1 Impact of YMCA of the USA Diabetes Prevention Program on Medicare Spending and Utilization Maria L. Alva RTI International
Goals and Background 2 Diabetes is preventable. Diabetes Prevention Program trial participants reduced their incidence of diabetes by 58% over 3 years. 1 YMCA of the USA received a Health Care Goals Innovation Award of $11.8 million from the Participants will lose 5% or more of body Centers for Medicare & Medicaid Services to weight and increase physical activity to 150 offer a diabetes prevention program to Medicare minutes/week while taking part in a 16- fee-for-service (FFS) beneficiaries with session program + maintenance meetings. prediabetes . Question Y-USA enrolled participants Did the Y-USA Diabetes Prevention Program January 2013 ─ June 2015. reduce health care spending and utilization? 1 Diabetes Prevention Program Research Group, Knowler, et al.: 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet Nov 14;374(9702):1677-86, 2009.
Study Sample and Design 3 We analyzed Medicare FFS claims data The Y-USA model test did not have random assignment. through December 2015 for 3,319 We used econometric methods to select a comparison participants enrolled in FFS Medicare group with similar characteristics to participants. Parts A and B. People selected for the comparison group were good matches to participants based on observable factors.
Conclusions 4 • The overall weighted average savings per member per quarter during the innovation’s first 3 years was $278. There were also 9 fewer inpatient stays and 9 fewer ED visits per 1,000 participants per quarter. • Evidence that the model led to lower spending for the innovation group was strongest in the first three quarters after enrollment — i.e., when participants were actively engaged. • Results of spending estimates from the first 2 years of this evaluation informed CMS’ policy that Medicare will include diabetes prevention programs as a covered benefit in 2018.
Do timely mental health services reduce recidivism among prison releasees with severe mental illness? Marisa Elena Domino, Joe Morrissey, Alex Gertner, Brigid Grabert, Gary Cuddeback UNC-CH Funding: Research grant funding from the NIMH (MH086232) is gratefully acknowledged. (
Motivation Lack of insurance coverage upon release from prison for adults with severe mental illness (SMI) is an important barrier to continuous psychiatric care and may affect subsequent incarceration. Prior research has shown that Medicaid coverage upon release is linked to greater mental health services use but does not affect recidivism (Morrissey et al., 2016; Grabert et al., 2017) In this study, we examine whether the timely receipt of mental health services after release from prison by adults with SMI leads to differences in criminal justice contacts.
Methods Data: linked administrative data on publicly funded mental health services, criminal justice contacts, and other records Population: 3004 adults with SMI who were released from prison in WA in 2006 or 2007. Methods: referral to expedited Medicaid (n=649) served as an instrumental variable for mental health service receipt, using two measures of quality/timeliness. We model binary outcomes using 2SRI, 2SLS, and bivariate probit models. We examine four 12-month criminal justice outcomes.
Conclusions We find no evidence that timely receipt of services protects against prison re-incarceration generally. However, New Charges : We find substantial evidence that receiving timely mental health services reduces arrests and re- incarceration in prison for new charges within 12 months Treatment + Supervision : In sub-sample analyses, we find effects may be larger in a community custody sample, indicating treatment plus supervision may be more effective in deterring re-incarceration for new charges. We also find that mental health treatment reduces repeat episodes in prison among those with non-drug index crimes in contrast to no effect on prison use among those with drug crimes.
9 Who is Referred for Inpatient Palliative Care Consultation? Melissa M Garrido, PhD Department of Veterans Affairs Icahn School of Medicine at Mount Sinai
Palliative Care = 10 Standard of Care for Patients with Advanced Cancer Palliative Care for Cancer (PC4C) study (NCI/NINR R01, PI: Diane Meier) • 3,096 patients with advanced cancer • 5 hospitals • 2007-2011
Palliative Care Consultation Referrals Sensitive to 11 Physical Illness Burden Less likely More likely Lymphoma Needs transfer assistance On pain medication at admission Number of comorbidities Physical symptom severity Psychological symptom severity 0.5 1.0 1.5 2.0 2.5 Odds Ratios and 95% Confidence Intervals
Need for Improved Access to Palliative Care 12 • All of the patients in our sample were appropriate candidates for palliative care • < 20% of our sample received a palliative care consultation referral Penrod JD, Garrido MM, McKendrick K, May P, Aldridge MD, Meier DE, Ornstein KA, Morrison RS. Characteristics of hospitalized cancer patients referred for inpatient palliative care consultation. Forthcoming in Journal of Palliative Medicine.
Xinxin Han, MS, Qian Luo, MPSA, Leighton Ku, PhD, MPH AcademyHealth Annual Research Meeting New Orleans, LA June 27, 2017 DOI: 10.1377/hlthaff.2016.0929. HEALTH AFFAIRS 36, NO. 1 (2017): 49 – 56
Objective • The expansion of Medicaid under the Affordable Care Act (ACA) has increased the number of Medicaid beneficiaries in expansion states, which could potentially affect community health center capacity • The ACA also sought to enhance the capacity of community health centers to serve more low-income population in medically underserved areas through increases in core federal funds • Using data from 2012-2015 Uniform Data System (UDS), we employed a difference-in-difference (DID) approach to examine the effects of Medicaid expansion and changes in federal grant level on patient and visit volumes, by type of insurance and services category, in 805 federally funded health centers nationally
Xinxin Han et al. Health Aff 2017;36:49-56 (C) 2017 by Project HOPE/Health Affairs Presentation reuse permitted
Implication • The American Health Care Act (AHCA) would end the ACA’s enhanced funding for adult expansion population and cap federal spending per Medicaid enrollee • The additional mandatory federal funding to health centers expires at the end of fiscal year 2017, creating a “funding cliff” • Changes to Medicaid’s eligibility requirements or to other aspects of the program and drops in funding to health centers would likely affect health centers’ capacity to serve more low -income population, which in return could result in harder access to care
Experiences of PCPs and Staff After Lean Redesign of Care Team Workflows Dorothy Y. Hung,* 1 Michael I. Harrison, 2 Quan A. Truong, 1 Xue Du 1 1 Palo Alto Medication Foundation Research Institute 2 Agency for Healthcare Research and Quality AcademyHealth Annual Research Meeting New Orleans, June 27, 2017 * hungd@PAMFRI.org
Background • Pre-post study of staff in Primary Care (PC) clinics within large ambulatory delivery system that underwent Lean-based redesigns. • Lean: seeks to enhance quality, efficiency, and improvement capacity through staff empowerment, workflow standardization, & measurement. • Limited findings to date on staff responses to Lean redesigns, especially in PC.
Lean Redesigns; Data Sources • Implementation : 46 departments housed within 17 clinics (1 pilot; 3 beta sites;13 role-out sites) • Redesigns : ► Equipment & supply standardization ► Co-location of physician or other PC provider (PCP) & medical assistant (MA) teams in shared workspace ► Workflows: daily team huddles, MA visit agenda setting; joint MA-MD management of electronic inboxes • Data: Baseline surveys of PCPs & staff (n=1333); follow-up in same departments 18-36 months post implementation (n=1,164)
Findings and Conclusions • After redesign PCPs & other staff report higher levels of engagement (e.g., motivation, ownership), participation in decision making, teamwork, favorable perceptions of Lean. • They also reported higher burnout & finding work overly busy & stressful. • Survey responses may reflect redesign’s unique work demands, but results may also reflect growing work burden across primary care. • Redesigns for quality and efficiency must produce direct benefits to PCPs and staff without overtaxing an already overstretched workforce .
How Have 30-Day Readmission Penalties Affected Racial/Ethnic Disparities in Readmissions? Cameron M. Kaplan, Michael M. Thompson & Teresa M. Waters University of Tennessee Health Science Center, Department of Preventive Medicine • Medicare’s Hospital Readmission Reduction Program (HRRP) – Financial penalties on hospitals with higher than expected readmissions • after adjusting for case mix • but not socioeconomic factors • More likely to penalize safety net, urban, and minority- serving hospitals
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