Population Health Exam 1 Flashcards
1
Q
What are the 3 parts of pharmacoeconomics?
A
-Costs
-Interventions
-Outcomes
2
Q
True or False: Healthcare costs in the US are rising but healthcare outcomes are declining
A
True
3
Q
What are the 4 types of costs?
A
- Direct medical costs
- Direct non-medical costs
- Indirect costs
- Intangible costs
4
Q
What are direct medical costs?
A
Medical costs for providing treatment
ex: cost of medication, physician visits, hospitalizations
5
Q
What are direct non-medical costs?
A
Costs to patient/family that are directly associated with treatment but ARE NOT MEDICAL
ex: cost of transportation to clinic, babysitter, food/lodging
(associated with medical treatment but not specifically to therapy)
6
Q
What are indirect costs?
A
Result from loss of productivity because of illness or death
*Do not involve a transfer of money
ex: Missed work or school days, decreased productivity
7
Q
What are intangible costs?
A
Costs of pain, suffering, anxiety, or fatigue due to illness or treatment
*Difficult to measure and assign value to
8
Q
What are the 4 types of pharmacoeconomic analyses?
A
Cost-minimization analysis (CMA)
Cost-benefit analysis (CBA)
Cost-effectiveness analysis (CEA)
Cost-utility analysis (CUA)
9
Q
What is a Cost-Minimization Analysis (CMA)?
A
Used to compare costs of interventions with EQUIVALENT CLINICAL OUTCOMES
10
Q
What is the defining point of cost-minimization analysis?
A
Interventions must have EQUIVALENT CLINICAL OUTCOMES
11
Q
What are some examples of Cost-Minimization Analyses?
A
Generic vs Brand name drugs
Drug A vs Drug B (equal efficacy and safety + same drug class)
12
Q
What is the cost measurement unit of the cost-minimization analysis (CMA)?
A
$$
13
Q
What is the outcome measurement unit of the cost-minimization analysis (CMA)?
A
*Not measured
*Assumed to be equivalent
14
Q
What is a Cost-Benefit Analysis (CBA)?
A
Measures cost of interventions and outcomes in monetary units
*determines which intervention provides the best monetary benefit
*must assign monetary outcome to clinical endpoints (things we normally do not think about monetarily)
15
Q
What is the cost measurement unit and outcome measurement unit of a cost-benefit analysis (CBA)?
A
$$
(for both)
16
Q
What is a Cost-Effectiveness Analysis (CEA)?
A
Measures outcomes in natural health units
**Determines which intervention achieves a given objective at the lowest cost
*Compares different interventions using same measured outcome
ex: infections cured, lives saved, number of life years saved
17
Q
What is the most common type of analysis?
A
Cost-Effectiveness Analysis (CEA)
18
Q
What is the equation for the Incremental Cost-Effectiveness Ratio (ICER)?
A
Total $ of A - Total $ of B
_____________________________
Outcome of A- Outcome of B
19
Q
What does the Incremental Cost-Effectiveness ratio (ICER) tell us?
A
The additional cost required to obtain the additional effect gained by switching from Drug A to Drug B
20
Q
What is the cost measurement unit and outcome measurement unit of the cost-effectiveness analysis (CEA)?
A
Cost Mes Unit: $$
Outcome Mes Unit: Natural (Health) Related Units
21
Q
What is the Cost-Utility Analysis (CUA)?
A
Measures outcomes in terms of the quality of the outcome produced
*Examines the cost of an intervention and the value of the outcome
“Utility Units”
*Most common outcome is quality-adjusted life years (QALY)
22
Q
What two things are taken into account with QALY?
A
Quantity and Quality of life
23
Q
How do we calculate QALY?
A
Amount of time in health state x % of health
*do for each drug
24
Q
What is the cost measurement unit and outcome measurement unit of the Cost-Utility Analysis?
A
Cost Mes Unit: $$
Outcome Mes Unit: QALY or other utility measures (patient preferences)
25
What is a benefit of the Cost-Utility Analysis (CUA)?
Accounts for both quantity and quality of the outcome
26
What is pharmacoepidemiology?
Study of the use, risks, and benefits of drugs in populations
27
What is pharmacovigilance?
Continual monitoring for unwanted effects and other safety-related aspects of marketed drugs
28
What is comparative effectiveness research (CER)?
Determining what therapeutic intervention (not just drug products) works best for a given disorder in patients likely to be seen in clinical practice
29
What is pragmatic research?
Studies (often using randomization) that test small practical changes that could impact health outcomes
30
What type of study is considered "experimental"?
Randomized Control Trial (RCT)
**all others are nonexperimental
*we can control causality
31
What studies are considered nonexperimental (observational)?
Case-control
Cohort
*we cannot control exposure to drug, just gather individuals who have been exposed
32
What studies are considered observational?
Pharmacoepidemiologic
Pharmacovigilance
33
What is the difference between bias vs confounding?
Bias: systematic deviation from the truth that distorts the results of research
Confounding: relationship between treatment and response is actually attributable to another variable
*independently related to both the exposure and the outcome
34
What is information bias?
Bias related to information about exposure or outcome
*includes measurement and/or classification error
ex: Hawthorne effect
35
What is detection bias?
Specific outcome is diagnosed preferentially in subjects exposed to the agent
36
What does "confounding by indication" mean?
The indication for a drug or severity of disease predicts the use of the drug
*the risk of an event is related to the INDICATION for use of a drug but not the use of the drug itself
*When the reason for a prescription is associated with the outcome of interest
37
What is selection bias?
Bias related to procedures used to select subjects/influence study participation
*can be due to systematic differences in characteristics between those who are selected for the study and those who are not
38
What is referral bias?
Reason for encounter is related to drug treatment
39
What is protopathic bias?
Drug is initiated to treat an adverse event related to an undiagnosed disease
40
What is prevalence bias?
Prevalent cases rather than new cases are selected
41
What is Immortal Time Bias?
A period of follow-up when, due to exposure definition, the outcome being studied could never occur
(follow up includes a period of time where an event or death cannot occur)
*immortal period*
ex: heart transplant patients who died before receiving a transplant were automatically bumped to the no transplant group
42
What is the Indiana Network for Patient Care?
Database with >100 separate healthcare entities that provide data such as:
major hospitals, health networks, insurance providers, patient data, clinical observations, encounter records, etc
43
Which groups of people are more likely to have worse outcomes when started on opioids?
-Males
-Patients with comorbidities
-Patients with mental health problems
44
What are the predictors for long-term opioid use?
-Older patients
-Female
-Black
-Comorbidities
-Existing substance use disorder
**all show increased opioid use duration**
45
What is the rationale behind why pharmacovigilance is important for continued monitoring of drugs?
-Premarketing studies exclude patients with complicated comorbidities
-Premarketing studies only determine efficacy of a drug vs placebo
-Statistical power of a premarketing study is too weak to detect infrequent adverse effects
46
What does the FDA Adverse Event Reporting System (FAERS) do?
Houses postmarketing adverse event reports received by the FDA
47
What does the FDA Sentinel System do?
Monitors the safety of FDA regulated products
48
What is the FDA VARES?
Vaccine adverse event reporting system
49
What adverse affect was found to be associated with Fluoroquinolone Exposure in the 2013 Pharmacovigilance Review?
Disabling Peripheral Neuropathy
**primarily musculoskeletal and neuropsychiatric
50
What is efficacy?
Whether a drug has the ability to bring about a given intended effect in controlled settings
51
What is effectiveness?
Whether, in real-world patients and settings, a treatment, in fact achieves its desired effect
(what happens when we bring the drug to the real world?)
52
What is pragmatic research?
Studies that often test practical changes that could have a big impact on health outcomes
53
What is a Pragmatic Randomized Controlled Trial?
A randomized clinical trial with one or more pragmatic elements
*used to overcome limitations of traditional RCTs
54
What fraction of working-age adults are uninsured?
2/5
54
What subgroups of people are more likely to be uninsured?
-Young
-Latinx/Hispanic
-Poor
-Sicker
-Living in the South
54
What fraction of people with chronic health problems had not filled a prescription in the past year for their health condition due to cost?
1/4
55
What year did the Social Security Act go into effect?
1935
56
True or False: When the Social Security Act was first put in place it did not include health coverage
True
57
What model was the entire health insurance system built on?
The employer-sponsored model
58
What day/year were Medicare and Medicaid started?
Signed into Law: July 30, 1965
Medicare begins: July 1, 1966
Medicaid begins: January 1, 1966
59
What is Medicare?
System for the retired
60
What is Medicaid?
System for the poor
61
What is the Affordable Care Act?
System for the self-employed who had to buy insurance on their own through exchanges
62
What is the main goal of the Affordable Care Act?
Improve quality of care
63
What percent of Medicare patients are historically readmitted within 30 days?
20%
64
What percent of Medicare readmissions are preventable?
75%
65
What affect did the Affordable Care Act have on Medicare readmission rates?
ACA penalizes hospitals for excessive readmission rates (3%)
66
Who was the first president to suggest that we need healthy people to be a strong country?
Teddy Roosevelt
67
Who was the president that passed Medicare and Medicaid?
Lyndon B Johnson
68
What does Medicare not include?
No DENTAL or EYE benefits
No drug benefit for outpatients
69
What part of Medicare accounts for the largest share of Medicare benefit spending?
Part B (physician services)
70
What is Medicare part A?
Covers hospital costs
*everyone gets this, do not pay extra
71
What is Medicare part B?
Covers physicians costs
"Medigap"
**deducted from social security
*not required, have to opt in
72
What is Medicare part C?
Parts A+B+C
(covers a broad list of services)
"Medicare Advantage"
*Managed care
73
What is Medicare part D?
Drug benefit (prescription coverage)
*premium costs deducted from social security
74
When can a patient enroll in Medicare?
3 months before 65th birthday
75
True or Fale: Medicare enrollees do not need to be retired
True
76
What patient population does not need to enroll in Medicare?
Those with a comparable insurance plan
77
What Medicare part do people typically receive for free?
Part A
78
What is an important point to remember about Medigap?
It is not administered through the Centers for Medicare
***Purchased through private companies
79
What is the purpose of Medigap?
-Picks up deductibles for Part A
-Picks up deductibles and copays for Part B
80
What does Medicare Part C primarily cover?
Medicare Advantage Plans
81
What are some features of Medicare Advantage Plans?
-Administered by private companies
-May offer extra benefits including vision and dental
-Offer fewer choices
82
What is the Medicare STAR rating system?
Measures how well Medicare Advantage and Part D plans perform
(1 to 5)
*less stars is bad
83
What was the largest change in insurance processing in retail pharmacy history?
Medicare Part D
84
Who runs Medicare Part D?
private insurance companies
85
True or False: Formularies for each plan under Medicare Part D are the same
FALSE
*formularies are different
86
True or False: Medicaid was not required for states to adopt
True
87
Who manages Medicaid?
State government
88
Who can enroll in Medicaid?
The poor and medically indigent of all ages
*People with income up to 138% of Federal Poverty Level can qualify with the expanded program only
89
Who is Medicaid spending greatest for?
Elderly and Individuals with disabilities
90
What percent of IN population is covered by Medicaid?
20%
91
What percent of the Federal Poverty Level must pregnant women and children <6 be to enroll in Medicaid in Indiana?
<158%
**differs from normal <138%
92
How long are pregnant mothers covered on Medicaid after the pregnancy ends?
12 months
93
Why is managed care a thing?
Because healthcare has gotten more expensive
94
What is Managed Care?
An approach to the delivery of healthcare services in a way that puts limited resources to best use in optimizing patient care
*control cost by controlling supply and demand
95
Why have Health Management Organizations (HMOs) fallen out of favor?
When you were in an HMO, you had to see HMO physicians which limited access to who you could se
--today, employees are less likely to stay with their employer
(employers do not see why they should be concerned about an employee's health across their life if they are only going to be there a few years)
96
What is the main goal of managed care?
Cost containment
96
What are Accountable Care Organizations (ACOs)?
Groups of doctors, hospitals, and other health care providers who work together to provide coordinated high-quality care to their Medicare patients
*accept financial risk/reward tied to clinical outcomes
97
What is a Preferred Provider Organization (PPO)?
Managed care delivery model consisting of preferred networks of providers with some out-of-network coverage
*Offer patients more choice than HMOs
98
What is included in Tier 1 of prescription drugs?
Most generic prescription drugs
*lowest copayment
99
What is included in Tier 2 of prescription drugs?
Preferred brand-name drugs
*medium copayment
100
What is included in Tier 3 of prescription drugs?
Non-preferred brand-name drugs
*higher copayment
101
What is included in the Specialty tier of prescription drugs?
Very high-cost prescription drugs
*highest copayment
102
What type of healthcare plan has Purdue moved to?
High deductible health plans
103
What is a deductible?
A fixed amount that an insured person must pay out-of-pocket before health care benefits become payable
104
What is a premium?
The amount paid to a health insurance carrier for providing coverage under contract
105
What is co-insurance?
The percentage of the cost of health care services that are paid by the patient after deductible
106
Why has the average annual expenditures growth rate for prescription drugs gone up so much?
Specialty drugs
107
What is the largest contributor to total national health expenditures?
Hospitals
108
What is wrong with our healthcare system?
-Disconnect between what we pay for, what we value, and outcomes achieved
-Compares poorly to other industrialized countries
-Too much is spent on older patients and at end of life with no clear benefits
-Small % of population consumes most of the resources
-Drug companies can charge whatever they want
-Lack of transparency with respect to cost
-Access issues, too few PCPs
-Lack of care coordination
-Underfunding of public health by politicians
109
True or False: The US has the lowest life expectancy among large, wealthy countries
True
*even though we outspend them on health care
110
Why are there too few primary care providers?
They are poorly reimbursed
*also poorly distributed
111
What is population health?
The health outcomes of a group of individuals including the distribution of such outcomes within the group
112
Who in the public/private sector has responsibility for overall health improvement?
NO ONE currently
113
What are the 2 organizational interventions (culture/environment) in the Care Continuum?
Health Promotion, Wellness
Health Risk Management
114
What are the 2 tailored interventions in the Care Continuum?
Care Coordination/Advocacy
Disease/Case Management
115
Rank the 4 parts of the Care Continuum from lowest to highest risk
L: Health Promotion/Wellness
Health Risk Management
Care Coordination/Advocacy
H: Disease/Case Management
116
What are some examples of Health Promotion/Wellness?
Diet, Nutrition, Exercise
117
What are some examples of Health Risk Management?
Antibiotic stewardship
Contraception
Medication safety interventions
118
What are some examples of Care Coordination/Advocacy?
Drug therapy management
Mental health services
Transitions of care
119
What makes examining population health possible?
Data
120
What type of data is easiest to obtain?
Claims data
121
What type of data makes it easy to group patients?
Electronic health record data
122
What are some examples of population health outcomes?
-Life expectancy
-Mortality (infant and maternal/ death rates)
-Premature death
-Cost burden
-Access to care
etc
123
What is the life expectancy in the US?
77
124
What is the rank of the US in mortality compared to other countries?
45th
125
What is the #1 and #2 cause of death for children age 1-19 in the US?
1: Firearm
2: Motor Vehicles
126
What ethnicity is projected to increase the most in the US by 2050?
Hispanic
127
What fraction of healthcare workers say that racism against patients is a major problem or crisis?
1/2
128
What is a co-payment?
A cost-sharing arrangement where a covered patient pays a specific charge for a specific service
ex: person pays a fixed dollar amount for each prescription received
*usually paid when service/product is provided
129
What is a Health Savings Account?
A tax-sheltered savings account that may be used by beneficiaries covered by high-deductible health plans to pay for routine health care expenses
