Self-insured University Research Articles

Factors Associated With Adherence to Statin Medications of Patients Enrolled in a Self-insured University Health Plan

PurposeThe purpose of this study was to examine the association of patient and prescription factors with statin adherence of patients enrolled a self-insured university health plan. MethodsWe conducted a retrospective, longitudinal analysis of pharmacy claims data from a self-insured university for those enrollees prescribed a statin during a 38-month period (2009-2012). Adherence was calculated as the portion of days covered and was defined as portion of days covered ≥80%. To be included in the study, patients had to have ≥2 statin claims and be continuously enrolled in the plan. A logistic regression model was constructed to identify longitudinal predictors of adherence. In addition, a Cox proportional hazards model was run to examine predictors of adherence during 1 year of statin therapy. FindingsThere were 222 patients in the study. These 222 patients generated a total of 3,349 statin claims. With a mean (SD) observation period of 970 (346.5) days, those patients taking statin medications had a mean adherence rate of 54.5%. Adherent and nonadherent patients were similar regardless of statin switching and inferred household income. However, those patients with greater adherence levels were older, more likely to be male, had previous statin exposure, paid higher mean copayments, and were more likely to use mail order as their delivery channel. In logistic regression, older age (odds ratio [OR] = 1.07, P = 0.001), male sex (OR = 1.79, P = 0.047), and the use of mail order (OR = 3.07, P = 0.002) were significantly associated with adherence. Of the original 222 patients, 200 patients completed 1 full year of therapy. In a subsequent Cox proportional hazards analysis, the retail delivery channel (hazard ratio = 1.904, P = 0.025) was associated with higher risk for nonadherence during a 1-year period. ImplicationsDespite the benefits associated with statin medications, adherence remains a challenge for certain groups of patients, including patients who are female, younger patients, and patients who use retail pharmacies (vs mail order) when filling their prescriptions. Health care professionals and employers, especially those employers who are self-insured, would be well served in developing adherence interventions aimed at these specific populations.

Effectiveness of an on-Site Health Clinic at a Self-Insured University

This study assessed the impact and cost-effectiveness of an on-site health clinic at a self-insured university. Health care costs and number of claims filed to primary care providers were trended before and after the clinic was established to determine savings. A retrospective chart review of all full-time, insured employees treated for upper respiratory tract infections (URIs) during a 1-year study period was conducted. On-site clinic costs for the treatment of URIs were compared to costs at outside community providers for similar care. Community cost norms for the treatment of URIs were provided by Primary Physicians Care, the administrator of insurance claims for the University. A cost-benefit analysis compared the cost of services on-site versus similar services at an outside community provider. Based on the results of this study, the University's on-site health care services were determined to be more cost-effective than similar off-site health care services for the treatment of URIs. [Workplace Health Saf 2014;62(4):162-169.].

Effectiveness of an on-Site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Effectiveness of an on-Site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Effectiveness of an On-site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Effectiveness of an On-site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Effectiveness of an On-site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Effectiveness of an On-site Health Clinic at a Self-Insured University: A Cost-Benefit Analysis

Preliminary Results From a Multidisciplinary University-Based Disease State Management Program Focused on Hypertension, Hyperlipidemia, and Diabetes

Objective: To describe the implementation and evaluation of a pilot multidisciplinary disease state management (DSM) program for diabetes, hypertension, and hyperlipidemia at a private, self-insured university (over 900 covered lives). Methods: Enrollees met with a pharmacist, nurse, exercise physiologist, and students in these disciplines to improve clinical outcomes and fitness parameters. Clinical values, quality of life, patient knowledge of disease states, and patient satisfaction were assessed. Results: Of the 20 patients in the pilot program, 17 completed 1 nursing and 2 pharmacist visits; 8 completed exercise physiology visits. At baseline, elevated blood pressure readings were observed in 64.7% (11 of 17) of patients, 20% of those with diabetes (1 of 5) had an elevated hemoglobin A1c value (HbA1c), and 82.4% (14 of 17) had a cholesterol value that was not at goal. At least 1 medication-related problem was observed in 16 patients (94.1%). At 3 months, all patients with diabetes achieved HbA1c levels at or below 7%, 4 patients attained blood pressure control, and 1 achieved normal cholesterol readings. Patients characterized participation in the program as valuable and convenient. Conclusions: Patients involved in the multidisciplinary DSM showed improved clinical outcomes after 3 months. Ongoing analysis of patient outcomes will determine the long-term effectiveness of the DSM.

The effect of a health care management initiative on reducing workers' compensation costs.

The effect of both a cost control and health care management initiative (HCMI) on Workers' Compensation costs at a self-insured University Hospital was assessed. Seven cohorts of injured workers were studied. Cost control measures started in 1993 included early return to work and injury prevention programs, internal administration of legal cases, and utilization of modified duty assignments. The health care management initiative fully in place in 1997 included aggressive case management and preferred provider panel utilization. Workers' Compensation indemnity costs and lost workdays incurred by each cohort were compared. A 41 to 59% reduction in indemnity payments and 46 to 67% reduction in lost time cases were realized after the health care management initiative was fully in place. During this time, accepted claims were reduced by 10 to 15%. The quality of the provider panel, as measured by academic credentials, experience and board certification, did not change. Cost control measures, without comprehensive case management, did not decrease these parameters significantly. The health care management initiative realized reductions in lost time cases and Workers' Compensation indemnity costs.