Abstract
Impact of Medicare prescription drug improvement, and modernization act of 2003 on potentially preventable hospitalizations in adults over 65
Obioma Nwaiwu, MD, PhD1, Robert Ohsfeldt, Ph.D2, Hongwei Zhao, ScD3, Sean Gregory, MBA, MS, PhD4 and Charles Phillips, PhD, MPH5
(1)University of Arkansas for Medical Sciences, Little Rock, AR, (2)Texas A&M University School of Public Health, College Station, TX, (3)Texas A&M School of Rural Public Health, College Station, TX, (4)University of South Florida, Tampa, FL, (5)School of Rural Public Health, Texas A&M Health Science Center, College Station, TX
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Background: Over $25 billion of United States annual healthcare expenditure is attributable to preventable hospitalizations. Unfortunately, most preventable hospitalizations occur in older adults. Lack of access to and inability to afford medications contribute to hospitalizations from a preventable cause. Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (also known as Medicare Part D) expanded Medicare coverage to allow for outpatient prescription drug coverage. The aim of our research was to investigate the impact of Medicare Part D on preventable hospitalizations for conditions that are medication sensitive for older adults.
Research question: Did the implementation of Medicare Part D reduce the rate of hospitalizations in older adults for conditions that are potentially preventable?
Method: We explored this important relationship by conducting an ecological study with the use of Texas hospital discharge data, specifically using the difference in difference approach. This study focused on pre and post Medicare part D analysis of preventable hospitalizations on conditions that are medication sensitive, with the non-medication sensitive conditions as the comparison group. To derive both groups (medication sensitive and non-medication sensitive), we utilized the AHRQ's prevention quality indicators to identify all potentially preventable hospitalizations from Texas hospital discharge database and categorized them as either medication sensitive or not.
Results: The results show that the average hospitalization rate for medication sensitive potentially preventable conditions decreased from 3,300 per 100,000 populations to 1,912 per 100,000 populations after part D implementation. The total average outpatient prescription coverage for older adults increased from an average of 57 percent outpatient prescription drug coverage to 96 percent coverage. The multivariate result show that the increase in Medicare Part D coverage was responsible for a 7 percent decline on hospitalizations for potentially preventable medication sensitive conditions [OR=0.93, 95% CI (0.93, 0.94)].
Conclusions: Our analysis suggests that the expansion of Medicare by implementing the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 to cover for outpatient prescription drug significantly reduced preventable hospitalizations. Reducing these rates are important for improving quality of care and containing rising hospital costs. Further research needs to investigate the overall cost savings that can be attributable to reducing potentially preventable hospitalizations.
Public health or related public policy Public health or related research
Abstract
Priorities for America's Health: Saving Lives by Closing Gaps in Key Preventive Services
Anne Haddix, PhD1, Michael Maciosek, PhD2, George Isham, MD, MS3, Eduardo Sanchez, MD, MPH, FAAFP4, Steve Teutsch, MD, MPH5, Steven Woolf, MD, MPH6, Warren A. Jones, MD, FAAFP7 and Amy LaFrance, MPH2
(1)Minga Analytics, Savannah, GA, (2)HealthPartners Institute, Minneapolis, MN, (3)HealthPartners, Bloomington, MN, (4)American Heart Association, Dallas, TX, (5)University of Southern California, Los Angeles, CA, (6)Virginia Commonwealth University School of Medicine, Richmond, VA, (7)Dillard University, New Orleans, LA
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Improved access to care made possible by the Affordable Care Act has not closed all gaps in routine delivery of evidence-based preventive services known to be both life-saving and cost-effective. A 2016 review of 27 evidence-based clinical preventive services identified which gaps in the uptake of key services are having the greatest impact on the health of Americans. Assessed services have a nationwide uptake that ranges from an estimated 10% to 85% of the eligible population.
The 2016 priorities list has not yet been published, so we are not yet able to disclose which interventions are the most lifesaving; however, publication is anticipated well before the APHA annual meeting.
We will present a priority list of evidence-based clinical preventive services, drawn from the A- and B-recommended services from the U.S. Preventive Services Task Force, as well as population-wide recommendations from the Advisory Committee on Immunization Practices. We highlight which services would yield the greatest return in Quality-Adjusted Life-Years (QALYs) saved if uptake were increased to comparable levels across services. This presentation will focus on significant care gaps, and highlight where gaps in in measurement may be hindering progress toward improving delivery of high-priority preventive care. We will discuss strategies at the policy and practice levels for closing those gaps.
Chronic disease management and prevention Planning of health education strategies, interventions, and programs Program planning Provision of health care to the public Public health or related public policy
Abstract
Priorities for America's Health: Capitalizing on Life-Saving, Cost-Effective Preventive Services
Eduardo Sanchez, MD, MPH, FAAFP1, George Isham, MD, MS2, Anne Haddix, PhD3, Warren A. Jones, MD, FAAFP4, Steve Teutsch, MD, MPH5, Steven Woolf, MD, MPH6, Michael Maciosek, PhD7 and Amy LaFrance, MPH7
(1)American Heart Association, Dallas, TX, (2)HealthPartners, Bloomington, MN, (3)Minga Analytics, Savannah, GA, (4)Dillard University, New Orleans, LA, (5)University of Southern California, Los Angeles, CA, (6)Virginia Commonwealth University School of Medicine, Richmond, VA, (7)HealthPartners Institute, Minneapolis, MN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Making the right decisions for patient or a population health means getting the most benefit from limited resources. Physicians with little time must choose the most relevant care for each patient and prioritize the most beneficial care ahead of other services. Public health planners, policy-makers, payers, employers, accountable care organizations and others also need to understand how best to allocate limited financial resources for the greatest benefit. Even for those preventive services proven to be effective, some have greater impact for less cost than others. We will present a priority list of 27 evidence-based clinical preventive services, drawn from the A- and B-recommended services from the U.S. Preventive Services Task Force, as well as population-wide recommendations from the Advisory Committee on Immunization Practices. We highlight which ones lead to the greatest health improvement and are the most cost-effective. These rankings can serve as a guidepost to policy-making and clinical decision-making alike.
To develop these priorities, we modeled the potential impact of 27 recommended, evidence-based clinical preventive services for cost-effectiveness and clinically preventable burden across a cohort of the U.S. population. We use a variety of models, including microsimulation models in support of this approach, which allows for accurate comparison of the health benefit and cost-effectiveness across vastly different preventive services. We then ranked the services with a separate measure for each category, drawing on methods developed for previously published rankings in 2001 and 2006. The 2016 priorities list has not yet been published, so we are not yet able to disclose which interventions are the most lifesaving, but publication is anticipated well before the APHA annual meeting.
We will show how the 2016 rankings can be applied to national policy decisions, as well as to decision-making for primary care providers, health insurers, employers and public health, from clinic visits to community health needs assessments. We will identify key steps that stakeholders can take to apply these priorities to improve individual and population health. We will highlight the complementarity of key clinical services with community health initiatives that together can be implemented to address needs identified in community health needs assessments.
Chronic disease management and prevention Clinical medicine applied in public health Provision of health care to the public Public health or related public policy
Abstract
Priorities for America's Health: Identifying highest-impact, highest-value services outside of primary care
George Isham, MD, MS1, Eduardo Sanchez, MD, MPH, FAAFP2, Steve Teutsch, MD, MPH3, Michael Maciosek, PhD4, Steven Woolf, MD, MPH5, Anne Haddix, PhD6, Warren A. Jones, MD, FAAFP7, Amy LaFrance, MPH4 and Andrew Nelson, MPH8
(1)HealthPartners, Bloomington, MN, (2)American Heart Association, Dallas, TX, (3)University of Southern California, Los Angeles, CA, (4)HealthPartners Institute, Minneapolis, MN, (5)Virginia Commonwealth University School of Medicine, Richmond, VA, (6)Minga Analytics, Savannah, GA, (7)Dillard University, New Orleans, LA, (8)HealthPartners, Minneapolis, MN
APHA 2016 Annual Meeting & Expo (Oct. 29 - Nov. 2, 2016)
Understanding what health-related services or policies provide the greatest health benefits for the most cost-effectiveness is a widespread problem. We propose that a solution developed in the realm of clinical preventive services merits application beyond primary care.
The 2016 ranking of clinical preventive services builds on a robust, peer-reviewed approach to understanding and comparing the relative health and cost impact of disparate clinical services. To develop these priorities, we modeled the potential impact of 27 recommended, evidence-based clinical preventive services for cost-effectiveness and clinically preventable burden across a cohort of the U.S. population. We use a variety of models, including microsimulation models in support of this approach, which allows for accurate comparison of the health benefit and cost-effectiveness across vastly different preventive services. We then ranked the services with a separate measure for each category, drawing on methods developed for previously published rankings in 2001 and 2006.
This presentation will focus on the relevance of these rankings outside of a primary care clinic. We will review the concept behind making evidence-based comparisons across treatments, highlight the benefits of quantifying the differences in value among disease management services, new drugs and medical devices, and discuss applications well beyond the walls primary care.
Biostatistics, economics Program planning Provision of health care to the public