Healthcare Utilization and Costs Associated with New-Onset Pain in a Medicare Population.

BACKGROUND: Chronic pain is a common and growing problem in the United States with variable strategies for its treatment. Surgical interventions are necessary in some cases but not required for all patients with new-onset pain. For some patients, interventional pain management (IPM) techniques can treat chronic pain without the cost or risk associated with surgical intervention. OBJECTIVE: The objective of this study was to compare healthcare utilization and costs for new-onset chronic pain treated by IPM specialists to those treated by providers with surgical specialties (i.e., orthopedists and neurosurgeons). STUDY DESIGN: This was a retrospective observational study of qualifying patients over 36-months (2016-2019). SETTING: This study was conducted using 100% Medicare FFS Parts A, B, and Prescription Drug Event (PDE) Part D data, including enrollment and claims. METHODS: Patients with a diagnosis of pain were identified in the claims data. Twelve months of pre-period claims were examined to ensure the incident diagnosis of pain, and 2 additional pain diagnoses were required after initial diagnosis. Patients were assigned either to the IPM cohort or a Surgical cohort based on the specialty of the provider involved in their first pain-related visit after initial diagnosis. Key outcomes, such as the utilization of healthcare services and cost of care, were evaluated for both cohorts over the 24-months following the index diagnosis of pain. RESULTS: 106,658 beneficiaries were included in the study with roughly 36% in the IPM cohort. Patients in the IPM cohort were less healthy and had lower incomes in the baseline period compared to the Surgical cohort. Fewer members of the IPM cohort had an inpatient stay in the 24-months post index pain diagnosis (40% compared to 43% in the surgery cohort) and the IPM cohort had fewer patients with a post-acute care stay (29% compared to 31% in the inpatient stay cohort). The IPM cohort had lower risk-adjusted total costs of care than the Surgical cohort, driven by lower inpatient, outpatient, and post-acute care costs. LIMITATIONS: Retrospective claims data may not include some factors important to patients with a pain diagnosis (such as over-the-counter medications, holistic treatments, or pain scores). CONCLUSION(S): By shifting patients from higher-cost and more invasive surgical procedures, IPM's multidisciplinary approach to pain treatment can reduce surgical utilization and costs for certain chronic pain patients. This shift away from more expensive surgical treatments fits well with Medicare's move toward value-based care, driven by a focus on patient outcomes including health care utilization and costs.

The effect of narrow network plans on out-of-pocket cost.

OBJECTIVES: To estimate the effects of selecting a narrow provider network on outpatient utilization and outpatient out-of-pocket (OOP) expenditures among individuals who chose to enroll in a narrow network plan in 2014. STUDY DESIGN: Claims data from a large insurer in the southeastern United States. METHODS: The sample consisted of individuals continuously enrolled for 2 years (2013-2014) who had Affordable Care Act-compliant plans in 2014. We compared unadjusted results and then used difference-in-differences (DID) models to determine the effect of narrow networks on the number of outpatient visits and outpatient OOP expenditures. RESULTS: Our DID model found no significant change in visits or outpatient OOP expenditures for individuals who selected a narrow network plan in 2014. However, unadjusted outpatient OOP expenditures and premiums were lower for individuals who selected narrow network plans. CONCLUSIONS: Our findings suggest that individuals who selected narrow network plans in 2014 were able to keep costs low without changing their overall number of outpatient visits. Narrow network plans can reduce costs to beneficiaries without affecting the volume of outpatient visits, if appropriate incentives to visit participating providers are followed.