Morefield B, et al., J Community Med Public Health Care 2021, 8: 080 DOI: 10.24966/CMPH-1978/100080
HSOA Journal of Community Medicine and Public Health Care Research Article
Personalized Preventive Care for Patients at Risk of Heart Attack or Stroke Brant Morefield1, Lisa Tomai2* and Andrea Klemes3 1
Blue Cross/Blue Shield of North Carolina, USA
2
L&M Policy Research, LLC, Washington, DC, USA
3
Chief Medical Officer, MDVIP, Boca Raton, Florida, USA
Abstract Objectives: This study examines the impact of MDVIP enrollment on incidence of acute myocardial infarction (AMI) or stroke/transient ischemic attack (TIA) for an at-risk population of Medicare fee-forservice (FFS) beneficiaries. Study Design: We obtained participating physician and beneficiary enrollment lists from MDVIP and used Medicare FFS claims from 2005 to 2015 to identify those at risk of AMI or stroke/TIA based on at least two instances of the following: hypertension, hyperlipidemia, and/or diabetes. Methods: Propensity score weights achieved and maintained balance in baseline characteristics across MDVIP enrollees and comparisons throughout the study period. Linear probability models measured differences in the change in AMI and stroke/TIA incidence rates over time, along with two falsification outcomes, hip fracture and colorectal cancer. Results: The estimates indicate a 0.8 percentage point drop in the occurrence of either AMI or stroke after MDVIP enrollment (p-value < .0001). For each condition separately, the model estimates reductions in the probability of occurrence, 0.12 percentage points (p-value = 0.0588) for AMI and 0.67 percentage points for stroke/TIA (p-value < .0001). Relative to rates in the comparison population, the point estimates represent relative reductions of 12% and 11% for AMI and stroke/TIA, respectively. Conclusion: Our analysis utilizes Medicare FFS claims to provide initial evidence that an alternative primary care arrangement, MDVIP, *Corresponding author: Lisa Tomai, L&M Policy Research, LLC, Connecticut Ave NW, Washington, DC, USA, Tel: +1 2034489249; E-mail: LTomai@ LMpolicyresearch.com Citation: Morefield B, Tomai L, Klemes A (2021) Personalized Preventive Care for Patients at Risk of Heart Attack or Stroke. J Community Med Public Health Care 8: 080. Received: March 01, 2021; Accepted: March 26, 2021; Published: March 31, 2021 Copyright: © 2021 Morefield B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
is associated with reduced incidence of vascular events in an atrisk population. The evidence adds to prior literature by indicating an effect on measures of health, to accompany prior evidence of changes in utilization and expenditures.
Objectives/Introduction MD-Value in Prevention (MDVIP) is a national program in which physicians and patients participate in a personalized primary care arrangement, sometimes referred to as retainer medicine. MDVIP patient members pay an annual fee (average of $1,800) and, in return, receive a personalized wellness plan, including screenings and diagnostic tests, diet and exercise coaching and resources, and other ancillary benefits, such as 24/7 availability and same-day appointments [1]. To provide such care, MDVIP-affiliated physicians agree to serve a smaller panel, maximum of 600 patients. Prior studies of MDVIP participation have shown overall cost savings, decreased ED utilization, decreased hospital admissions and readmissions, and increased evaluation and management utilization [2-5]. This study expands focus beyond the costs and utilization to examine the impact of MDVIP enrollment on the incidence of acute myocardial infarction (AMI) or stroke/TIA for a population of Medicare fee-for-service (FFS) beneficiaries who are at higher risk of these events.
Methods Study populations Common predictors of vascular risks include age, blood pressure, diabetes, and cholesterol levels, as noted in the Framingham and Omnibus risk estimators. We defined the at-risk population for our observational study as 65 and older Medicare FFS beneficiaries with at least two of three risk-related chronic conditions—hypertension, hyperlipidemia, and diabetes— identified in the chronic conditions segment of CMS’s Master Beneficiary Summary File [6]. Among atrisk beneficiaries, we used Medicare FFS claims to identify MDVIP enrollees receiving at least one Part B service from an MDVIP-affiliated physician in the 15 months prior to the physician’s, and beneficiary’s subsequent, MDVIP enrollment, between 2005 and 2014. We also identified non-enrollees receiving care from non-MDVIP physicians in the same primary care service area during the same 15-month period (“non-MDVIP comparisons”). We excluded any beneficiaries without coverage under Medicare Parts A and B for the 12 months prior to and following the local MDVIP physicians’ enrollment dates. Finally, for both enrollees and non-MDVIP comparisons, we created beneficiary-year observations for the three years prior and up to five years following the local MDVIP enrollment date.
Statistical analysis We balanced the MDVIP and non-MDVIP comparison populations over observed pre-enrollment characteristics using propensity score overlap weights, where each observation is weighted by the predicted probability of being in the opposite group. Overlap weights minimize