Epigenex Health, Inc.
**Winner of the 2019 Health Value Award for Program Provider – Specialty Cardiometabolic**
Question / Intervention Goal / Objectives
Does the use of web-based, patient-centric health information exchange tools lower the medical costs for patients with chronic conditions? This analysis focused on patients who had hypertension, diabetes, high cholesterol, ischemic vascular disease, chronic kidney disease, and heart failure. Published studies have shown that care coordination does lead to lower costs for chronic condition patients; the HIE tools could support better care coordination and therefore lower costs.
The allowed amount for hospital admissions with a chronic condition diagnosis and the total allowed amount for all medical services was compared between program participants and propensity-score matched non-participants. The allowed amounts came from medical and pharmacy claims from 89,034 adults age 18 and older who were covered continuously by the insurer for the 12-month period. Allowed amounts were expressed as a rate per 1,000 member months for each group.
Findings / Metric/ Outcome/ Savings
The intervention group’s PMPM total allowed medical costs were eight percent lower than the control group. The difference between the two groups was statistically significant; thus, it would not reasonably be due to random variation. The intervention group also had a reduction in hospital admissions for chronic conditions while the control group had an increase. These differences were also large enough to be statistically significant.
Any observational study has the potential to have missed an unmeasured difference between the intervention and control group, despite having adjustments for various known factors.