Incentivizing multisector health activities may be an effective way to lessen Medicare expenditures, according to study data presented at the American Public Health Association 2018 Annual Meeting and Expo, held November 10 to 14, in San Diego, California.
Investigators performed a retrospective cohort study with survey data collected from 350 US metropolitan communities over 18 years (1998-2016). Surveys comprised information collected by local health officials on health improvement activities and associated organizations, including hospitals, insurers, and schools. Communities were then categorized by multisector health activity level per cluster analysis on the “scope of recommended activities contributed by each…organization, along with the density of relationships [with] these organizations.” These data were then compared with area-level information on Medicare spending and sociodemographic characteristics. Random-effects modeling was used to investigate the impact of changes in multisector health activities on Medicare spending.
Communities with a higher density of multisector health activities had significantly lower levels of Medicare expenditures per beneficiary. This association remained significant when instrumental variables analysis was used to adjust for the impact of unobserved heterogeneity on both multisector activity and medical care spending. Communities with the highest density of activity had Medicare spending levels 37.2% lower than their counterparts with the lowest density of activity (P <.01) after controlling for heterogeneity and other factors.
These data support increased multisector health activities as a means of controlling medical costs under Medicare. Study investigator Glen Mays, PhD, MPH, of the Department of Health Management and Policy at the University of Kentucky in Lexington, noted that providers currently operating under Medicare should “seek to strengthen relationships with social and public health organizations” to maximize multisector community health activity and minimize expenditures. Savings produced by community-based initiatives can then be “[re-invested] in strengthening the community networks,” he concluded.
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Mays G. Economics of aligning medical, social, and public health systems: evidence from Medicare. Presented at: American Public Health Association 2018 Annual Meeting and Expo; November 10-14, 2018; San Diego, CA. Abstract 3409.0