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The American Journal of Managed Care September 2018
Food Insecurity, Healthcare Utilization, and High Cost: A Longitudinal Cohort Study
Seth A. Berkowitz, MD, MPH; Hilary K. Seligman, MD, MAS; James B. Meigs, MD, MPH; and Sanjay Basu, MD, PhD
Language Barriers and LDL-C/SBP Control Among Latinos With Diabetes
Alicia Fernandez, MD; E. Margaret Warton, MPH; Dean Schillinger, MD; Howard H. Moffet, MPH; Jenna Kruger, MPH; Nancy Adler, PhD; and Andrew J. Karter, PhD
Hepatitis C Care Cascade Among Persons Born 1945-1965: 3 Medical Centers
Joanne E. Brady, PhD; Claudia Vellozzi, MD, MPH; Susan Hariri, PhD; Danielle L. Kruger, BA; David R. Nerenz, PhD; Kimberly Ann Brown, MD; Alex D. Federman, MD, MPH; Katherine Krauskopf, MD, MPH; Natalie Kil, MPH; Omar I. Massoud, MD; Jenni M. Wise, RN, MSN; Toni Ann Seay, MPH, MA; Bryce D. Smith, PhD; Anthony K. Yartel, MPH; and David B. Rein, PhD
“Precision Health” for High-Need, High-Cost Patients
Dhruv Khullar, MD, MPP, and Rainu Kaushal, MD, MPH
From the Editorial Board: A. Mark Fendrick, MD
A. Mark Fendrick, MD
Health Literacy, Preventive Health Screening, and Medication Adherence Behaviors of Older African Americans at a PCMH
Anil N.F. Aranha, PhD, and Pragnesh J. Patel, MD
Early Experiences With the Acute Community Care Program in Eastern Massachusetts
Lisa I. Iezzoni, MD, MSc; Amy J. Wint, MSc; W. Scott Cluett III; Toyin Ajayi, MD, MPhil; Matthew Goudreau, BS; Bonnie B. Blanchfield, CPA, SM, ScD; Joseph Palmisano, MA, MPH; and Yorghos Tripodis, PhD
Currently Reading
Economic Evaluation of Patient-Centered Care Among Long-Term Cancer Survivors
JaeJin An, BPharm, PhD, and Adrian Lau, PharmD
High-Touch Care Leads to Better Outcomes and Lower Costs in a Senior Population
Reyan Ghany, MD; Leonardo Tamariz, MD, MPH; Gordon Chen, MD; Elissa Dawkins, MS; Alina Ghany, MD; Emancia Forbes, RDCS; Thiago Tajiri, MBA; and Ana Palacio, MD, MPH
Adjusting Medicare Advantage Star Ratings for Socioeconomic Status and Disability
Melony E. Sorbero, PhD, MS, MPH; Susan M. Paddock, PhD; Cheryl L. Damberg, PhD; Ann Haas, MS, MPH; Mallika Kommareddi, MPH; Anagha Tolpadi, MS; Megan Mathews, MA; and Marc N. Elliott, PhD

Economic Evaluation of Patient-Centered Care Among Long-Term Cancer Survivors

JaeJin An, BPharm, PhD, and Adrian Lau, PharmD
Providing patient-centered comprehensive care to long-term cancer survivors may lead to reduced total healthcare expenditures.
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Objectives: To evaluate the economic outcomes associated with patient perceptions of patient-centered medical home (PCMH) characteristics among long-term cancer survivors in the United States.

Study Design: A retrospective analysis of the 2008 to 2012 Medical Expenditure Panel Survey.

Methods: A nationally representative sample of adult long-term cancer survivors (≥3 years since diagnosis) was categorized into either patient-centered care (PCC) or non-PCC groups based on responses to PCMH model hallmark attributes of “comprehensive care,” “whole-person orientation,” and “accessible care.” The positive perception of all 3 attributes was defined as PCC. The patient perceptions, as well as patient characteristics, were measured at year 1 (baseline), with a propensity score model to balance baseline characteristics. Adjusted total healthcare utilization and healthcare expenditures in 2014 US$ at year 2 (follow-up) were compared between the PCC and non-PCC groups.

Results: A total of 4288 long-term cancer survivors were identified, with a mean (SD) age of 65.2 (13.8) years. The PCC group was associated with a reduction in mean adjusted healthcare expenditures at follow-up (savings of $1596 per cancer survivor; P = .020). These findings are driven by lower odds of hospitalization (odds ratio, 0.81; 95% CI, 0.66-0.99; P = .035) and lower hospitalization-related healthcare expenditures (PCC: $3323; 95% CI, $2727-$3918; non-PCC: $4912; 95% CI, $4039-$5785; P = .002) associated with PCC among the population who were 65 years and older. The whole-person orientation attribute had a major impact on reduced healthcare expenditures.

Conclusions: The positive patient perception of PCMH characteristics was associated with reduced healthcare expenditures in adult long-term cancer survivors.

Am J Manag Care. 2018;24(9):e292-e299
Takeaway Points
  • A patient-centered medical home (PCMH) model may reduce healthcare expenditures among adult long-term cancer survivors.
  • The positive patient perception of PCMH characteristics was associated with overall reduced total healthcare expenditures in long-term cancer survivors.
  • These findings are mainly driven by long-term cancer survivors 65 years and older, who had reduced odds of hospitalization and reduced hospitalization-related healthcare expenditures.
  • The PCMH hallmark attribute of “whole-person orientation,” but not “comprehensive care” or “accessible care,” had a major impact on reduced healthcare expenditures.
Cancer is the second-leading cause of mortality in the United States as of 2014, superseded only by heart disease, according to the CDC.1 Despite this, cancer survivorship rates have increased in recent years due to advances in early detection and treatment.2 A “cancer survivor,” as defined by the National Coalition for Cancer Survivorship, is a person who has been diagnosed with cancer, from the time of initial diagnosis through the remainder of the person’s lifetime.3 As of January 2016, there are an estimated 15.5 million cancer survivors in the United States, and this number is expected to increase to 20.3 million by 2026 and to 26.1 million by 2040.2

As the number of cancer survivors in the United States continues to climb over the next decade, specialized long-term care—including, but not limited to, chemotherapy long-term and late-effects management, follow-up visits, and preventive screenings—may be necessary to ensure continuity of remission and prevention of secondary relapse, due to each cancer survivor’s unique medical and social histories. Moreover, cancer survivors are at risk for the development of comorbid conditions associated with poor survival.4 This much-needed specialized long-term care often presents an economic challenge for cancer survivors, with some opting to forgo necessary treatments due to their financial concerns.5,6 Not only does the high cost of providing specialized long-term care present an economic challenge for the cancer survivors, it can create a high economic burden for society as well. One study estimated the annual excess economic burdens of cancer survivorship among recently diagnosed and previously diagnosed cancer survivors aged 18 to 64 years to be $16,213 and $4427, respectively, with excess medical expenditures making up the largest share of the economic burden.7 Because of this, it may be necessary to further explore ways to improve the affordability of providing specialized long-term care for cancer survivors, as the current fee-for-service payment system still being used in many oncology practices is costly and ineffective.8

One solution to the affordability issue of specialized long-term care among cancer survivors may be through providing patient-centered comprehensive care. Based on a patient-centered medical home (PCMH) model, this care is guided by a set of joint principles, which include a personal physician, a physician-directed medical practice, whole-person orientation, coordinated and/or integrated care, quality and safety, enhanced access to care, and payment.9 The PCMH model encourages patient-centered healthcare services among providers with a triple aim of improved health, improved quality, and controlled cost.10 Although results from previously published studies have demonstrated the benefits of utilizing a PCMH model for the treatment of other chronic conditions, such as diabetes, asthma, and hyperlipidemia,11-15 or in active cancer patients,16-19 the economic benefits of its use among long-term cancer survivors have yet to be determined.

This study aimed to investigate the association between patient perceptions of PCMH characteristics of the healthcare they receive and economic outcomes. To guide the future design of a PCMH model among cancer survivors, it is important to understand how each PCMH characteristic of their healthcare is associated with overall healthcare costs. In this study, we evaluated total medical expenditures and healthcare utilization among long-term cancer survivors based on patient perceptions of healthcare in a nationally representative United States sample.


Study Design and Data Source

This study was a retrospective analysis of survey data acquired from the 2008 to 2012 Medical Expenditure Panel Survey (MEPS) Household Component longitudinal files (Panels 13-16). MEPS, published by the Agency for Healthcare Research and Quality, is a set of large-scale nationally representative surveys of families and individuals, in addition to medical providers and employers, across the United States.20 The goal of MEPS is to gather data on the usage of medical care and expenditures. Data are collected over 2 years in 5 rounds of in-person interviews.

Study Population

The study population included adults 18 years and older who self-reported that they had ever been diagnosed with cancer, as indicated by the “CANCERY1” variable in the MEPS Household Component. Survey respondents were also asked about their cancer type and the age at which they received their cancer diagnosis. The type of diagnosed cancer was also identified using unique clinical classification coding variables from these self-reported data. Cancer survivors were excluded from this study if they did not have a usual care provider. Furthermore, because the study’s population of interest was long-term cancer survivors, cancer survivors were also excluded from this study if the survey was conducted within 3 years of their last cancer diagnosis.21

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