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Apta Health

Apta Health

Apta Health

Apta Health

Question / Intervention Goal / Objectives

Apta Health brings care coordination services to groups with fewer than 1000 lives. Care Coordinators interact with members when they are making choices, guiding them to proven programs and efficient providers. The real-time support strives to eliminate duplication of services and re-admissions. Apta clients had annual cost growth that is lower than national benchmarks.

 

Method/ Calculation

In a case study of a 300-employee group, the analysis measured the employer’s payment per employee per month costs (PEPM) in 2015 and 2016, the year before the intervention and the year after.  The PEPM cost reflected pharmacy benefit rebates; cost for high-dollar claimants was segregated.

Additional analysis was done on 22 Apta clients’ medical and pharmacy cost data for four years.  The analysis combined the cost data for the years 2016 and 2017 and compared it to similarly combined data from 2017 and 2018.

 

Findings / Metric/ Outcome/ Savings

The 300-employee group had an 11.25% decrease in PEPM costs paid by the employer.  After taking into account payments by a reinsurer for catastrophic claims, the plan in total had a 4.04% decrease is costs.  (One claim was over $500,000.)

The multiple employer analysis showed a negative 3.9% change in medical costs from the 2016/2017 to the 2017/2018 years; this compares to a national trend of 10.3%.  Pharmacy costs had a 13.8% increase for the cited time periods, compared to a national trend of 15.9%.

 

Limitations

The statistical significance of the rate decrease for the 300-employee group was not calculated.

The benchmark cited is the actuary’s own book of business; because there was not a description of this population, it is not clear whether this is a reasonable comparison. Benchmarks from Kaiser Family Foundation 2017 employer Health Benefits Survey[1] show slightly lower medical with pharmacy cost trends than the benchmark cited: 3% for single coverage, 4 – 5% for family coverage for 2017 and 2018.

 

DISCUSSION

Intervention Link to Outcome

  • State the outcome being measured.

The outcome is the Per Employee Per Month medical and pharmacy cost for a two-year period of time for the case study.

The annual medical and pharmacy rate increase is the outcome for the multi-employer analysis.

  • Detail the intervention.

Care Coordinators interact with members when they are making choices, guiding them to proven programs and efficient providers.

  • Does the applicant discuss published literature or other credible source demonstrating correlation between intervention and outcome? If yes, describe the correlation and the source cited by applicant. If no, does the literature exist to demonstrate a correlation between intervention and outcome?  The applicant provides no published literature, though there is a body of literature supporting the efficacy of care coordination.

 

Data Source

  • Describe the data source.

The data came from the group’s medical and pharmacy claims.  Data on pharmacy rebates presumably came from other records.

  • Did the applicant have adequate data from a credible, reliable source?  Yes.
  • How is the data source appropriate for the outcome being measured?  The impact of the care coordination program should be apparent in the group’s total medical and pharmacy costs.  Therefore, using the total costs is appropriate.

 

Methodology

  • Describe the evaluation methodology, i.e. trend from pre- to post-, comparing similar groups, etc.

The case-study evaluation compared a pre-intervention to a post-intervention period, blending year one of the intervention into both the pre- and the post- periods.

The multi-employer analysis compared the annual rate increases to a benchmark.

  • Did the applicant collect and manage data in accord with standard evaluation methodology? Comment on any issues with compiling the measure, such as missing or incomplete data or lack of data on non-participants.   Yes.

 

  • Describe the findings/results.

The 300-employee group had an 11.25% decrease in PEPM costs paid by the employer.  After taking into account payments by a reinsurer for catastrophic claims, the plan in total had a 4.04% decrease is costs.  (One claim was over $500,000.)

The multiple employer analysis showed a negative 3.9% change in medical costs from the 2016/2017 to the 2017/2018 years; this compares to a national trend of 10.3%.  Pharmacy costs had a 13.8% increase for the cited time periods, compared to a national trend of 15.9%.

 

Additional Comments from Reviewer

Blending the first intervention year into the pre- and the post-periods may be understating the impact. 

Score

 

Intervention to Outcome

SCORE (0-5)

Data Source

SCORE (0-5)

Methodology

SCORE (0-5)

Quality of Application

SCORE (0-3)

Overall

SCORE (0-18)

3 5 4 2 14

 

[1] https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/

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