Showing papers by "Aetna published in 2009"
TL;DR: Post-AF total direct healthcare costs were 3 times greater than pre-AF costs, and warfarin exposure appeared to be associated with lower pmpm costs in this population.
Abstract: Objective:To determine the direct healthcare costs associated with the onset of chronic nonvalvular atrial fibrillation (CNVAF), warfarin utilization and the occurrence of cerebrovascular events in a commercially-insured population.Research design and methods:This retrospective, observational cohort study utilized medical and pharmacy claims from a large, geographically diverse managed-care organization (N = 18.5 million) to identify continuously benefit-eligible CNVAF patients ≥45 years of age without prior valvular disease or warfarin use between January 1, 2001 and June 1, 2002. All patients were followed at least 6 months, until plan termination or the end of study follow-up. Stroke risk was assessed using the CHADS2 (stroke-risk) index; warfarin use was defined as having filled at least one pharmacy claim. Inpatient and outpatient cost benchmarks were utilized to estimate total direct healthcare costs (pre- and post-AF index claim). For patients with transient ischemic attacks (TIA), ischemic...
35 citations
Patent•
21 Sep 2009TL;DR: In this paper, an electronic health care information system with custom interfaces and underlying processing optimized for the health plan member and health care provider contexts is presented. But the authors do not consider the various specifics of information available to health plan members and providers in the context of estimating the members' out-of-pocket payments.
Abstract: To take into account the various specifics of health care information available to the health plan members and health care providers in the context of estimating the members' out-of-pocket payments, embodiments of the invention are used to provide an electronic health care information system with custom interfaces and underlying processing optimized for the health plan member and health care provider contexts. Embodiments of the health care information system construct a pseudo-claim based on the information gathered via the member or provider interfaces and provide an accurate real-time estimate of the member's out-of-pocket responsibility based on adjudicating the pseudo-claim by taking into account the details of the member's health plan and current benefit levels.
18 citations
TL;DR: Eliminating health-care disparities will require assuring access to the patient-centered medical home, and addressing differences in health- care coverage that contribute to lower rates of Latino access to a PCMH will also reduce disparities.
Abstract: Background
Disparities can be caused by minorities receiving care in low-quality settings. The patient-centered medical home (PCMH) has been identified as a model of high-quality primary care that can eliminate disparities. However, Latinos are less likely to have PCMHs.
TL;DR: Comprehensive health plan CM and more liberal hospice benefit design may help to break down barriers to hospice use; benefits might be liberalized within the context of such case management programs without adverse impact on total costs.
Abstract: Objective: The objective of this study was to evaluate the impact of comprehensive case management (CM) and expanded insurance benefits on use of hospice and acute health care services among enrollees in a national health plan. Study Design: Retrospective cohort design with three intervention groups, each matched to a historical control group. Methods: Intervention groups were health plan enrollees who died after 2004: 3491 commercial enrollees with CM; 387 commercial enrollees with CM and expanded hospice benefits; and 447 Medicare enrollees with CM. Control groups consisted of enrollees who died in 2004 prior to the start of the palliative care CM program. The main outcomes measured were the proportion using hospice, mean number of hospice days, and number of inpatient days measured through medical claims. Results: Hospice use increased for all groups receiving CM compared to the respective control groups: from 30.8% to 71.7% (p < 0.0001) for commercial members with CM and from 27.9% to 69.8% (...