In the United States, approximately 600,000 hysterectomies are performed each year. Several surgical approaches are used to perform them. Open abdominal hysterectomy is the most common and invasive approach. All other approaches are classified as minimally invasive procedures. In this paper, Milliman’s Kate Fitch and Andrew Bochner analyze commercial payer differences in the average costs and readmission rates between inpatient open hysterectomies and three types of outpatient hysterectomies: laparoscopic, laparoscopic assisted, and vaginal.
This article was originally published in the August 2016 issue of Managed Care.
Numerous studies comparing the safety and efficacy of minimally invasive surgery (MIS) and open surgery have shown that MIS is associated with shorter intensive care and hospital stays and lower rates of transfusion, readmission, surgical site infections, pain, mortality, and time taken to return to normal activities or work. Despite evidence supporting the benefits of MIS, its use varies widely by region and hospital. In this study, Milliman consultants analyze the difference in payer costs between MIS and open surgery in a commercial population for four commonly performed elective surgical procedures.
This article was originally published in the September 2015 issue of Managed Care.
Major efforts to improve the care and reduce the cost of heart failure patients have recently been implemented. Despite these efforts, however, the rate of heart failure is rising and only small improvements in survival have been realized. The lack of novel therapies and limited improvement in medical management highlight the need for more focus on heart failure, especially among the Medicare population. Milliman consultants Bruce Pyenson, Kate Fitch, and Pamela Pelizzari provide some perspective in this report.
The opportunity to reduce Medicare claims cost in the Bundled Payment for Care Improvement Initiative (BPCI) of the Center for Medicare and Medicaid Innovation (CMMI) is typically in the post-acute care (PAC) period. Analyzing the opportunity to reduce Medicare PAC spending requires providers to adopt a payor state of mind—payor tools and approaches will be very helpful. Benchmarking to best practices is one of those tools.
Milliman has developed nationwide average and well-managed (WM) benchmarks for PAC periods of one to 30, 31 to 60, and 61 to 90 days. Milliman’s Bruce Pyenson, Kate Fitch, Michele Barrios, and Tyler Engel provide perspective in this healthcare reform paper.
Changes from the Patient Protection and Affordable Care Act (ACA) are dominating the healthcare landscape. These changes are very important for people infected with the hepatitis C virus (HCV). Last year there was an increased federal public health effort aimed at diagnosing people with HCV. Baby Boomers, the generation with the most HCV-infected people, has started to become eligible for Medicare.
Further, new treatments for HCV are under development. Undiagnosed individuals and uninsured individuals may represent a population that payors and stakeholders have not yet experienced. This paper discusses how increased diagnosis, increased Medicare eligibility, and newly insured individuals with HCV will affect the U.S. healthcare system.
Cancer patients receiving active treatment with chemotherapy incur four times the costs of cancer patients not receiving chemotherapy. The cost of patients receiving chemotherapy has been reported to vary by site of service, with higher costs when treatment is delivered in a hospital outpatient setting (HOP) versus a physician office visit (POV). Recent reports indicate an increasing portion of chemotherapy is being delivered in HOP settings and less in POV settings, which can increase costs for payors and/or employers.
This study provides new information by examining Truven MarketScan® commercial claims data (index years 2009 and 2010) to calculate the episode cost of chemotherapy delivered in the HOP versus POV settings for specific disease states. HOP costs were 28% to 53% higher than the POV costs depending on the cancer and adjuvant or metastatic stage. In particular, we noted significantly higher per-episode cost for chemotherapy drugs, radiation oncology, imaging (CT, MRI, and PET scans) and laboratory services in the HOP setting.
This report was commissioned by Genentech.