Changes In Health Care Spending Research Articles

Trends in health care spending on kidney cancer in the United States, 1996-2016.

Paradigm shifts in kidney cancer management have led to higher health care spending. Here, total and per capita health care spending and primary drivers of change in health expenditures for kidney cancer in the United States between 1996 and 2016 are estimated. Public databases developed by the Institute for Health Metrics and Evaluation for the Disease Expenditure Project were used. The prevalence of kidney cancer was estimated from the Global Burden of Disease Study. Changes in health care spending on kidney cancer were assessed by joinpoint regression and expressed as annual percent changes (APCs). In 2016, total health care spending on kidney cancer was $3.42 billion (95% CI, $2.91 billion to $3.89 billion) compared with $1.18 billion (95% CI, $1.07 billion to $1.31 billion) in 1996. Per capita spending had two inflection points in 2005 and 2008, close to the approval years of targeted therapies, which corresponded to APCs of +2.9% (95% CI,+2.3% to +3.6%; p<.001) per year, 1996-2005; +9.2% (95% CI,+3.4% to +15.2%; p=.004) per year, 2005-2008; and +3.1% (95% CI,+2.2% to +3.9%; p<.001) per year, 2008-2016. Inpatient care was the largest contributor to health expenditures, which accounted for $1.56 billion (95% CI, $1.19 billion to $1.95 billion) in 2016. Price and intensity of care was the primary driver of increased health expenditures, whereas service utilization was the primary driver of reduced health expenditures. Prevalence-adjusted health care spending on kidney cancer continues to rise in the United States, which is primarily attributable to inpatient care and driven by the price and intensity of care over time.

Examining annual transitions in healthcare spending among U.S. medicare beneficiaries using multistate Markov models: Analysis of medicare current beneficiary survey data, 2003–2019

Many studies have examined factors associated with individuals of high or low healthcare spending in a given year. However, few have studied how healthcare spending changes over multiple years and which factors are associated with the changes. In this study, we examined the dynamic patterns of healthcare spending over a three-year period, among a nationally representative cohort of Medicare beneficiaries in the U.S. and identified factors associated with these patterns. We extracted data for 30,729 participants from the national Medicare Current Beneficiary Survey (MCBS), for the period 2003–2019. Using multistate Markov (MSM) models, we estimated the probabilities of year-to-year transitions in healthcare spending categorized as three states (low (L), medium (M) and high (H)), or to the terminal state, death. The participants, 13,554 (44.1%), 13,715 (44.6%) and 3,460 (11.3%) were in the low, medium and high spending states at baseline, respectively. The majority of participants remained in the same spending category from one year to the next (L-to-L: 76.8%; M-to-M: 71.7%; H-to-H: 56.6 %). Transitions from the low to high spending state were significantly associated with older age (75–84, ≥85 years), residing in a long-term care facility, greater assistance with activities of daily living, enrollment in fee-for-service Medicare, not receiving a flu shot, and presence of specific medical conditions, including cancer, dementia, and heart disease. Using data from a large population-based longitudinal survey, we have demonstrated that MSM modelling is a flexible framework and useful tool for examining changes in healthcare spending over time.

An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs

To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States. Observational retrospective cohort study with propensity score matching of treated and control groups. Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months. The study included 1800 adults with substance use disorder (SUD), anxiety, or depression who were eligible for the intervention. Treated members (n = 900) graduated from the program. Matched control members (n = 900) were eligible but never enrolled. Primary outcomes included all-cause and disease-attributable health care cost and utilization PMPM, categorized by place of service. There were statistically significant reductions in total all-cause medical costs of $485 PMPM (P < .001) and a 66% pre-post reduction in inpatient encounters, with $488 PMPM DID savings for inpatient admissions (P < .001) among the treated cohort compared with the control cohort over 36 months. Conversely, there were statistically significant cost increases ($110 PMPM; P < .001) for all-cause office visits in the treated cohort compared with the control cohort. Similar results were seen in SUD-attributable and BH-attributablecosts. Although the results could be affected by unmeasured confounding, they suggest that care coaching interventions that offer BH provider referrals may produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat BH conditions. Rigorous evaluations are needed to confirm these findings.

Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members.

Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members.

Association of Private Equity Acquisition of Physician Practices With Changes in Health Care Spending and Utilization

Private equity acquisitions of physician practices in the US have been increasing rapidly; however, the implications for health care delivery and spending are unclear. To examine changes in prices and utilization associated with private equity acquisitions of physician practices across multiple specialties. This was a difference-in-differences event study of US physician practices specialized in dermatology, gastroenterology, and ophthalmology that were acquired by private equity firms from 2016 to 2020. Within each specialty, each private equity-acquired (PE-acquired) practice was matched with as many as 5 control practices based on the preacquisition number of unique patients, encounters, risk score, share of services billed out-of-network, and spending. The PE-acquired practices were compared with matched controls through year 2 after acquisition, using a difference-in-differences event study. Data analyses were performed from March 2021 to February 2022. Private equity acquisition of physician practices. Measures of spending and utilization, including the charge and price (amount paid) per claim, new and unique patients, and total encounters. Compared with the 2874 control practices, the 578 PE-acquired physician practices exhibited an average increase of $71 (+20.2%) charged per claim (95% CI, 13.1%-27.3%; P < .001) and $23 (+11.0%) in the allowed amount per claim (95% CI, 5.6%-16.5%; P < .001). The PE-acquired practices increased their numbers of unique patients seen by 25.8% (95% CI, 15.8%-35.6%; P < .001) compared with control practices, driven by a 37.9% increase in visits by new patients (95% CI, 25.6%-50.2%; P < .001). In aggregate, their volume of encounters increased by 16.3% (95% CI, 1.0%-32.0%; P = .04) compared with the control group, with a 9.4% increase in the share of office visits for established patients that were billed as longer than 30 minutes (95% CI, 1.7%-17.0%; P = .02). No statistically significant changes in patient risk scores were found between PE-acquired practices and controls. Within specialties, we found modest differences along selected outcomes. In this difference-in-differences study, private equity acquisition of physician practices in dermatology, gastroenterology, and ophthalmology were associated with differential increases in allowed amount and charges per claim, volume of encounters, and new patients seen, as well as some changes in billing and coding.

Changes in Health Care Spending, Use, and Clinical Outcomes After Nonfatal Firearm Injuries Among Survivors and Family Members : A Cohort Study.

Despite increasing awareness of firearm-related deaths, evidence on the clinical and economic implications of nonfatal firearm injuries is limited. To measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members. Cohort study. MarketScan Medicare and commercial claims data, 2008 to 2018. 6498 survivors of firearm injuries matched to 32490 control participants and 12489 family members of survivors matched to 62445 control participants. Exposure to nonfatal firearm injury as a survivor or family member of a survivor. Changes in health care spending, use, and morbidity from preinjury through 1 year postinjury relative to control participants, on average and by type and severity of firearm injury. After nonfatal firearm injury, medical spending increased $2495 per person per month (402%) and cost sharing increased $102 per person per month (176%) among survivors relative to control participants (P < 0.001) in the first year after injury, driven by an increase in the first month of $25554 (4122%) in spending and $1112 (1917%) in cost sharing per survivor (P<0.001). All categories of health care use increased relative to the control group. Survivors had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders after firearm injury relative to control participants (P < 0.001), accompanied by increased pain and psychiatric medications. Family members had a 12% increase in psychiatric disorders relative to their control participants (P = 0.003). These overall clinical and economic changes were driven by intentional firearm injuries and more severe firearm injuries. Precision of diagnostic codes and generalizability to other patient populations, including Medicaid and uninsured patients. In survivors, nonfatal firearm injuries led to increases in psychiatric disorders, substance use disorders, and pain diagnoses, alongside substantial increases in health care spending and use. In addition, mental health worsened among family members. National Institutes of Health.

Out-of-pocket spending and financial burden among low income adults after Medicaid expansions in the United States: quasi-experimental difference-in-difference study

ObjectiveTo examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of...

Cardiologist Participation in Accountable Care Organizations and Changes in Spending and Quality for Medicare Patients With Cardiovascular Disease.

Despite widespread adoption of Medicare accountable care organizations (ACOs), healthcare spending reductions have been modest. This may relate to variable participation in ACOs by specialist physicians, who disproportionately drive spending. To examine whether specialist participation in Medicare ACOs was associated with changes in healthcare spending and clinical quality, we analyzed national Medicare data. Working with a 20% random sample of Medicare beneficiaries (2008 to 2015), we identified those with cardiovascular disease. We estimated linear regression models at the beneficiary-quarter level to evaluate changes in healthcare spending and clinical quality after the start of the Shared Savings Program in 2012. We then examined whether changes in spending and quality across ACOs were conditional on cardiologist participation. Our study included ≈1.6 million beneficiaries per year. Although the number of ACOs increased over the study period (from 114 in 2012 to 392 in 2015), the proportion with any cardiologist participation remained stable (from 80% in 2012 to 83% in 2015). Compared with unaligned beneficiaries, those cared for by ACOs without cardiologist participation were associated with a spending reduction (per quarter) of -$75 (95% CI, -$105 to -$46; P<0.001). Care receipt in an ACO with cardiologist participation was associated with an additional difference in spending of -$56 (95% CI, -$87 to -$25; P<0.001), driven by lower spending for skilled nursing facilities, evaluation and management services, procedural care, and testing. While heart failure admission rates were similar among aligned and unaligned beneficiaries, ACO care was associated with fewer all-cause readmissions (P<0.001) and emergency department visits (P<0.001). Rates of these outcomes did not vary by cardiologist participation. Annual spending for beneficiaries with cardiovascular disease was ≈$200 lower when cared for by ACOs with cardiologist participation (compared with those without). These spending reductions did not come at the expense of clinical quality.

Quantifying Overinsurance Tied to the Tax Exclusion for Employment-Based Health Insurance and Its Variation by Health Status.

The exclusion of employment-based health insurance from income and payroll taxes is thought to increase the generosity of insurance coverage and, in turn, increase the overutilization of low-value health care services. We examine this inefficiency of overinsurance by quantifying the change in expected utility across 4 benchmark plans varying in actuarial value (AV) and focus on the distribution of each of these estimates across different groups of people varying in health status. Specifically, we quantify the changes in health care spending due to moral hazard and the changes in uncertainty tied to risk aversion using data from the nationally representative sample of adults with employment-based coverage from the 2007-2016 Medical Expenditure Panel Survey, and produce estimates of expected utility for 24 groups of people based on their age, gender, and preexisting conditions. Our model suggests an average preferred AV of 78% without the tax exclusion, with 29.0% of the population preferring a 60% AV, 6.5% preferring a 70% AV, 18.1% preferring an 80% AV, and 46.4% preferring a 90% AV. When incorporating the distortionary effect of the employment-based tax exclusion, the preferred plan increases to an 83% AV for low-income people (with 71.0% of the population preferring a 90% AV) and an 84% AV for high-income people (with 76.0% of the population preferring a 90% AV). We estimate that policy changes to make subsidies independent of a plan’s AV could result in increases in utility equal to about 2.7% of total health care spending, but with those net gains concentrated among the healthy.

Factors Associated With Increases in US Health Care Spending, 1996-2013

Health care spending in the United States increased substantially from 1995 to 2015 and comprised 17.8% of the economy in 2015. Understanding the relationship between known factors and spending increases over time could inform policy efforts to contain future spending growth. To quantify changes in spending associated with 5 fundamental factors related to health care spending in the United States: population size, population age structure, disease prevalence or incidence, service utilization, and service price and intensity. Data on the 5 factors from 1996 through 2013 were extracted for 155 health conditions, 36 age and sex groups, and 6 types of care from the Global Burden of Disease 2015 study and the Institute for Health Metrics and Evaluation's US Disease Expenditure 2013 project. Decomposition analysis was performed to estimate the association between changes in these factors and changes in health care spending and to estimate the variability across health conditions and types of care. Change in population size, population aging, disease prevalence or incidence, service utilization, or service price and intensity. Change in health care spending from 1996 through 2013. After adjustments for price inflation, annual health care spending on inpatient, ambulatory, retail pharmaceutical, nursing facility, emergency department, and dental care increased by $933.5 billion between 1996 and 2013, from $1.2 trillion to $2.1 trillion. Increases in US population size were associated with a 23.1% (uncertainty interval [UI], 23.1%-23.1%), or $269.5 (UI, $269.0-$270.0) billion, spending increase; aging of the population was associated with an 11.6% (UI, 11.4%-11.8%), or $135.7 (UI, $133.3-$137.7) billion, spending increase. Changes in disease prevalence or incidence were associated with spending reductions of 2.4% (UI, 0.9%-3.8%), or $28.2 (UI, $10.5-$44.4) billion, whereas changes in service utilization were not associated with a statistically significant change in spending. Changes in service price and intensity were associated with a 50.0% (UI, 45.0%-55.0%), or $583.5 (UI, $525.2-$641.4) billion, spending increase. The influence of these 5 factors varied by health condition and type of care. For example, the increase in annual diabetes spending between 1996 and 2013 was $64.4 (UI, $57.9-$70.6) billion; $44.4 (UI, $38.7-$49.6) billion of this increase was pharmaceutical spending. Increases in US health care spending from 1996 through 2013 were largely related to increases in health care service price and intensity but were also positively associated with population growth and aging and negatively associated with disease prevalence or incidence. Understanding these factors and their variability across health conditions and types of care may inform policy efforts to contain health care spending.

Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis.

IntroductionWe sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities.MethodsWomen aged 18–49 years with endometriosis (N = 180,278) were extracted from 2006–2015 de-identified Clinformatics® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient’s index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre–post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis.ResultsThe number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren’s/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p < 0.001 except for headache (p = 0.045)]. Spending decreased significantly for fatigue, cystitis/UTI, and eczema [p < 0.001 except for fatigue (p = 0.048)] and was not statistically different for the other 11 comorbidities. Difference-in-differences estimates were significantly higher for comorbidity patients for all comorbidities except eczema (p ≤ 0.003). Mean 5-year total cumulative spending was $58,191 per endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims.ConclusionFor all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending.FundingAbbVie Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s12325-017-0630-8) contains supplementary material, which is available to authorized users.

Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study.

Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. European Union countries 1995-2010. Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening population health.

Changes in Health Care Spending and Quality 4 Years into Global Payment

BackgroundSpending and quality under global budgets remain unknown beyond 2 years. We evaluated spending and quality measures during the first 4 years of the Blue Cross Blue Shield of Massachusetts Alternative Quality Contract (AQC).MethodsWe compared spending and quality among enrollees whose physician organizations entered the AQC from 2009 through 2012 with those among persons in control states. We studied spending changes according to year, category of service, site of care, experience managing risk contracts, and price versus utilization. We evaluated process and outcome quality.ResultsIn the 2009 AQC cohort, medical spending on claims grew an average of $62.21 per enrollee per quarter less than it did in the control cohort over the 4-year period (P<0.001). This amount is equivalent to a 6.8% savings when calculated as a proportion of the average post-AQC spending level in the 2009 AQC cohort. Analogously, the 2010, 2011, and 2012 cohorts had average savings of 8.8% (P<0.001), 9.1% (P<0.001), and 5.8% (P=0.04), respectively, by the end of 2012. Claims savings were concentrated in the outpatient-facility setting and in procedures, imaging, and tests, explained by both reduced prices and reduced utilization. Claims savings were exceeded by incentive payments to providers during the period from 2009 through 2011 but exceeded incentive payments in 2012, generating net savings. Improvements in quality among AQC cohorts generally exceeded those seen elsewhere in New England and nationally.ConclusionsAs compared with similar populations in other states, Massachusetts AQC enrollees had lower spending growth and generally greater quality improvements after 4 years. Although other factors in Massachusetts may have contributed, particularly in the later part of the study period, global budget contracts with quality incentives may encourage changes in practice patterns that help reduce spending and improve quality. (Funded by the Commonwealth Fund and others.)

Targeting housing mobility vouchers to help families with children.

Targeting housing mobility vouchers to help families with children.

Editorial: Welcome to Molecular Endocrinology: Pitfalls and Promises for the Future

Iwant to be the first to welcome all of the readers of Molecular Endocrinology to our new era of electroniconly publishing! These are exciting times for our journal, and I am thrilled that I have been given the opportunity to play even a small role in helping to steer the Endocrine Society journals into the next phase of scientific publishing. That said, these are dangerous and complex times for our entire profession, including basic scientists, clinical researchers, clinician educators, and full-time clinicians. The perfect storm is rising, and it is unclear what we should be doing to prepare for it. Due to stagnant budgets and complex spending strategies, the National Institutes of Health is funding R01s in the 8%–10% range with no sign of any changes in the near future. Industry has significantly stripped down its basic, translational, and clinical research ventures due to budget concerns and fear of making long-term investments in new products. With the Affordable Care Act and other changes in health care spending, hospitals and clinical practices have no idea from where their future income will come. Finally, there is talk of reducing fellowship slots in subspecialties to make more room for primary care and hospitalist residency positions. This has the potential of reducing endocrinology fellowship positions at a time when endocrinologists are already an underrepresented commodity. With all these changes, academic endocrinology is taking a huge hit because some of our best and brightest young (and older) minds are opting out of academic careers for fear of the unknown future. To deal with the chaos and uncertainty swirling around us, it is critical that the Endocrine Society play a leadership role in keeping academic endocrinology moving forward. With this in mind, our goal for Molecular Endocrinology is to do our best to support basic scientists doing endocrine-related research. Just as previous editors have emphasized, the new Editorial Board understands that the main purpose of Molecular Endocrinology is to serve as a supportive forum for endocrine researchers to publish and advertise their research. Similarly, Molecular Endocrinology serves as a resource to Society members and others to read about the latest exciting basic research in the field of endocrinology. To best achieve these goals, we are making several exciting changes. First, as mentioned above, Molecular Endocrinology is moving to an online-only format. Benefits for our authors include faster time from submission to publication, flexibility with regard to the number of papers published per month, and more interactive options to link journal articles with related web sites. In addition, the cost of publication will be reduced because color charges will be eliminated. A second change will be the start of a new article type called Rapid Communications. The purpose of this new option is to provide researchers with an opportunity to rapidly publish new and exciting high-impact data. These papers will be shorter (three to four figures), will be reviewed rapidly (within 2 weeks), and, if accepted, will require minimal changes. These papers will be freely available and will often be featured on the Molecular Endocrinology web site as well by the Endocrine Press. More details will follow soon with regard to this exciting new feature offered by Molecular Endocrinology. A third change will be the selection of a monthly featured article. This will substitute for the traditional cover art that will be less meaningful after going to an onlineonly format. We will feature selected articles and authors on the Molecular Endocrinology web site, using photos, figures, interviews, and possibly videos. We hope that this feature will give our authors, particularly the trainees,

Changes in Health Care Spending and Quality for Medicare Beneficiaries Associated With a Commercial ACO Contract

In a multipayer system, new payment incentives implemented by one insurer for an accountable care organization (ACO) may also affect spending and quality of care for another insurer's enrollees served by the ACO. Such spillover effects reflect the extent of organizational efforts to reform care delivery and can contribute to the net impact of ACOs. We examined whether the Blue Cross Blue Shield (BCBS) of Massachusetts' Alternative Quality Contract (AQC), an early commercial ACO initiative associated with reduced spending and improved quality for BCBS enrollees, was also associated with changes in spending and quality for Medicare beneficiaries, who were not covered by the AQC. Quasi-experimental comparisons from 2007-2010 of elderly fee-for-service Medicare beneficiaries in Massachusetts (1,761,325 person-years) served by 11 provider organizations entering the AQC in 2009 or 2010 (intervention group) vs beneficiaries served by other providers (control group). Using a difference-in-differences approach, we estimated changes in spending and quality for the intervention group in the first and second years of exposure to the AQC relative to concurrent changes for the control group. Regression and propensity score methods were used to adjust for differences in sociodemographic and clinical characteristics. The primary outcome was total quarterly medical spending per beneficiary. Secondary outcomes included spending by setting and type of service, 5 process measures of quality, potentially avoidable hospitalizations, and 30-day readmissions. Before entering the AQC, total quarterly spending per beneficiary for the intervention group was $150 (95% CI, $25-$274) higher than for the control group and increased at a similar rate. In year 2 of the intervention group's exposure to the AQC, this difference was reduced to $51 (95% CI, -$109 to $210; P = .53), constituting a significant differential change of -$99 (95% CI, -$183 to -$16; P = .02) or a 3.4% savings relative to an expected quarterly mean of $2895. Savings in year 1 were not significant (differential change, -$34; 95% CI, -$83 to $16; P = .18). Year 2 savings derived largely from lower spending on outpatient care (differential change, -$73; 95% CI, -$97 to -$50; P < .001), particularly for beneficiaries with 5 or more conditions, and included significant differential changes in spending on procedures, imaging, and tests. Annual rates of low-density lipoprotein cholesterol testing differentially improved for beneficiaries with diabetes in the intervention group by 3.1 percentage points (95% CI, 1.4-4.8 percentage points; P < .001) and for those with cardiovascular disease by 2.5 percentage points (95% CI, 1.1-4.0 percentage points; P < .001), but performance on other quality measures did not differentially change. The AQC was associated with lower spending for Medicare beneficiaries but not with consistently improved quality. Savings among Medicare beneficiaries and previously demonstrated savings among BCBS enrollees varied similarly across settings, services, and time, suggesting that organizational responses were associated with broad changes in patient care.

A physician led approach to telehealth-enabled care coordination: innovation in reimbursement and delivery system models to support physician engagement

Introduction: The U.S. study, entitled, ‘Integrated Telehealth and Care Management Program for Medicare Beneficiaries with Chronic Disease Linked to Savings’ (Health Affairs, September 2011), explored the economic impact of using content-based remote patient monitoring combined with physician led patient-centred care management for high cost patients with congestive heart failure, chronic obstructive pulmonary disease and/or diabetes mellitus. Researchers conducted an analysis evaluating changes in healthcare spending resulting from physician led patient-centred care management supported by remote patient monitoring (n=1767) and demonstrated spending reductions of 7.7–13.3% (£197.17–£342.52) per intervention patient in acute hospital cost per quarter over the two-year period studied. In addition, significant mortality differences between the treatment and control groups were noted, which suggest that the intervention may have produced noticeable Improvements/changes in health outcomes. Aim and objectives: the presentation will outline the: 1. Findings from the analysis of the two-year study that could guide the design of future innovative physician led telehealth-enabled care coordination projects in the UK. Parallels between the proposed UK local health system model as described by the Health and social care bill and the Medicare 2. system in the US in the context of an innovative community-based physician led telehealth enabled integrated system of care. Design and deployment of a system of care utilizing content-based telehealth technology to enable physician led integrated care 3. coordination. Results: In an intent-to-treat population of 1725 patients, a reduction in critical aspects in utilization including hospitalization and A and E resulted in improved quality, satisfaction and cost outcomes for the patients and providers in the local region. Conclusion: Innovative reimbursement models drove physician led telehealth enabled care coordination that generated reductions in key utilization and cost while optimizing health status. The intervention also generated substantive efficiency improvements that led to substantive cost savings.

Mental Health Spending by Private Insurance: Implications for the Mental Health Parity and Addiction Equity Act

The study developed information on behavioral health spending and utilization that can be used to anticipate, evaluate, and interpret changes in health care spending following implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA). Data were from the Thomson Reuters' MarketScan database of insurance claims between 2001 and 2009 from large group health plans sponsored by self-insured employers. Annual rates in growth of total health spending and behavioral health spending and the contribution of behavioral health spending to growth in spending for all diseases were determined. Separate analyses examined behavioral health and total health spending by 135 employers in 2008 and 2009, and simulations were conducted to determine how increases in use of mental health services after implementation of parity would affect overall health care expenditures. Across the nine years examined, behavioral health expenditures contributed .3%, on average, to the total rate of growth in all health expenditures, a contribution that fell to .1%, on average, when prescription drugs were excluded. About 2% of employers experienced an increased contribution by behavioral health spending of more than 1%. More than 90% of enrollees used well below the maximum 30 inpatient days or outpatient visits typical of health insurance plans before parity. Simulations indicated that even large increases in utilization would increase total health care expenditures by less than 1%. The MHPAEA is unlikely to have a large effect on the growth rate of employers' health care expenditures. The data provide baseline information to further evaluate the implementation effect of the MHPAEA.

Cryosurgery for Cutaneous Malignancy An Update

Cryosurgery is a successful modality for destruction of basal and squamous cell carcinomas. There is a trend toward more aggressive freezing of lesions and treatment of selected difficult tumors. The indications and advantages for cryosurgery, recent treatment techniques, tissue response, complications, and results merit description. The standard method of treatment is used with aggressive freezing of the lesion, including a greater lateral spread of freeze and attainment of lower tissue temperatures. The cure rate of cryosurgery is high and the cosmetic results are good to excellent. The results of cryosurgery are comparable with other modalities. It may be preferable or advantageous for some patients because of the quickness and safety of the procedure and its low cost. With changes in health care spending due to law or regulation, and within the environment of a managed care system, dermatologists may choose cryosurgery on the basis of outcome and cost.