The Impact of a Value-Based Insurance Design Plus Health Coaching on Medication Adherence and Medical Spending

The objective of this study was to evaluate medication adherence, medical services utilization, and combined medical and pharmacy expenditures associated with diabetes and hypertension value-based insurance design (VBID) plus health/disease coaching programs implemented by a large employer. A pre/post participant versus nonparticipant study design was used to measure medication possession ratios (MPRs), inpatient admissions, emergency room utilization, and combined medical and pharmacy expenditures for employees/spouses with diabetes (n=1090; average 23 months follow-up) and hypertension (n=3254; average 13 months follow-up) participating in a VBID plus health/disease coaching relative to eligible nonparticipants. Outcome measures were propensity score weighted and regression adjusted to estimate the independent impact of the programs. MPRs for diabetes and hypertension were significantly increased 3 to 4 percentage points for VBID participants, while MPRs for respective nonparticipants decreased by about 10 percentage points. Employer-paid pharmacy expenditures increased significantly for both participants with diabetes and hypertension while out-of-pocket patient co-payments decreased significantly. Medical expenditures for diabetes VBID participants decreased but not significantly. Hypertension participants experienced medical expenditure increases. Medical services utilization of inpatient admissions and emergency room visits underwent minimal change. Thus employer-sponsored diabetes and hypertension VBID plus health/disease coaching programs can be expected to lower patient co-payments and significantly increase medication adherence. Meanwhile, medical spending outcomes indicated that increased diabetes and hypertension pharmacy expenditures were partially offset by medical savings (for diabetes) but not sufficiently to be cost neutral. (Population Health Management 2015;18:151?158)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140186/1/pop.2014.0081.pd

The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures

The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140194/1/pop.2015.0171.pd

The impact of resilience among older adults

AbstractThe purpose of this literature review was to provide an overview of resilience for the purpose of informing potential intervention designs that may benefit older adults. While numerous reviews have focused on various specific aspects of resilience, none have provided the necessary information required to design an effective resilience intervention. Research examining resilience suggests that older adults are capable of high resilience despite socioeconomic backgrounds, personal experiences, and declining health. Thus opportunities to inform interventions in this area exist. Research studies have identified the common mental, social, and physical characteristics associated with resilience. High resilience has also been significantly associated with positive outcomes, including successful aging, lower depression, and longevity. Interventions to enhance resilience within this population are warranted, but little evidence of success exists. Thus this review provides an overview of resilience that may aid in the design of resilience interventions for the often underserved population of older adults

A More Generalizable Method to Evaluate Changes in Health Care Costs with Changes in Health Risks Among Employers of All Sizes

The objective of this study was to estimate the association between changes in health care expenditures relative to changes in health risk status for employers of all sizes. Repeat health risk assessments (HRAs) were obtained from 50,005 employees and spouses with 2 years of health plan enrollment, and from 37,559 employees and spouses with 3 years of enrollment in employer-sponsored medical coverage. Changes in health care expenditures were measured from the year before completion of the first HRA to the years before and after the completion of the second HRA. Propensity score weighting was used to adjust for those who did not repeat the HRA so results could be extrapolated to the larger population. Propensity score weighted multiple regression analyses were used to estimate the relationship between changes in health care expenditures with changes in risk status for 9 risk categories. Significantly higher health care expenditures were associated with those who moved from low risk to medium or high risk, compared to those who remained low risk. Expenditure reductions estimated for those who improved their health status from high risk to medium or low risk were not statistically significant. This study is unique because of its large sample size, its use of data from a wide range of employer sizes, and its efforts to extend generalizability to those who did not complete both HRAs. These results demonstrate that the potential for short-term health care savings may be greater for programs that help maintain low risk than for programs focused on risk reduction. (Population Health Management 2014;17:297?305)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140183/1/pop.2013.0103.pd

The association of health promotion participation with health risks and medical costs.

Health promotion programming was initiated in the mid 1970s as a rational effort to prevent high-cost diseases that consume the majority of corporate health benefit dollars. The growth of corporate investments expanded the scientific efforts to evaluate the health and cost benefits of these programs. Evidence from these evaluations demonstrated improvements in selected health outcomes. However, the relationship between participation in health programs and definitive economic returns in medical cost savings has been more difficult to establish. The purpose of this project was to evaluate the effect of employee participation in health promotion programs at The Progressive Insurance Corporation by assessing the association of increasing program participation with health risk change and selected medical cost outcomes. Medical cost trends and health risk changes were monitored over a 6-year study period. Program participation was operationalized as a summed program participation score based on company attendance records. Programs were also categorized and summed by program-type: knowledge classes, biometric screening programs, health risk appraisals, or intervention/interactive classes. Increasing levels of program participation were associated with increasingly higher cost employees but not with higher numbers of health risks. This was an unexpected finding since higher cost employees participating in health promotion programs would also be expected to be associated with higher numbers of individual high risks. In this company, with a comparatively younger employee population, increasing program participation was frequently associated with increased medical costs not related to physical disease, e.g., injuries, musculo-skeletal complications, and mental disorders. Although knowledge, screening, and HRA programs attracted participation by higher cost employees, positive health risk change/maintenance and medical cost moderation were associated primarily with participation in intervention programs. High risk for stress was reduced and low risk for exercise was maintained with more participation in intervention programs. Medical cost moderation occurred among those employees with more access to intervention programs while medical costs continued to increase among those employees participating primarily in health risk awareness and identification programs. These findings provide evidence for the effectiveness of intervention programs in reducing or maintaining health risk status and in moderating medical care costs.Ph.D.Health and Environmental SciencesHealth care managementPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131059/2/9825311.pd

The economic value of healthy workers

Objective 1) To demonstrate the feasibility of a designed intervention in changing targeted health behaviors and 2) to evaluate the impact of changes in health risks on the two measures of job performance (a self-reported measure of health-related work impairment (presenteeism) and an objective measure of illness absenteeism). Design A pre/post study design (2004-2005) utilizing Health Risk Appraisal (HRA) data to assess changes in prevalence of individual health risks and changes in two productivity measures. Setting and Subjects Employees of a private insurance provider in Australia. Measures An HRA questionnaire was used to evaluate self-reported work impairment on different aspects of job demands and to assess the prevalence of health risks during March 2004 with a follow-up assessment December 2005. Absence hours due to illness (illness absenteeism) were obtained from company administrative records. Results The most improved health risks associated with the on-site lifestyle program interventions were increased physical activity, better perception of physical health and reduction in smoking although some health risks increased during the time period (e.g., job dissatisfaction and high stress). Changes in percentages of work impairment were significantly associated with changes in numbers of health risks—as health risks decreased, work impairment decreased; as health risks increased, work impairment increased. On average, each risk factor increased or reduced over time was associated with an incremental change of 4.2 percentage points of work impairment. Although there was a trend for changes in illness absenteeism to follow changes in health risks, the differences were not statistically significant. Conclusions This study demonstrates 1) the impact of a designed intervention program on changing health behaviors and 2) preliminary results indicating that changes in productivity measures follow changes in health risks. The study provides a first indication of the potential benefits of health promotion programming to Australian employees in improving health and to the corporation in minimizing health-related productivity loss

The growing need for resources to help older adults manage their financial and healthcare choices

Abstract Background Both financial literacy (managing personal finances) and health literacy (managing personal health) become increasingly important for older adults, potentially impacting their quality of life. Resources in these constructs of literacy tend to be distinct, although the skills and decision-making involved overlap as financial issues impact healthcare choices. Thus the primary purpose of this commentary is to propose a new area of research focus that defines the intersection of financial and health literacy (i.e., financial health literacy). Methods We conducted a limited literature review related to financial, health, and health insurance literacy to demonstrate gaps in the literature and support our position. Online search engines were utilized to identify research in our primary areas of interest. Results We define the intersection of financial and health literacy as an area of need labeled financial health literacy, with a focus on four domains. These include: 1) the ability to manage healthcare expenses; 2) pay medical bills; 3) determine health needs and understand treatment options; and 4) make sound healthcare decisions with financial resources available. Despite some overlap with health insurance literacy, financial health literacy would define an area of need encompassing health management choices and health plan selections integrated with other financial management issues including living arrangements, financial planning, and retirement planning. Conclusions Potential initiatives should be considered to help at-risk older adults find resources to improve their financial health literacy, which in turn will enhance their abilities to manage medical choices in the environment of an increasingly complex healthcare system

Costs and Benefits of Prevention and Disease Management

Prevention and long term disease management have been added relatively recently as `new' components of a modern day total healthcare services system. The goal of primary prevention, which includes medical preventive services, lifestyle interventions and screening services, is to maintain a symptom- and disease-free population. Disease management is a systematic post-disease attempt to manage the consequences of a disease. This article focuses on the costs and savings of prevention and treatment for 7 major diseases which accounted for nearly 80% of the deaths in the US in 1990: heart disease, cancer, diabetes, arthritis, chronic bronchitis, influenza and asthma. The potential impact of prevention and disease management on costs, including productivity, represents a significant return-on-investment to society. Differences in the allocation of direct resources, however, make it nearly impossible to find a single suitable cost measure for the relative cost-effectiveness comparisons of prevention, acute treatment of disease and long term disease management. The relevant question may not be so much the relative cost effectiveness or benefits of the components of healthcare, but the benefits that an integrated approach brings to a total healthcare delivery system.Reviews-on-treatment, Pharmacoeconomics, Disease-management-programmes, Cost-analysis, Coronary-disorders, Cancer, Cancer, Diabetes-mellitus, Rheumatoid-arthritis, Chronic-bronchitis, Influenza-virus-infections, Asthma

Excess Healthcare Costs Associated with Excess Health Risks in Diseased and Non-Diseased Health Risk Appraisal Participants

Background: Concerns regarding the effectiveness and impact of disease management are largely based on disease compliance measures. Although disease management programs have measured improvements in compliance and quality of life and cost savings from reductions in hospitalizations and emergency room visits, few programs have focused on changing behavioral health risks not directly related to the specific disease. The basic relationship between behavioral health risks and healthcare costs shows that those individuals with more high-risk behaviors are associated with higher healthcare costs compared with those with low-risk behaviors. The concept of excess costs associated with excess risks is a calculation of theoretical maximum percent savings for an entire group assuming everyone reduces to low risk, and changes in healthcare costs follow the changes in risks. Objective: To establish the magnitude of excess healthcare costs associated with excess health risks, given a diagnosed chronic disease. Methods: 135 251 current and retired employees of General Motors Corporation who had completed a Health Risk Appraisal (HRA) were evaluated. Participants were continuously enrolled in traditional or Preferred Provider Organization (PPO) medical plans from 1996 to 1999 and had completed at least one HRA between 1996 and 1998. Results: Those with and without self-reported disease averaged 19.2 and 9.1% excess healthcare costs associated with excess health risks, respectively. However, the magnitude of the impact differed across age groups and diseases. Individuals less than 45 years of age with self-reported disease were most affected by the presence of additional health risks (44% excess costs) while those aged >=65 years without disease were least affected (8.2% excess costs). Among those with diseases, those with diabetes mellitus and bronchitis/emphysema were most affected (19.2 and 21.0%, respectively). Conclusions: Disease management programs should ideally provide a systematic approach to assist patients with interventions that improve overall health, as well as focusing on disease compliance measures. The implications for disease management programs are that, even given the presence of disease, promoting and/or maintaining low-risk status can result in potential cost savings.Cost analysis, Pharmacoeconomics