Impact of dementia on costs of modifiable comorbid conditions.

OBJECTIVES: To use the CMS 5% data sample to explore the impact of Alzheimer disease and other dementias (ADOD) on individual and population costs of certain potentially modifiable comorbid conditions, in order to assist in the design of population health management (PHM) programs for individuals with ADOD. STUDY DESIGN: A cross-sectional retrospective analysis was performed on parts A and B claims data of 1,056,741 Medicare beneficiaries 65 years and older with service dates in 2010. METHODS: The primary analysis compared the prevalence and costs of 15 comorbid conditions among those with and without ADOD in the entire sample of 1,056,741; in addition, a subset of beneficiaries without ADOD were matched by age, sex, and race on a 1:1 basis to beneficiaries with ADOD. Prevalence and cost ratios were calculated to examine the impact of potentially modifiable study comorbid conditions in both populations. RESULTS: The prevalence of ADOD in the entire sample was 9.4%, and their costs represented 22.8% of the total. In the matched sample, all 15 comorbid conditions chosen for the study were more prevalent and showed higher mean individual costs in beneficiaries with ADOD compared with those without. The ADOD population also had higher costs and prevalence than the non-ADOD population when single comorbid conditions were examined separately. Study conditions with the highest individual cost ratios were urinary tract infections (UTIs), diabetes with complications, and fractures. Study conditions with the highest population cost ratios were fractures, UTIs, and diabetes without complications. CONCLUSIONS: Prevalence and costs of all study comorbidities were higher in beneficiaries with ADOD compared with those without. Individual cost ratios and population cost ratios may be useful for PHM programs trying to cost-effectively manage individuals with ADOD and comorbid chronic conditions.

Loss of confidence in diabetes management.

UNLABELLED: Using current treatment approaches, many patients with type 2 diabetes do not achieve glycemic goals--and do experience macrovascular complications that contribute to morbidity and mortality. It's time to consider other options. IMPLICATIONS: Aggressive therapeutic interventions aimed at insulin resistance and cell dysfunction may alter outcomes. Managed care organizations may need to modify the way they look at diabetes and should consider changing their focus from drug costs to wellness. Value-based insurance design may provide opportunities to optimize diabetes management, resulting in improved outcomes for patients and economic benefits for managed care organizations.

Outcomes research priorities in chronic care: a private purchaser perspective.

Private purchasers would benefit from outcomes research in chronic care that could inform their purchasing activities, including benefit design decisions. This article presents 1 purchaser's perspective on 10 areas of research of interest to the purchasing community.

Determining the value of disease management programs.

BACKGROUND: Increasing prevalence, rising costs, and persisting deficiencies in quality of care for chronic diseases pose economic and policy challenges to providers and purchasers. Disease management (DM) programs may address these challenges, but neither purchasers nor providers can assess their value. The potpourri of current quality indicators provides limited insight into the actual clinical benefit achieved. A conference sponsored by the Agency for Healthcare Research and Quality (AHRQ) and held in October 2002 explored new approaches to measuring and reporting the value of DM for diabetes mellitus. RESULTS: Quantifying the value of DM requires measuring clinical benefit and net impact on health care costs for the entire population with diabetes. If quality is measured with indicators that are clearly linked to outcomes, clinical benefit can be estimated. Natural history models combine the expected benefits of improvements in multiple indicators to yield a single, composite measure, the quality-adjusted life-year. Such metrics could fairly express, in terms of survival and complications prevention, relatively disparate DM programs' benefits. Measuring and comparing health care costs requires data validation and appropriate case-mix adjustment. Comparing value across programs may provide more accurate assessments of performance, enhance quality improvement efforts within systems, and contribute generalizable knowledge on the utility of DM approaches. CONCLUSIONS: Conference attendees recommended pilot projects to further explore use of natural history models for measuring and reporting the value of DM.

Screening for colorectal cancer: the business case.

Colorectal cancer screening is advocated by expert groups based on strong evidence of effectiveness, yet only approximately 1 in 3 Americans are screened. For a screening program to be effective, it is necessary for providers to offer and patients to accept screening, insurers to pay for screening, and provider groups to have monitoring and reminder systems and the expertise and facilities to perform the tests well. Whether and when such screening programs become successful depends on the priorities of healthcare decision makers as much as on the efforts of individual physicians and patients. There are strong arguments for decision makers giving colorectal cancer screening programs high priority: it saves as many lives as other services now in common use; it is a good use of scarce resources, costing less than $20,000 per year of life saved; and members of insurance programs increasingly expect screening benefits and programs, and failure to offer them might lead to member dissatisfaction and malpractice claims. Screening is costly, however, taking into account the cost of screening, follow-up tests, and treatments, and the costs occur many years before the benefits. Programs that are promoted to members but not fully implemented could create disappointment and backlash. Also, this screening can cause medical complications. Nevertheless, successful programs have been developed, proving that they are feasible in today's cost-conscious environment. We believe that colorectal cancer screening programs are integral to any organization purporting to provide high-quality care. Organizations without such programs should give them high priority for implementation.