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The American Journal of Managed Care February 2019
The American Journal of Managed Care February 2019
CLINICAL
Haley Bush, MSPH; James Paik, PhD; Pegah Golabi, MD; Leyla de Avila, BA; Carey Escheik, BS; and Zobair M. Younossi, MD, MPH
COMMENTARY
Jackson Williams, JD
EDITORIAL
A. Mark Fendrick, MD; and Darrell George, BA
From The Editorial Board
Sachin H. Jain, MD, MBA
POLICY
Nirosha Mahendraratnam, PhD; Corinna Sorenson, PhD, MHSA, MPH; Elizabeth Richardson, MSc; Gregory W. Daniel, PhD, MPH, RPh; Lisabeth Buelt, MPH; Kimberly Westrich, MA; Jingyuan Qian, MPP; Hilary Campbell, PharmD, JD; Mark McClellan, MD, PhD; and Robert W. Dubois, MD, PhD
Seth A. Seabury, PhD; J. Samantha Dougherty, PhD; and Jeff Sullivan, MS
TRENDS FROM THE FIELD
Anna D. Sinaiko, PhD, MPP; Shehnaz Alidina, SD, MPH; and Ateev Mehrotra, MD, MPH
WEB EXCLUSIVE
Rebecca A. Gourevitch, MS; Ateev Mehrotra, MD, MPH; Grace Galvin, MPH; Avery C. Plough, BA; and Neel T. Shah, MD, MPP
Cheryl L. Damberg, PhD; Marissa Silverman, MSPH; Lane Burgette, PhD; Mary E. Vaiana, PhD; and M. Susan Ridgely, JD
Currently Reading
Validating a Method to Assess Disease Burden From Insurance Claims
Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Marcia Lowry, MS; Pawan D. Patel, MD; Sachin Rauri, MS; Juliana O. Tillema, MPA; Jeanette Y. Ziegenfuss, PhD; Nicolaas P. Pronk, PhD, MA; and Susan M. Knudson, MA
Felix Sebastian Wicke, Dr Med; Anastasiya Glushan, BSc; Ingrid Schubert, Dr Rer Soc; Ingrid Köster, Dipl-Stat; Robert Lübeck, Dr Med; Marc Hammer, MPH; Martin Beyer, MSocSc; and Kateryna Karimova, MSc
Jesús Antonio Álvarez, PhD, MD; Rubén Francisco Flores, PhD; Jaime Álvarez Grau, PhD; and Jesús Matarranz, PhD
Validating a Method to Assess Disease Burden From Insurance Claims
Thomas E. Kottke, MD, MSPH; Jason M. Gallagher, MBA; Marcia Lowry, MS; Pawan D. Patel, MD; Sachin Rauri, MS; Juliana O. Tillema, MPA; Jeanette Y. Ziegenfuss, PhD; Nicolaas P. Pronk, PhD, MA; and Susan M. Knudson, MA
When we weighted health insurance claims with a disease burden score, we were able to generate valid estimates of disability-adjusted life-years.
ABSTRACT
Objectives: To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population.
Study Design: Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners’ commercial products and completed a health assessment in 2011, 2012, or 2013.
Methods: We calculated values of Spearman’s ρ, the rank-order coefficient of correlation, for the correlation of DALYs with self-reported function and self-reported health. We did the same for the number of medical conditions per member and the cost of claims per member.
Results: The Spearman’s ρ values for the correlation of DALYs with function were –0.241, –0.238, and –0.229 in 2011, 2012, and 2013, respectively (all P <.0001). The respective Spearman’s ρ values for the correlation of DALYs with health were –0.197, –0.189, and –0.192 (all P <.0001). These Spearman’s ρ values were similar in magnitude to those for the correlation of the number of medical conditions per member with function (–0.212, –0.213, and –0.205) and health (–0.199, –0.196, and –0.198) over the 3 years. The Spearman’s ρ values for the correlation of DALYs with function and health were greater than or equal to those for the correlation of cost of claims per member with function (–0.144, –0.193, and –0.186) and greater than those for the cost of claims per member with health (–0.126, –0.150, and –0.151).
Conclusions: Health plans can use DALYs calculated from their own health insurance claims and death records as a valid and inexpensive method to identify the conditions that place the greatest burden of poor function and ill health on their insured populations.
Am J Manag Care. 2019;25(2):e39-e44
Objectives: To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population.
Study Design: Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners’ commercial products and completed a health assessment in 2011, 2012, or 2013.
Methods: We calculated values of Spearman’s ρ, the rank-order coefficient of correlation, for the correlation of DALYs with self-reported function and self-reported health. We did the same for the number of medical conditions per member and the cost of claims per member.
Results: The Spearman’s ρ values for the correlation of DALYs with function were –0.241, –0.238, and –0.229 in 2011, 2012, and 2013, respectively (all P <.0001). The respective Spearman’s ρ values for the correlation of DALYs with health were –0.197, –0.189, and –0.192 (all P <.0001). These Spearman’s ρ values were similar in magnitude to those for the correlation of the number of medical conditions per member with function (–0.212, –0.213, and –0.205) and health (–0.199, –0.196, and –0.198) over the 3 years. The Spearman’s ρ values for the correlation of DALYs with function and health were greater than or equal to those for the correlation of cost of claims per member with function (–0.144, –0.193, and –0.186) and greater than those for the cost of claims per member with health (–0.126, –0.150, and –0.151).
Conclusions: Health plans can use DALYs calculated from their own health insurance claims and death records as a valid and inexpensive method to identify the conditions that place the greatest burden of poor function and ill health on their insured populations.
Am J Manag Care. 2019;25(2):e39-e44
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