5 Findings From the February 2019 Issue of AJMC®

The February 2019 issue of The American Journal of Managed Care^® featured research on value-based arrangements, effects of cesarean delivery data, and more. Here are 5 findings from the research published in the issue.

1. Hepatitis C virus prevalence and mortality rates highest in Medicaid population

A retrospective observational study used national survey data to assess the association of payer status and mortality in those with hepatitis C virus (HCV). The researchers found that HCV-positive patients were more likely to be covered by Medicaid or be uninsured than HCV-negative patients, and in the population with HCV, those with Medicaid had an increased mortality risk than even patients who were uninsured.

“Now that the availability of highly effective treatment regimens is wider, access to these regimens for the Medicaid population with HCV is urgently needed,” the study authors noted. Because Medicaid populations have a high burden of HCV infection and worse prognoses, the authors recommended that policy makers devote increased funding to support Medicaid programs.

2. Providing women with cesarean delivery data affects perceptions but not hospital choice

When pregnant women can easily compare the cesarean delivery rates of nearby hospitals within an app, they are more likely to believe that hospitals have differing rates, but this increased familiarity did not affect where they chose to deliver their babies, according to a randomized controlled trial. There was no significant difference in the proportion of women who selected hospitals with low cesarean delivery rates between the control and intervention groups.

The authors explained that simply providing women with the data may not have helped them interpret and apply it, or women may have believed that their preferences and individual doctors would drive their likelihood of having a cesarean delivery. They recommended further research into how mobile apps “can be more effectively utilized to help women navigate their options to select hospitals, as well as other decisions that may affect their pregnancy outcomes.”

3. Drug manufacturers and payers provide insight on value-based arrangement prevalence

Value-based payment arrangements (VBAs) between pharmaceutical manufacturers and payers may be more common than previously thought, based on survey responses used in this study. The respondents also detailed which factors make certain therapeutic areas prime for VBAs, such as having easily measured outcomes, and the reasons why some VBA negotiations break down, such as disagreements on the financial terms of the arrangement.

Understanding of VBAs’ prevalence and impact may have been limited until now because most such arrangements are not publicly disclosed. Given the barriers to implementation, the study authors suggested developing “a tool or guidance document that can help manufacturers and payers assess the desirability of pursuing a VBA and optimize the difficult negotiation process.”

4. Value-based incentives are sparking care delivery transformation in California physician organizations

A study involving qualitative interviews and surveys suggested that value-based payment (VBP) has promoted care delivery transformation in California physician organizations (POs), especially in efforts to control hospital costs and redesign primary care. However, very few investments were made in redesigning specialty care, and physician VBP incentives remain small relative to total compensation.

The researchers made several recommendations that could help maximize the potential of VBP, including more emphasis on specialty care, amplified payment incentives, integrated care delivery partnerships, and a fortified data-sharing infrastructure. “By facilitating delivery of appropriate care, such structural supports may help POs achieve larger improvements in performance than have been achieved with small financial incentives,” they concluded.

5. Measuring disease burden through insurance claims is feasible and inexpensive

Health plans seeking to understand the burden of disease among their members can use insurance claims to calculate disability-adjusted life years (DALYs), rather than simply counting conditions per individual, according to this study. The investigators confirmed the validity of their method by comparing DALYs with self-reported levels of health and function.

They explained that their method of determining disease burden is inexpensive and adds value, so it “holds promise as a feasible and informative method for organizations that submit or process health insurance claims to use to assess the current health status and the greatest losses to health of the populations they serve.”