5 Findings From the November 2019 Issue of AJMC®

The November issue of The American Journal of Managed Care^® (AJMC^®) included studies on a kidney disease intervention, perceptions of alternative financing models, population health screening, and more. Here are 5 findings from research published in the issue.

1. Multidisciplinary cancer care creates challenges in attribution of patients to providers

Significant proportions of patients with cancer are treated with more than 1 treatment modality (ie, surgery, radiation, and chemotherapy), and just 6%, 17%, and 11% of patients receiving multimodality care for colorectal, lung, and breast cancer, respectively, received all of their care from the same practice, according to this research letter.

The finding of multimodality cancer care being delivered by multiple practices creates a challenge when seeking to attribute patients to oncology providers in alternative payment models like bundled or episode-based payments. Although these payment models offer the potential to incentivize cost-efficient care, the authors note that “creative approaches are needed that hold multiple distinct providers accountable for costs and quality.”

2. Pharmacist-delivered health management model delivers reductions in costs, emergency visits

A retrospective study presents the results of a program that integrated pharmacists into family medicine clinics to optimize medication use for patients with chronic illnesses. The pharmacists met face-to-face with patients, set therapeutic goals, identified medication-related problems, and helped to solve issues in conjunction with the patients and their physicians.

Emergency department visits remained stable in the group participating in the program but increased in a comparator group, resulting in a significant difference between the groups. The investigators calculated a cost savings of $2.10 to $2.60 for every $1.00 spent on the medication management program, and they say their study “supports the inclusion of pharmacists on healthcare teams.”

3. Scalable population health intervention for kidney disease demonstrates feasibility

By using laboratory test results to stratify primary care patients by their risk of chronic kidney disease (CKD) according to a heat map, the quality improvement intervention assessed in this study was able to increase testing rates and reduce some types of utilization while lowering selected expenditures. The intervention within a patient-centered medical home engaged primary care practitioners in kidney care with the help of local care coordinators.

The findings include reductions in hospital admissions and readmissions, an increase in urinary albumin-creatinine ratio testing, and net savings in medical costs for patients with CKD classes 3 and 5. “These preliminary results support the stratification of laboratory data for CKD population health innovation in commercial health plans,” the authors concluded.

Watch lead author Dr Joseph Vassalotti discuss the findings with AJMC^®.

4. Medicare Advantage plan representatives express their interest in Pay for Success

The alternative financing model Pay for Success (PFS) has not been adopted in the Medicare Advantage (MA) program although it presents an opportunity to target plan members’ social risk factors. The qualitative interviews described in this study reveal that MA plan representatives are interested in learning more about PFS, but some expressed potential concerns. For instance, some were unsure if CMS would approve of such a model while others were hesitant to have their data evaluated by a third party.

The study authors explain that the PFS model could help MA plans expand their offerings of supplemental benefits by testing them without assuming additional financial risk, then adding services with successful outcomes into their benefits packages. However, they caution that “further guidance from CMS is needed to assuage the concerns raised by these representatives.”

5. Early identification of disease through laboratory testing can avert cases, costs

This study of an employee population found that annual health screenings involving laboratory testing can help identify prediabetes before it progresses to diabetes, detect CKD before worsening to end-stage kidney disease, and catch colorectal cancer in earlier stages. Researchers estimate that early identification can delay 34 cases of end-stage kidney disease and prevent 210 cases of diabetes and 3 cases of late-stage colorectal cancer over 5 years per 1000 cases identified, with significant cost implications.

Knowledge of previously unrecognized disease can encourage greater health engagement and better outcomes for these individuals as well as delivering cost benefits for their employers, the authors write. These insights could help target population health programs to segments of employees for greater effectiveness.