Role of Sacubitril/Valsartan in Improving Provider Performance in Managing Heart Failure Under Medicare Alternative Payment Models
Condition: Heart Failure
MeSH terms: Heart Failure
Study type: Observational

Summary: 
      This study evaluated the association between sacubitril/valsartan utilization and HF
      patients' Part A & B expenditures within the reimbursement framework of BPCI and MSSP, and
      identified BPCI/MSSP participants with the greatest potential for performance improvement
      (with respect to improving quality and efficiency of care for HF patients) through optimized
      utilization of sacubitril/valsartan.
    

Detailed description: 
      This drug utilization study employed a retrospective cohort design using the 100% files of
      2015-2018 Medicare enrollment and Part A, B & D claims data in conjunction with publicly
      available information on providers participating in Bundled Payments for Care Improvement
      (BPCI) and/or Medicare Shared Savings Program (MSSP).

      BPCI Study Design The unit of analysis for addressing study objectives was a unique
      Congestive Heart Failure (CHF) episode of care, which encompassed an initial acute inpatient
      stay plus all Part A & B covered medical services during the 90 days post hospital discharge.
      Episode index date was defined as the date of a beneficiary's initial acute hospital stay
      with a qualifying Medicare Severity-Diagnosis Related Group (MS-DRG) for CHF, triggering a
      CHF episode of care. Beneficiaries were followed longitudinally from episode index date
      through episode end date to measure their utilization of sacubitril/valsartan and Part A & B
      expenditures during the CHF episode of care. A 12-month lookback period, based on when the
      episode was initiated, was utilized to capture beneficiaries' baseline characteristics. For
      example, episodes initiated on 2/1/2018 will have a 2/1/2017 to 1/31/2018 baseline lookback
      period. Balancing the need for data recency, all qualifying CHF episodes from 2016-2018 were
      included in the analysis. Given this is an episode-level analysis, a beneficiary may have
      contributed multiple CHF episodes to the data analysis. To account for potential
      within-subject clustering, a generalized linear model with a gamma distribution was applied
      for estimating the association between sacubitril/valsartan use and CHF episode costs.

      MSSP Study Design The unit of analysis for addressing study objectives was a HF patient's
      Part A & B expenditures within the MSSP. Given the most recent year of data available at the
      time the study was conducted was 2018, the study population included HF patients for whom the
      MSSP participants were accountable in 2018 per Centers for Medicare & Medicaid Services (CMS)
      assignment. These beneficiaries' utilization of sacubitril/valsartan and annual Part A & B
      expenditures was measured from January 1, 2018 - December 31, 2018. Data from CY 2017 was
      leveraged for capturing these patients' baseline characteristics.
    

Intervention name(s): Sacubitril/valsartan; ACEI or ARB and no sacubitril/valsartan
Intervention type(s): Drug; Drug
Intervention description(s): Beneficiaries with one or more prescription claim with an NDC for sacubitril/valsartan (from the PDE file) during the 90-day episode window. Patients who met these criteria were assigned a value of '1'; patients that did not meet these criteria were assigned a value of '0'; Beneficiaries with one or more prescription claim with an NDC for any ACEI/ARB and no prescription claims for sacubitril/valsartan during the 90-day episode window. Patients who met these criteria were assigned a value of '1'; patients that did not meet these criteria were assigned a value of '0'
Intervention MeSH terms: Valsartan; Sacubitril and valsartan sodium hydrate drug combination
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Adult Medicare FFS beneficiaries diagnosed with HF and who received care from a BPCI or
        MSSP participant
      
Keywords: Heart failure,; Medicare,; Alternative Payment Models,; HFrEF,; Healthcare Expenditures