Costs of Chronic Disease Management for Newly Insured Adults
ABSTRACT Healthcare reform will result in substantial numbers of newly insured, low-income adults with chronic conditions. This paper examines the costs of a chronic disease management program among newly insured adults with diabetes and/or hypertension.
Low-income adults with diabetes and/or hypertension were provided County-sponsored health insurance coverage and access to disease management. Health econometric methods were used to compare costs among participants in disease management to nonparticipants, both overall and in comparison between those who were newly insured versus previously insured under an alternative County-sponsored insurance product. Costs were also compared between those who qualified for County-sponsored coverage due to diabetes versus hypertension.
Annual inpatient costs were $1260 lower, and outpatient costs were $723 greater, among participants in disease management (P<0.001 each). Participants in disease management without previous County-sponsored coverage had higher pharmacy costs ($154, P=0.002) than nonparticipants; whereas participants with diabetes had marginally significant lower overall costs compared with nonparticipants ($-685, P=0.070).
Disease management was successful in increasing the use of outpatient services among participants. The offsetting costs of the program suggest that disease management should be considered for some newly insured populations, especially for adults with diabetes.
- SourceAvailable from: ncbi.nlm.nih.govDiabetes care 11/2011; 34(11):2486-7. DOI:10.2337/dc11-1335 · 8.57 Impact Factor
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ABSTRACT: Medicaid's key role in financing diabetes care will grow when many low-income uninsured people with diabetes gain eligibility to the program in 2014 under the Affordable Care Act. Using a national data set to describe current health care use and spending among the nonelderly, low-income adult population, we found that adult Medicaid beneficiaries with diabetes had total annual per capita health expenditures more than three times higher ($14,229 versus $4,568) than those of adult beneficiaries without diabetes. At the same time, Medicaid facilitates financial protection and care access among beneficiaries with diabetes. Low-income adults with diabetes who were uninsured used fewer services, spent more out of pocket, and reported worse access than did their peers who were covered by Medicaid. Uninsured adults with diabetes who gain Medicaid coverage under health reform are likely to enter the program with unmet needs, and coverage is likely to result in both improved access and increased use of health care.Health Affairs 01/2012; 31(1):159-67. DOI:10.1377/hlthaff.2011.0903 · 4.64 Impact Factor
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ABSTRACT: The U.S. Patient Protection and Affordable Care Act (hence, Affordable Care Act, or ACA) was signed into law on March 23, 2010. Goals of the ACA include decreasing the number of uninsured people, controlling cost and spending on healthcare, increasing the quality of care provided, and increasing insurance coverage benefits. This manuscript focuses on how the ACA affects pharmacy benefit managers and consumers when they have prescriptions dispensed. PBMs use formularies and utilization control tools to steer drug usage towards cost-effective and efficacious agents. A logic model was developed to explain the effects of the new legislation. The model draws from peer-reviewed and gray literature commentary about current and future U.S. healthcare reform. Outcomes were identified as desired and undesired effects, and expected unintended consequences. The ACA extends health insurance benefits to almost 32 million people and provides financial assistance to those up to 400% of the poverty level. Increased access to care leads to a similar increase in overall healthcare demand and usage. This short-term increase is projected to decrease downstream spending on disease treatment and stunt the continued growth of healthcare costs, but may unintentionally exacerbate the current primary care physician shortage. The ACA eliminates limitations on insurance and increases the scope of benefits. Online healthcare insurance exchanges give patients a central location with multiple insurance options. Problems with prescription drug affordability and control utilization tools used by PBMs were not addressed by the ACA. Improving communication within the U.S. healthcare system either by innovative healthcare delivery models or increased usage of health information technology will help alleviate problems of healthcare spending and affordability.Research in Social and Administrative Pharmacy 08/2014; 11(3). DOI:10.1016/j.sapharm.2014.08.004 · 2.35 Impact Factor