Private Insurance Data Research Articles

Association Between Rapid Opioid Reduction or Discontinuation and Self-Harm, Suicide Attempt, and Suicide Death Among High-Dose Long-Term Opioid Therapy Patients in North Carolina, 2006-2018.

We examined the association between rapid opioid reduction or discontinuation and self-harm, suicide attempt, and suicide death among high-dose long-term opioid therapy (HD-LTOT) patient and examined effect measure modification by individual and neighborhood-level characteristics. Using private insurance data from North Carolina, this retrospective cohort study covered January 2006 to September 2018, with up to four years of follow-up. Participants included patients aged 18-64 years who were prescribed HD-LTOT. Time-varying exposure was ever exposed to rapid opioid reduction or discontinuation vs never exposed. The outcomes were self-harm or suicide attempt, suicide death, and the combined outcome. We estimated cumulative incidence and used Fine-Gray models to estimate sub-distribution hazard ratios (HRs). There were 21,450 HD-LTOT patients. In year 1, rapid opioid reduction or discontinuation was not associated with the combined outcome, HR: 1.09 (95% CI: 0.61-1.96). However, in years 2-4, rapid opioid reduction or discontinuation was associated with higher hazard of the combined outcome, HR: 2.77 (95% CI: 1.45-5.27). This association was stronger among patients with mental health conditions and those residing in underserved neighborhoods. These findings underscore the importance of provider training in adhering to guideline-concordant gradual tapering, offering mental health support, and ensuring patient safety throughout the tapering process.

Perinatal Psychotherapy Use and Costs Before and After Federally Mandated Health Insurance Coverage

Insurance coverage affects health care access for many delivering women diagnosed with perinatal mood and anxiety disorders (PMADs). The Mental Health Parity and Addiction Equity Act (MHPAEA; passed in 2008) and the Patient Protection and Affordable Care Act (ACA; passed in 2010) aimed to improve health care access. To assess associations between MHPAEA and ACA implementation and psychotherapy use and costs among delivering women overall and with PMADs. This cross-sectional study conducted interrupted time series analyses of private insurance data from January 1, 2007, to December 31, 2019, for delivering women aged 15 to 44 years, including those with PMADs, to assess changes in psychotherapy visits in the year before and the year after delivery. It estimated changes in any psychotherapy use and per-visit out-of-pocket costs (OOPCs) for psychotherapy associated with MHPAEA (January 2010) and ACA (January 2014) implementation. Data analyses were performed from August 2022 to May 2023. Implementation of the MHPAEA and ACA. Any psychotherapy use and per-visit OOPCs for psychotherapy standardized to 2019 dollars. The study included 837 316 overall deliveries among 716 052 women (mean [SD] age, 31.2 [5.4] years; 7.6% Asian, 8.8% Black, 12.8% Hispanic, 64.1% White, and 6.7% unknown race and ethnicity). In the overall cohort, a nonsignificant step change was found in the delivering women who received psychotherapy after MHPAEA implementation of 0.09% (95% CI, -0.04% to 0.21%; P = .16) and a nonsignificant slope change of delivering women who received psychotherapy of 0.00% per month (95% CI, -0.02% to 0.01%; P = .69). A nonsignificant step change was found in delivering individuals who received psychotherapy after ACA implementation of 0.11% (95% CI, -0.01% to 0.22%; P = .07) and a significantly increased slope change of delivering individuals who received psychotherapy of 0.03% per month (95% CI, 0.00% to 0.05%; P = .02). Among those with PMADs, the MHPAEA was associated with an immediate increase (0.72%; 95% CI, 0.26% to 1.18%; P = .002) then sustained decrease (-0.05%; -0.09% to -0.02%; P = .001) in psychotherapy receipt; the ACA was associated with immediate (0.77%; 95% CI, 0.26% to 1.27%; P = .003) and sustained (0.07%; 95% CI, 0.02% to 0.12%; P = .005) monthly increases. In both populations, per-visit monthly psychotherapy OOPCs decreased (-$0.15; 95% CI, -$0.24 to -$0.07; P < .001 for overall and -$0.22; -$0.32 to -$0.12; P < .001 for the PMAD population) after MHPAEA passage with an immediate increase ($3.14 [95% CI, $1.56-$4.73]; P < .001 and $2.54 [95% CI, $0.54-$4.54]; P = .01) and steady monthly increase ($0.07 [95% CI, $0.02-$0.12]; P = .006 and $0.10 [95% CI, $0.03-$0.17]; P = .004) after ACA passage. This study found complementary and complex associations between passage of the MHPAEA and ACA and access to psychotherapy among delivering individuals. These findings indicate the value of continuing efforts to improve access to mental health treatment for this population.

Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs.

The Centers for Medicare & Medicaid Services implemented federal requirements on January 1, 2021, under the Public Health Service Act that require hospitals to provide a list of payer-negotiated prices or "standard charges" in a machine-readable file and in a patient-friendly online estimator for standard services. We sought to assess compliance by United States hospitals associated with neurosurgical training programs with these federal requirements for 11 common neurosurgical procedures. We performed a cross-sectional analysis in March 2023 of 116 United States hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements to have a machine-readable, downloadable file with standard charges and a patient-friendly online estimator for two spinal procedures. A total of 110/114 (96.5%) hospitals were compliant with the requirement for a machine-readable file with payer-negotiated prices. A total of 47/110 hospitals (42.7%) were compliant with downloadable machine-readable files and reported at least one payer-negotiated price for 1 of the 11 common neurosurgical procedures. A total of 45/110 (40.9%) used bundled Diagnosis-Related Group codes, and 18/110 (16.4%) did not contain any price information for neurosurgical procedures. For neurosurgical procedures, the percent difference between the average negotiated private insurance and Medicare price per procedure ranged from 17.5% to 77.6%. Medicare and private insurance data for each procedure were available on average for 10.3 states (SD = 3.8) and 15.6 states (SD = 4.8), respectively. While hospital compliance with federal requirements for machine-readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on Current Procedural Terminology codes was sparce. Consequently, meaningful conclusions on procedure-related charges for elective procedures are difficult for patients to make because of the unintelligible format of data and a lack of reporting of charges per Current Procedural Terminology code in a comprehensive manner.

Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance.

Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.

Inventory Control of Drugs Listed in Private Health Insurance at Pharmacies in South Tangerang using ABC Analysis

Inventory control in pharmacies must be appropriately and effectively maintained to promote continuous drug affordability and availability in the community within the healthcare delivery system. Initially, effective drug planning and procurement are essential to attain proper drug selection, quantification, and procurement based on the consumption pattern with good economic impact and clinical value. Therefore, the ABC analysis method is suggested to be implemented to optimize efficient budget and effective drug planning. This study aimed to investigate the planning and procurement process of drug listed in private health insurance using the ABC analysis method in the pharmacies X and Y. This study was non-experimental study with descriptive analysis utilizing qualitative and quantitative data. Drug enlisted in the private insurance data in 2019 were taken retrospectively. Based on the ABC analysis results, in pharmacy store X, drug listed in group A showed 83 items with the highest investment value of 86.38%, group B showed 102 items with 15.61%, and group C showed 129 items with the lowest investment value of 4.79%. Meanwhile, in pharmacy Y, drug listed in group A showed 87 items with the highest investment value of 89.62%, group B showed 100 items with 7.62%, and group C showed 134 items with the lowest investment value of 2.76%. Using the ABC analysis to manage the drug inventory system could assist pharmacy store X and Y in planning the procurement of drug listed in the private healthcare insurance effectively. Also, taking into account the values of consumption and investment are obtained efficiently.

Use of contraception before and after a diabetes diagnosis: An observational matched cohort study

AimsTo determine how a diabetes diagnosis affects contraception use. MethodsThis retrospective cohort study used private insurance data from non-pregnant women aged 15–49 years, 2000−2014. We identified women with a new diabetes diagnosis and a control group without diabetes, matched on important potential confounders. We compared rates of prescription or procedural contraception use in the two groups before and after an index date (diabetes diagnosis and outpatient visit, respectively), yielding difference-in-differences estimates of the effect of a diabetes diagnosis on contraception use. ResultsWe identified 75,355 women with a new diabetes diagnosis and 7.5 million women without a diabetes diagnosis. Overall rates of contraception use did not increase in the year after diagnosis (absolute difference-in-difference: 0.4% [99.9% CI, −2.1% to 2.9%]; p < 0.001). In method-specific analyses, there was a decline in estrogen-containing and injectable contraceptives in the year after diagnosis (absolute difference-in-difference: −2.2% [−4.0% to −0.4%] and −0.8% [−1.5% to −0.1%], respectively; p < 0.001); no corresponding increase was noted for intrauterine contraception or subdermal implants. ConclusionsWomen with diabetes are less likely to use contraception after their diabetes diagnosis. Efforts are needed to ensure that women with diabetes receive the counseling and clinical services needed to carefully plan their pregnancies.

Health resource utilization and costs during the first 90days following robot-assisted hysterectomy.

To compare health resource utilization, costs and readmission rates between robot-assisted and non-robot-assisted hysterectomy during the 90days following surgery. The study used 2008-2012 Truven Health MarketScan data. All patients admitted as inpatients with a CPT code for hysterectomy between January 2008 and September 2012 were identified and the first hysterectomy-related admission in each patient was included. Patients were categorized based on the route of their hysterectomy and the use of laparoscopy as: total abdominal hysterectomy, vaginal hysterectomy (VH), laparoscopy-assisted supracervical hysterectomy, laparoscopy-assisted vaginal hysterectomy' and total laparoscopic hysterectomy (TLH). Hospitalization costs, including hospital, physician, pharmacy and facility costs, were calculated for the index admissions and for the 90-day follow-up periods. Health resource utilization was determined in terms of inpatient readmissions, outpatient visits, and emergency room visits, RESULTS: There were 302,923 hysterectomies performed over 5years for benign indications in the inpatient setting (55% abdominal, 17% vaginal, and 28% laparoscopic). Concurrent use of robot assistance steadily increased and was reported in 50% of TLH procedures in 2012. The rates of readmission overall were 4.9% for robot-assisted procedures and 4.3% for procedures without robot assistance (OR 0.89, CI 0.82-0.97). Readmission rates were lowest for VH (3.2%) and highest for TLH (5.6%). Following robot-assisted hysterectomy and VH, 8.3% and 4.6% of patients, respectively, had more than ten outpatient visits in the 90-day follow-up period. The average total cost for 90days was $16,820 for robot-assisted hysterectomy and $13,031 for procedures without robot assistance. Of the additional costs for robot-assisted surgery, 25% were incurred in the 90-day follow-up period. The study using private insurance data found that robot-assisted hysterectomy was associated with higher health resource utilization and costs than other minimally invasive approaches. Given the high costs associated with robot-assisted hysterectomy, it is important to understand the specific indications for this approach and to identify the patients who may benefit.

Creating National Weights for a Patient-level Longitudinal Database.

Objective: To create a nationally-representative estimate from longitudinal data by controlling for sociodemographic factors and health status. Method: The Agency for Healthcare Research and Quality's (AHRQ) Medicare Expenditures Panel Survey (MEPS) was used as the basis for adjustment methodology. MEPS is a data source representing health insurance coverage cost and utilization, and comprises several large-scale surveys of families, individuals, employers, and health care providers. Using these data, we created subset populations. We then used multivariate logistic regression to construct demographics and case-mix-based weights, which were applied to create a population sample that is similar to the national population. The weight was derived using the inverse probability of the weighting approach, as well as a raking mechanism. We compared the results with the projected number of persons in the US population in the same categories to examine the validity of the weights. Results: The following variables were used in the logistic regression: Age group, gender, race, location, income level and health status (Charlson Comorbidity Index scores and chronic condition diagnosis). Relative to MEPS data, patients included in the private insurance data were more likely to be male, older, to have a chronic condition, and to be white (p=0.0000). Adjusted weighted values for patients in the commercial group ranged from 15.47 to 36.36 (median: 16.91). Commercial insurance and MEPS data populations were similar in terms of their socioeconomic and clinical categories. As an outcomes measure, the predicted annual number of patients with prescription claims from private insurance data was 6 963 034. The annual number of statin users were predicted as 6 709 438 using weighted MEPS data. Conclusion: National projections of large-scale patient longitudinal databases require adjustment utilizing demographic factors and case-mix differences related to health status.

What are the Safety Benefits of Australian High Productivity Vehicles when Compared to the Conventional Heavy Vehicle Fleet?

The introduction of High Productivity Vehicles (HPVs) began in Australia from 1999. Since then, the question of actual safety performance was examined in 2013/2014. To develop safety metrics for HPVs major accident benchmarks for the conventional truck fleet were established. This was a major step in national safety research. The second step examined the accident histories of the Australian HPV fleet and compared these to the conventional fleet benchmarks. An operator survey was conducted to establish HPV crash histories, which were compared to private insurance data and conventional truck accident rates. The results for the HPV fleet showed significant accident savings.

The Impact of the US Food and Drug Administration Chlorofluorocarbon Ban on Out-of-pocket Costs and Use of Albuterol Inhalers Among Individuals With Asthma.

The US Clean Air Act prohibits use of nonessential ozone-depleting substances. In 2005, the US Food and Drug Administration announced the ban of chlorofluorocarbon (CFC) albuterol inhalers by December 31, 2008. The policy resulted in the controversial replacement of generic CFC inhalers by more expensive, branded hydrofluoroalkane inhalers. The policy's impact on out-of-pocket costs and utilization of albuterol is unknown. To study the impact of the US Food and Drug Administration's CFC ban on out-of-pocket costs and utilization of albuterol inhalers. Using private insurance data from January 1, 2004, to December 31, 2010, we investigated the effect of the CFC ban on out-of-pocket costs and utilization of albuterol inhalers among individuals with asthma (109,428 adults; 37,281 children), as well as asthma-related hospitalizations, emergency department visits, and outpatient visits. We estimated multivariable models adjusted for age, sex, comorbidities, and mean out-of-pocket costs of albuterol inhalers in an individual's drug plan. We analyzed whether effects varied between adults vs children and those with persistent vs nonpersistent asthma. Pharmacy claims for albuterol inhalers, as well as asthma-related hospitalizations, emergency department visits, and outpatient visits. The mean out-of-pocket albuterol cost rose from $13.60 (95% CI, $13.40-$13.70) per prescription in 2004 to $25.00 (95% CI, $24.80-$25.20) immediately after the 2008 ban. By the end of 2010, costs had lowered to $21.00 (95% CI, $20.80-$21.20) per prescription. Overall albuterol inhaler use steadily declined from 2004 to 2010. Steep declines in use of generic CFC inhalers occurred after the fourth quarter of 2006 and were almost fully offset by increases in use of hydrofluoroalkane inhalers. In multivariable analyses, a $10 increase in out-of-pocket albuterol prescription costs was estimated to lower utilization by 0.92 percentage points (95% CI, -1.39 to -0.44; P < .001) for adults and 0.54 percentage points (95% CI, -0.84 to -0.24; P = .001) for children, with no difference between adults vs children and patients with persistent vs nonpersistent asthma and with no impact on asthma-related hospitalizations, emergency department visits, and outpatient visits. The Federal ban of CFC inhalers led to large relative increases in out-of-pocket albuterol costs among privately insured individuals with asthma and modest declines in utilization. The policy's impact on individuals without insurance, who faced greater cost increases, is unknown.

Anthracyline (A) use among women with breast cancer (BC).

1019 Background: Recent patterns of use of A vs taxane-based chemotherapy are unknown. Methods: Patients were identified from Medicare and private insurance datasets with the following criteria. 1) The 5% National Medicare file 1995−2008: Female bc treated with mastectomy or breast conserving surgery between 1/1996 and 6/2008, ³66 years, Medicare A and B coverage and no HMO, and chemotherapy 3 mo before−6 mo after surgery (n=5956). 2) Private insurance claims data: dx 4/98−6/07, female bc, age <65, breast surgery, and chemotherapy from 3 mo before −6 mo after surgery (n=25354). Patients receiving chemotherapy were classified as receiving either A-based chemotherapy (A +/− any other chemo) or taxane-based chemotherapy if codes for paclitaxel, docetaxel, or nab-paclitaxel were present with no codes for A. Chemotherapy use by year was calculated overall and by geographic area, and piecewise logistic regression analysis was used to determine changes over time. Results: 1) Medicare: A-based chemotherapy slowly increased from 1996 to 2005 (41% to 70.0% of patients) but fell sharply down to a low of 32.3% in 2008. A corresponding increase in taxane-based chemotherapy was seen, from 10.5% of patients in 2005 to 50.2% in 2008. By 2008, the majority of patients received taxane-based chemotherapy without an A. Regression analysis showed a significant increase in the use of taxane-based chemotherapy starting in the end of 2005. 2) Private insurance: Similar but less dramatic trends were seen with a fall of A chemotherapy from a peak of 86% in 2004 to 68% in 2007. Taxane-based chemotherapy increased to 28% of younger patients in 2007. While use remained stable in some states, A use declined up to 33% in other states. Analysis will be updated with the 2008−2009 private insurance data. Conclusions: Starting at the end of 2005, there has been a dramatic decline in the use of anthracyclines for women with breast cancer, with the sharpest decline among women over age 65. Anthracycline regimens are increasingly being replaced by taxane-based chemotherapy.

The Argument to Support Broader Application of Extracranial Carotid Artery Stent Technology

As new technology becomes available, the stent technique for the extracranial carotid artery continues to evolve into a safer, more effective therapy for stroke prevention. With the availability of embolic protection, improved stent designs, and added endovascular physician experience, outcomes for carotid artery stenting (CAS) now consistently parallel those for carotid endarterectomy (CEA). Although carotid endarterectomy was established as the gold standard for carotid revascularization, the available scientific evidence must continue to be interpreted in the context of further advancements in nearly all related areas of medicine. One multicenter randomized trial and several nonrandomized registries have successfully established the CAS indications for patients with high surgical risk and have provided evidence to support the use of CAS techniques in patients with low surgical risk. Clinicians must continue to improve their understanding of patient-specific factors and conduct research that will refine indications while optimizing current medical therapy and that will integrate CAS and carotid endarterectomy as complementary treatments. Response by LoGerfo p 1610 The outcomes for CAS have been improving over the past 10 years and now appear nearly equivalent to those for CEA. In fact, many historical similarities are seen in the development of these 2 techniques. Although CEA was established as the gold standard for extracranial carotid revascularization, the available scientific evidence must continue to be interpreted in the context of further advancements in nearly all related areas of medicine. The current research comparing CAS and CEA has not shown a clinically robust and statistically significant difference between the 2 treatments. When differences do exist, clinicians must continue to refine patient-specific indications and to conduct further research to understand these complex risk-benefit analyses in the context of advanced medical treatments and complementary revascularization techniques. The following review details the argument to support implementation of CAS technology for athero-occlusive carotid …