- The Economic Impact of Medicare Part D on Congestive Heart Failure
Challenge
A major biopharmaceutical research organization needed to understand Medicare Part D's impact on medication adherence by congestive heart failure (CHF) patients. The organization wanted to find out if Part D would lead to greater adherence and lower overall medical expenditures.
Solution
We combined published literature findings with original public file analysis to estimate current and projected future savings given better patient adherence. We modeled incremental savings with improved adherence across specific populations.
Results
We found that improved medication adherence due to Part D led to nearly $2.6 billion in reduced medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage. More than $2.3 billion of that total was in Medicare savings. Further adherence improvements could save Medicare another $1.9 billion annually, generating $22.4 billion in federal savings over 10 years. Our client used these findings to illustrate to government decision makers the value of improved medication access for a high-cost population.
- Burden of Disease
Challenge
Life sciences organizations often need health care use and expenditure data, and the indirect societal burden tied to disease. This information helps inform research priorities.
Solution
We used disease burden models that integrated analysis of medical claims, hospital discharge records and national surveys with public information to assess the burden of diabetes and Parkinson's disease in the US. Using these models, our consultants calculated increased medical costs and decreased productivity tied to the two diseases and provided an estimate of their indirect costs and mortality implications.
Results
The American Diabetes Association, the Centers for Disease Control and Prevention, and the National Institutes of Health presented the diabetes burden findings, demonstrating that diabetes cost $245 billion in 2012 in the form of higher medical expenditures and reduced productivity. On average, diabetics incurred $13,700 in annual medical costs whereas non-diabetics averaged $7,000. Our study showed that although Parkinson's disease poses a much smaller national burden ($14 billion in 2010) than diabetes, the burden per patient was much higher. Parkinson's patients incurred $22,100 in medical costs, on average, whereas a similar population without Parkinson's averaged medical costs of $9,300. Study sponsors used these findings to educate the public and policy makers on the magnitude of disease burden and the health and economic benefits of disease prevention.
- Implications of Policy Changes
Challenge
Government agencies, professional associations, hospital systems and insurers often need to quantify the impact of changing demographics, proposed policies, and emerging care delivery models on the current and future demand for health care services and providers.
Solution
We modeled demand for healthcare products and services using a health profile for a stratified random population sample. Each person's health profile contained information on demographics, socio-economic characteristics, disease prevalence, health risk factors and insurance type. Armed with this information, we forecasted each state's use of health care services and providers through 2025.
Results
Organizations use the study results for different aims: Governments and educational institutions—to inform funding levels and new health professional training plans, professional associations—to stress the need for appropriate reimbursement rates for attracting and retaining health professionals, and hospital systems—to inform marketing strategies and expansion plans.
