Association of Health Care Delivery and Payment Innovations with Avoidable Cardiovascular Hospitalizations

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The annual cost of cardiovascular disease (CVD) in the United States is estimated to exceed $1.2 trillion by 2035, with the costs of CVD hospitalizations driving that estimate.[1] Despite this projected growth, many hospitalizations for CVD are potentially preventable if patients receive appropriate and timely ambulatory care. The role that healthcare delivery and payment reform may play in attenuating the expected rise in both the rate of CVD hospitalizations and associated costs is currently unknown. Examples of innovative models of healthcare delivery and payment include the patient centered medical home (PCMH), shared savings accountable care organizations (ACO), meaningful use of electronic medical records (EMR), and the presence of regional health improvement collaboratives (RHIC). These four approaches saw widespread adoption during the last decade. For example, between 2008 and 2014 the number of medical home sites rose nationally from 214 to 6,800. In Ohio, the number of medical home sites rose from zero in 2008 to 520 in 2014.[2] Despite this rapid growth, uncertainty exists about the effect of these four approaches on patient outcomes and cost of care for cardiovascular conditions. For chronic illnesses such as CVD, these approaches demonstrated early successes across a range of disease management indicators such as provider experience,[3] patient experience,[3-5] processes of care,[5, 6] preventive care utilization,[7] and high cost care utilization.[3] Importantly, prior studies of the effects of these paradigms on potentially preventable CVD hospitalization have focused on each approach individually and have not addressed associated costs. Moreover, no prior study has mapped the evolution of the healthcare market penetration of these four approaches. Thus the question of whether and how the growing healthcare market penetration of these four approaches affects the hospitalization rate and costs for CVD remains unanswered. The overall objective of this proposal is to address this question with two specific aims: first, to quantify the healthcare market penetration of patient centered medical homes, shared savings accountable care organizations, regional health improvement collaboratives, and electronic medical records throughout the state of Ohio; second, to model the relationship between changes in the rate of CVD hospitalization and changing healthcare market penetration of each of the four approaches. Successful model development will empower policy makers to make data-driven decisions regarding further implementation and support of integrated models of healthcare delivery and payment transformation that will help improve care quality and reduce costs.