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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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Healthcare Utilization

After applying the PS, the weighted sample showed good balance in baseline characteristics between the PCC and non-PCC groups with small standardized differences. Differences in healthcare utilization between the PCC and non-PCC groups were not statistically significant after applying the PS model (Table 2). Despite this finding, the PCC group, compared with the non-PCC group, had a trend of lower odds of hospitalization and ED visits, as well as decreases in utilization of hospitalizations, ED visits, office visits, and PCP visits.

Healthcare Expenditures

The overall crude mean total healthcare expenditures were similar at baseline between the PCC group ($11,193; 95% CI, $10,122-$12,265) and the non-PCC group ($11,783; 95% CI, $11,055-$12,512; P = .357) (Table 3). At follow-up, the PCC group had significantly lower crude mean total healthcare expenditures ($11,208; 95% CI, $10,204-$12,212) than the non-PCC group ($13,316; 95% CI, $12,463-$14,169; P = .002). Considering baseline differences between the 2 groups using the PS model, the PCC group had significantly lower adjusted mean total healthcare expenditures ($11,433; 95% CI, $10,430-$12,437) than the non-PCC group ($13,020; 95% CI, $12,166-$13,873), yielding cost savings of $1587 per cancer survivor (P = .020) (Figure).

Subgroup and Secondary Analyses

Subgroup analyses showed that cost savings were from those 65 years and older. Among cancer survivors younger than 65 years, there were no statistical differences in total healthcare expenditures, but a significant decrease in prescription expenditures in the PCC group ($2580; 95% CI, $2152-$3008) compared with the non-PCC group ($3309; 95% CI, $2858-$3760) yielded a cost savings of $729 per cancer survivor in that subgroup (P = .023) (Table 4).

In the 65 years and older subgroup, the PCC group was associated with lower odds of hospitalization compared with the non-PCC group (odds ratio [OR], 0.81; 95% CI, 0.66-0.99; P = .035). Moreover, there were statistically significant differences in adjusted total healthcare expenditures between the PCC group ($11,918; 95% CI, $10,881-$12,954) and the non-PCC group ($14,382; 95% CI, $13,187-$15,576; P = .002). Hospitalization-related healthcare expenditures were also lower in the PCC group ($3323; 95% CI, $2727-$3918) than in the non-PCC group ($4912; 95% CI, $4039-$5785) in this subgroup analysis (P = .002) (Table 4). Other types of costs were not statistically different between the PCC and non-PCC groups.

The secondary analysis indicated that of the 3 hallmark attributes of the PCMH model (ie, comprehensive care, whole-person orientation, accessible care), the whole-person orientation attribute was mainly responsible for the reductions observed in the PCC group’s healthcare utilization and healthcare expenditures (P = .006). On the contrary, the comprehensive care attribute (P = .906) and the accessible care attribute (P = .905) did not show any significant impact. From these findings, the whole-person orientation attribute was further analyzed to determine which specific healthcare utilization and/or expenditure types were affected by it. It was revealed that the PCC group had lower adjusted mean total healthcare expenditures ($11,666; 95% CI, $10,891-$12,440) than the non-PCC group ($13,572; 95% CI, $12,405-$14,739), yielding cost savings of $1906 per cancer survivor in this subgroup (P = .006). Furthermore, the whole-person orientation attribute was associated with decreased odds of ED visits (OR, 0.79; 95% CI, 0.68-0.92; P = .003) and decreased healthcare expenditures associated with ED visits (cost savings of $96 per cancer survivor; P = .024) (Table 4).

DISCUSSION

The long-term cancer survivor population is more likely to utilize more healthcare resources and accumulates more total medical expenditures over time than adults without a history of cancer, due to their complex medical history and continuous need for rigorous preventive screening, follow-up visits, chemotherapy long-term and late-effect management, and specialized care to prevent secondary relapse of their cancer.2,29 In addition, a higher risk for developing comorbid conditions and higher treatment costs further burden the patients. There is an urgent need for a more cost-effective method of managing this patient population.8,30-35 A patient-centered comprehensive care model has the potential to provide more benefits to cancer survivors than to other patient cohorts, and this study tried to establish an association between patient perceptions of PCMH characteristics and total medical expenditures to further guide the future design of a PCMH model.


 
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