GPC Health Economics - gpcnetwork/health-economics GitHub Wiki

GPC is interested in the area of Health Economics research.

See Avenues for Strengthening PCORnet’s Capacity to Advance Patient-Centered Economic Outcomes in Patient-Centered Outcomes Research (PCOR)

Economic Outcomes and PCORI

Initially PCORnet studies avoided direct economic comparative effectiveness as a topic.

  • Context of ACA (Obamacare discussion)

However, PCORI’s authorizing law was amended in 2019 to allow studies to incorporate patient-centered economic outcomes in primary research aims.

  • Compare effectiveness also from cost perspective (particularly patient’s)

PCORI guidance is just emerging

PCORI leaders have noted areas to enhance infrastructure for economics

Individual-level Data Linkage Infrastructure

  • Linking patients represented in a PCORnet site’s curated CDM with other individual-level sources, such as insurance claims, has two main advantages: 1) ascertaining healthcare received and outcomes that occur outside the PCORnet partner health system and 2) incorporating data not available from the site’s CDM such as insurance payments to the provider.
  • Have Datavant Privacy Preserving Record Linkage deployed across network – link patient identity and share data without exchanging protected health information

Commercial Health Plan Partnerships

  • Greater variability challenges national integration versus Medicare

Linking Medicare/Medicaid Claims

  • focus for Greater Plains Collaborative with State-wide claims across 10 years (2011-2020)

Health System Billing-based Benchmarking

  • Visient Clinical Database (prior University Healthsystem Consortium) provides cost benchmarking

Area-level Measures

  • PCORnet CDM stores patients’ addresses at various levels of resolution (county, 5 and 9 digit postal codes, street address and detail) and address changes over time to support geographic linkage (i.e. geocoding)
  • social deprivation indices incorporating Census tract median incomes; Agency for Healthcare Research and Quality’s Social Determinants of Health; environmental exposure databases on Water, Soil, Air and Climate

Individual-level Social Determinants of Health and Patient-Reported Data

  • Personal or household attributes include income, home/car ownership, educational attainment, and health/personal care/diabetes purchasing interest. Mizzou is currently piloting Acxiom consumer SDoH package
  • AHRQ, the Gravity Project developing standard representations of SDOH data and terminology to support consistency and sharing of measures between EHR systems

Pharmacy Benefits and Retail Pharmacy Data

  • Pharmacy Benefits Managers connected to Surescripts which can directly update EHRs
  • The National Retail Data Mart, a complementary area-level resource used by CDC for outbreaks

We are exploring whether will our work will align with the Broad Pragmatic Studies Category 3

Initial call with potentially interested collaborators.

Attendees:

Name Email Area of Interest
Elmer Bernstam [email protected] Background in Biomedical informatics and Internal Medicine. GPC site leader at UT Houston who has a strong interest in refined computable phenotype for health economics analysis.
Deandra Cassone [email protected] Administrative Director and Project manager for the GPC with a background in Industrial Engineering.
Rigoberto Delgado [email protected] Cost effectiveness in elderly and emergency care populations with an interest in linkage to Visient data.
Christopher Garmon [email protected] Assistant Professor of Health Administration studying surprise medical bills and hospital mergers.
Andwele Jolly [email protected] President & CEO at St Louis Integrated Health Network working in the areas of health equity and federally qualified health centers.
Huzaifa Khan [email protected] MU PhD student developing LOINC document ontologies and building the master cost table.
Liisa Laine [email protected] Assistant Professor of Economics studying the impact of health information technology on care coordination, provider competition, and causal inference. She is interested in subscripts, prescribing data.
Trevor Mandy [email protected] MU PhD student and Health Systems Analyst for MU health care working on in the areas of using Cystic Fibrosis as a test case for consequences with change in CF patients on new therapies and cost analysis.
Tamara McMahon [email protected] Senior Clinical Informatician in the UMKC Department of Biomedical and Health Informatics.
Yahia Mohamed [email protected] UMKC PhD student working on data quality across EHRs linked with medical claims data.
Mary C Schroeder [email protected] A longstanding GPC researcher with an R01 using GROUSE for rural health and pharmacy research.
Xing Song [email protected] MU Biomedical Informatics and Statistics faculty leading GROUSE and machine learning discovery.
Christine Spinka [email protected] GPC lead data scientist for data quality and GROUSE support.
Russ Waitman [email protected] PI for the GPC interested in health economics.
George Wehby [email protected] Head of the Department of Health Management & Policy working in health economics and with an interest in social determinants of health.

Additionally we met with Tina Shin, a Professor in Radiation Oncology at UCLA is director for the health informatics. She is interested in cost of cancer care and financial toxicity as well as financial social determinants of health such as the ability to incorporate credit score.

GPC has an evolving infrastructure to support health economics research.

In production

  • EHR contains over 30 million patients
  • Individual linkage to Claims data
  • Area level measures available but they still need to be linked in i2b2.

In development

  • Cost table
  • Individual level social determinants of health in pilot for MU only right now. Roughly 800K patients with roughly 100 variables. Christie Spinka is point person on this work with contributions from Russ Waitman, Xing Song, Xiaofan Niu)

Future

  • Incorporating Vizient data is currently conceptual at MU, but prior work completed by KUMC. We need to reengage Vizient with respect to out of pocket patient cost and accounts receivable.
  • Many sites populate with Surescripts pharmacy but we have not done data analysis on it yet.