Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An...
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![Page 1: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/1.jpg)
NHANES Dissertation Design & MethodsProblem.
Medical processes match at-risk patients with obesity and
pre-clinical heart disease to beneficial anti-cholesterol, weight
loss, and lifestyle therapies (per 2013 American College of
Cardiology guidelines), but financing & scaling rules that
enable risk-reduction haven’t been defined.
• Research question: How does the relationship between
obesity and heart risk impact total medical costs?
• Purpose. Determine how obesity and healthy weight
depend on heart risk to amplify costs, and how disease-
free/normal patients differ from moderate heart risk
patients with obesity (pre-clinical well-appearing).
Design:
Cross-sectional for baseline cost estimates and service non-
use, as naturally distributed in the population. Exploratory
analysis for hypothesis generation and definition of stage-
contingent rules.
Methods
Who:
Adults (20-74 years old) representing the US
non-institutionalized population
• Not pregnant without outlier/rare diseases
• Disease-free and obesity-based heart risk
Measures of effect
• Mean costs difference relative
to normal/disease-free
• Magnitude of dependency
trend
Data description
• Patient-level service use (NHANES
public health data 2003-2012) mapped to
market prices (Healthcare Bluebook &
Micromedex Redbook) and estimates of
non-service use; and
• Clinical lab, exam, and vital sign data
mapped to risk of heart attack/stroke (10-
year calculator benefit groups, then
defaulting to low lifetime risk categories)
and body size.
Defining cost types
• Disease-free versus moderate
heart risk (incubating, well-
appearing), stratified by obesity
• Sub-clinical heart risk
(≥7.5%diabetics & genetic high
cholesterol) versus clinical
ASCVD (had severe event),
stratified by obesity
Statistical evaluation/test:
• Model main effects and moderation
interaction effects with R Sq,
• Hypothesis equivalence testing of mean
total cost by Wald F & T test for subgroups
• Estimated marginal means difference from
disease-free baseline for magnitude of
effects with Wald F and T test.
Comparator criteria
• Cost difference of higher risk
(10 year calculator) relative to
lower risk (30 year calculator)
cost
• R square of obesity-based
heart risk model compared to
industry actuarial risk
adjustment R square (Milliman)
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
Body size (BMI Category)
X
2
Medical costs(Rx, visits, hosp.)
Y
Heart risk (anti-cholesterol statin
benefit groups)
Z
Product term moderator
XZ
5
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Dissertation findings applied to decision making
If heart risk is at this level…
…Then consider specific behavioral change and prevention order
sets (heart risk levels: with behavioral factor vs. w/o behavioral
factor)
Cost
difference
Not diabetic and at risk for
heart attack/stroke in the
short term
(10-year ASCVD calculator ≥7.5%)
1. Resolve depression, pain, gastric reflux, asthma, and thyroid hormones issues (w/ 2 factors vs w/o factors)
2. Moderation of alcohol binge drinking vs. binge drinkers
1. $4,748
2. $1,157
Diabetic and at risk for heart
attack/stroke in the long term (30-year CVD calculator ≥39%)
1. Depression, pain, gastric reflux, asthma, and thyroid hormones management (w/ 2 factors vs w/o factors)
2. Moderation of alcohol binge drinking vs. binge drinkers3. Prescription medication adherence vs non-Rx adherence4. Weight maintenance vs weight gain
1. $3,107
2. $1,885
3. $2,390
4. $3,325
Not diabetic and at risk for
heart attack/stroke in the long
term (30-year CVD calculator ≥39%)
1. Resolve depression, pain, gastric reflux, asthma, and thyroid hormones issues (w/ 2 factors vs w/o factors)
2. Prescription medication adherence vs non-Rx adherence3. Weight maintenance vs weight gain
1. $1,490
2. $1,611
3. $552
Normal
(not diabetic, and 10-year
ASCVD calculator <7.5%, and
30-year CVD calculator <39%,
and did not have heart
attack/stroke)
1. Moderate or rigorous exercise at 120 minutes per week vs. less than 120 to zero
2. Weight maintenance vs weight gain
1. $825
2. $409
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS obesity
algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because other algorithms
are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
![Page 3: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/3.jpg)
3
Dissertation findings applied to decision making
If heart risk is at this level……Then channel to a preventive program with these change
element.
Cost
difference in
behavioral
change
Heart attack/stroke survivor
(clinical atherosclerotic
cardiovascular disease)
1. Resolve depression, pain, gastric reflux, asthma, and thyroid hormones issues (w/ 2 factors vs w/o factors)
2. Moderate or rigorous exercise at 120 minutes per week vs. less than 120 to zero
3. Prescription medication adherence (anti-cholesterol statin eligible) vs non-Rx adherence
1. $6,037
2. $4,601
3. $3,167
Familial high cholesterol (bad cholesterol LDL ≥190)
1. Moderate or rigorous exercise at 120 minutes per week (anti-cholesterol statin eligible) vs. less than 120 to zero
2. Moderation of alcohol binge drinking vs. binge drinkers
1. $3,088
2. $436
Diabetic and at risk for heart
attack/stroke in the short
term
(10-year ASCVD calculator ≥7.5%)
1. Resolve depression, pain, gastric reflux, asthma, and thyroid hormones issues (anti-cholesterol statin eligible) (w/ 2 factors vs w/o factors)
2. Moderation of alcohol binge drinking vs. binge drinkers3. Moderate or rigorous exercise at 120 minutes per week vs.
less than 120 to zero
1. $2,636
2. $2,062
3. $1,648
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS obesity
algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because other algorithms
are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
![Page 4: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/4.jpg)
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John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
Difference between Rx adherence & non-adherence(exploratory analysis for hypothesis generation)
![Page 5: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/5.jpg)
5
Heart risk & obesity difference from disease-free
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
![Page 6: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/6.jpg)
6
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
Difference between binge drinkers & modest drinkers(exploratory analysis for hypothesis generation)
![Page 7: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/7.jpg)
7
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
Difference between fit and non-fit heart risk(exploratory analysis for hypothesis generation)
![Page 8: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/8.jpg)
8
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
Difference between weight gain and maintenance(exploratory analysis for hypothesis generation)
![Page 9: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/9.jpg)
9
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
(exploratory analysis for hypothesis generation)
Impact of obesity complications
![Page 10: Cost Of Obesity-Based Heart Risk In The Context Of Preventive And Managed Care Decision-Making: An NHANES Cross-Sectional Concurrent Study by John Frias Morales, Dr.BA, MS](https://reader031.fdocuments.us/reader031/viewer/2022022202/587cac5c1a28ab356c8b6b9b/html5/thumbnails/10.jpg)
10
John Frias Morales (2015) dissertation for Golden Gate University doctorate in business administration. Sources: NHANES 2003-2012, Healthcare Bluebook, Micromedex Redbook, AHA/ACC/TOS
obesity algorithm (Jensen and Ryan, 2013), AHA/ACC ASCVD 10-yr calculator (Goff, et. al., 2013) , and lifetime calculator (Lloyd-Jones, et. al., 2006) . The following are ineligible for inclusion because
other algorithms are more accurate for outlier populations: transplant, HIV, MS, dialysis/CKD, hepatitis, rheumatic, pregnant, <20 or 76+; and participants must have survey and exam.
(exploratory analysis for hypothesis generation)
Impact of obesity complications