Presentation by Felix Bradbury, RN, ScD, FACHE for Mckesson entitled
PM-O5 Assessing the Economic Impact of Case Management on Diabetics in a Commercially Insured Population, 2004.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
The Near Future of Healthcare Delivery - 2015 Policy Prescriptions® SymposiumCedric Dark
The symposium is designed for clinicians – physicians, nurses, nurse practitioners, physician assistants, and students – and healthcare executives interested in expanding their scope of knowledge about currently popular health policy topics.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
How to Engage Physicians in Quality/Safety Improvement Using MetricsWellbe
The unsustainable rising cost of medical care is creating financial pressures that will critically alter the way that health care is both paid for and delivered. Limited resources dictate that we become more efficient at providing high quality care. In an effort to provide financial incentive for delivering quality care the Federal government instituted Value Based Purchasing (VBP) and Bundled Payments. In order to maximize reimbursement under these programs, providers of health care must follow to the basic tenants of the quality principles.
Lorraine Hutzler, Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center, will discuss:
• How to build a quality infrastructure for your orthopedic program
• What quality metrics to measure and how to engage surgeons using them
• Lean and Six Sigma principles to use to accelerate improvement
About the Speaker:
Lorraine100Lorraine Hutzler is the Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center and a Principal of Labrador Healthcare Consulting. She designed, built and maintains a robust quality infrastructure for the Department of Orthopaedic Surgery. Lorraine has extensive expertise in quality metrics management and reporting as well as Lean and Six Sigma Certification.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Every hospital and health care system is significantly impacted by readmission policies mandated by new regulations.
And every facility must implement strategies to reduce the number of costly and unnecessary readmissions.
During this presentation you will discover how to decrease your readmission rates and take advantage of incentives, rather than suffer penalties that can significantly impact your bottom line.
Effective pharmaceutical product management through health economics outcomes performance measurements.
Health Economics Outcomes Research - HEOR - has a widening role in accountable care and improved healthcare delivery results.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
http://www.ASAMcriteria.org
This slide presentation provides an overview of what is new in The ASAM Criteria, Third Edition, including a new title, new sections, new terminology, as well as improved functionality and design. Releasing along with the book will be a new enhanced web-based version as well as The ASAM Criteria Software.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Rising Importance of Health Economics & Outcomes ResearchCitiusTech
Health Economics & Outcomes Research (HE&OR) guides stakeholders to make informed decisions regarding patient access to drugs and services. This document highlights specific use cases for healthcare information technology that add value to HE&OR.
CRITICAL PATHWAY FOR NURSING ADMINISTRATION.VIKRANT KULTHE
Respected,
all Administration and Nursing Management student its very helpful for a critical planing and critical care plan for the patients those who are hospitalize. The critical pathway means a plan of care to the patients or plan for project. I hope its helpful for all student.
thanking you!!!!!!!
Admission Disposition: Inpatient or Outpatient Observationampeterson03
This was a staff presentation for Rio Grande Hospital staff in 2012 regarding the correct admission status for patients, billing, and the impact that RACs auditors have on the hospital
How to Engage Physicians in Quality/Safety Improvement Using MetricsWellbe
The unsustainable rising cost of medical care is creating financial pressures that will critically alter the way that health care is both paid for and delivered. Limited resources dictate that we become more efficient at providing high quality care. In an effort to provide financial incentive for delivering quality care the Federal government instituted Value Based Purchasing (VBP) and Bundled Payments. In order to maximize reimbursement under these programs, providers of health care must follow to the basic tenants of the quality principles.
Lorraine Hutzler, Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center, will discuss:
• How to build a quality infrastructure for your orthopedic program
• What quality metrics to measure and how to engage surgeons using them
• Lean and Six Sigma principles to use to accelerate improvement
About the Speaker:
Lorraine100Lorraine Hutzler is the Associate Director of the Center for Quality and Patient Safety at NYU Hospital for Joint Diseases at the NYU Langone Medical Center and a Principal of Labrador Healthcare Consulting. She designed, built and maintains a robust quality infrastructure for the Department of Orthopaedic Surgery. Lorraine has extensive expertise in quality metrics management and reporting as well as Lean and Six Sigma Certification.
This e-book focuses on Health Management Solutions the value it adds alongside other systems that are already in place throughout the care lifecycle...
Managing Total Joint Replacement Bundled Payment Models: Keys to SuccessWellbe
Speaker: Andrew Duncan, Executive Director for Orthopaedics and Rehabilitation at University of Florida Health
This webinar will describe bundled payments and episode of care based patient management strategies. Attendees can learn to successfully manage total joint replacement bundled payment programs and what clinical service delivery strategies to use to be positioned for success. The importance of collecting and using data to understand costs for the episode of care and to negotiate will also be a focus.
About the Speaker:
Andrew Duncan has been a licensed physical therapist since 1991, when he graduated from the State University of New York at Buffalo with his Bachelor of Science in Physical Therapy. Upon completion of entry-level training, he worked as a physical therapist for two years and then completed his post professional Master’s degree in Human Movement Science and became certified in Athletic Training at the University of North Carolina at Chapel Hill. He then underwent board certification by the American Board of Physical Therapy Specialties and became a Sports Certified Specialist in 2002. While working as a manager at rehabilitation corporations and later at an academic health care center, he developed a passion for the business of health care and went on to complete his MBA from the Simon School of Business at the University of Rochester and has also earned his DPT from Boston University. Since 2012, Duncan serves as the Executive Director for Orthopaedics and Rehabilitation at the University of Florida College of Medicine, Co-Director of the UF Health Orthopaedic and Sports Medicine Institute, and also serves as the Executive Director for Rehabilitation and Radiology Services at UF Health Shands Hospitals. He holds an adjunct clinical lecturer appointment in the University of Florida Department of Physical Therapy providing instruction in the Patient and Families First and Professional Issues courses of the DPT curriculum.
Every hospital and health care system is significantly impacted by readmission policies mandated by new regulations.
And every facility must implement strategies to reduce the number of costly and unnecessary readmissions.
During this presentation you will discover how to decrease your readmission rates and take advantage of incentives, rather than suffer penalties that can significantly impact your bottom line.
Effective pharmaceutical product management through health economics outcomes performance measurements.
Health Economics Outcomes Research - HEOR - has a widening role in accountable care and improved healthcare delivery results.
www.healthcaremedicalpharmaceuticaldirectory.com
John G. Baresky
https://www.linkedin.com/in/johngbaresky
#baresky
http://www.ASAMcriteria.org
This slide presentation provides an overview of what is new in The ASAM Criteria, Third Edition, including a new title, new sections, new terminology, as well as improved functionality and design. Releasing along with the book will be a new enhanced web-based version as well as The ASAM Criteria Software.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
A few months ago I wrote an article entitled Unplanned Readmissions: Are They Quality Measures or Utilization Measures? It explained the Hospital Readmissions Reduction Program (HRRP) that began in October 2012 as part of the Affordable Care Act (ACA). That article explained the program and its results over the past 5 years. However, more and more healthcare leaders and organizations are beginning to question whether HRRP is a valuable program or whether it is time to move on to something that focuses on quality of care and clinical outcomes, rather than cost savings. This article will address those issues. (In this article “readmissions” mean unplanned or preventable readmissions).
Uncover Hidden Population Using Predictive Modeling Tool VitreosHealth
Using Predictive Modeling Tool to Identify at Risk Patients who has a chance of becoming users of High-Cost Healthcare service and subsequently Reducing PMPM (Per Member Per Month) Costs While Increasing Member Satisfaction
4508 Final Quality Project Part 2 Clinical Quality Measur.docxblondellchancy
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
4508 Final Quality Project Part 2 Clinical Quality Measurromeliadoan
4508 Final Quality Project
Part 2: Clinical Quality Measures for Hospitals
Overview
This activity focuses on Quality Measures for Hospitals. The activity uses online resources from
the CMS website. The Clinical Quality Measures for Hospitals activity focuses on the Hospital
Value Based Purchasing (VBP) Program
Background
The National Quality Strategy (NQS) was first published in March 2011 as the National Strategy
for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and
Quality on behalf of the U.S. Department of Health and Human Services (HHS). Today, the NQS
serves as a guide for identifying and prioritizing quality improvement efforts, sharing lessons
learned, and measuring the collective success of Federal, State, and public‐ and private‐sector
healthcare stakeholders across the country.
The Aims of the NQS are threefold:
Better Care: Improve the overall quality by making health care more patient‐centered,
reliable, accessible, and safe.
Healthy People/Healthy Communities: Improve the health of the U.S. population by
supporting proven interventions to address behavioral, social, and environmental
determinants of health in addition to delivering higher‐quality care.
Affordable Care: Reduce the cost of quality health care for individuals, families,
employers, and government.
To align with this, CMS has set goals for their Quality Strategy. These include:
• Make care safer by reducing harm caused in the delivery of care
– Improve support for a culture of safety
– Reduce inappropriate and unnecessary care
– Prevent or minimize harm in all settings
• Strengthen person and family engagement as partners in their care
• Promote effective communication and coordination of care
• Promote effective prevention and treatment of chronic disease
• Work with communities to promote best practices of healthy living
• Make care affordable
CMS’s vision states that if we can find better ways to pay providers, deliver care, and distribute
information than patients can receive better care, health dollars are spent more wisely, and
there are healthier communities, a healthier economy, and a healthier county. It is with this in
mind that they have created multiple quality payment programs.
In January 2015, the Department of Health and Human Services made an announcement that
set in place measurable goals and a timeline to move the Medicare program towards paying
providers based on the quality of care rather than the quantity. This was the first time in the
history of the program that explicit goals were set. They invited private sector payers to match
or exceed these goals as well. These goals included:
1. Alternative Payment Models
a. 30% of Medicare payments tied to quality or value through Alternative Payment
models by the end of 2016 and 50% by the end of 2018
2. Linking Fee‐For‐Service payments to Quality/Value
a. 85% of all Medi ...
140306 dr tim ferris healthcare cost challengeNuffield Trust
In this slideshow, Dr Tim Ferris, Vice President for Population Health Management, Partners HealthCare, and Medical Director of the Massachusetts General Physicians Organisation; explores a new approach to meeting the health care cost challenge.
2023 — Focus on the Margin (Vitalware by Health Catalyst)Health Catalyst
In this webinar, we will look at pressures exerted in 2023 on the margin and explore how cost management and complete charge capture can protect and enhance the margin. We will provide details on patient activity costing versus the cost-to-charge ratio (CCR), looking at common themes for lost charges and providing an example of where patient activity cost management was able to provide insight into cost containment and practice patterns of a system provider.
ECO/561 Week 5 Assignment Rubric
Individual Assignment: Effectiveness of the Counter-Cyclical PoliciesPurpose of Assignment
This assignment addresses how both monetary and fiscal policies have been used during the so-called Great Recession, which began in December 2007 and ended in June 2009, to the present to moderate the business cycle. Resources Required
Tutorial help on Excel® and Word functions can be found on the Microsoft® Office website. There are also additional tutorials via the web offering support for Office products.Grading Guide
Content
Met
Partially Met
Not Met
Comments:
Selected an industry that suffered heavy losses during the Great Recession and produced an Excel® Workbook including the following data from December 2007 to the present:
· One dataset related to the U.S. housing industry such as housing starts, the FHFA housing price index, or another dataset of your choice related to the housing market.
· One dataset related to personal or household income or to personal or household saving.
· One dataset related to the labor market such as the unemployment rate, initial claims for unemployment insurance, or another dataset of your choice related to the U.S. labor force.
· One dataset related to production and business activity within the market or industry you choose to analyze.
15 points
Using data results analyzed the economic and sociological forces that drove the market equilibrium to unsustainable heights, commonly referred to as "bubbles," and the shocks that brought the markets back down.
10 points
Discussed specific changes in supply and demand within the markets and/or industries you chose to analyze.
10 points
Determined whether specialization of industry had any influence on the impact of the recession. 10 points
Examined prior government policies and legislation that might have exacerbated the impact of the shocks. Also, discuss government actions/regulations that might be undertaken, and/or have been undertaken, to moderate the effects of extreme economic fluctuations. 15 points
Evaluated the actions of the federal government (fiscal policy) and the Federal Reserve (monetary policy) to restore the economy and foster economic growth. Based your evaluation on information available at Internet sources such as, but not limited to, the Fed's The Economy Crisis and Response website as well as other appropriate sources found on the Internet and in the University Library. You did address the effectiveness of those counter-cyclical policies. 20 points
The analysis is a minimum of 1,050 words in length. 5 points
Total Available
Total Earned
85
#/85
Writing Guidelines
Met
Partially Met
Not Met
Comments:
The paper—including tables and graphs, headings, title page, and reference page—is consistent with APA formatting guidelines and meets course-level requirements. 10 points
Intellectual property is recognized with in-text citations and a reference page. 10 points
Paragraph and s ...
POV Healthcare Payer Medical Informatics and AnalyticsFrank Wang
Health Insurance / Payer Analytics
Medical Informatics
Fraud Detection
Care Management
Utilization Management
Business Performance Management
Clinical Outcome Measures
This presentation will walk the viewer through the following key moments:
Slide 2 – About Ochsner
Slide 3 – Book of business
Slide 4 – Key differentiators
Slides 5/6 – The problems we’re solving
Slides 7/8 – Care team and collaboration
Slides 9/10 – Results, outcomes and ROI
Slides 11/12 – Employer experience and ideal client profile
Slides 13/14 – Employee engagement
More than just condition monitoring:
Ochsner Digital Medicine is remote clinical management, including clinicians and pharmacists on the care team to adjust medications accordingly.
Full clinical management - including medication management and ordering labs. The only program delivering at national scale that is backed by a not-for-profit, Center of Excellence health system. The only program that augments the member's PCP care via seamless data integration with Epic electronic health record.
EDM ForumEDM Forum CommunityeGEMs (Generating Evidence & M.docxgreg1eden90113
EDM Forum
EDM Forum Community
eGEMs (Generating Evidence & Methods to
improve patient outcomes) Publish
4-20-2017
Reducing Healthcare Costs Through Patient
Targeting: Risk Adjustment Modeling to Predict
Patients Remaining High-Cost
Jonathan A. Wrathall
Intermountain Healthcare, [email protected]
Tom Belnap
Intermountain Healthcare, [email protected]
Follow this and additional works at: http://repository.edm-forum.org/egems
Part of the Other Medicine and Health Sciences Commons, and the Social Statistics Commons
This Methods Case Study is brought to you for free and open access by the the Publish at EDM Forum Community. It has been peer-reviewed and
accepted for publication in eGEMs (Generating Evidence & Methods to improve patient outcomes).
The Electronic Data Methods (EDM) Forum is supported by the Agency for Healthcare Research and Quality (AHRQ), Grant 1U18HS022789-01.
eGEMs publications do not reflect the official views of AHRQ or the United States Department of Health and Human Services.
Recommended Citation
Wrathall, Jonathan A. and Belnap, Tom (2017) "Reducing Healthcare Costs Through Patient Targeting: Risk Adjustment Modeling to
Predict Patients Remaining High-Cost," eGEMs (Generating Evidence & Methods to improve patient outcomes): Vol. 5: Iss. 2, Article 4.
DOI: https://doi.org/10.13063/2327-9214.1279
Available at: http://repository.edm-forum.org/egems/vol5/iss2/4
Reducing Healthcare Costs Through Patient Targeting: Risk Adjustment
Modeling to Predict Patients Remaining High-Cost
Abstract
Context: The transition to population health management has changed the healthcare landscape to identify
high risk, high cost patients. Various measures of patient risk have attempted to identify likely candidates for
care management programs. Pre-screening patients for outreach has often required several years of data.
Intermountain Healthcare relied on cost-ranking algorithms which had limited predictive ability. A new risk-
adjusted algorithm shows improvements in predicting patients’ future cost status to facilitate identifying
patient eligibility for care management.
Case Description: A retrospective cohort study design was used to evaluate high-cost patient status for two
of the next three years. Modeling was developed using logistic regression and tested against other decision tree
methods. Key variables included those readily available in electronic health records supplemented by
additional clinical data and estimates of socio-economic status.
Findings: The risk-adjusted modeling correctly identified 79.0% of patients ranking among the top 15% of
costs in one of the next three years. In addition, it correctly estimated 48.1% of the patients in the top 15% cost
group in two of the next three years. This method identified patients with higher medical costs and more
comorbid conditions than previous cost-ranking methods.
Major Themes: This approach improves the predictive accuracy of identifying high cost patients in the future
.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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Mckesson Payor Solutions Conference Presentation of Case Management, 2004
1. PM-O5 Assessing the Economic Impact of Case Management on Diabetics in a Commercially Insured Population Felix J. Bradbury, RN, MHA, ScD*, CHE Blue Cross Blue Shield of Louisiana 2004
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6. QUESTION 1: What is the ROI for the Various Departments within Medical Management?
7. Summary of Medical Management Cost Savings, 2003 Medical management cost-savings are generated via a combination of the following activities: ( Note that cost savings due to non-certified days and changes in level of care (LOC) are based on per diem reimbursement. Case rates and DRG rates are not included in the current cost savings methodology.) -Changes in level of care, i.e., acute day to sub-acute day using M&R criteria and directly attributable to care management activities. -Non-certified care, i.e., denied days or services because of lack of medical necessity or pre-existing condition. Any admission day this was subsequently denied. Non-certification days may be applied to acute care, rehabilitation, SNF, LTAC, home health or hospice rates -Medical policy review, i.e., denial based on experimental or investigational procedures, or therapeutics. -Pharmacy benefit management, i.e., increasing generic utilization relative to brand utilization and leveraging pharmacy tiers.
8. Examples of Cost Savings from LOC Changes or Non-Certified Care in Per Diem Facilities Cost-savings are calculated by subtracting the median value for a lower level of care from the median value for a higher level of care. For example, the median allowed amount for a SNF day is $500/day; the median allowed amount for an acute day is $1,592.50. The difference between $1,592.50 and $500 is the cost savings. In this example, the cost savings for this change in level-of-care is $1,092.50 per change in level-of-care. All cost-saving estimates are based on the median allowed dollars. Median values across levels-of-care were used to generate estimated reimbursement amounts; median values were used in lieu of averages because the former is less susceptible to the influences of outlier values.
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10. QUESTION 2: What is the Cost-Benefit of Case Management Activities for Diabetic Members Over the Short-term Period of a Single Year?
21. What Do We Hope to See? 1500 Estimated Savings in Dollars 2.6 2.8 3 3.2 3.4 RR Score 0 5 10 15 Time Period (Months) Baseline Score Observed_RR_Score Savings Source: Blue Cross Blue Shield of Louisiana, MMRD, 2003 N=2,500 active members from January 1-December 31, 2003 Hypothetical ROI Analysis for High-Risk Members 0 500 1000
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26. QUESTION 3: How Can We Model the Cost-Benefit of the Long-term Savings Associated with Case Management Activities?
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28. Markov Transition State Models for Diabetics Enrolled and Not Enrolled in Case Management Programs
GOOD AFTERNOON HONORED COLLEAGUES - WELCOME TO PM 05 Assessing the Economic Impact of Case Management on Diabetics in a Commercially Insured Population – I’M DELIGHTED THAT THERE’S BEEN SUCH A TERRIFIC TURNOUT. MY NAME IS FELIX BRADBURY AND I’M THE DIRECTOR OF MMRD FOR BLUE CROSS AND BLUE SHIELD OF LOUISIANA. Louisiana is my home so I bid you welcome hope you enjoy your stay. AS A HOUSEKEEPING NOTE , I HAVE A LOT OF GROUND TO COVER IN THE NEXT HOUR SO PLEASE WRITE YOUR QUESTIONS DOWN AND HOLD THEM TO THE END OF THE PRESENTATION. I’VE ALLOWED 15-20 MINUTES TO ANSWER YOUR QUESTIONS. Before I begin I want to relate a story about cost-benefit and cost-savings that one of our case management nurses shared with me. She told me “See, if you don’t make us look good and we go away, then you have nothing to report on and you go away…” So I have a clear motive to make case management look good. THE PRIMARY PURPOSES OF THIS PRESENTATION ARE TO DISCUSS : Cost savings attributable to Medical management activities The economic impact of diabetes on the population Our method for evaluating the short term economic impact of case management on a diabetic population Present a Markov model for assessing the long-term economic impact of case management on a diabetic population. Where we are with the results The data I am going to discuss reflects our own data but I’ve altered the numbers a little bit to protect the innocent, or perhaps the guilty, whichever the case may be.
Background and Introduction Three Questions We’re Working to Answer A Few Definitions The BCBSLA Population The Economic Impact of Diabetes The CRMS Data Short-term savings – Medical Management Overall Medical Management Processes Estimates of Annual hard dollar savings for Medical Management Measuring the Impact of Case Management Short-term Impact Long-term savings estimates via Markov Models Most studies focus on cost-effectiveness. In contrast, my efforts at BCBSLA have focused on cost-benefit analysis and cost minimization analysis.
Q1: What is the ROI for the various departments within Medical Management? Q2: What s the cost-benefit of case management activities for diabetic members over the short-term period of a single year? Q3: How can we model the cost-benefit of the long-term savings associated with case management activities? One way in which the health plans are working to manage the costs associated with this costly and debilitating chronic condition is by implementing diabetes case management programs. These programs are designed to target members with diabetes and provide education and information to assist members with managing their condition. Case management programs are increasing in popularity throughout the United States among both health plans and employer groups. The former groups seek to use Case management programs to demonstrate the value add of their plan, while the latter seeks to use Case management programs as a tool to combat spiraling premium costs that result from, other factors, higher utilization of health care resources by members with chronic conditions such as diabetes. Both groups see these programs as the Holy Grail in controlling healthcare costs but no one has really worked to determine conclusively if there really is gold – in the form of hard-dollar savings - at the end of the Case management rainbow.
Without trying to be too academic, the following definitions are presented in order to get us all grounded in the same framework: Cost-benefit analysis: An economic evaluation method for determining whether or not an intervention or program is worth doing. The basic approach is to measure all relevant costs and benefits and determine the ratio between the two. In cost-benefit analysis, both costs and benefits are expressed in terms of dollars. Cost-effectiveness analysis: An economic evaluation method in which costs are expressed in terms of dollars but benefits, or consequences, are generally expressed in non-dollar terms, i.e., QALYS, life-years gained per dollar spent, reduction in ALOS/dollar spent, etc Cost-minimization analysis: An economic evaluation method in which the goal is a search for the least-costly alternative that yields equivalent – or better – results when compared to all other alternatives.
-Commercially insured population -No Medicare primary -No Medicaid members -Large individual underwritten book of business -Significant number of small self funded accounts -277,324 members – MBA members - are excluded from analysis because they did not fall within the control of care management and case management programs for one or more of the following reasons: they do not reside in Louisiana, are over 65 and receive their healthcare benefits through Medicare Part A and B, hold a policy with very limited benefits, i.e., dental only, or life-insurance only benefits
QUESTION 1: What is the ROI for the Various Departments within Medical Management?
Medical management cost-savings are generated via a combination of the following activities: ( Note that cost savings due to non-certified days and changes in level of care (LOC) are based on per diem reimbursement. Case rates and DRG rates are not included in the current cost savings methodology.) -Changes in level of care, i.e., acute day to sub-acute day using M&R criteria and directly attributable to care management activities. -Non-certified care, i.e., denied days or services because of lack of medical necessity or pre-existing condition. Any admission day this was subsequently denied. Non-certification days may be applied to acute care, rehabilitation, SNF, LTAC, home health or hospice rates -Medical policy review, i.e., denial based on experimental or investigational procedures, or therapeutics. -Pharmacy benefit management, i.e., increasing generic utilization relative to brand utilization and leveraging pharmacy tiers.
Cost-savings are calculated by subtracting the median value for a lower level of care from the median value for a higher level of care. For example, the median allowed amount for a SNF day is $500/day; the median allowed amount for an acute day is $1,592.50. The difference between $1,592.50 and $500 is the cost savings. In this example, the cost savings for this change in level-of-care is $1,092.50 per change in level-of-care. All cost-saving estimates are based on the median allowed dollars. Median values across levels-of-care were used to generate estimated reimbursement amounts; median values were used in lieu of averages because the former is less susceptible to the influences of outlier values.
Assumptions: Model reflects cost-savings which are the direct result of activities conducted by medical management staff. All financial calculations are hard-dollar estimates. Cost-savings estimates are based on the median allowed amounts across all products and lines of business Because the number of actual days a member will be in the hospital is not known until the member has actually incurred the days, it is impossible to estimate all of the days saved. One day per member per non-certification of level-of-care change is assumed. This results in conservative cost-savings estimates.
QUESTION 2: What is the Cost-Benefit of Case Management Activities for Diabetic Members Over the Short-term Period of a Single Year?
What are We Attempting to Demonstrate? Does the incremental cost-benefit associated with case management mean it’s a program worth doing? Short-term savings <= 1 year Long-term savings > 1 year
The Impact of Diabetes in Louisiana According to the Louisiana State Office of Public (OPH), diabetes affects an estimated 7.6 percent of Louisiana’s 4,496,334 citizens – over 301,254 people as of 2003. OPH also estimates the direct and indirect costs of diabetes in Louisiana - considered a conservative estimate given that approximately one third of all diabetics are undiagnosed - to be over $2.2 billion as of 1997. Unfortunately, these costs extend well beyond the enormous economic burden. In 2000, Louisiana had the highest death rate in the nation due to diabetes with a mortality rate of 42.2 per 100,000 population. The Centers for Disease Control and Prevention (CDC) ranks diabetes as the primary cause of blindness in adults aged 20 to 74 as well as the most common cause of non-traumatic amputations and end stage renal disease.
Diabetes imposes a significant economic burden to Louisiana residents. There are approximately 19,783 diagnosed diabetics out of a population of 625,484 managed members – this is approximately 3.2 percent of the BCBSLA managed membership as of the first quarter of 2004. Of these 19,783 diabetics, an average census of approximately 80 diabetics are actively enrolled in diabetes case management programs on a monthly basis with a enrollment period of 60 to 90 days; this average includes both newly diagnosed and previously enrolled diabetics. The average annual per capita cost for diabetic members across all lines of business for 2003 was ~ $10,798.97, sd = $28,391.01. This cost includes all inpatient, outpatient, professional and pharmacy costs. The annualized costs for case managed diabetics is $26,178.53, sd = $54,377.93. The annualized costs for diabetics not enrolled in case management $9,741.553, sd = $25,319.6 The incremental difference between members enrolled and not enrolled is $26,178.53 - $9,741.553 = $16,436.96, sd = $39,848. N = 1,920 members for the two year study period in question.
Retrospective (case-control) study design. The relative advantages of case-control studies include the following attributes: Case-control studies are relatively quick and inexpensive as compared to cohort study designs. Case-control studies tend to support causality by establishing associations between dependent and independent variables Historical data are often available from either administrative databases or clinical records so secondary analyses – analyses of existing data – are easily performed without having to obtain more information from the cases or controls. The sample size requirements needed to test hypotheses of association are generally smaller than the sample sizes need for more robust designs such as cross-sectional and cohort designs. The disadvantages of case-control studies include the following attributes: Potential for administrative or clinical data to be incomplete. The criteria used in the diagnoses of cases may not be the same among providers so that cases and controls are not homogeneous. The occurrence of the assumed antecedent (disease state or condition) in the history is obtained from selected cases and controls and is not randomized. Thus, the antecedents are not obtained from a universe of all antecedents, so one cannot know what the association would be for all or for a different representative sample of all people having the antecedent.
The above diagram shows the basic model which is under evaluation. The vertical dashed lines are a Visio thing that, while I trie repeatedly, was unable to remove. EXPLAIN DIAGRAM STARTING FROM TOP
This is a basic schematic of the retrospective study design: The “0s” represent observations on the dependent variable, in this case the average allowed costs for diabetic members each month within each of the two groups, and the “Xs” represent interventions from case management. The dotted lines indicate the study participants are not randomly selected but are assigned to either case group or a control group depending on whether or not they elected to participate in a case management program, i.e., the members are self-selecting. Self-selection may be controlled for using the Heckman approach to self-selection bias, i.e., the Heckman two-step consistent estimator for modeling with censored data.
The advantages of case-control studies include the following attributes: Relatively quick and inexpensive as compared to cohort study designs. Generally support causality by establishing associations between dependent and independent variables Historical data are often available from either administrative databases or clinical records so secondary analyses are easily performed without having to obtain more information from the cases or controls. The sample size requirements needed to test hypotheses of association are generally smaller than the sample sizes need for more robust designs such as cross-sectional and cohort designs.
Cases are defined as plan members diagnosed with either Type I or Type II diabetes – with or without comorbid conditions - and who have been actively enrolled in the plan’s case management program for diabetes at any point between January 1, 2002 and December 31, 2003. The control group consists of plan members – with or without comorbid conditions - diagnosed with Type I or Type II diabetes and who did not participate in the plan’s case management program for diabetes during the same calendar year. Reasons for non-participation include: Unable to contact member because of incorrect contact information or member moved Member declined to enroll
CRMS DATA ICD-9-CM codes in the 2500-2500.x code range, This definition includes Type I and Type II diabetes as well as any co-morbid conditions that may associated with diabetes. ETGs: Insulin dependent diabetes, w/o comorbidity Insulin dependent diabetes, with comorbidity Non-insulin dependent diabetes, w/o comorbidity Non-insulin dependent diabetes, with comorbidity Comorbidities: ICD-9 CM codes for the most common comorbid conditions associated with diabetes were included in the analysis and include: cardiovascular disease, hypertension, septicemia, bacteremia, hyperosmolarity, nephropathy, neuropathy, and retinopathy.
This table shows the data used in this study. With the exception of the SES data from our Marketing Research area, all data was obtained from CRMS.
This is a slide from last year’s presentation on predictive modeling. In terms of our results, we’re not there yet. LAGNIAPE: THIS LAST SECTION PRESENTS ONE POSSIBLE METHODOLOGY FOR CALCULATING ROI. The above plot shows the change in RR score relative to baseline and estimated savings. If you know a member’s baseline RR Score and then track their RR score across time before and after their entry into Care Management, you can calculate the change in their RR Score. Because there is a 1-to-1 correlation between RR Score and Predicted costs, any difference in RR score can directly translated into costs savings. For example: if John Doe has a baseline RR score of 3.2, then we know he has a a predicted total annual cost of $6,384 because the predicted costs increase by an average of $1,995 per one unit change in RR Score. Therefore, If his RR score is reduced by two points from 3.2 down to 1.2, then we know ~$4,000 has been saved. The advantage of using a baseline study is that the member acts as his or her own control group.
Using ordinary least squares regression models to compare the total allowed dollars per year between the cases (enrolled) and controls (not enrolled) after adjusting for: Age (excludes Medicare primary) Sex Number of comorbid conditions Differences in benefits design Length of time enrolled as BCBSLA member Enrolled or not enrolled in case management Case management severity (moderate high) SES – using zip code data Self-selection bias
This slide shows the summary statistics for members enrolled in case management vs. members not enrolled in case management between August 2003 and July 2004. It is based on claims paid and incurred during that time period and includes a 90 day claims lag runout. Hx costs are annualized costs and represent the sum of all medical and pharmacy costs for a member observed during the 12-month period. These costs are computed as the total allowed PMPM cost multiplied by 12. Data are age-sex adjusted using OLS regression. The CV is coefficient of variation and is calculated as the standard deviation divided by the mean and is another measure of variation.
Using CRMS data, the incremental difference between the allowed paid claims for diabetics enrolled in case management vs. diabetics not enrolled case management is: $9,741.55 - $26,178.53= -$16,436.98/year/enrolled diabetic. Diabetic members enrolled in case management appear to have significantly greater utilization of health services including primary care and specialty care services. Is there a long-term payoff?
The initial conclusions indicate: Its too early to publish any conclusive findings as the study was designed to run 2002 through 2004 and use completed claims data so a 39 month period of time is needed. We will be publishing our conclusions next year. Diabetic members in case management programs appear to be consuming greater healthcare resources in the short-term than members not enrolled in case management programs. What conclusions can we draw from this? Nothing yet – it is hoped that the greater short-term consumption will result in long-term savings, and improved quality of life, for case management enrolled members through: Reduced inpatient hospital admits Reduced ER utilization Reduced incidence and prevalence of ESRD
Markov analysis is a technique that deals with probabilities of future occurrences by analyzing presently known or estimated probabilities. Well-regarded as a method for evaluating long-term cost-benefit when long-term data are limited or nonexistent. Markov models are useful when the decision problem involves risk over time, and when events may happen more than once. There are four assumptions to the Markov process: There is a limited or finite number of possible states The probability of changing states remains the same over time (i.e., stationary vs. non-stationary Markov models) We can reasonable predict any future state from the previous state and the matrix of transition probabilities. The size and the makeup of the system – for example the proportion of diabetics- does not change during the analysis.
The above is a cohort simulation model established to demonstrate the long-term savings associated with case management activities for diabetics. The low, moderate and high risk categories are arbitrary constructs intended as proxies for severity of diabetes. They are based on RR score range from the BCBSLA predictive model, or HbA1c values, or allowed/dollars/diabetic/year.
The above is the Markov cohort simulation model produced using TreeAge data 4.0 software. The data from the Markov transition state diagram were loaded into the model, estimated costs/savings were used as the payoff and the results are shown on the next slide.
This Markov model output assumes a monthly savings cycle for case management activity and a half-cycle correction factor for a five year time horizon. The savings are estimated at $5,268.82/year/enrolled diabetic assuming a five year horizon and a nominal discount rate of 3%/year. Also note the expected rate of cost increase is greater for the diabetics not enrolled in case management. Note that the Markov model shows savings because the likelihood of a diabetic member enrolled in case management incurring higher claims costs is lower than for a diabetic member not enrolled in case management.