Editor\u27s Updates from the College

CAMHB Gets a New Name. The College for Advanced Management of Health Benefits has been renamed The College for Value-Based Purchasing of Health Benefits (CVBP). When the College was founded in 2004 the term “value-based purchasing” was relatively unknown outside of the limited circle of employers and coalitions that were already engaged in VBP activity. Since that time, the VBP movement has gathered steam, due in no small part to DHHS’ stated commitment to becoming a value-based purchaser of health services. The College curriculum has always been focused on value-based purchasing, and will continue to have this focus, so, in a year of major change for the nation, we thought the time right to update the College’s name. Hope you approve

Assessing Quality of Primary Care Through Medical Record Review: Lessons and Opportunities

No abstract available

Welcome to Value-Based Purchasing

No abstract available

Indirect costs associated with surgery for low back pain-a secondary analysis of clinical trial data.

This study examines the indirect costs associated with surgery for axial low back pain using data obtained from a prospective multicenter clinical trial that compared Charité artificial disc replacement with anterior lumbar interbody fusion using iliac crest bone graft. While 75% of study subjects reported full- or part-time employment prior to surgery, this percentage dropped to 45% at 6 weeks postoperatively. Return to preoperative employment levels occurred at approximately 6 months postoperatively. Two years after surgery, employment levels were 16% higher than preoperative levels. Lost productivity related to absenteeism resulted in lost wages averaging $2884 per patient during the first postoperative year. Although short-term indirect costs of surgery are substantial from a societal perspective, the higher employment rate at 2 years suggests a long-term economic benefit. The findings demonstrate the significant, though not surprising, impact of spinal disability on productivity, and the importance of including measurement of lost productivity and return to work in the economic evaluation of related interventions

Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health.

INTRODUCTION: Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities. METHODS: We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions. We calculated community health scores at the regional level, by using metrics similar to the Robert Wood Johnson Foundation (RWJF) County Health Rankings but with local data. We used descriptive analyses and multilevel linear modeling to explore relationships between community health and 3 outcome variables: emergency department (ED) use, hospital use, and paid claims. Business leaders reviewed findings and offered insights on preparedness to invest in community health improvement. RESULTS: Poorer community health was associated with high use of ED services, after controlling for age and sex. After including a summary measure of racial composition at the zip code region level, the relationship between community health and ED use became nonsignificant. No significant relationships between community health and hospitalizations or paid claims were identified. Business leaders expressed interest in further understanding health needs of communities where their employees live. CONCLUSION: The health of communities in which adult employees and dependents live was associated with ED use, but similar relationships were not seen for hospitalizations or paid claims. This finding suggests a need for more primary care access. Despite limited quantitative evidence, business leaders expressed interest in guidance on investing in community health improvement

Predicting high utilization of emergency department services among patients with a diagnosis of psychosis in a Medicaid managed care organization

Studies have demonstrated increased utilization of medical services for patients with behavioral health diagnoses. Medicaid managed care organizations (MMCOs) that operate under behavioral health carve-outs face the challenge of effectively targeting disease management initiatives in the absence of information on behavioral diagnoses. This study sought to develop a predictive model of emergency department (ED) utilization for patients where a diagnosis of psychosis could be identified from a claim associated with a medical service provider visit. A retrospective cohort analysis was performed using medical and pharmacy claims from an MMCO in Philadelphia, Pennsylvania, to identify patients known to have a diagnosis of psychosis and to develop the predictive model. Demographics, comorbidities, medical utilization, and medications were assessed as predictor variables. Within the MMCO, 764 members were identified with at least one medical claim having a psychosis diagnosis. Ordinary least squares multiple regression analysis was performed to measure the correlation between independent variables and ED visits. Variables with significant F ratios in the regression analysis were retained as factors in a risk model to evaluate their additive and cumulative effects. Four variables were significant predictors of high ED utilization: prior number of ED visits, prior number of hospitalizations, history of alcohol abuse, and history of depression. ED utilization increased as the number of risk factors increased: With no risk factors, mean ED use was 0.58 visits (per 6 months), while the cumulative effects of all four factors equated to 8.5 ED visits. The model may be useful to other MMCOs, or similar organizations, seeking to risk-stratify their ED-related disease management activities for patients identified with psychosis