Primary Submission Category: Health equity
The First Steps Towards Solving Medicare: An Analysis of the End Stage Renal Disease Model
Authors: Aarush Tutiki,
Presenting Author: Aarush Tutiki*
Abstract: End-stage renal disease (ESRD) patients despite being only 1% of Medicare beneficiaries, account for 7% ($35.9 Billion) of Medicare Spending. They have higher readmissions rate, higher mortality rate, and are more expensive than other Medicare population. To improve patient outcomes and increase cost savings for these patients, Medicare established an incentive rewards program called the Comprehensive ESRD Care (CEC) model. Dialysis centers, patients, and providers across the country were sorted into groups called ESCO (ESRD Seamless Care Organizations). My analysis will help policymakers build payment models to improve the health outcomes of the vulnerable population.
Rationale: Understanding what makes certain ESCOs successful would improve patient quality, reduce mortality, and increase cost savings. Understanding the Medical economics behind this would have significant extensions into the Medicare’s Accountable Care Organizations, which serve a full third of the American Population.
Methods: Success of the program was measured by three metrics: Standardized Mortality Ratio, Overall Total Quality Score, and Savings Rates. The standardized independent variables used were a series of ESCO specific datasets and Demographic data. Results were compared using direct visual cues from graphing, linear regression modeling, and cluster analysis (K-Means with the Elbow Method).
Results: Programs with less young people, a higher percentage male, and a higher percentage of the general population without health insurance see higher savings. Programs with a lower ratio between provider and patients and higher incomes see lower mortality rates. A plan of care for falls had a significant relationship to Mortality Rates, and Diabetic Eye Exams had a significant relationship to Overall Quality. Out of 37 participants: 26 had lower than expected Mortality Rates (SMR < 1). The 26 with better than expected mortality had, on average, a mortality ratio of .88.