Lower Health Care Expenditures Research Articles

Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations

Racial concordance between patients and clinician has been linked to improved satisfaction and patient outcomes. (1) To examine the likelihood of clinician-patient racial concordance in non-Hispanic White, non-Hispanic Black, Asian, and Hispanic patients and (2) to evaluate the impact of patient-clinician race concordance on healthcare use and expenditures within each racial ethnic group. We analyzed data from the 2010-2016 Medical Expenditure Panel Survey (MEPS). We used bivariate and multivariate models to assess the association between patient-clinician race concordance and emergency department (ED) use, hospitalizations, and total healthcare expenses, controlling for patient socio-demographic factors, insurance coverage, health status, and survey year fixed effects. Of the 50,626 adults in the analysis sample, 32,350 had racial concordance with their clinician. Among Asian and Hispanic patients, low income, less education, and non-private insurance were associated with an increased likelihood of patient-clinician racial concordance. Emergency department use was lower among Whites and Hispanics with concordant clinicians compared to those without a discordant clinician (15.6% vs. 17.3%, p= 0.02 and 12.9% vs. 16.2%, p= 0.01 respectively). Total healthcare expenditures were lower among Black, Asian, and Hispanic patients with race-concordant clinicians than those with discordant clinicians (14%, 34%, and 20%, p< 0.001 respectively). These results add to the body of evidence supporting the hypothesis that racial concordance contributes to a more effective therapeutic relationship and improved healthcare. These results emphasize the need for medical education surrounding cultural humility and the importance of diversifying the healthcare workforce.

Going beyond the mean: economic benefits of myocardial infarction secondary prevention

BackgroundUsing the example of secondary prophylaxis of myocardial infarction (MI), our aim was to establish a framework for assessing cost consequences of compliance with clinical guidelines; thereby taking cost trajectories and cost distributions into account.MethodsSwiss mandatory health insurance claims from 1840 persons with hospitalization for MI in 2014 were analysed. Included persons were predominantly male (74%), had a median age of 73 years, and 71% were pre-exposed to drugs for secondary prophylaxis, prior to index hospitalization. Guideline compliance was defined as being prescribed recommended 4-class drug prophylaxis including drugs from the following four classes: beta-blockers, statins, aspirin or P2Y12 inhibitors, and angiotension-converting enzyme inhibitors or angiotensin receptor blockers. Health care expenditures (HCE) accrued over 1 year after index hospitalization were compared by compliance status using two-part regression, trajectory analysis, and counterfactual decomposition analysis.ResultsOnly 32% of persons received recommended 4-class prophylaxis. Compliant persons had lower HCE (− 4865 Swiss Francs [95% confidence interval − 8027; − 1703]) and were more likely to belong to the most favorable HCE trajectory (with 6245 Swiss Francs average annual HCE and comprising 78% of all studied persons). Distributional analyses showed that compliance-associated HCE reductions were more pronounced among persons with HCE above the median.ConclusionsCompliance with recommended prophylaxis was robustly associated with lower HCE and more favorable cost trajectories, but mainly among persons with high health care expenditures. The analysis framework is easily transferrable to other diseases and provides more comprehensive information on HCE consequences of non-compliance than mean-based regressions alone.

Association of cardiovascular risk profile with healthcare expenditure and resource utilization in chronic obstructive pulmonary disease, with and without atherosclerotic cardiovascular disease

ObjectiveAtherosclerotic cardiovascular disease (ASCVD) and chronic obstructive pulmonary disease (COPD) are among the leading causes of morbidity, mortality, and economic burden in the United States (US). While previous reports have shown that an optimal cardiovascular risk factor (CRF) profile is associated with improved outcomes among COPD patients, the impact of ASCVD and CRF on healthcare costs and resource utilization is not well described. MethodsThe Medical Expenditure Panel Survey (MEPS) database was used from 2011 to 2016 to study healthcare expenditure for COPD patients with and without ASCVD and across CRF profiles in a nationally representative population of adults in the United States. ResultsThe study population consisted of 14,807 adults with COPD, representing 28 million cases annually. Presence of ASCVD was associated with higher reported expenditure across the spectrum of CRF profiles among those with COPD. On average, after adjusting for confounders, presence of ASCVD represented a mean difference per capita of $5438 (95% CI $4121 - $6754; p ​< ​0.001). Mean per capita expenditures were significantly higher comparing poor vs optimal CRF profiles, with marginal expenditures of $8552 and $6531 among those with and without ASCVD, respectively. When comparing individuals with ASCVD and poor CRF profile versus individuals without ASCVD and optimal CRF profile, those in the latter group used 13% fewer prescription medications and required 24% fewer hospitalizations. Furthermore, an optimal CRF profile was associated with lower odds of most sources of healthcare utilization regardless of ASCVD status. ConclusionAn absence of ASCVD and a favorable CRF profile was associated with lower healthcare expenditure and resource utilization among patients with COPD. These results provide robust estimates for potential healthcare savings as preemptive strategies continue to become integrated into new healthcare delivery models, for increased awareness and the need for improvement of CRF profiles among high-risk patients.

The Role of Incremental Peritoneal Dialysis in the Era of the Advancing American Kidney Health Initiative.

On July 10, 2019, President Trump signed the Advancing American Kidney Health (AAKH) Executive Order—an order that aims to shift care delivery for kidney failure to patient-centered home therapies ([1][1]). One main goal of AAKH is for 80% of patients with incident kidney failure to receive a

Is the economic and social cost of one-stage bilateral hip resurfacing lower than two-stage procedures? Retrospective case-control study of 260 hips

BackgroundStudies on the economic impact of medical practices and estimates of intra- and extra-hospital costs have an important role in controlling healthcare spending. But few studies of this nature have been done for bilateral surgery in a single operative session. This led us to carry out a health economics study to determine whether (1) bilateral hip resurfacing arthroplasty (HRA) performed in one stage instead of two stages will reduce the health care expenditures (costs of hospitalization, medical leave, rehabilitation), (2) it is equally safe for the patient.Hypothesis One-stage bilateral HRA is less costly for the health care system than two-stage bilateral resurfacing. MethodsThis was a single-center, single-surgeon retrospective cohort study comparing patients who underwent bilateral HRA in one stage (53 cases) or in two stages (77 cases). We determined the intra-hospital costs based on the French National Cost Scales and the extra-hospital costs (medical leave and rehabilitation), perioperative data (blood loss, operation time, duration of narcotic analgesic use, medical and surgical complications) and the outcomes with a mean follow-up of 4.8 years [1.7–10.1]. ResultsThe total costs for the one-stage group (€16,840.94±7042.7) were significantly less than those of the two-stage group (€19,335.0±7296.9) (p=0.0101). The two groups were comparable except for the one-stage group having more primary hip osteoarthritis indications (72% (38/53)) than the two-stage group (49% (38/77)) (p=0.0111). The main differences between groups was the cost and duration of hospitalization, with cost of €10,546.06±2049.47 and average length of stay (ALS) of 9.83±2.19 days in the one-stage group and €13,569.49±2186.30, ALS=15.04±3.15 days in the two-stage group (p<0.0001). There was no significant difference in the length of medical leave: 67.15±50.36 (0–180) days for the one-stage group and 97.89±108.39 (0–730) days for the two-stage group (p=0.1933). ConclusionPerforming bilateral HRA during a single hospital stay results in lower health care expenditures than performing it during two separate hospital stays. Similar studies on other surgical procedures could help to promote the simultaneous nature of bilateral procedures and reset the current pricing, which is currently too low in the French health care system. Level of evidenceIII, Retrospective case-control study.

Ethnic Disparities in Use of Bariatric Surgery in the USA: the Experience of Native Americans

PurposeTo examine disparities in use of bariatric surgery in the USA with particular focus on the experience of Native Americans.Materials and MethodsMultivariable logistic regression models were applied to the hospital discharge HCUP-NIS dataset (2008–2016) in order to examine the influence of ethnicity in use of bariatric surgery while controlling for aspects of need, predisposing and enabling factors. Separate models investigated disparities in length of stay, cost and discharge to healthcare facility among patient episodes for bariatric surgery.ResultsFull data for 1,729,245 bariatric surgery eligible participants were extracted from HCUP-NIS. The odds of Native Americans receiving bariatric surgery compared to White Americans were 0.67 (95% CI, 0.62–0.73) in a model unadjusted for covariates; 0.65 (95% CI, 0.59–0.71) in a model adjusted for demography and insurance; 0.59 (95% CI, 0.54–0.64) in a model adjusted for clinical variables; and 0.72 (95% CI, 0.66–0.79) in a model adjusted for demographic, insurance types and clinical variables. Native Americans who underwent surgery had significantly shorter lengths of stay, lower healthcare expenditures and lower likelihood of discharge to other healthcare facilities relative to White Americans (controlling for covariates).ConclusionOur study, the first study to examine this subject, showed apparent variations in receipt of bariatric surgery between Native Americans and White Americans even after a range of covariates were controlled. In addition, Native Americans have shorter lengths of stay and significantly lower expenditures.

Patients with coronary artery disease after acute myocardial infarction: effects of continuous enrollment in a structured Disease Management Program on adherence to guideline-recommended medication, health care expenditures, and survival

ObjectiveAcute myocardial infarction (AMI) carries increased risk of mortality and excess costs. Disease Management Programs (DMPs) providing guideline-recommended care for chronic diseases seem an intuitively appealing way to enhance health outcomes for patients with chronic conditions such as AMI. The aim of the study is to compare adherence to guideline-recommended medication, health care expenditures and survival of patients enrolled and not enrolled in the German DMP for coronary artery disease (CAD) after an AMI from the perspective of a third-party payer over a follow-up period of 3 years.MethodsThe study is based on routinely collected data from a regional statutory health insurance fund (n = 15,360). A propensity score matching with caliper method was conducted. Afterwards guideline-recommended medication, health care expenditures, and survival between patients enrolled and not enrolled in the DMP were compared with generalized linear and Cox proportional hazard models.ResultsThe propensity score matching resulted in 3870 pairs of AMI patients previously and continuously enrolled and not enrolled in the DMP. In the 3-year follow-up period the proportion of days covered rates for ACE-inhibitors (60.95% vs. 58.92%), anti-platelet agents (74.20% vs. 70.66%), statins (54.18% vs. 52.13%), and β-blockers (61.95% vs. 52.64%) were higher in the DMP group. Besides that, DMP participants induced lower health care expenditures per day (€58.24 vs. €72.72) and had a significantly lower risk of death (HR: 0.757).ConclusionPrevious and continuous enrollment in the DMP CAD for patients after AMI is a promising strategy as it enhances guideline-recommended medication, reduces health care expenditures and the risk of death.

Association Between Bariatric Surgery and Long-term Health Care Expenditures Among Veterans With Severe Obesity

Bariatric surgery has been associated with improvements in health in patients with severe obesity; however, it is unclear whether these health benefits translate into lower health care expenditures. To examine 10-year health care expenditures in a large, multisite retrospective cohort study of veterans with severe obesity who did and did not undergo bariatric surgery. A total of 9954 veterans with severe obesity between January 1, 2000, and September 30, 2011, were identified from veterans affairs (VA) electronic health records. Of those, 2498 veterans who underwent bariatric surgery were allocated to the surgery cohort. Sequential stratification was used to match each patient in the surgery cohort with up to 3 patients who had not undergone bariatric surgery but were of the same sex, race/ethnicity, diabetes status, and VA regional network and were closest in age, body mass index (calculated as weight in kilograms divided by height in meters squared), and comorbidities. A total of 7456 patients were identified and allocated to the nonsurgery (control) cohort. The VA health care expenditures among the surgery and nonsurgery cohorts were estimated using regression models. Data were analyzed from July to August 2018 and in April 2019. The bariatric surgical procedures (n = 2498) included in this study were Roux-en-Y gastric bypass (1842 [73.7%]), sleeve gastrectomy (381 [15.3%]), adjustable gastric banding (249 [10.0%]), and other procedures (26 [1.0%]). The study measured total, outpatient, inpatient, and outpatient pharmacy expenditures from 3 years before surgery to 10 years after surgery, excluding expenditures associated with the initial bariatric surgical procedure. Among 9954 veterans with severe obesity, 7387 (74.2%) were men; the mean (SD) age was 52.3 (8.8) years for the surgery cohort and 52.5 (8.7) years for the nonsurgery cohort. Mean total expenditures for the surgery cohort were $5093 (95% CI, $4811-$5391) at 7 to 12 months before surgery, which increased to $7448 (95% CI, $6989-$7936) at 6 months after surgery. Postsurgical expenditures decreased to $6692 (95% CI, $6197-$7226) at 5 years after surgery, followed by a gradual increase to $8495 (95% CI, $7609-$9484) at 10 years after surgery. Total expenditures were higher in the surgery cohort than in the nonsurgery cohort during the 3 years before surgery and in the first 2 years after surgery. The expenditures of the 2 cohorts converged 5 to 10 years after surgery. Outpatient pharmacy expenditures were significantly lower among the surgery cohort in all years of follow-up ($509 lower at 3 years before surgery and $461 lower at 7 to 12 months before surgery), but these cost reductions were offset by higher inpatient and outpatient (nonpharmacy) expenditures. In this cohort study of 9954 predominantly older male veterans with severe obesity, total health care expenditures increased immediately after patients underwent bariatric surgery but converged with those of patients who had not undergone surgery at 10 years after surgery. This finding suggests that the value of bariatric surgery lies primarily in its associations with improvements in health and not in its potential to decrease health care costs.

Bold leadership is needed for transforming health care.

Health care in the United States is going through significant changes and is at the forefront of the political landscape. While the health care debate rages on, leaders need to forge ahead and continue to work towards population-based health care and investing in their communities in a fiscally conscious way. Many innovations are happening but more needs to be done, especially in upstream services improving the health of the community. Research shows that investing in social care services and community-based investments results in lower health care expenditures and better health outcomes. Efforts should be placed on exploring a blended medical/social model of care while considering blended funding sources wherein the community needs to be active participants in this explorative process.

Abstract 30: Association of Cardiovascular Risk Factor Profile with Financial Hardship from Medical Bills and Other Cost-Related Barriers to Care Among US Non-Elderly Adults: The National Health Information Survey 2013-2017

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a nation-wide crisis. Optimal cardiovascular risk factor (CRF) profile has been associated with lower mortality and morbidity, as well as lower healthcare expenditure and resource utilization. In this study, we examined the association of optimal CRF profile to financial hardship and other cost-related barriers to care, both with and without ASCVD. Methods: We used a nationally representative sample of non-elderly adults aged between 18-64 years from the National Health Interview Survey (2013-2017). We assessed atherosclerotic cardiovascular disease (ASCVD) status, CRF profile, financial hardship from medical bills, unable to pay bill at all, cost-related medication non-adherence, forgone/delayed care, and perceived financial distress from self-reported questionnaire. Results: A total of 119,388 individuals were included in the study. Individuals with ASCVD had financial hardship and inability to pay bills at 45% and 19%, respectively, significantly higher than those without ASCVD and optimal CRF profile at 24% and 6%, respectively. Similarly, the prevalence of other cost-related barriers to care was significantly higher among ASCVD (&gt;2-fold) compared to non-ASCVD with optimal CRF profile. Individuals without ASCVD and optimal CRF profile among low/poor income and uninsured had higher prevalence of all the outcomes when compared to ASCVD among high income and insured. Individuals without ASCVD and optimal CRF profile had lowest odds of financial hardship (OR 0.44, 95% CI 0.41, 0.48), inability paying bills (OR 0.30, 95% CI 0.26, 0.34), cost-related medication non-adherence (OR 0.42, 95% CI 0.38, 0.48), foregone/delayed care (OR 0.41, 95% CI 0.37, 0.45), and high financial distress (OR 0.52, 95% CI 0.47, 0.58) (Table). There were no significant differences in these outcomes when comparing individuals without ASCVD and poor CRF profile to those with ASCVD. Conclusion: Optimal CRF profile is strongly associated with lower prevalence of financial hardship and other cost-related barriers to care. Upfront investment of preventive health programs, especially among vulnerable populations, may improve overall health and decrease financial hardship.

Short-term budget affordability of hepatitis C treatments for state Medicaid programs

BackgroundWith some Medicaid state programs still restricting patient access to hepatitis C (HCV) treatment, it is important to demonstrate how states could expand treatment access to a broader Medicaid population and balance short-term budget concerns.MethodsWe used the HCV Transmission and Progression (TaP) Markov model to quantify the impact of removing restrictions to HCV treatment access on the infected populations, expenditures, and net social value for the North Carolina (NC), Oregon (OR), and Wisconsin (WI) Medicaid programs. Four HCV treatment access scenarios were modeled: 1) Baseline: Patients were treated according to Medicaid disease severity and sobriety requirements in 2015; 2) Remove Sobriety Restrictions: Disease severity restrictions were maintained, but people who inject drugs (PWID) were given access to treatment; 3) Treat Early: All patients, except for PWIDs, regardless of disease severity, were eligible for treatment and the diagnosis rate increased from 50 to 66%; and 4) Remove Access Restrictions: all patients, regardless of disease severity and sobriety, were eligible for treatment. Our key model outputs were: number of infected Medicaid beneficiaries, HCV-related medical and treatment expenditures, total social value, and state Medicaid spending over 10 years.ResultsAcross all three states, removing access restrictions resulted in the greatest benefits over 10 years (net social value relative to baseline = $408 M in NC; $408 M in OR; $271 M in WI) and the smallest infected population (5200 in NC; 2000 in OR; 614 in WI). Reduced disease transmission resulted in lower health care expenditures (-$66 M in NC; -$50 M in OR; -$54 M in WI). All of the expanded treatment access policies achieved break-even costs—where total treatment and health care expenditures fell below those of Baseline—in 4 to 8 years. Removing access restrictions yielded the greatest improvement in social value (net of medical expenditures and treatment costs, QALYs valued at $150 K per QALY).ConclusionsWhile increasing treatment access in Medicaid will raise short-term costs, it will also provide clear benefits relatively quickly by saving money and improving health within a 10-year window. Patients and taxpayers would benefit by considering these gains and taking a more expansive and long-term view of HCV treatment policies.

United States-based global otolaryngology surgery: A call to more horizontal sustainable efforts.

To examine global surgery involvement among general members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) and characterize international otolaryngology surgical interventions. Data on global surgery involvement were derived from responses provided by voluntary online survey respondent members of the AAO-HNS, obtained in October 2017. These data were compared against World Bank metrics of national health expenditure and surgical specialists per capita as benchmarks for need. There were 362 responses (response rate of 3.7%). A large proportion of respondents reported being involved in global surgery (61.3%). Locations where respondents worked included: South America (13.3%), Central America (17.7%), Caribbean (10.2%), Europe (4.1%), Africa (16.3%), Asia (16.6%), the Middle East (4.1%), and Oceania (3.6%). A greater proportion of respondents reported traveling to locations that have lower health care expenditure per capita and lower mean number of surgical specialists per 100,000 people, according to data from the World Bank. The primary purpose of trips was most commonly surgical mission (60.3%), followed by education (37.8%), and research (1.9%). Members of the AAO-HNS are active in global surgery efforts around the world. Collaboration among members of the AAO-HNS may serve to improve long-term sustainability of these efforts.

In This Issue: Continuity, Relationships, and the Illusion of a Steady State

This issue of Annals , the last I will be introducing as Editor, is about relationships. A study of more than one million Medicare patients seen by 6,551 primary care physicians finds that multiple measures of continuity of care are associated with lower health care expenditure and hospitalization

Clostridium difficile infection in the USA: incidence and associated factors in revision total knee arthroplasty patients.

Revision total knee arthroplasty (TKA) procedures performed secondary to periprosthetic joint infection (PJI) are associated with significant morbidity and mortality. These poor outcomes may be further complicated by postoperative infection requiring antibiotics. However, antibiotic overuse may suppress patients' bacterial flora, leading to Clostridium difficile infection (CDI). Therefore, we aimed to study the: (1) incidence; (2) costs; and (3) risk factors associated with CDI in revision TKA patients. The National Inpatient Sample database was queried for individuals diagnosed with PJI who underwent revision TKA between 2009 and 2013 (n = 83,806). Patients who developed CDI during their inpatient stay were identified (n = 799). Logistic regression analysis was conducted to assess the association between hospital- and patient-specific characteristics and the development of CDI. The incidence of CDI after revision TKA was 1.0%. These patients were older (mean age 69.05 vs. 65.52 years), had greater LOS (median 11 vs. 5days) and greater costs ($30,612.93 vs. 18,873.75), and experienced higher in-hospital mortality (3.6 vs. 0.5%; p < 0.001 for all) compared to those without infection. Patients with CDI were more likely to be treated in urban, not-for-profit, medium/large hospitals in the Northeast or Midwest (p < 0.05 for all) and to have underlying depression (OR 4.267; p = 0.007) or fluid/electrolyte disorders (OR 3.48; p = 0.001). Although CDI is rare following revision TKA, it can have detrimental consequences. We demonstrate that CDI is associated with longer LOS, higher costs, and greater in-hospital mortality. With increased legislative pressure to lower healthcare expenditures, it is crucial to identify means of preventing costly complications.

Minimally invasive mitral valve surgery

Mitral valve surgery and particularly minimally invasive mitral valve surgery has experienced constant evolution and improvement. To date, a broad and effective armamentarium of surgical techniques for mitral valve repair exists. Conventional and minimally invasive mitral valve surgeries are proven methods for achieving excellent and durable results by a minimized surgical risk. Minimally invasive mitral valve surgery additionally provides reduced morbidity by means of bleeding, transfusions, re-exploration, and impaired wound healing. Reduced postoperative pain is a major benefit of minimally invasive mitral valve surgery. This beneficial effect additionally can be enhanced by implementation of a non-rib-spreading, fully endoscopic approach. The reduction of postoperative pain translates into improved patient satisfaction, shorter length of stay, and lower health care expenditures. This review gives a detailed outline of the past and present of minimally invasive mitral valve surgery, results, outcomes and durability.

Hospice Exposure Is Associated With Lower Health Care Expenditures in Taiwanese Cancer Decedents' Last Year of Life: A Population-Based Retrospective Cohort Study

ContextEvidence for the association of hospice exposure with lower health care expenditures at end of life (EOL) remains inconclusive and neglects EOL care being concentrated in patients' last few months. ObjectiveThe association between hospice exposure and health care expenditures in cancer patients' last one, three, six, and 12 months was evaluated. MethodsIn this population-based, retrospective cohort study, Taiwanese cancer decedents in 2001–2010 (N = 195,228) were matched 1:1, with proportions of matched hospice users reaching 87.8%, by a hospice-utilization propensity score. For each matched pair, exposure to hospice (time from hospice enrollment to death) was matched to equivalent periods for hospice nonusers before death. Hospice-care associations with health care expenditures were evaluated by hospice use/exposure interactions with multilevel linear regression modeling using generalized estimating equations. ResultsThe unadjusted main effect showed lower total mean health care expenditures for hospice users than for hospice nonusers only in the last one and three months (rate ratio [95% CI]: 0.86 [0.81, 0.90] and 0.93 [0.89, 0.96], respectively). However, after accounting for exposure time, hospice care was significantly associated with lower health care expenditures at exposures of ≤30, ≤60, and ≤180 days for health care expenditures measured in the last one and three months, six months, and 12 months, respectively. Savings for patients with lengthy hospice stays were neutralized or even disappeared. ConclusionHospice care was associated with lower health care expenditures when it could actively intervene in EOL care. Hospice philosophy should be applied not only shortly before death but also throughout the dying trajectory to achieve maximum cost savings.

Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay for Children With Special Health Care Needs

Children with special health care needs (CSHCN) have disproportionate health care utilization. Previous studies have demonstrated that a primary medical home improves health care outcomes for this population. To elucidate if enrollment in a multidisciplinary aerodigestive clinic improves outcomes and reduces health care costs by decreasing admissions and inpatient days. A retrospective medical record review of 113 patients with aerodigestive disorders enrolled in a pediatric multidisciplinary clinic from June 2009 to December 2013 was performed. Of the 113 particpants, 58 (51.3%) were male, 59 (52.2%) had a tracheostomy, and 90 (80.5%) had a gastrostomy tube during their enrollment period. Patient ages at enrollment ranged from 0 to 20 years, with 59 (52.2%) ranging from 0 to 5 years, 23 (20.4%) ranging from 6 to 10 years, 18 (15.9%) ranging from 11 to 15 years, and 13 (11.5%) being 16 years or older. Admissions data before and after enrollment in a pediatric multidisciplinary clinic were examined. The main outcomes studied were changes in admissions and inpatient days before and after enrollment. Financial data were also examined to determine the reduction in technical direct cost. The admissions data for 113 children were analyzed. No significant difference in number of admissions per year was seen with enrollment with a median difference of -0.30 admissions per year (range, -10.6 to 6.7 admissions per year; 95% CI, -3.5 to 2.9). However, there was a significant decrease seen in inpatient days per year following enrollment, with a median decrease of 4.1 inpatient days per year (range, -80 to 283.3 inpatient days per year; 95% CI, 0.33 to 91.0). When examining aerodigestive admissions alone, the median number of aerodigestive hospital days avoided per patient was 0.57 days per month, or 6.8 days per year, representing a 70% reduction in technical direct cost. These findings indicate that for children with special health care needs, enrollment in a multidisciplinary aerodigestive clinic may improve health care outcomes by decreasing technical direct cost by 70% and significantly decreasing patient hospital days by an estimated 1 week per year. Furthermore, coordinated aerodigestive care in a medical home setting may lower health care expenditures from a systems-based perspective.

Cost-Effectiveness of Health Coaching: An Integrative Review.

The purpose of this review was to evaluate published literature to distinguish how health coaching influences the cost of chronic disease management in insured adults with chronic conditions. An integrated literature review was conducted. MEDLINE, Business Source Complete, and OneSearch were searched for the years 2001-2016 utilizing the following key words: health coaching, health coaching AND insurance companies, health coaching AND cost, health coaching AND health insurance, and health coaching AND insurance cost. A total of 67 articles met inclusion criteria and were assessed for applicability. Of those, 27 articles were found to be relevant to the research question. The practice settings of these articles are mostly primary care and wellness programs. Throughout the literature, health coaching has been found effective in chronic disease management such as hypertension, diabetes, and hyperlipidemia. Studies evaluating the cost-effectiveness of health coaching are limited. The current literature does not clearly demonstrate that health coaching lowers expenditures and patient copayments in the short term but projects future savings. Health coaching has the potential to improve chronic disease management and lower health care expenditures. Further long-term research is needed to evaluate the cost-effectiveness of health coaching. It has been projected that the cost-effectiveness of health coaching will be long-term or over 12 months after initiating the health coaching program.

Observation Status vs. Inpatient Status

With the growth of value-based purchasing contracts and other public and private efforts to lower healthcare expenditures, many hospitals have

Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study

ObjectiveTo examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. Participants and MethodsEmployees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. ResultsOf 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, –$3241 to –$801) and $940 (95% CI, –$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. ConclusionFavorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population.