Integrated Healthcare System’s Effect on Clinical and Economic Results

San Francisco—A retrospective cohort study found that for patients with atrial fibrillation and atrial flutter, a closed system healthcare model was associated with significantly lower costs compared with an open system model over a 12-month period.

Results were presented at the ACC meeting during a poster session. The poster was titled Clinical and Economic Impact of an Integrated Healthcare System on Patients with New-Onset Atrial Fibrillation and Flutter.

Approximately 3.3 million people have atrial fibrillation and atrial flutter, which accounts for the second most common cardiovascular condition in the United States, according to the authors. In addition, there are 470,000 hospital admissions related to atrial fibrillation each year in the United States, and healthcare costs associated with atrial fibrillation were $13.9 billion in 2010.

In this analysis, the authors examined data from the Geisinger Health System (GHS), which provides health services to nearly 3 million people in Pennsylvania and includes the Geisinger Clinic, which has 4 hospitals and >40 clinics, and the Geisinger Health Plan (GHP), which insures >220,000 individuals. The GHS serves GHP enrollees (accounting for one third of patients) as well as people enrolled in other plans.

Patients were eligible if they were ≥18 years of age, had ≥1 inpatient or ≥2 outpatient claims for atrial fibrillation and atrial flutter, and were continuously enrolled in the GHP 12 months before and after their diagnosis. The authors examined people enrolled between June 2004 and June 2011. Patients were excluded if they were newly diagnosed with atrial fibrillation and atrial flutter based on an outpatient claim for electrocardiography or evidence of transient atrial fibrillation and atrial flutter or hyperthyroidism.

The study included 14,726 patients: 5632 were from the GHS and 9094 were not from the GHS. All were enrolled in the GHP. The GHS had a greater overall burden of illness, although the non-GHS group had higher stroke, renal disease, and tumor rates. In the GHS group, 54.8% of patients were males compared with 55.3% in the non-GHS group, while the mean age was 72.9 years in the GHS group and 70.5 years in the non-GHS group (P<.001).

The mean all-cause healthcare costs in the 12 months after the initial diagnosis were $29,642 per patient in the GHS group compared with $31,039 per patient in the non-GHS group (P<.001), a 4.5% difference. During that same time period, the mean cardiovascular-related healthcare costs were $27,799 per patient in the GHS group and $29,077 per patient in the non-GHS group (P<.001), a 4.4% difference.

In the 12 months after diagnosis, patients in the GHS group had a median of 5.0 all-cause primary care visits compared with 4.0 in the non-GHS group (P<.001), while the GHS group had a median of 5.0 cardiovascular-related outpatient primary care visits compared with 3.0 in the non-GHS group (P<.001). The GHS group had a median of 7.0 visits compared with 6.0 visits for the non-GHS group (P<.001).

The authors cited a few limitations of the study, including that they only collected data for a short time period and could not determine the long-term economic impact of closed healthcare systems. In addition, providers could have different cost discounts and/or negotiated payment rates, although the authors indicated that the GHS group had fewer hospitalizations, which would likely lead to lower costs compared with the non-GHS group.

This study was supported by Sanofi.