Quantitative Evaluation of the Impact of the Healthy Communities Initiative in Cincinnati

Quantitative Evaluation of the Impact of the Healthy Communities Initiative in Cincinnati

Soeren Mattke
Hangsheng Liu
Samuel Hirshman
Saw H. Wah
Sydne Newberry
Copyright Date: 2014
Published by: RAND Corporation
Pages: 66
https://www.jstor.org/stable/10.7249/j.ctt14bs337
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  • Book Info
    Quantitative Evaluation of the Impact of the Healthy Communities Initiative in Cincinnati
    Book Description:

    Recently, large employers, health plans, and health care providers in the Cincinnati area joined with community organizations in an effort to improve health care and population health, as well as reduce health care costs. The resulting Healthy Communities Initiative in Cincinnati was implemented in 2009. In 2012, RAND Health Advisory Services assessed the Initiative’s progress to date.

    eISBN: 978-0-8330-8962-5
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vi)
  4. Figures
    (pp. vii-viii)
  5. Tables
    (pp. ix-x)
  6. Executive Summary
    (pp. xi-xviii)

    Metropolitan Cincinnati residents have traditionally had among the highest health care costs in the United States, yet little evidence exists that people are getting their money’s worth, especially in terms of preventive and primary care. On measures of misuse of care—such as emergency department (ED) visits or hospital admissions for conditions that should be managed in primary care settings, such as asthma—Cincinnati’s rates are higher than rates in the state of Ohio or nationwide. Cincinnati also has higher rates of preventable mortality (Radley and Commonwealth Fund, 2012).

    Recognizing that high health care spending was not resulting in a...

  7. Acknowledgments
    (pp. xix-xx)
  8. Abbreviations
    (pp. xxi-xxii)
  9. 1 Introduction
    (pp. 1-4)

    Metropolitan Cincinnati residents have traditionally had among the highest health care costs in the United States, yet little evidence exists that people are getting their money’s worth, especially in terms of preventive and primary care. On measures of overuse of care—such as emergency department (ED) visits or hospital admissions for ambulatory care sensitive conditions that should be managed in primary care settings, such as asthma—Cincinnati’s rates are higher than state and national averages. Cincinnati also has above-average rates of preventable mortality (Radley and Commonwealth Fund, 2012).

    Recognizing that high health care spending was not resulting in a healthy...

  10. 2 Data and Methods
    (pp. 5-12)

    To evaluate the impact of the Healthy Communities Initiative on the Triple Aim of better health, better care, and lower costs, we aimed to estimate the differential changes in measures by comparing trend data reflecting the Triple Aim from the Cincinnati MSA to those for 15 other MSAs with similarly sized populations (see Table A.1 in Appendix A, available online, for details). This approach allowed us to separate the effect of the Healthy Communities Initiative from the secular time trends in various outcomes. Measures for better health were derived from the SMART data of the BRFSS and the CPS. We...

  11. 3 Results
    (pp. 13-34)

    All three datasets include the data for Cincinnati and the 15 reference cities for the years 2006–2012. In the CPS data, the final sample included only individuals who were employed at the time they responded to the CPS surveys, because the measures of interest are absence from work and the number of work hours missed due to illness. This restriction resulted in a sample size of 570,019 observations (29,192 for Cincinnati and 540,827 for reference cities) for the CPS data. A final sample of 263,833 observations (12,469 for Cincinnati and 251,364 for reference cities) was provided by the SMART...

  12. 4 Discussion
    (pp. 35-40)

    The Healthy Communities Initiative in Cincinnati combines primary care innovation, care coordination, the introduction of a health information exchange, public reporting of provider performance data, payment innovation, and targeted initiatives to improve care for patients with asthma and diabetes. We report on the early results of this ambitious initiative three years into the intervention. The analysis is based on a comparison of market-level trends for health status, health care quality, and cost and utilization of care in Cincinnati relative to 15 comparable reference markets. In addition, we used statistical techniques to account for market-level and resident-level differences between those markets...

  13. 5 Conclusions
    (pp. 41-42)

    We conducted the first quantitative evaluation on the Healthy Communities Initiative in Cincinnati for its first three intervention years. Overall, our findings were largely inconclusive because of the concomitant marketwide shift to HDHPs and the early stage of the intervention.

    Transitioning to HDHPs is known to have profound effects on care-seeking behaviors—particularly immediately after a change in benefit design, as plan members adapt to the new incentives. As the share of HDHP plans more than doubled in Cincinnati during our analysis period, it may have concealed intervention effects. As the level of HDHP penetration in Cincinnati stabilizes—and, thus,...

  14. Bibliography
    (pp. 43-44)