Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices

ObjectiveMusculoskeletal problems like hip and knee osteoarthritis and low-back pain are preference sensitive conditions. Patient engagement strategies (PES), such as shared decision-making and motivational interviewing, can help align patients’ preferences with treatment options and potentially reduce spending. We assess the association of physician practice-level adoption of PES with utilisation and spending.DesignCross-sectional study in which patients were matched across low, moderate and high levels of PES via coarsened exact matching.SettingPrimary and secondary care in 2190 physician practices.Participants39 336 hip, 48 362 knee and 67 940 low-back patients who were Medicare beneficiaries were matched to the 2017–2018 National Survey of Healthcare Organizations and Systems.Primary and secondary outcome measuresTotal hip replacement (THR), total knee replacement (TKR), 1–2 level posterior lumbar fusion (LF), total annual spending, components of total annual spending.ResultsTotal annual spending for patients with musculoskeletal problems did not differ for practices with low versus moderate PES, low versus high PES or moderate versus high PES, but spending was significantly lower in some categories for practices with relatively higher PES adoption. For hospital-owned and health system-owned practices, the ORs of receiving LF were 0.632 (95% CI 0.396 to 1.009) for patients attributed to practices with high PES compared with patients attributed to practices with moderate PES. For independent practices, the odds of receiving THR were 1.403 (95% CI 1.035 to 1.902) for patients attributed to practices with moderate PES compared with patients attributed to practices with low PES.ConclusionsPractice-level adoption of PES for patients with musculoskeletal problems was generally not associated with total spending. PES, however, may steer patients toward evidence-based treatments. Opportunities for overall spending reduction exist as indicated by the variation in the subcomponents of total spending by PES adoption.

Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study

ObjectivesTo examine trends in high deductible health plan (HDHP) enrolment among members with diabetes and cardiovascular disease (CVD) compared with healthy members and compare out-of-pocket (OOP) and total spending for members with chronic conditions in HDHPs versus low deductible plans.DesignDescriptive study with time trends.SettingA large national commercial insurance database.Participants1.2 million members with diabetes, 4.5 million members with CVD (without diabetes) and 18 million healthy members (defined by a low comorbidity score) under the age of 65 years and insured between 2005 and 2013.Outcome measuresPercentage of members in an HDHP (ie, annual deductible ≥$1000) by year, annual mean OOP and total spending, adjusted for member sociodemographic and employer characteristics.ResultsEnrolment in HDHPs among members in all disease categories increased by 5 percentage points a year and was over 50% by 2013. On average, over the study period, HDHP enrolment among members with diabetes and CVD was 2.84 (95% CI: 2.78 to 2.90) and 2.02 (95% CI: 1.98 to 2.05) percentage points lower, respectively, than among healthy members. HDHP members with diabetes, CVD and low morbidity had higher annual OOP costs ($636 (95% CI: 630 to 642), $539 (95% CI: 537 to 542) and $113 (95% CI: 112 to 113)) and lower total costs (−$529 (95% CI: −597 to −461), −$364 (95% CI: −385 to −342) and −$79 (95% CI: −81 to −76)), respectively, than corresponding low deductible members when averaged over the study period. Members with chronic diseases had yearly OOP expenditures that were five to seven times higher than healthier members.ConclusionHigh HDHP enrolment coupled with the high OOP costs associated with HDHPs may be particularly detrimental to the financial well-being of people with diabetes and CVD, who have more healthcare needs than healthier populations.

Trends in Pediatric Private Insurance and Medicaid Spending: A Repeated Cross-Sectional Analysis of Data from 2002 to 2014

Given increased focus on health spending, this investigation aims to compare trends in pediatric Medicaid and private insurance spending on type of service from 2002 to 2014 in order to inform policy and research. A repeated cross-sectional analysis of 2002 to 2014 National Health Expenditure Accounts data was conducted. Total spending, per capita spending, and compounded annual growth rates for type of service were determined for children ages 0 to 18 at the national level. Per capita spending growth was higher for private insurance than for Medicaid, and the areas of high per capita spending growth differed for private insurance and Medicaid. While Medicaid spent more per capita on hospital care than private insurance, private insurance demonstrated greater per capita spending growth on hospital care than Medicaid (8.49% vs 1.99%, respectively). Conversely, per capita spending on home health care grew more for Medicaid (6.79%) than for private insurance (3.18%). Trends in private insurance and Medicaid overall and per capita spending differ. Medicaid experienced higher annual growth in total spending than per capita spending, while private insurance had greater annual growth in per capita spending than total spending. Growth in private insurance per capita spending was higher than growth in Medicaid per capita spending, but growth in Medicaid total spending was higher than growth in private insurance total spending. These data suggest that Medicaid and private insurance may have different drivers of spending growth, highlighting the need for policy makers to examine spending patterns by payer. Further research to determine why such differences in spending growth exist will better inform efforts to increase health care value.

Navigating the Last Mile: The Demand Effects of Click-and-Collect Order Fulfillment

Many retailers are rushing into the click-and-collect (C&C) format, where shoppers place orders online and pick up the goods themselves later. The authors study the demand implications of C&C and postulate how different ways of organizing this format—each with its own convenience features—appeal to households with different shopper characteristics. Using two data sets, each covering the introduction of two C&C fulfillment types by a major grocery retailer in a large number of local markets, the authors compare the impact of in-store fulfillment (pickup at existing stores), near-store fulfillment (pickup at outlets adjoining stores), and stand-alone fulfillment (pickup at free-standing locations). The authors find that the shift in online consumer spending significantly differs between the three order fulfillment types, as does the impact on total spending. No one order fulfillment type systematically dominates; the effects depend heavily on shopper characteristics. The study’s results provide guidance on which C&C fulfillment type(s) to operate under what conditions and caution retailers not to take the easy in-store route routinely.

The sound of music on the pocket: A study of background music in retail

Influences of background music on consumer behavior have economic potential for businesses. However, the precise parameters for manipulating these effects have remained elusive. In this study, the impact of different genres of background music on consumer spending was examined in three branches each of both a Japanese-themed and a Mexican-themed restaurant chain in Singapore. Three music genre conditions (“pop,” “traditional,” “mix”) corresponding to the restaurants’ cultural theme, were played for a week in each restaurant. Data on total spending and spending per customer were collected and analyzed. While direct music genre effects were not statistically significant, results indicated certain trends where higher consumer expenditure was observed in conditions utilizing a mixture of pop and traditional music (“mix”). Specifically, spending per customer for the “mix” condition was 11.4% higher than for “pop” for the Japanese restaurant, whereas it was 6.3% higher for the “mix” condition than for “traditional” for the Mexican restaurant. The results suggest that music could be tailored to different days of the week to appeal to different customer profiles and that music can be parameterized to influence consumer behaviors.

A Study of the Online Impulse Buying Behaviour during COVID-19 Pandemic

Impulse buying is an important element in e-commerce. Now-a-days impulse buying has become so common that it constitutes approximately 50 percent of total spending by customers. Technology provides endless opportunities to customers for impulse buying by providing faster, smarter and convenient buying options. People are forced to stay indoors due to pandemic and as a consequence they spend more time on internet. This research paper investigates the phenomenon of impulse buying behaviour during pandemic as well as the factors behind the impulse buying behaviour. It brings insight regarding online impulse buying, impact of advertisements on impulse buying and price concerns during impulse buying. After a thorough literature review to explore key factors related to impulse buying, a survey has been conducted to record the data of various customers involved in impulse buying. After analysing the data, conclusions have been drawn with respect to various aspects of impulse buying.