Health Care Cost Management Research Articles

Mapping data-driven strategies in improving health care and patient satisfaction

Health services involve data analytics, central to healthcare service delivery, research, and planning. Based on the literature, this specific article seeks to enlighten the reader about data analytics in health services by discussing its advantages, shortcomings, and issues that come with it. Section one mapping outlines how data analytics optimizes the results of health service delivery through risk factor definition, disease detection, and case-by-case management. It helps inform disease trajectory, determine drug interaction, monitor disease, support decision-making, and enhance service delivery quality. The research also examines data analysis in health services, medicine, and pharmaceuticals. Several big data analytics applications have been identified as relevant to drug development, personalized medication, and specialized trials. Evaluations that rely on biomarkers differentiate between patients who are convenient for specific therapies, improving the patient's status and developing health care services. The third section also stresses the role of data analytics in enhancing efficiency and profitability. They involve detecting fraud, abuse, and unnecessary medical activities, creating savings and better financial returns. Data analytics also leads to identifying high-cost patients and ways of managing healthcare costs, increasing revenues and profitability. The fourth section discusses how big data complements traditional public health surveillance and outbreak platforms. It facilitates collecting data, analyzing different sources, and identifying special patterns or outliers to detect the outbreak early enough, contain it, or allocate resources to control it. It anticipates and addresses the dangers to the public's well-being and effectively controls episodes of infectious diseases. However, some key issues are associated with data analytics implementation, such as data quality, governance, privacy, bias, integration, expertise, and ethics, among others. Therefore, solving these challenges to achieve the optimum shifting of health service paradigms through data analytics in inpatient treatment, organizational management, and affordability is imperative.

Cost-Effectiveness of Influenza Vaccination in Healthy Children: A 10-Year Population-Based Study

Background/Objectives: Seasonal influenza annually puts a significant burden on the pediatric population, especially the youngest, causing severe illness and death. Additionally, associated healthcare costs cause a significant financial strain on healthcare systems. While vaccination is the most effective prevention method, its cost-effectiveness for healthy children remains unassessed. Methods: Using the Pedianet database spanning from 2009 to 2019, we analyzed influenza cases among 6-month-olds to 14-year-olds in Italy. Data included influenza-related medical visits, prescriptions, exams, emergency visits, hospitalizations, and costs. Adverse events and quality-adjusted life years (QALYs) were considered from the existing literature. A static decision-tree model compared annual vaccination strategies, assessing probabilities for influenza or influenza-like illnesses by vaccination status. Incremental cost-effectiveness ratios (ICERs) were calculated, along with sensitivity analyses and cost-effectiveness acceptability curve generation. Results: Mean total influenza costs for vaccinated children averaged EUR 18.6 (range 0–3175.9, including EUR 15.79 for the influenza vaccination), whereas costs for unvaccinated children were consistently lower at around EUR 4.6 (range 0–3250.1). The average ICER for years where vaccine and virus strains are matched was EUR 29,831 per QALY, which is below the EUR 40,000 threshold set by the Italian National Health Services. The ICER values range from EUR 13,736 (2017/2018) to EUR 72,153 (2013/2014). Averted influenza costs averaged EUR 23 per case, with fluctuations over the years. In most observed years, influenza vaccination was cost-effective from the healthcare providers’ standpoint. The exception was 2009–2010, due to a mismatch between vaccine and virus strains. Conclusions: This study highlights the economic viability of influenza vaccination, especially when virus and vaccine strains align. It demonstrates the potential of vaccination programs in preserving children’s health and well-being while managing healthcare costs.

Return on investments in social determinants of health interventions: what is the evidence?

There has been an increasing recognition of the importance and the value of addressing social determinants of health (SDOH) to improve population health outcomes, manage health care costs, and reduce health inequities. Despite the strong interest in investing in SDOH initiatives by various stakeholders, the literature on the return from such investments is scarce. The differences in study populations and methodologies, and the lack of data on SDOH intervention outcomes and/or costs, make it challenging to quantify and generalize outcomes for decision-making. We reviewed the literature on SDOH interventions focused on food and housing insecurity, and developed a methodology for estimating a key outcome: the return on investment (ROI), defined as the net returns from an intervention divided by its costs. The ROI estimates we report can be used by stakeholders to prioritize among alternative SDOH interventions for fundraising, investing, and implementing purposes. The average ROI for food-insecurity programs was 85% (ranging from 1% to 287%; except for 1 study's ROI, -31%) and for housing-insecurity programs was 50% (ranging from 5% to 224%; except for 1 ROI, -38%). In addition, these estimates can serve as key inputs for designing and employing innovative financing and policy solutions to increase the use of these interventions.

Balancing Costs and Care: Nonoperative Appendicitis Treatment Outcomes in Pakistan.

Dear Respected Editor, In Pakistan, approximately 110,000 cases of appendicitis are reported annually [1], highlighting the condition's prevalence and significance. Traditional management predominantly revolves around widely practiced surgical intervention, such as appendectomy. [2]. Immediate appendectomy has become the standard treatment due to the significant morbidity and mortality difference between perforated and non-perforated acute appendicitis. However, the country's healthcare landscape presents a complex challenge due to varying regional access to medical resources. This variation in healthcare infrastructure exacerbates the difficulty of effectively managing appendicitis and underscores the need for solutions that strike a balance between clinical outcomes and economic considerations. While appendectomy remains a standard surgical procedure, it comes with inherent disadvantages, chief among them being the cost burden it places on patients and healthcare systems [3]. For patients in a low- to middle-income nation like Pakistan, the financial strain associated with surgery—which includes preoperative evaluations, surgical costs, hospital stays, and postoperative care—can be challenging [4]. Furthermore, the ripple effects affect the whole healthcare system, diverting resources that may otherwise be used for other urgent medical needs. A study by Siddiqui et al. emphasizes the need for a comprehensive analysis of economic factors in appendicitis management, particularly in low- and middle-income countries like Pakistan. The challenges in countries such as Pakistan require the exploration of alternative approaches that can optimize clinical outcomes while effectively managing healthcare costs without compromising patient care. [2] The recent study by Lee et al. introduces a promising alternative to conventional appendicitis management [5]. The research focuses on nonoperative treatment approaches, such as antibiotic therapy and observation, which have gained traction for their potential benefits Further, the study shows that the majority of the patients who had nonoperative treatment did not encounter a recurrence of appendicitis and were able to avoid surgical intervention for a period of around 20 years. Furthermore, there is a lack of data indicating any long-term dangers associated with nonoperative care. One of the prominent advantages lies in the reduction of immediate healthcare expenses, which can alleviate the financial burden on both patients and healthcare systems. By presenting evidence on the effectiveness and safety of nonoperative approaches, this study opens avenues for a paradigm shift in appendicitis management in Pakistan. The potential to achieve comparable clinical outcomes while minimizing the economic burden is a compelling proposition that warrants further exploration and consideration within Pakistan's healthcare challenges.

Analyzing the Benefits and Costs of the Safe Step Act on Patients, Physicians, and Insurers

Pharmaceutical expenditures in the United States, particularly in dermatology, have grown rapidly, driven by expensive topical and biologic treatments. Insurers are employing cost-containing strategies such as step therapy, which mandates the use of lower-cost treatments before more expensive medications. The bipartisan Safe Step Act aims to enhance step therapy policies by introducing a transparent process for requesting exceptions and reasonable timelines for the process. However, there is limited analysis on how the Safe Step Act would affect the healthcare environment. We examine the policies of the Safe Step Act and existing literature on prior authorizations and discuss how the bill could affect patients, physicians, and insurers. While the act could expedite access to necessary medications and prevent irreversible harm to patients from delaying efficacious treatment, it falls short in relieving the administrative burdens on dermatology clinics. Although there is no ideal solution for managing healthcare costs, measures like step therapy encourage cost-effective treatments and optimizing care for the population. Curtailing step therapy with the exemptions process of the Safe Step Act might streamline patient access to treatments but could impede cost-containment strategies, weaken the bargaining power of insurers, and result in higher insurance premiums.

Assessing the Accuracy of Generative Conversational Artificial Intelligence in Debunking Sleep Health Myths: Mixed Methods Comparative Study With Expert Analysis.

Adequate sleep is essential for maintaining individual and public health, positively affecting cognition and well-being, and reducing chronic disease risks. It plays a significant role in driving the economy, public safety, and managing health care costs. Digital tools, including websites, sleep trackers, and apps, are key in promoting sleep health education. Conversational artificial intelligence (AI) such as ChatGPT (OpenAI, Microsoft Corp) offers accessible, personalized advice on sleep health but raises concerns about potential misinformation. This underscores the importance of ensuring that AI-driven sleep health information is accurate, given its significant impact on individual and public health, and the spread of sleep-related myths. This study aims to examine ChatGPT's capability to debunk sleep-related disbeliefs. A mixed methods design was leveraged. ChatGPT categorized 20 sleep-related myths identified by 10 sleep experts and rated them in terms of falseness and public health significance, on a 5-point Likert scale. Sensitivity, positive predictive value, and interrater agreement were also calculated. A qualitative comparative analysis was also conducted. ChatGPT labeled a significant portion (n=17, 85%) of the statements as "false" (n=9, 45%) or "generally false" (n=8, 40%), with varying accuracy across different domains. For instance, it correctly identified most myths about "sleep timing," "sleep duration," and "behaviors during sleep," while it had varying degrees of success with other categories such as "pre-sleep behaviors" and "brain function and sleep." ChatGPT's assessment of the degree of falseness and public health significance, on the 5-point Likert scale, revealed an average score of 3.45 (SD 0.87) and 3.15 (SD 0.99), respectively, indicating a good level of accuracy in identifying the falseness of statements and a good understanding of their impact on public health. The AI-based tool showed a sensitivity of 85% and a positive predictive value of 100%. Overall, this indicates that when ChatGPT labels a statement as false, it is highly reliable, but it may miss identifying some false statements. When comparing with expert ratings, high intraclass correlation coefficients (ICCs) between ChatGPT's appraisals and expert opinions could be found, suggesting that the AI's ratings were generally aligned with expert views on falseness (ICC=.83, P<.001) and public health significance (ICC=.79, P=.001) of sleep-related myths. Qualitatively, both ChatGPT and sleep experts refuted sleep-related misconceptions. However, ChatGPT adopted a more accessible style and provided a more generalized view, focusing on broad concepts, while experts sometimes used technical jargon, providing evidence-based explanations. ChatGPT-4 can accurately address sleep-related queries and debunk sleep-related myths, with a performance comparable to sleep experts, even if, given its limitations, the AI cannot completely replace expert opinions, especially in nuanced and complex fields such as sleep health, but can be a valuable complement in the dissemination of updated information and promotion of healthy behaviors.

Expert consensus on quality control indicators of integrative medicine in primary Sjögren's syndrome (2023 version)

AbstractTreatment integrating traditional Chinese and Western medicine for primary Sjögren's syndrome (pSS) has yielded positive results and gained wide acceptance. However, the absence of standardized clinical management in certain regions has led to suboptimal outcomes in the diagnosis and treatment of pSS in China. In response, the Center for Traditional Chinese and Western Medicine at the China‐Japan Friendship Hospital, in collaboration with the Beijing Association of Traditional Chinese and Western Medicine Rheumatology Professional Committee, initiated a project led by the Traditional Chinese Medicine Department of Rheumatism. The project (Beijing Association of the Integrating of Traditional and Western Medicine standardization expert consensus record number: 2021Z031A3) aims to develop a set of quality control indicators for the integrated treatment of pSS using traditional Chinese and Western medicine. Based on the 2021 version, the consensus revision incorporates seven new items, focusing on essential assessment areas for pSS patients, treatment response, and healthcare cost management. The 2023 expert consensus update seeks to enhance pSS diagnosis and treatment practices in China, offering a benchmark for medical quality control.

Associations between aerobic exercise, muscle strength training and the prevalence of shoulder pain in manual wheelchair users with spinal cord injury

Introduction&#x0D; The primary objective of this study is to explore associations between meeting spinal cord injury (SCI)-specific exercise guidelines and the prevalence of shoulder pain in manual wheelchair users (MWU) with SCI in Switzerland. The rationale behind this investigation lies in the high prevalence of shoulder pain among MWU with SCI, impacting their daily activities, leisure- and labor participation, and overall quality of life. Understanding the association between exercise adherence and shoulder pain is crucial, not only for the well-being of the individuals but also for managing healthcare costs associated with pain treatments.&#x0D; Methods&#x0D; The study utilizes data from the SwiSCI Community Survey 2022 (Gross-Hemmi et al., 2021), focusing on a cohort of 593 manual wheelchair users (MWU) for a cross-sectional analysis, investigating the reporting of shoulder pain, and adherence to SCI-specific exercise guidelines (Martin Ginis et al., 2018). The guidelines, proposed by Martin-Ginis et al. (2018), encompass aerobic exercise and muscle-specific strength training. Logistic regression analyses were employed to assess the association of meeting these guidelines and the prevalence of shoulder pain, while considering potential confounding factors.&#x0D; Results&#x0D; High prevalence of shoulder pain was observed, affecting 40% of the MWU surveyed, which is in line with previous observations. Additionally, the study found that a significant proportion of the population did not meet the recommended guidelines for aerobic exercise (46%) and muscle strength training (64%). Logistic regression analyses showed that non-adherence to aerobic exercise guidelines was associated with 1.55 to 1.97 higher odds of reporting shoulder pain. No association of muscle strength training with the shoulder pain could be found. Therefore, meeting both aerobic and muscle strength guidelines did not yield any association with shoulder pain. Adjustments for potential confounders such as sex, age, lesion level, completeness, time since injury, and mobility scores, did not change the association between adherence to guidelines and shoulder pain.&#x0D; Discussion/Conclusion&#x0D; The prevalence of shoulder pain in the study sample is high (40%) and in line with previous publications. Compared to 75% of the Swiss general population being physical active for more than 2.5 hour a week (Bundesamt für Statistik, 2019), only 54% of the study sample is meeting the guidelines for at least the “Starter level” on aerobic exercise (cardiorespiratory, ≥ 2x 20 min/week). Those who are not meeting the aerobic exercise guidelines have 1.55 to 1.97 higher odds to have shoulder pain. Despite foreseen shoulder fitness benefit, 64% is not meeting the guidelines on muscle strength training. To further examine the relation between shoulder use, -exercise and shoulder pain, longitudinal studies on dose-effect are needed.&#x0D; References&#x0D; Gross-Hemmi, M. H., Gemperli, A., Fekete, C., Brach, M., Schwegler, U., &amp; Stucki, G. (2021). Methodology and study population of the second Swiss national community survey of functioning after spinal cord injury. Spinal Cord, 59, 363-372. https://doi.org/10.1038/s41393-020-00584-3&#x0D; Martin Ginis, K. A., van der Scheer, J. W., Latimer-Cheung, A. E., Barrow, A., Bourne, C., Carruthers, P., Bernardi, M., Ditor, D. S., Gaudet, S., de Groot, S., Hayes, K. C., Hicks, A. L., Leicht, C. A., Lexell, J., Macaluso, S., Manns, P. J., McBride, C. B., Noonan, V. K., Pomerleau, P. … Goosey-Tolfrey, V. L. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord, 56(4), 308-321. https://doi.org/10.1038/s41393-017-0017-3&#x0D; Bundesamt für Statistik. (Ed.). (2019). Schweizerische Gesundheitsbefragung 2017. Körperliche Aktivität und Gesundheit [Swiss Health Survey 2017: Physical activity and health]. Bundesamt für Statistik. https://www.sportobs.ch/inhalte/Downloads/213-1708.pdf

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Globally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)-defined as asynchronous, consultative communication between family physicians and hospital specialists-may offer advantages to face these challenges. To provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals. A systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence. The search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies. In this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

The Relationship Between Aging, Economic Development and Healthcare Expenditure in Japan: An Empirical Analysis

This paper investigates the relationship between ageing, economic development, and healthcare expenditure in Japan, considering the challenges posed by an ageing population. The study utilizes a VAR and ARMAX modelling approach to analyse the complex dynamics among these variables. The empirical results reveal interesting findings that contrast with previous literature. While population ageing is often assumed to lead to increased healthcare spending, this study finds no significant correlation between population ageing and healthcare expenditure as a percentage of GDP. The analysis suggests that factors such as advancements in medical technology, healthcare system efficiency, and cultural variations in healthcare utilization patterns may have mitigated the expected rise in healthcare expenditure associated with an ageing population. These findings have implications for policymakers and investors. Policymakers should consider a broader range of factors beyond population ageing when projecting future healthcare expenditures and developing strategies for managing healthcare costs. Investors can benefit from a nuanced understanding of the healthcare sector, focusing on areas such as medical technology, innovation, and healthcare delivery models that are likely to be influenced by population ageing and changing healthcare needs. Overall, this research contributes to the existing knowledge base, offering insights for addressing the challenges of population ageing and healthcare sustainability.

Transition readiness among adolescents and young adults with haemophilia in the Netherlands: Nationwide questionnaire study.

Care for adolescents with haemophilia is transferred from paediatric to adult care around the age of 18 years. Transition programs help to prepare adolescents for this transfer and prevent declining treatment adherence. Evaluating transition readiness may identify areas for improvement. Assess transition readiness among Dutch adolescents and young adults with haemophilia, determine factors associated with transition readiness, and identify areas of improvement in transition programs. All Dutch adolescents and young adults aged 12-25 years with haemophilia were invited to participate in a nationwide questionnaire study. Transition readiness was assessed using multiple-choice questions and was defined as being ready or almost ready for transition. Potential factors associated with transition readiness were investigated, including: socio-demographic and disease-related factors, treatment adherence, health-related quality of life, and self-efficacy. Data of 45 adolescents and 84 young adults with haemophilia (47% with severe haemophilia) were analyzed. Transition readiness increased with age, from 39% in 12-14 year-olds to 63% in 15-17 year-olds. Nearly all post-transition young adults (92%, 77/84) reported they were ready for transition. Transition readiness was associated with treatment adherence, as median VERITAS-Pro treatment adherence scores were worse in patients who were not ready (17, IQR 9-29), compared to those ready for transition (11, IQR 9-16). Potential improvements were identified: getting better acquainted with the adult treatment team prior to transition and information on managing healthcare costs. Nearly all post-transition young adults reported they were ready for transition. Improvements were identified regarding team acquaintance and preparation for managing healthcare costs.

Coping strategies for health care financing among informal sector workers in Dar es Salam, Tanzania

Background: In low- and middle-income countries (LMICs) health financing systems has been dependent on out-of-pocket payments (OOP). This type of payment is thought to increase income to finance health care but it’s unaffordable to economically disadvantaged persons. Health insurance was introduced in order to reduce catastrophic health expenditure caused by OOP but its implementation to informal sector workers is a challenge. Therefore, this study examines the coping strategies for managing health care costs among informal sector workers in Dar es Salaam, Tanzania. Methods: This cross-sectional descriptive study was conducted between September and December 2020 to 889 informal sector workers. The study respondents were randomly selected and questionnaire was used to collect data. Chi-square test and multivariate logistic regression were used to analyze data through the use of Statistical Package for Social Sciences (SPSS) version 23. Results: The findings showed that the mean age of the respondents was 34.8 years (SD±10.4) and majority, (90.1%) of the respondents were uninsured. The methods to carter for medical expenditures were cash payments (p=0.297; 95%CI=0.195-0.452), selling assets (p=0.672, 95%CI=0.507-0.891) and borrowing money (p=0.578, 95%CI=0.412-0.811). Conclusions: The health care financing methods that the informal sector workers use in order to access health services are effective in reducing short run problems of health care accessibility but it contributes to impoverishment. Designing an affordable insurance scheme with consideration of the social economic aspects of individuals will improve uptake to insurance schemes and hence achievement of the Sustainable Development Goals (SDGs).

Socializing employees into a culture of health

PurposeA culture of health within an organization offers benefits such as managing healthcare costs and supporting employees in becoming and staying healthy. This study aims to identify successful organization's strategies utilized to socialize employees into a culture of health.Design/methodology/approachIn-depth interviews were conducted with 19 representatives from organizations recognized for their success in creating a culture of health. Grounded theory analysis of collected data was used to identify themes related to the goals of this study.FindingsNew employees are socialized into the culture of health during the recruitment process, at new employee orientation and throughout the early employment period. Existing employees are also continually socialized using a variety of on-going communication strategies. This process is consistent with Jablin's organizational assimilation model, and this study offers the opportunity to use this model to help understand organizational health.Practical implicationsOrganizations desiring to create a culture of health can support this culture by incorporating socialization strategies into the recruitment, hiring and new employee on-boarding process.Originality/valueThough strategies have been shown to be helpful in socializing new employees into organizations, limited research has explored the relationship between socialization and a culture of health. Results from this study offer insight into how organizations that have been recognized for their success in creating a culture of health socialize new and existing employees to create and maintain a culture that supports health and well-being. Also, this study applies socialization theories to health within the workplace, offering new insights both theoretically and practically.

User Perception of Integrated Health Care Quality: The Case of Croatia

BackgroundThe availability of health care to all individuals is one of the main sustainable development goals of the modern world, and one of the main policy objectives of the World Health Organization. The aim of universal health care is to provide health security and equal access to health care to everyone while achieving an adequate level of health care quality as well. Achieving these goals is important both in terms of promoting societal equality as well as achieving higher economical productivity. Another important aspect in achieving universal health care is cost effectiveness. With the ever growing costs of healthcare, governments around the world are looking for ways to simultaneously achieve cost and care efficiency. Over the past couple of years, integrated care has been widely used as a way to achieve the somewhat contradicting goals of improving population health, managing healthcare costs and promoting new ways of healthcare organization. One of the outcomes of successful integrated care strategies should be an increase in overall health care quality. Health care quality can be defined as the degree to which health care services increase the likelihood of desired health outcomes for their users. Health care quality can be assessed both from the user and service provider perspective. Although a number of authors have analysed health care quality from the user perspective there are still ambiguous findings regarding the user perceptions of integrated care strategies implemented in their health care systems. In order to shed more light on this understudied issue, this paper will analyse the user perception of integrated health care quality in primary health care institutions in Croatia.Aims and objectivesThe aim of this paper is to analyse the understudied user perception of integrated health care quality in primary health care institutions in Croatia in order to provide recommendations for integrated care quality improvement. The aim of the authors in the future is to include healthcare providers in the questionnaire in order to be able to provide more detailed recommendations on integrated care enhancement methods.MethodsThis paper will use the SERVQUAL survey for service quality assessment in order to analyse the perception of integrated health care quality in primary health care institutions in Croatia and explore the differences between user expectations and perceptions. The research will be conducted from October to December 2019 in randomly selected primary health institutions in different parts of Croatia.Target audienceThe findings of the paper are expected to be used by health care professionals as well as policy makers in order to enhance integrated care strategies in the Croatian health care system.

Michelle's Story: The Complexity of Patient Care in a Family Medicine Residency Clinic.

Family medicine covers all ages and specializes in chronic disease management as well as acute care medicine. As the health of the population continues to grow in complexity, treating patients appropriately and efficiently is imperative to improving health outcomes and managing health care costs. Family medicine physicians are uniquely poised to provide this type of care. A patient story plus a look at the patients seen over the course of a day within a family medicine residency clinic explores the complexity of care and the ability of family medicine physicians to provide the necessary care. Taking a close look at who comes through our door on a particular day highlights 3 points: primary care physicians are seeing patients with an increasing complexity of needs, our society is witnessing an extreme increase in patients suffering with mental health problems and substance use disorders, and addressing social determinants of health must be part of the solution.

Healthcare Cost Management in India: The Way Forward

Healthcare Cost Management in India: The Way Forward

Factors Determining the Efficacy of Recombinant Human Thrombomodulin in the Treatment of Sepsis-Induced Disseminated Intravascular Coagulation

Recombinant human thrombomodulin (rhTM) is an anti-coagulant used to treat disseminated intravascular coagulation (DIC). The efficacy of rhTM in patients with sepsis-induced DIC has been proved in some clinical trials, but the determining factors are not known. The aim of this study was to identify patients for whom rhTM will be effective and the factors that determine rhTM efficacy in alleviating DIC. A single-center, retrospective, observational study was conducted in patients with sepsis-induced DIC who were treated with rhTM in Okayama Saiseikai General Hospital (Okayama, Japan) between January 2010 and December 2019. Among 67 patients who were treated with rhTM, DIC was resolved in 24 patients. The multivariate logistic regression analysis revealed that age (odds ratio (OR) 1.05; 95% confidence interval (CI) 1.00-1.10; p < 0.05) and acute physiology and chronic health evaluation II scores (OR 0.88; 95% CI 0.78-0.98; p < 0.05) were factors that determined rhTM efficacy in alleviating DIC. Overall, our study provides valuable information on factors that should be considered before rhTM administration to patients with sepsis-induced DIC for a better management of healthcare costs.

Measuring and Visualizing Chlamydia and Gonorrhea Inequality: An Informatics Approach Using Geographical Information Systems.

Health inequality measurements are vital in understanding disease patterns in identifying high-risk patients and implementing effective intervention programs to treat and manage sexually transmitted diseases. To measure and identify inequalities among chlamydia and gonorrhea rates using Gini coefficient measurements and spatial visualization mapping from geographical information systems. Additionally, we seek to examine trends of disease rate distribution longitudinally over a ten-year period for an urbanized county. Chlamydia and gonorrhea data from January 2005 to December 2014 were collected from the Indiana Network for Patient Care, a health information exchange system that gathers patient data from electronic health records. The Gini coefficient was used to calculate the magnitude of inequality in disease rates. Spatial visualization mapping and decile categorization of disease rates were conducted to identify locations where high and low rates of disease persisted and to visualize differences in inequality. A multiple comparisons ANOVA test was conducted to determine if Gini coefficient values were statistically different between townships and time periods during the study. Our analyses show that chlamydia and gonorrhea rates are not evenly distributed. Inequalities in disease rates existed for different areas of the county with higher disease rates occurring near the center of the county. Inequality in gonorrhea rates were higher than chlamydia rates. Disease rates were statistically different when geographical locations or townships were compared to each other (p < 0.0001) but not for different years or time periods (p = 0.5152). The ability to use Gini coefficients combined with spatial visualization techniques presented a valuable opportunity to analyze information from health information systems in investigating health inequalities. Knowledge from this study can benefit and improve health quality, delivery of services, and intervention programs while managing healthcare costs.

Understanding purchasing patterns and product access of newly launched specialty generics

Background: Many specialty drugs have lost patent exclusivity and more specialty generics (SGs) are expected in the future. Payers continue to look for ways to manage health care costs in the specialty pharmacy space and SG products offer the opportunity for savings. Given increasing interest in SGs, manufacturers are expected to invest more than $100 billion in the development of SGs over the next five years. To remain competitive, pharmacies must have access to SG products and access to competitive pricing for SGs, which can be obtained by accessing pharmaceutical manufacturer agreements through MHA Specialty Pharmacy Solutions. Aims: Understand purchase patterns of newly launched SGs and see if increased access to product was facilitated by the entrance of a SG. Methods: To determine purchase patterns of newly launched SGs, the rate of change of both the brand and generic products were measured for five specialty drugs across MHA pharmacy members. When possible, the brand rate was measured by the units of brand product purchased the quarter prior to the generic launch compared to the number of units in first quarter 2019 (1Q19). The generic product rate was measured by the units of generic product in the quarter it launched compared to units in 1Q19. To detect changes in product access to SGs, the number of corporations dispensing the brand was measured in the quarter prior to the generic launch compared with the number of corporations dispensing the generic in 1Q19. Results: Brand imatinib (Gleevec1) number of units decreased 80% while generic imatinib units grew by 134%. The number of corporations dispensing generic imatinib increased 34%. Brand hydroxyprogesterone caproate (OHPC) (Makena2) number of units decreased 67% while generic OHPC units grew by 641%. The number of corporations dispensing generic OHPC increased 38%. Brand abiraterone acetate (Zytiga3) number of units decreased 63% while generic abiraterone units grew by 289%. The number of corporations dispensing generic abiraterone increased 60%. Brand tetrabenazine (Xenazine4) and brand dalfampridine ER (Ampyra5) could not be measured due to limited distribution. Generic tetrabenazine units increased 2967% and the number of corporations dispensing increased 2114%. Generic dalfampridine ER units increased 1451% and the number of corporations dispensing increased 463%. Conclusions: Pharmacies purchasing through MHA Specialty Pharmacy Solutions are able to expand their access to products and quickly adopt SGs in order to grow their businesses and serve patients.

Advocating for Patients With Inflammatory Bowel Disease: How to Navigate the Prior Authorization Process.

In an effort to manage health care costs and avoid improper medication use, prior authorizations (PAs) have become a standard stipulation required by payers in the determination of medication coverage. For gastroenterologists managing patients, especially those with inflammatory bowel disease (IBD), the PA process is time-consuming and further complicated by 2 additional factors: step therapy requirements and failure of payers to recognize updated IBD treatment pathways. These factors often lead to PA denials and cause treatment delays, which in turn can lead to disease progression, ongoing patient suffering, and ultimately an increase in both direct and indirect total costs. In this manuscript, the PA process, PA models, tips and available resources to navigate the PA process, and future advocacy efforts are discussed with the intent to help gastroenterology practices optimize PA outcomes and improve the care provided to patients with IBD and other gastrointestinal disorders.