Chibuzo Iloabuchi1, Nilanjana Dwibedi1, Traci LeMasters1, Chan Shen2, Amit Ladani3, Usha Sambamoorthi4. 1. Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Robert C. Byrd Health Sciences Center [North], P.O. Box 9510 Morgantown, WV 26506-9510. 2. Division of Outcomes Research and Quality, Department of Surgery, College of Medicine, Pennsylvania State University, Hershey, PA, USA. 3. Department of Medicine, Division of Rheumatology, West Virginia University Medicine, Morgantown, WV, USA. 4. Department of Pharmacotherapy, College of Pharmacy, "Vashisht" Professor of Disparities, Health Education, Awareness & Research in Disparities (HEARD) Scholar, Texas Center for Health Disparities, University of North Texas Health Sciences Center, 3500 Camp Bowie Blvd, Fort Worth, Texas, 76107. Professor Emerita, West Virginia University School of Pharmacy, Pharmaceutical Systems and Policy, Morgantown, WV, USA, Cell: 732-740-3760.
Abstract
Objective: To evaluate the association of low-value care with excess out-of-pocket expenditure among older adults diagnosed with incident breast, prostate, colorectal cancers, and Non-Hodgkin's Lymphoma. Methods: We used a retrospective cohort study design with 12-month baseline and follow-up periods. We identified a cohort of older adults (age ≥ 66 years) diagnosed with breast, prostate, colorectal cancers, or Non-Hodgkin's lymphoma between January 2014 and December 2014. We assessed low-value care and patient out-of-pocket expenditure in the follow-up period. We identified relevant low-value services using ICD9/ICD10 and CPT/HCPCS codes from the linked health claims and patient out-of-pocket expenditure from Medicare claim files and expressed expenditure in 2016 USD. Results: About 29% of older adults received at least one low-value care procedure during the follow-up period. Low-value care differed by gender, and rates were higher in women with colorectal cancer (32.7%) vs. (28.8%) and NHL (40%) vs. (39%) compared to men. Individuals who received one or more low-value care had significantly higher mean out-of-pocket expenditure ($8,726±$7,214) vs. ($6,802±$6,102). XGBOOST, a machine learning algorithm revealed that low-value care was among the five leading predictors of OOP expenditure. Conclusion: One in four older adults with incident cancer received low-value care in 12-months after a cancer diagnosis. Across all cancer populations, individuals who received low-value care had significantly higher out-of-pocket expenditure. Excess out-of-pocket expenditure was driven by low-value care, fragmentation of care, and an increasing number of pre-existing chronic conditions. Policy Statement: This study focuses on health policy issues, specifically value-based care and its findings have important clinical and policy implications for Centers for Medicare and Medicaid Services (CMS) which has issued a roadmap for states to accelerate the adoption of value-based care, with the Department of Health and Human Services (HHS) setting a goal of converting 50% of traditional Medicare payment systems to alternative payment models tied to value-based care by 2022.
Objective: To evaluate the association of low-value care with excess out-of-pocket expenditure among older adults diagnosed with incident breast, prostate, colorectal cancers, and Non-Hodgkin's Lymphoma. Methods: We used a retrospective cohort study design with 12-month baseline and follow-up periods. We identified a cohort of older adults (age ≥ 66 years) diagnosed with breast, prostate, colorectal cancers, or Non-Hodgkin's lymphoma between January 2014 and December 2014. We assessed low-value care and patient out-of-pocket expenditure in the follow-up period. We identified relevant low-value services using ICD9/ICD10 and CPT/HCPCS codes from the linked health claims and patient out-of-pocket expenditure from Medicare claim files and expressed expenditure in 2016 USD. Results: About 29% of older adults received at least one low-value care procedure during the follow-up period. Low-value care differed by gender, and rates were higher in women with colorectal cancer (32.7%) vs. (28.8%) and NHL (40%) vs. (39%) compared to men. Individuals who received one or more low-value care had significantly higher mean out-of-pocket expenditure ($8,726±$7,214) vs. ($6,802±$6,102). XGBOOST, a machine learning algorithm revealed that low-value care was among the five leading predictors of OOP expenditure. Conclusion: One in four older adults with incident cancer received low-value care in 12-months after a cancer diagnosis. Across all cancer populations, individuals who received low-value care had significantly higher out-of-pocket expenditure. Excess out-of-pocket expenditure was driven by low-value care, fragmentation of care, and an increasing number of pre-existing chronic conditions. Policy Statement: This study focuses on health policy issues, specifically value-based care and its findings have important clinical and policy implications for Centers for Medicare and Medicaid Services (CMS) which has issued a roadmap for states to accelerate the adoption of value-based care, with the Department of Health and Human Services (HHS) setting a goal of converting 50% of traditional Medicare payment systems to alternative payment models tied to value-based care by 2022.
Authors: Claire F Snyder; Kevin D Frick; Robert J Herbert; Amanda L Blackford; Bridget A Neville; Klaus W Lemke; Michael A Carducci; Antonio C Wolff; Craig C Earle Journal: J Cancer Surviv Date: 2015-02-26 Impact factor: 4.442
Authors: Allison Lipitz-Snyderman; Camelia S Sima; Coral L Atoria; Elena B Elkin; Christopher Anderson; Victoria Blinder; Chiaojung Jillian Tsai; Katherine S Panageas; Peter B Bach Journal: JAMA Intern Med Date: 2016-10-01 Impact factor: 21.873