Costs of Specialist Referrals From Employer-Sponsored Integrated Health Care Clinics Are Lower Than Those From Community Providers.
Costs of Specialist Referrals From Employer-Sponsored Integrated Health Care Clinics Are Lower Than Those From Community Providers.
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DOI：
10.1007/s11606-022-07724-w
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发表时间：
2022-11
影响因子：
5.7
通讯作者：
Bravata, Dena M.
中科院分区：
文献类型：
--
作者：
Wright, John R.;Madhusudhan, Divya K.;Lawrence, David C.;Watts, Sharon A.;Lord, Daniel J.;Whaley, Christopher;Bravata, Dena M.
很少有关于商业保险人群转诊管理的研究，也没有关于雇主赞助的健康中心转诊管理的研究。描述综合雇主赞助的医疗保健系统的转诊管理系统，并比较雇主赞助的医疗诊所和社区提供者发起的专家转诊率和专家就诊成本。回顾性比较队列研究，采用多变量分析的医疗索赔比较护理开始在雇主赞助的健康诊所与倾向匹配的控制有专家转诊社区提供者。2018年12月1日至2020年12月31日期间，有资格接受雇主申办的临床服务的成人患者（≥ 18岁）因专科转诊而发生医疗索赔。该研究队列由3129名在雇主赞助的诊所接受超过75%的护理的患者组成，这些患者与在社区接受护理的3129名患者相匹配。由Crossover Health雇主赞助的诊所实施的专家转诊管理计划。专家转诊的费率和费用。在雇主赞助的诊所接受治疗的患者中，专家转诊的相对比率（35.1%）比在社区接受治疗的患者（45%，p <0.001）低22%。研究队列中患者的每个用户每月总成本为372美元（SD $894），而社区队列为401美元（SD $947），差异为29美元（p<0.001），相对减少7.2%。较低的成本可以部分归因于较低的专科护理成本（63美元（SD $140）vs 76美元（SD $213）（p<0.001））。雇主赞助的健康诊所可以提供有效的综合护理，并可能能够减少可避免的专家利用。当需要转诊时，标准化的转诊管理和护理导航可能会降低专科医生的支出。在线版本包含补充材料，可通过10.1007/s11606-022-07724-w获得。
There have been very few published studies of referral management among commercially insured populations and none on referral management from employer-sponsored health centers. Describe the referral management system of an integrated employer-sponsored health care system and compare specialist referral rates and costs of specialist visits between those initiated from employer-sponsored health clinics and those initiated from community providers. Retrospective, comparative cohort study using multivariate analysis of medical claims comparing care initiated in employer-sponsored health clinics with propensity-matched controls having specialist referrals initiated by community providers. Adult patients (≥ 18 years) eligible for employer-sponsored clinical services incurring medical claims for specialist referrals between 12/1/2018 and 12/31/2020. The study cohort was comprised of 3129 receiving more than 75% of their care in the employer-sponsored clinic matched to a cohort of 3129 patients receiving care in the community. Specialist referral management program implemented by Crossover Health employer-sponsored clinics. Rates and costs of specialist referrals. The relative rate of specialist referrals was 22% lower among patients receiving care in employers-sponsored health clinics (35.1%) than among patients receiving care in the community (45%, p <0.001). The total per-user per-month cost for patients in the study cohort was $372 (SD $894), compared to $401 (SD $947) for the community cohort, a difference of $29 (p<0.001) and a relative reduction of 7.2%. The lower costs can be attributed, in part, to lower specialist care costs ($63 (SD $140) vs $76 (SD $213) (p<0.001). Employer-sponsored health clinics can provide effective integrated care and may be able to reduce avoidable specialist utilization. Standardized referral management and care navigation may drive lower specialist spend, when referrals are needed. The online version contains supplementary material available at 10.1007/s11606-022-07724-w.
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影响因子：
2.8
作者：
Greenwood-Lee, James;Jewett, Lauren;Marshall, Deborah A.
通讯作者：
Marshall, Deborah A.
影响因子：
3.5
作者：
Phillips, Jessica L. H.;Rondon, Alexander J.;Courtney, P. Maxwell
通讯作者：
Courtney, P. Maxwell
影响因子：
1.3
作者：
Wright, John R.;Hagg, Heather K.;Bravata, Dena M.
通讯作者：
Bravata, Dena M.
影响因子：
3
作者：
Zhang, Hui;Cowling, David W.;Taylor, Erik
通讯作者：
Taylor, Erik
影响因子：
4.8
作者：
McNamara, Michelle;Buck, Philip O.;Hogea, Cosmina
通讯作者：
Hogea, Cosmina