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Log In Sign Up. Klaus Lemke. Hsien-yen Chang. David Bodycombe. Consistent high-cost users CHUs may be better targets for cost-saving interventions. Conclusions: Five models identified different individuals as potential CHUs. For cost-saving interventions with long-term im- and and point high-cost users PHUs top users in pacts or focusing on medication, CHUs may be better targets. Key Words: risk adjustment, consistent high-cost users, adjusted Research Design: This is a retrospective cohort study.
Independent variables were derived from claims; 5 models with different sets of Med Care ; — independent variables prior costs, medications, diagnoses, medi- cations and diagnoses, medications and diagnoses and prior costs were constructed. Subjects: Three-year continuous enrollees aged from 18 to 62 years F acing escalating health care costs, payers and health care systems seek solutions to improve value in health service delivery. C-statistics, costs. The med- utilization. Although However, studies have shown that not all high-cost users ACGs are an important aspect of the paper, the goal of this paper is not to directly assess or evaluate the methodology.
The Johns Hopkins Uni- at 1 time remain high-cost users in the future; there is a ten- versity receives royalties for nonacademic use of software based on the dency for medical costs to regress to the mean. Broadway, Baltimore, MD, interventions on high-cost users are to be successful, the target E-mail: hchang2 jhsph. All rights reserved. However, they had several drawbacks. First, size of the CHUs group.
If there is a substantial overlap it CHUs were defined using information from 2 periods. We did not choose where differences would be expected. Medicare and Medicaid. Individuals are then placed into one of 93 discrete settings were included. The independent vari- sample size was 1,, To define CHUs, total cost percentiles r10, 11—25, 26—50, 51—75, 76—90, we considered several issues. The pharmacy model Rx- sources the health care industry can only focus on a small PM included the same 2 demographics characteristics plus fraction of enrollees; the size of CHUs should be relatively all 64 Rx-MGs.
First, we described the de- s. Given predictive value. CHUs risk scorers.
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We assessed demographics PHUs, and the total sample. Copyright r Wolters Kluwer Health, Inc. With consistent high-cost users — 52, , Conditions with the 3 largest absolute difference in preva- ADGs 8. On average, the CHU risk scores from the Anxiety Across all pairs, the correlation be- Hypothyroidism Among the rest, the risk scores from the prior cost Glaucoma 6. Overall, the overlap among top disease Schizophrenia 2. Top risk scorers from the prior cost model Addiction 1. On the contrary, top risk scorers from HIV 2.
The overlap of top risk scorers Age-related macular 0. Family and social problems 0. The top CHU risk scorers from the prior cost model female, whereas the mean age was about 50 years old. We have compared alternative models of CHU prediction. PHUs, defined as being among top 6. Overall, the more had higher total costs in than CHUs, but lower total comprehensive the model, the better the performance in Copyright r Wolters Kluwer Health, Inc. Among 3 models with a single-input type, Our study had several limitations.
Our sample con- the medication-only model performed better than the diag- sisted of people enrolled in health plans with at least some nosis-only model, whereas the prior cost model had the worst utilization. If we had included people with no or very few performance. Characteristics of the top risk scorers formed medical costs, this would have increased our sample size on by the prior cost model were different from others as the the low-cost end of the spectrum, and hence would increase prior-cost risk scorers had continuously decreasing total cost, the number of people defined as CHUs or PHUs.
Therefore, not continuously increasing pharmacy cost, and lower we expected that medical costs and the prevalence of con- prevalence of chronic and psychosocial conditions. By excluding the dead, it is likely we overestimate reported9; this might arise from the differences in study the overlap between PHU and CHU as some people who died samples and cutoff points. However, the general notion that were more likely that to be PHU due to high medical uti- the persistence of incurring high costs only exists for a subset lization before death than CHU people who died in the first of current high-cost users still holds.
This further underscores three quarters could not be CHU by definition. Also, we the importance of identifying CHUs instead of traditional excluded children and the elderly. Furthermore, we had to PHUs for interventions. The proportion higher baseline morbidity burden. This may medication-only model had the best performance among 3 also be explained in part by the necessity of continuous single-input models.
For cost-saving interventions that re- medications among patients with chronic and psychosocial quire a longer period to have an impact and that focus more conditions. In contrast, these continuous medications offer a on medications, CHUs may be better targets. Winkelman R, Mehmud S.
Becoming CHUs may require intensified disease management system for patients with type 2 diabetes. Burger S. On the other hand, persistence was related to energy intake in this study, consistent with previous research that showed demand elasticity was related to laboratory energy intake BMI Epstein et al. Additional research is needed to confirm that demand elasticity has a stronger relationship with the energy intake side of the energy balance equation than BMI, which integrates energy intake and energy expenditure.
Of particular interest is the observation that the same general factors are observed for alcohol, tobacco, and food purchasing. While alcohol is a drug, and the focus is often on the pharmacological properties of alcohol, alcohol is also a food product that has calories and that people consume for both its gustatory and pharmacological properties. Thus, it would be interesting to compare different aspects of reinforcing efficacy for alcohol and food product matched for nutrient composition to assess the unique role of the psychoactive compound of ethanol on reinforcing efficacy i.
Furthermore, alcohol is also a complement to food for some people and behavioral economic methods may illuminate the complementarities and substitutability of alcohol. Developing a better understanding of this relationship may be useful in developing unique interventions that reduce intake of foods that are strong complements to alcohol intake with the goal of reducing alcohol intake.
Although the current data cannot directly speak to these possibilities, they are clear priorities for the future. A major advantage of these demand curves is that they are easily measured, multiple commodities can be measured in the same session, and they do not pose a burden on subjects. Developing a better understanding of which facets of food reinforcement are most related to eating and body composition may provide ideas about which aspects of food reinforcement should be addressed in treatment.
This could allow investigators and clinicians to go beyond the idea that obese people find food reinforcing to what aspects of food reinforcement are susceptible to change and can influence the biggest effect on obesity. Grocery Store Study research was registered at http:www. Epstein and Bickel. Leonard H. Epstein is a consultant and has equity in Kurbo.
The other authors do not declare any conflict of interest with respect to the authorship or publication of this article.
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The snippet could not be located in the article text. This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Author manuscript; available in PMC May PMID: Epstein , 1 Jeffrey S.
Dx/Rx: Sexual Dysfunction In Men And Women
Stein , 2 Rocco A. Bickel 2.
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Jeffrey S. Rocco A. James MacKillop 3 Michael G. Warren K. Correspondence concerning this article should be addressed to Leonard H. Epstein, PhD.
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Copyright notice. The publisher's final edited version of this article is available at Appetite. See other articles in PMC that cite the published article. Abstract Background Demand curves provide an index of how reinforcing a food is.