• Margaret K Pasquale, Robert Dufour, Ashish V Joshi, Andrew T Reiners, David Schaaf, Jack Mardekian, George A Andrews, Nick C Patel, and James Harnett.
• Principal Researcher, Comprehensive Health Insights, Inc, 325 W Main St WFP6W, Louisville, KY 40202. E-mail: mpasquale@humana.com.
• Am J Manag Care. 2013 Oct 1;19(10):816-23.

ObjectiveTo identify inefficiencies in drug and medical service utilization related to pain management in patients with osteoarthritis and chronic low back pain.Study DesignThis retrospective cohort study applied revised measures of pain management inefficiencies to Humana Medicare members with osteoarthritis and/or chronic low back pain.MethodsSubjects had either 2 or more claims for osteoarthritis on different days or 2 or more claims for low back pain 90 or more days apart, from January 1, 2008, to June 30, 2010, with the first occurrence assigned the index date. Inefficiencies were identified for 365 days postindex.Pain-related healthcare costs postindex were compared between members with and without inefficiencies. A generalized linear model calculated adjusted costs per member controlling for age, sex, and comorbidities.ResultsMost members diagnosed with osteoarthritis, chronic low back pain, or both (N = 68,453) had at least 1 inefficiency measure (n = 37,863) during the postindex period. High per member costs were for repeated surgical procedures ($26,451) and inpatient admissions ($19,372) compared with members without inefficiencies ($781; P < .0001). High total costs (prevalence times per member cost) were for repeated diagnostic testing and excessive office visits. Members with an inefficiency had adjusted pain-related costs 5.42 times higher than those of members without an inefficiency (P <.0001).ConclusionsPain management inefficiencies are common and costly among Humana Medicare members with osteoarthritis and/or chronic low back pain. Further work by providers and payers is needed to determine benefits of member identification and early intervention for these inefficiencies.

21 keywords...

hide…