Neurologist ambulatory care, health care utilization, and costs in a large commercial dataset

Abstract

Objective: To determine the value of neurologist ambulatory care in chronic neurologic diseases in a large administrative claims dataset detailing costs, adverse events, and health care utilization. Methods:The Optum proprietary claims dataset (2010)(2011)(2012) was examined to describe direct health care costs, as well as specific outcome metrics for a large population of persons with chronic neurologic illnesses. In phase I of the study, we detail neurologist involvement and differences in annualized allowed third-party payments within episode treatment groups (ETGs) for 10 neurologic illnesses. For phase II, we examined health care utilization for ETGs of epilepsy, Parkinson disease (PD), stroke, and multiple sclerosis (MS) with and without neurologist involvement. Reported outcomes were unadjusted differences and odds ratios between treatment groups.Results: For phase I, a total of 1,913,605 ETGs for 10 neurologic conditions were identified, 30.1% meeting criteria for neurologist involvement. All conditions had higher direct costs when neurologists were involved with care, ranging from a 25% increase for Alzheimer dementia to 100% more for MS care. In phase II, fractures, infections, emergent care, and inpatient admission were less with neurologist ambulatory care, while neurologist care was associated with greater utilization of disease-specific treatments (immunotherapies in MS anticoagulation in atrial fibrillation-associated stroke, deep brain stimulation and dopaminergic therapies in PD). Conclusion:Neurologist involvement with care is associated with greater unadjusted allowed payments, but fewer adverse events and less acute care utilization. The effect of neurologist care on health care costs and utilization outcomes in persons with chronic neurologic illness is not well-characterized. Aggregation of health care information in large administrative claims datasets presents an opportunity to assess the effect of specialist physicians on downstream usage of health resources related to the diseases they treat. Payers, from the US Government to third-party private insurers and employers, are looking to this kind of big data analysis to inform coverage, decisions, regulatory actions, and policymaking decisions. 1-5Exploration of large datasets requires access to specialized expertise, programmers, and computing unavailable to clinicians in daily practice. Physician professional organizations, on behalf of their members, have the resources to engage in analysis of these data and advocate for value and quality.6 Therefore, the American Academy of Neurology (AAN) engaged Optum, Inc. (Philadelphia, PA), a health care consulting firm, for a guided exploratory analysis of their proprietary administrative claims dataset to assess the value of neurologist care.

Pilot of integrated, colocated neurology in a primary care medical home

“…Our findings complement prior studies in observing that specialty e‐consults help decrease the need for face‐to‐face visits and lower diagnostic test use . Recent assessment of neurologists working in traditional models demonstrated improved outcomes at a higher cost of care . This pilot study presents early insight into the potential impact of integrated neurology care in a PCMH as a model that may deliver equivalent care at a reduced cost.…”

“…12,[17][18][19][20][21] Recent assessment of neurologists working in traditional models demonstrated improved outcomes at a higher cost of care. 22 This pilot study presents early insight into the potential impact of integrated neurology care in a PCMH as a model that may deliver equivalent care at a reduced cost.…”

Demand for neurological services in Central Eastern Europe: a 10‐year national survey in Hungary

“…Health administrative data have been used to study features of certain neurological disorders, such as stroke [10], multiple sclerosis [11] or Parkinson's disease [12], in several countries. Such databases have also been used to evaluate healthcare costs in neurological outpatient services [13] and comorbidities in certain neurological conditions [14]. The burden and cost of neurological disorders (including cerebrovascular disorders) have been evaluated in Europe [15,16] and also worldwide by the Global Burden of Disease study [17][18][19][20].…”

Expanding incentives for coordinated, patient-centered care

“…Second, utilization is often measured via claims data, and CMS's support of the codes outlined in this article may increase the visibility of high-value services that neurologists deliver. As much as previous work has demonstrated higher costs but fewer adverse events when neurologists participate in patient care, 21 use of these codes could allow future health services research to explore the net benefit of neurology specialty non-face-to-face care.…”