatient claims for MR from 2008-2014 were reviewed. The index date was defined as a first inpatient claim or second outpatient claim. A 6-month pre-period (baseline) and 6-month post (washout) after index was used to define baseline etiology and severity. Three MR cohorts were defined: (1) Functional MR (FMR) was defined by the presence of heart failure during washout; (2) Degenerative MR (DMR) was defined by presence of chordal rupture or the absence of both heart failure and ischemia; and (3) Uncharacterized MR (UMR) was defined by patients otherwise not meeting the criteria for FMR or DMR. sMR was defined by a history of MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, chordal rupture (DMR only), or record of two or more echocardiograms (per clinical guidelines) during washout. Demographics, comorbidities, healthcare utilization, and all-cause expenditures were summarized. Results: Of the 164,682 MA patients with MR who met inclusion criteria, 70,452 (43%) had FMR, 51,399 (31%) had DMR, and 42,831 (26%) had UMR. Average age (SD) was similar across cohorts: 74 (7.95), 72 (8.46), and 74 (7.45) years for FMR, DMR, and UMR, respectively. Proportion of severe patients and Charlson Comorbidity Index (CCI) indicates that the FMR cohort was “sicker” as compared to the others: FMR (41,325 [59% of 70,452]; CCI 4.56), DMR (16,169 [32% of 51,399]; CCI 1.67), and UMR (16,131 [38% of 42,831]; CCI 2.80). 2,079 patients (1.26% of total 164,682) received mitral valve surgery at index or washout with the highest occurrence in FMR patients (1,663), followed by UMR (327) and DMR (89). When comparing across the MR cohorts, the FMR cohort had higher rates of hospital admission, but length of stay was similar between cohorts (FMR [19.9%, 4-days], DMR [9.4%, 4-days], and UMR [13.6%, 3-days]). FMR had the highest annual all-cause healthcare costs (SD) ($22,569, [$59,876]), followed by UMR ($14,735 [$32,070]) and DMR ($10,485 [$23,934]). Conclusions: MR in the Medicare Advantage population is associated with a substantial health care burden, with FMR patients having the highest cost and utilization patterns. This population should, therefore, have access to innovative treatment options that relieve symptoms and reduce economic burden.

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Health Care Utilization and Medical Cost Outcomes from a Digital Diabetes Prevention Program in a Medicare Advantage Population

Population Health Management ◽

10.1089/pop.2019.0184 ◽

2020 ◽

Vol 23 (6) ◽

pp. 414-421

Author(s):

Douglas Barthold ◽

Vinay Chiguluri ◽

Rajiv Gumpina ◽

Cynthia Castro Sweet ◽

Jason Pieratt ◽

...

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Medical Cost ◽

Prevention Program ◽

Diabetes Prevention ◽

Diabetes Prevention Program ◽

Care Utilization ◽

Medicare Advantage ◽

Cost Outcomes

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Reduced Health Care Costs Associated With Disease Management for Chronic Heart Failure: A Study Using Three Methods to Examine the Financial Impact of a Heart Failure Disease Management Program Among Medicare Advantage Enrollees

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2006.07.006 ◽

2006 ◽

Vol 12 (8) ◽

pp. 594-600 ◽

Cited By ~ 8

Author(s):

Jaan Sidorov

Keyword(s):

Heart Failure ◽

Health Care ◽

Chronic Heart Failure ◽

Disease Management ◽

Disease Management Program ◽

Management Program ◽

Financial Impact ◽

Medicare Advantage ◽

Heart Failure Disease Management ◽

Care Costs

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Are There Differences in Patient Characteristics, Treatment Patterns and Costs by Treatment Setting?

Blood ◽

10.1182/blood.v120.21.4259.4259 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4259-4259

Author(s):

Stacey Dacosta Byfield ◽

Carolina Reyes ◽

Laura K Becker ◽

Art Small

Keyword(s):

Health Care ◽

Multivariate Analyses ◽

Incidence Rates ◽

Treatment Patterns ◽

Cost Ratio ◽

Medicare Advantage ◽

Episode Of Care ◽

Comorbidity Index ◽

The Mean ◽

Care Costs

Abstract Abstract 4259 Background: Few studies have examined whether differences in treatment and outcomes exist among cancer patients by the setting where care is delivered. This study investigates differences in treatment patterns, health care resource use and costs among non-Hodgkin's Lymphoma (NHL) and Chronic Lymphocytic Leukemia (CLL) patients receiving rituximab (R) or R+ chemotherapy based on site of care: office/clinic (OC) vs. hospital outpatient (HOSP). Methods: Patients ≥18 years with evidence of NHL or CLL diagnoses codes at least 30 days apart and received ≥2 R claims from Jan 2007 to Mar 2011 were identified from a large US commercial insurance claims database. Patients were required to be enrolled in the health plan for at least 6 months before and after the index date (date of first R claim). The follow-up period was the date of the first infusion to 30 days after the last infusion prior to a gap of ≥7 months. Patients with evidence of multiple cancers or receipt of R at both sites of care were excluded. Cohorts were created based on site of care where R was administered and type of insurance, commercial (COM) vs. Medicare Advantage (MA). Descriptive analyses were conducted to examine differences in treatment patterns and per-patient per-month (PPPM) health care costs. Multivariate analyses adjusting for age, gender, baseline Charlson index score and receipt of monotherapy was also conducted to examine differences in PPPM health care costs. Results: A total of 2,594 OC and 286 HOSP patients were identified. A higher percentage of Medicare Advantage patients (27% of 878 patients, n=236) received Rituxan therapy in the HOSP setting compared to commercially insured patients (2% of 2002 patients, n=50). Among the Medicare Advantage patients, age, gender, and baseline Charlson comorbidity index were not significantly different by cohort. The mean length of the episode of care was not significantly different by site of service but the number of Rituxan infusions (5.4 vs. 6.8, p<0.01) and infusions/mth (0.99 vs. 1.27, p<0.01) were significantly less in the HOSP compared to the OC. Incidence rates of ER visits (0.11 vs. 0.08, p=0.02), but not hospitalizations were higher among the HOSP cohort. Unadjusted infusion day costs were higher among the HOSP compared to the OC ($6,479 vs. $4,998, p<0.01) but total PPPM costs were not significantly different by cohort ($9,323 vs. $10,051, p>0.05). In multivariate analyses, total PPPM costs were slightly less among the HOSP cohort (cost ratio=0.92, p<0.01). Among the commercially insured population, gender and baseline Charlson comorbidity index were not significantly different by cohort though patients in the HOSP were slightly younger than those in the OC (55 years vs. 59 years). The mean length of the episode of care was not significantly different by site of service but compared to the OC the number of Rituxan infusions (5.52 vs. 7.56, p<0.01) and infusions per month (1.05 vs. 1.17, p>0.05) were less in the HOSP though the difference in infusions/month was not significant. Incidence rates of ER visits and hospitalizations were also not significantly different. Unadjusted infusion day costs were higher among the HOSP cohort compared to the OC cohort ($10,939 vs. $5,464, p<0.01) as well as total PPPM costs ($17,230 vs. $11,549, p=0.01). In multivariate analyses, total PPPM costs remained significantly higher among the HOSP cohort (cost ratio=1.40, p<0.01). Conclusions: A lower percentage of COM patients receive Rituxan infusions in the HOSP setting compared to MA patients. However, regardless of insurance type, patients in the HOSP cohort incurred greater costs on the day of Rituxan infusion compared to the OC cohort. Among MA patients, although costs incurred on the day of infusions were significantly higher in the HOSP cohort, patients treated in the HOSP setting had slightly lower total PPPM costs likely due to fewer administrations per month of Rituxan during an episode of care. Among COM patients, higher infusion day costs contributed to higher total overall costs among the HOSP cohort. These results warrant further investigation to assess the impact of these differences on clinical outcomes by site of care. Disclosures: Dacosta Byfield: OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Reyes:Genentech, Inc.: Employment, Roche Stock Other. Becker:OptumInsight: Employment, OptumInsight received payment from Genentech to conduct the study described in the abstract Other. Small:Genentech, Inc: Employment, Roche stock Other.

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