The Experts below are selected from a list of 9795 Experts worldwide ranked by ideXlab platform
Dennis Rossdegnan - One of the best experts on this subject based on the ideXlab platform.
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impact of high Deductible health plans on medication use among individuals with bipolar disorder
2021Co-Authors: Alisa B Busch, Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Matthew Callahan, Robert F Lecates, Jeanne M Madden, Phyllis Foxworth, Frank J WharamAbstract:Objective: High-Deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study e...
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association between switching to a high Deductible health plan and major cardiovascular outcomes
2020Co-Authors: Frank J Wharam, Dennis Rossdegnan, Fang Zhang, Jamie Wallace, Adrian F Hernandez, Joseph P NewhouseAbstract:Importance Most people with commercial health insurance in the US have high-Deductible plans, but the association of such plans with major health outcomes is unknown. Objective To describe the association between enrollment in high-Deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-Deductible (≤$500) health plans during a baseline year followed by up to 4 years in high-Deductible (≥$1000) plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-Deductible plans. Data were analyzed from December 2017 to March 2020. Exposures Employer-mandated transition to a high-Deductible health plan. Main Outcomes and Measures Time to first major adverse cardiovascular event defined as myocardial infarction or stroke. Results The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-Deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-Deductible health plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07). Conclusions and Relevance Mandated enrollment in high-Deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.
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reduced cost sharing for preventive drugs preferentially benefits low income patients with diabetes in high Deductible health plans with health savings accounts
2020Co-Authors: Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Laura F Garabedian, Frank J WharamAbstract:BACKGROUND High Deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the Deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from Deductibles. OBJECTIVE The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.
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costs after incident breast cancer diagnosis among high Deductible health plan members
2019Co-Authors: James F Wharam, Dennis Rossdegnan, Stephen B Soumerai, Jamie Wallace, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Fang ZhangAbstract:120Background: High-Deductible health plans (HDHP) are associated with breast cancer treatment delays of up to 10 months, but their impact on health outcomes is unknown. We hypothesized that, compa...
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vulnerable and less vulnerable women in high Deductible health plans experienced delayed breast cancer care
2019Co-Authors: Frank J Wharam, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Larissa Nekhlyudov, Craig C Earle, Dennis RossdegnanAbstract:The effects of high-Deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, di...
Frank J Wharam - One of the best experts on this subject based on the ideXlab platform.
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impact of high Deductible health plans on emergency department patients with nonspecific chest pain and their subsequent care
2021Co-Authors: Shihchuan Chou, Arthur S Hong, Scott G Weiner, Frank J WharamAbstract:Background: Timely evaluation of acute chest pain is necessary, although most evaluations will not find significant coronary disease. With employers increasingly adopting high-Deductible health pla...
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impact of high Deductible health plans on medication use among individuals with bipolar disorder
2021Co-Authors: Alisa B Busch, Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Matthew Callahan, Robert F Lecates, Jeanne M Madden, Phyllis Foxworth, Frank J WharamAbstract:Objective: High-Deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study e...
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association between switching to a high Deductible health plan and major cardiovascular outcomes
2020Co-Authors: Frank J Wharam, Dennis Rossdegnan, Fang Zhang, Jamie Wallace, Adrian F Hernandez, Joseph P NewhouseAbstract:Importance Most people with commercial health insurance in the US have high-Deductible plans, but the association of such plans with major health outcomes is unknown. Objective To describe the association between enrollment in high-Deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-Deductible (≤$500) health plans during a baseline year followed by up to 4 years in high-Deductible (≥$1000) plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-Deductible plans. Data were analyzed from December 2017 to March 2020. Exposures Employer-mandated transition to a high-Deductible health plan. Main Outcomes and Measures Time to first major adverse cardiovascular event defined as myocardial infarction or stroke. Results The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-Deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-Deductible health plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07). Conclusions and Relevance Mandated enrollment in high-Deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.
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reduced cost sharing for preventive drugs preferentially benefits low income patients with diabetes in high Deductible health plans with health savings accounts
2020Co-Authors: Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Laura F Garabedian, Frank J WharamAbstract:BACKGROUND High Deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the Deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from Deductibles. OBJECTIVE The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.
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vulnerable and less vulnerable women in high Deductible health plans experienced delayed breast cancer care
2019Co-Authors: Frank J Wharam, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Larissa Nekhlyudov, Craig C Earle, Dennis RossdegnanAbstract:The effects of high-Deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, di...
Fang Zhang - One of the best experts on this subject based on the ideXlab platform.
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impact of high Deductible health plans on medication use among individuals with bipolar disorder
2021Co-Authors: Alisa B Busch, Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Matthew Callahan, Robert F Lecates, Jeanne M Madden, Phyllis Foxworth, Frank J WharamAbstract:Objective: High-Deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study e...
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association between switching to a high Deductible health plan and major cardiovascular outcomes
2020Co-Authors: Frank J Wharam, Dennis Rossdegnan, Fang Zhang, Jamie Wallace, Adrian F Hernandez, Joseph P NewhouseAbstract:Importance Most people with commercial health insurance in the US have high-Deductible plans, but the association of such plans with major health outcomes is unknown. Objective To describe the association between enrollment in high-Deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants This cohort study examined matched groups before and after an insurance design change. Data were from a large national commercial (and Medicare Advantage) health insurance claims data set that included members enrolled between January 1, 2003, and December 31, 2014. The study group included 156 962 individuals with risk factors for cardiovascular disease who were continuously enrolled in low-Deductible (≤$500) health plans during a baseline year followed by up to 4 years in high-Deductible (≥$1000) plans with typical value-based features after an employer-mandated switch. The matched control group included 1 467 758 individuals with the same risk factors who were contemporaneously enrolled in low-Deductible plans. Data were analyzed from December 2017 to March 2020. Exposures Employer-mandated transition to a high-Deductible health plan. Main Outcomes and Measures Time to first major adverse cardiovascular event defined as myocardial infarction or stroke. Results The study group included 156 962 individuals and the control group included 1 467 758 individuals; the mean age of members was 53 years (SD: high-Deductible group, 6.7 years; control group, 6.9 years), 47% were female, and approximately 48% lived in low-income neighborhoods. First major adverse cardiovascular events among high-Deductible health plan members did not differ relative to controls at follow-up vs baseline (adjusted hazard ratio, 1.00; 95% CI, 0.89-1.13). Findings were similar among subgroups with diabetes (adjusted hazard ratio, 0.93; 95% CI, 0.75-1.16) and with other cardiovascular risk factors (adjusted hazard ratio, 0.93; 95% CI, 0.81-1.07). Conclusions and Relevance Mandated enrollment in high-Deductible health plans with typical value-based features was not associated with increased risk of major adverse cardiovascular events.
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reduced cost sharing for preventive drugs preferentially benefits low income patients with diabetes in high Deductible health plans with health savings accounts
2020Co-Authors: Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Laura F Garabedian, Frank J WharamAbstract:BACKGROUND High Deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the Deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from Deductibles. OBJECTIVE The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.
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costs after incident breast cancer diagnosis among high Deductible health plan members
2019Co-Authors: James F Wharam, Dennis Rossdegnan, Stephen B Soumerai, Jamie Wallace, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Fang ZhangAbstract:120Background: High-Deductible health plans (HDHP) are associated with breast cancer treatment delays of up to 10 months, but their impact on health outcomes is unknown. We hypothesized that, compa...
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vulnerable and less vulnerable women in high Deductible health plans experienced delayed breast cancer care
2019Co-Authors: Frank J Wharam, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Larissa Nekhlyudov, Craig C Earle, Dennis RossdegnanAbstract:The effects of high-Deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, di...
Stephen B Soumerai - One of the best experts on this subject based on the ideXlab platform.
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impact of high Deductible health plans on medication use among individuals with bipolar disorder
2021Co-Authors: Alisa B Busch, Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Matthew Callahan, Robert F Lecates, Jeanne M Madden, Phyllis Foxworth, Frank J WharamAbstract:Objective: High-Deductible health plans (HDHPs) require substantial out-of-pocket spending for most services, although medications may be subject to traditional copayment arrangements. This study e...
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reduced cost sharing for preventive drugs preferentially benefits low income patients with diabetes in high Deductible health plans with health savings accounts
2020Co-Authors: Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Laura F Garabedian, Frank J WharamAbstract:BACKGROUND High Deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the Deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from Deductibles. OBJECTIVE The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.
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costs after incident breast cancer diagnosis among high Deductible health plan members
2019Co-Authors: James F Wharam, Dennis Rossdegnan, Stephen B Soumerai, Jamie Wallace, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Fang ZhangAbstract:120Background: High-Deductible health plans (HDHP) are associated with breast cancer treatment delays of up to 10 months, but their impact on health outcomes is unknown. We hypothesized that, compa...
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vulnerable and less vulnerable women in high Deductible health plans experienced delayed breast cancer care
2019Co-Authors: Frank J Wharam, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Larissa Nekhlyudov, Craig C Earle, Dennis RossdegnanAbstract:The effects of high-Deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, di...
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high Deductible insurance and delay in care for the macrovascular complications of diabetes
2018Co-Authors: Frank J Wharam, Dennis Rossdegnan, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Matthew Callahan, Joseph P NewhouseAbstract:In this observational, longitudinal, before–after study using 10 years of data from a large national health insurer, the authors sought to determine whether a transition from low-Deductible to high...
Larissa Nekhlyudov - One of the best experts on this subject based on the ideXlab platform.
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costs after incident breast cancer diagnosis among high Deductible health plan members
2019Co-Authors: James F Wharam, Dennis Rossdegnan, Stephen B Soumerai, Jamie Wallace, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Fang ZhangAbstract:120Background: High-Deductible health plans (HDHP) are associated with breast cancer treatment delays of up to 10 months, but their impact on health outcomes is unknown. We hypothesized that, compa...
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vulnerable and less vulnerable women in high Deductible health plans experienced delayed breast cancer care
2019Co-Authors: Frank J Wharam, Stephen B Soumerai, Fang Zhang, Jamie Wallace, Larissa Nekhlyudov, Craig C Earle, Dennis RossdegnanAbstract:The effects of high-Deductible health plans (HDHPs) on breast cancer diagnosis and treatment among vulnerable populations are unknown. We examined time to first breast cancer diagnostic testing, di...
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total and out of pocket expenditures among women with metastatic breast cancer in low Deductible versus high Deductible health plans
2018Co-Authors: Christine Leopold, Dennis Rossdegnan, Fang Zhang, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Frank J WharamAbstract:High-Deductible health plan (HDHP) enrollment is expanding rapidly and might substantially increase out-of-pocket (OOP) payment burden. We examined trends in total and OOP health service expenditures overall and by insurance coverage type among women with metastatic breast cancer. We used a longitudinal time series design to examine measures among 5364 women with metastatic breast cancer insured by a large US health insurer from 2004 to 2011. We measured outcomes during the 12 months after a first identified metastatic breast cancer diagnosis and required women to have at least 6 months of prior enrollment. We plotted enrollment measures and adjusted total and OOP spending. We fit trend lines using linear autoregressive models. Between 2004 and 2011, the percentage of women with metastatic breast cancer enrolled in employer-mandated HDHPs increased from 8 to 23% while the percentage enrolled in employer-mandated low-Deductible plans (LDHPs) decreased from 69 to 37%. Over the same time period, estimated annual inflation-adjusted total health service spending among women with metastatic breast cancer whose employers only offered HDHPs or LDHPS increased from $96,899 to $104,688 (increase of $1197 per year; 95% confidence interval [CI]: $47,$2,348). Corresponding OOP spending values among these women with employer-mandated Deductible levels were $4,496 and $5,151 ($91 per year trend; 95% CI -$13,$195). From 2004–2011, women in HDHPs and LDHPs had unchanged annual OOP spending, estimated at of $6642 (95% CI $6,268,$7016) and $4,247 (95% CI $3956,$4538), respectively. Thus, women in HDHPs experienced 55% (44%, 66%) more OOP spending than women in LDHP. OOP spending among women with metastatic breast cancer and employer-mandated Deductible levels was 55% higher among HDHP than LDHP members, and employer-mandated HDHP enrollment increased substantially from 2004 to 2011. Stakeholders and policymakers should design health plans that protect financially vulnerable cancer patients from high OOP costs.
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impact of high Deductible insurance on breast cancer care among lower income women
2018Co-Authors: James F Wharam, Fang Zhang, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Soumerai Stephen, Dennis RossdegnanAbstract:6560Background: High-Deductible health plans (HDHP) are increasingly common but delay important breast cancer diagnostic tests and treatment. We hypothesized that such delays would be especially pr...
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impact of high Deductible insurance on out of pocket cost burden in breast cancer
2018Co-Authors: Fang Zhang, Dennis Rossdegnan, Stephen B Soumerai, Jamie Wallace, Anita K Wagner, Larissa Nekhlyudov, Craig C Earle, Matthew Callahan, Robert F Lecates, James F WharamAbstract:545Background: High-Deductible health plans (HDHP) requiring out-of-pocket (OOP) costs for most services may place heavy economic burden on patients. This study examined the impact of modern HDHPs ...
