Health plans: Consider new metrics for assessing organ transplant programs

payer_transplant_blogOrgan transplants save lives, and the number of transplants is rising. That’s why it’s important for health plans to reassess the metrics they use to measure the value of organ transplant programs.

Our white paper,“Reassessing how payers determine the value of organ transplant programs,” explores the Transplant Value Initiative. This Optum initiative looks at how different variables in the spectrum of transplant care impact overall clinical and financial outcomes.

Exploring outcomes, costs and practice patterns

One-year patient survival and one-year graft survival have long been accepted as key quality metrics uniformly adopted by health plans, providers and regulators. But this model focuses on a few short-term results and doesn’t account for wait times, mortality on the waitlist, long-term survival, quality of life and other metrics, including costs.

Among the medical centers we analyzed, these traditional yardsticks revealed little variance. However, when we compared other outcomes, costs and practice patterns, we found substantial variation in:

  • 30-day readmission rates
  • 30-day complication rates
  • Post-transplant admission days
  • Median number of days on the waiting list
  • Waiting list mortality

All of these, of course, affect patients’ quality of life and life expectancy.

The research also analyzed the benefits of kidney transplants from living donors, which results in better outcomes for patients as well as shorter times on dialysis and waiting lists. Our research shows that cost savings with living donor transplants are significant.

This insight is put into action through our transplant Centers of Excellence (COE). In an Optum-managed population with heavy utilization of Optum COEs for kidney transplant, more than two-thirds of transplants involved a living donor. The national average is about one-third.

The research also examined outcomes and compared costs of pre-emptive kidney transplants, in which a patient receives a transplant prior to dialysis. The paper shows the results in terms of length of phases of treatment and average savings of pre-emptive transplant in different scenarios.

While one-year patient and graft survival remain important indicators of performance, other metrics should be considered. The white paper includes a list of questions for health plans to look at in terms of their population, and metrics they may want to consider as important drivers of cost and clinical outcomes. Read “Reassessing how payers determine the value of organ transplant programs” to learn more.

 

1. Hanson S, Bentley T. 2014 U.S. organ and tissue transplant cost estimates and discussion. Milliman, Inc. Estimated costs based on the population under 65 years old.

 

About the Author:

fdi_headshot072909%20frank%20irwinDr. Frank Dennis Irwin is National Medical Director for Optum Complex Medical Conditions, with a focus and responsibility for transplantation and ventricular assist devices. His more than 40-year career includes private practice in internal medicine, assistant professor of medicine, and leadership positions as chief medical officer for health plans and health management companies. Dr. Irwin received his M.D. from Case Western Reserve University and is certified by the American Board of Internal Medicine.

One thought on “Health plans: Consider new metrics for assessing organ transplant programs

  1. It’s been great to read your article here. Organ Transplant is a big procedure and donation of organs and tissues is an even bigger thing. Only a person with a great character can undergo such a procedure.

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