Currently Viewing:
The American Journal of Managed Care August 2018
Currently Reading
Impact of a Medical Home Model on Costs and Utilization Among Comorbid HIV-Positive Medicaid Patients
Paul Crits-Christoph, PhD; Robert Gallop, PhD; Elizabeth Noll, PhD; Aileen Rothbard, ScD; Caroline K. Diehl, BS; Mary Beth Connolly Gibbons, PhD; Robert Gross, MD, MSCE; and Karin V. Rhodes, MD, MS
Precision Medicine and Sharing Medical Data in Real Time: Opportunities and Barriers
Y. Tony Yang, ScD, and Brian Chen, PhD, JD
Levers to Reduce Use of Unnecessary Services: Creating Needed Headroom to Enhance Spending on Evidence-Based Care
Michael Budros, MPH, MPP, and A. Mark Fendrick, MD
From the Editorial Board: Michael E. Chernew, PhD
Michael E. Chernew, PhD
Optimizing Number and Timing of Appointment Reminders: A Randomized Trial
John F. Steiner, MD, MPH; Michael R. Shainline, MS, MBA; Jennifer Z. Dahlgren, MS; Alan Kroll, MSPT, MBA; and Stan Xu, PhD
Impact of After-Hours Telemedicine on Hospitalizations in a Skilled Nursing Facility
David Chess, MD; John J. Whitman, MBA; Diane Croll, DNP; and Richard Stefanacci, DO
Baseline and Postfusion Opioid Burden for Patients With Low Back Pain
Kevin L. Ong, PhD; Kirsten E. Stoner, PhD; B. Min Yun, PhD; Edmund Lau, MS; and Avram A. Edidin, PhD
Patient and Physician Predictors of Hyperlipidemia Screening and Statin Prescription
Sneha Kannan, MD; David A. Asch, MD, MBA; Gregory W. Kurtzman, BA; Steve Honeywell Jr, BS; Susan C. Day, MD, MPH; and Mitesh S. Patel, MD, MBA, MS
Evaluating HCV Screening, Linkage to Care, and Treatment Across Insurers
Karen Mulligan, PhD; Jeffrey Sullivan, MS; Lara Yoon, MPH; Jacki Chou, MPP, MPL; and Karen Van Nuys, PhD
Reducing Coprescriptions of Benzodiazepines and Opioids in a Veteran Population
Ramona Shayegani, PharmD; Mary Jo Pugh, PhD; William Kazanis, MS; and G. Lucy Wilkening, PharmD
Medicare Advantage Enrollees’ Use of Nursing Homes: Trends and Nursing Home Characteristics
Hye-Young Jung, PhD; Qijuan Li, PhD; Momotazur Rahman, PhD; and Vincent Mor, PhD

Impact of a Medical Home Model on Costs and Utilization Among Comorbid HIV-Positive Medicaid Patients

Paul Crits-Christoph, PhD; Robert Gallop, PhD; Elizabeth Noll, PhD; Aileen Rothbard, ScD; Caroline K. Diehl, BS; Mary Beth Connolly Gibbons, PhD; Robert Gross, MD, MSCE; and Karin V. Rhodes, MD, MS
Among HIV-positive Medicaid patients with comorbid medical and psychiatric disorders, there was increased outpatient service utilization, yet relative cost savings, for patients who were treated in patient-centered medical homes.
RESULTS

Characteristics of Study Population

Table 1 provides details on demographics and health conditions for HIV-positive patients with medical and psychiatric comorbidities treated in CCI versus non-CCI practices. Although the CCI group had higher percentages of patients who were African American, higher baseline comorbidity scores, and higher prevalence of cocaine, opioid, and alcohol use disorders, there were no statistically significant between-group differences on any of these characteristics after weighting by propensity score. Average (SD) per patient total healthcare costs during the 1-year preindex period per month eligible were $2721.29 ($6323.52) for the non-CCI group and $2951.48 ($4854.14) for the CCI group (t = –0.75; P = .43, without adjusting for propensity score). The results of the weighted conditional standardized difference analyses revealed that for most variables in Table 1, except presence of any psychiatric disorder, the weighted conditional standardized difference was smaller than the standardized difference. For presence of any psychiatric disorder, the standardized difference was 0.026 and the weighted conditional standardized difference was 0.091. Although the weighted conditional standardized difference was slightly larger than the standardized difference, it still fell below the recommended 0.10 threshold for concern about a potential residual imbalance between the treatment groups.44 Visual assessment of the balance of propensity scores using quintile plots showed adequate balance between CCI and non-CCI over the quintiles. We conclude that the CCI and non-CCI groups were adequately balanced following the propensity adjustment.

Cost Analysis

The adjusted mean total cost DID scores for the CCI group relative to the non-CCI group were –$214.10 (95% CI, –$345.65 to –$82.55) per patient per eligible month (P = .002) (Table 2). This effect did not vary significantly by region of the state (region by intervention group interaction, P = .14). The most significant contributors to this cost savings were relatively greater decreases in inpatient medical costs (–$415.69 per patient per eligible month; P = .007) and outpatient substance abuse treatment costs (–$4.86; P = .001) for the CCI group compared with the non-CCI group. Exploratory analyses examined the CCI versus non-CCI difference in outpatient substance abuse treatment costs separately for the subgroups of patients with and without a substance use disorder. The overall effect was carried by the patients with a substance use disorder (n = 141 and 940 for CCI and non-CCI groups, respectively), with a relative reduction in costs of $12.25 (95% CI, –$17.57 to –$6.93; P <.001) for the CCI group compared with the non-CCI group. There was no significant difference in outpatient substance abuse treatment costs for patients without a substance use disorder diagnosis.

The CCI group increased outpatient costs significantly from the pre- to postindex periods relative to the non-CCI group ($181.54; 95% CI, $68.94-$294.14; P = .002), with this effect driven by greater increases in non-HIV pharmacy costs ($158.43; 95% CI, $68.42-$248.44; P =.001). To further understand this increase in non-HIV pharmacy costs, these costs were subdivided into costs for medications for substance use disorder, psychotropic medications, and other medical non-HIV medication costs. No significant differences between the CCI and non-CCI groups were evident for psychotropic or substance use medications; medical (non-HIV) pharmacy costs were significantly higher for the CCI group compared with the non-CCI group ($153.94; 95% CI, $65.94-$241.91; P = .001).

Utilization Analysis

Relative reductions in healthcare utilization for CCI compared with non-CCI patients were evident for inpatient services (Table 3). For inpatient services of any type, the CCI group had a reduction in any usage from the pre- to postindex period, whereas the non-CCI group had an increase in any claims (OR, 0.404; 95% CI, 0.280-0.575; P = .001). The most significant contributor to this effect was inpatient medical services, for which the CCI group experienced a reduction in any services, whereas the non-CCI group had an increase in any claims (OR, 0.619; 95% CI, 0.446-0.837; P = .002). With respect to outpatient medical claims, there was a significantly greater increase in utilization for CCI patients compared with non-CCI patients when outpatient medical claims occurred, with the average difference in number of claims per month eligible increased by 11.7% (95% CI, 3.9%-20.3%; P = .003) for CCI compared with non-CCI patients. Additionally, there was a significant increase in pharmacy claims for CCI compared with non-CCI patients, with the average number of claims per month eligible increasing by 8.0% (95% CI, 3.2%-13.1%; P = .0009) for the CCI group relative to the non-CCI group. This increase was driven by significantly greater pharmacy claims for non-HIV medications for CCI compared with non-CCI patients (9.7%; 95% CI, 4.6%-15.1%; P = .001).


 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up