Disparities in Major Joint Replacement Surgery among Adults with Medicare Supplement Insurance

Hawkins, Kevin; Escoto, Kamisha Hamilton; Ozminkowski, Ronald J.; Bhattarai, Gandhi R.; Migliori, Richard J.; Yeh, Charlotte S.

doi:10.1089/pop.2010.0042

Cited by 37 publications

(34 citation statements)

References 25 publications

(55 reference statements)

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“…First, this study used medical claims data that were collected for insurance purposes rather than for research purposes, but these data have been used successfully in the past for similar research exercises. 26 Second, the study was limited to AARP insureds with Medigap coverage and may not be generalizable to other segments of the Medicare population. However, similar programs that utilized a holistic case management approach and enrolled predominantly younger populations had similar success.…”

Section: Discussionmentioning

confidence: 99%

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

Navratil-Strawn

Hawkins

Wells

et al. 2014

Population Health Management

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The objective of this study was to evaluate an Emergency Room having a Decision-Support (ERDS) program designed to appropriately reduce ER use among frequent users, defined as 3 or more visits within a 12-month period. To achieve this, adults with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York) were eligible to participate in the program. These included 7070 individuals who elected to enroll in the ERDS program and an equal number of matched nonparticipants who were eligible but either declined or were unreachable. Program-related benefits were estimated by comparing the difference in downstream health care utilization and expenditures between engaged and not engaged individuals after using propensity score matching to adjust for case mix differences between these groups. As a result, compared with the not engaged, engaged individuals experienced better care coordination, evidenced by a greater reduction in ER visits (P=0.033) and hospital admissions (P=0.002) and an increase in office visits (P<0.001). The program was cost-effective, with a return on investment (ROI) of 1.24, which was calculated by dividing the total program savings ($3.41 million) by the total program costs ($2.75 million). The ROI implies that for every dollar invested in this program, $1.24 was saved, most of which was for the federal Medicare program. In conclusion, the decrease in ER visits and hospital admissions and the increase in office visits may indicate the program helped individuals to seek the appropriate levels of care.

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Section: Discussionmentioning

confidence: 99%

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

Navratil-Strawn

Hawkins

Wells

et al. 2014

Population Health Management

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“…However, zip code-level data have been successfully used in the past for similar research exercises. 42 Finally, as with all statistical models that use multivariable adjustment, the propensity score and regression approaches may not have fully adjusted for motivational or other differences between participants and nonparticipants that could not be measured but may have influenced the results.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a High-Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage

Hawkins

Parker²,

Hommer

et al. 2015

Population Health Management

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The objective was to evaluate the 3-year experience of a high-risk case management (HRCM) pilot program for adults with an AARP Medicare Supplement (Medigap) Insurance Plan. Participants were provided in-person visits as well as telephonic and mailed services to improve care coordination from December 1, 2008, to December 31, 2011. Included were adults who had an AARP Medigap Insurance Plan, resided in 1 of 5 pilot states, and had a Hierarchical Condition Category score > 3.74, or were referred into the program. Propensity score weighting was used to adjust for case-mix differences among 2015 participants and 7626 qualified but nonparticipating individuals. Participants were in the program an average of 15.4 months. After weighting, multiple regression analyses were used to estimate differences in quality of care and health care expenditures between participants and nonparticipants. Increased duration in the program was associated with fewer hospital readmissions. Additionally, participants were significantly more likely to have recurring office visits and recommended laboratory tests. The program demonstrated $7.7 million in savings over the 3 years, resulting in a return on investment of $1.40 saved for every dollar spent on the program. Savings increased each year from 2009 to 2011 and with longer length of engagement. The majority of savings were realized by the federal Medicare program. This study focused on quality of care and savings for an HRCM program designed solely for Medicare members with Medicare Supplement coverage. This program had a favorable impact on quality of care and demonstrated savings over a 3-year period. (Population Health Management 2015;18:93-103)

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“…Racial and ethnic disparities in surgical outcomes have been reported after surgery for many types of cancer, as well as for the treatment of such benign diseases as morbid obesity and diverticulitis [7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Potential causes of these disparities include poor access to surgical care, lack of access to minimally invasive surgery [10,18,19], type of insurance [14], and a higher incidence of co-morbidities in some racial and etchnic groups than in others.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors for and the Effect of a Program To Reduce the Incidence of Surgical Site Infection after Cardiac Surgery

Hogle

Cohen

Hyman

et al. 2014

Surgical Infections

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Background: Surgical site infection (SSI) after cardiac surgery (CS) is a serious complication that increases hospital length of stay (LOS), has a substantial financial impact, and increases mortality. The study described here was done to evaluate the effect of a program to reduce SSI after CS. Methods: In January 2007, a multi-disciplinary CS infection-prevention team developed guidelines and implemented bundled tactics for reducing SSI. Data for all patients who underwent CS from 2006-2008 were used to determine whether there was: 1) A difference in the incidence of SSI in white patients and those belonging to minority groups; 2) a reduction in SSI after intervention; and 3) a statistically significant difference in the incidence of SSI in the third quarter of each year as compared with the other quarters of the year. Results: Of 3,418 patients who underwent CS; 1,125 (32.9%) were members of minority groups and 2,293 (67.1%) were white. Eighty (2.3%) patients developed SSI. There was no significant difference in the incidence of SSI in non-Hispanic white patients and all others (2.1% vs. 2.8%, p = 0. 42). The incidence of SSI decreased significantly from 2006 (3.0%) to 2007 (2.5%) and 2008 (1.4%), (p = 0.03). Surgical site infection occurred more often in the third quarter of each of the years of the study than in other quarters of each year (3.3 vs. 2.0%, p = 0.038). Conclusions: Implementation of a program to reduce SSI after CS was associated with a lower incidence of SSI across all racial and ethnic groups and over time, but was not associated with a lower incidence of SSI in the third quarter of each year than in the other quarters.

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Disparities in Major Joint Replacement Surgery among Adults with Medicare Supplement Insurance

Cited by 37 publications

References 25 publications

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

An Emergency Room Decision-Support Program That Increased Physician Office Visits, Decreased Emergency Room Visits, and Saved Money

Evaluation of a High-Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage

Incidence and Risk Factors for and the Effect of a Program To Reduce the Incidence of Surgical Site Infection after Cardiac Surgery

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