Economic issues

[jawalonoski]

@rlieberthal posted Issue 255 on the Module Builder Repo:

Economic issues

Add annual wellness visit (AWV) price and utilization to reflect the overall cost of visits

• AWVs were introduced into Medicare in 2011 as part of the ACA (http://www.latimes.com/business/lazarus/la-fi-lazarus-obamacare-physicals-20160802-snap-story.html)

• Annual Wellness Visits have a cost of $175 per beneficiary per year (https://www.ajmc.com/journals/issue/2019/2019-vol25-n3/medicare-annual-wellness-visit-association-with-healthcare-quality-and-costs)

• AWVs had a utilization of 7.5% in 2011 rising to 15.6% among Medicare beneficiaries in 2014 (https://jamanetwork.com/journals/jama/fullarticle/2622010)

• AWVs are covered by SNOMED codes 444971000124105 (general) and 456201000124103 (Medicare AWV) (https://phinvads.cdc.gov/vads/ViewCodeSystemConcept.action?oid=2.16.840.1.113883.6.96&code=456201000124103)

[nblake989]

I really like this from the concept of preventative encounters and adding the probability of utilization by various groups based on benefit type and demographics. I’ll try to find some of the published private insurance utilization rates. Is the accepted practice in this scenario to use a basic state in the module to act as a coverage/insurance_plan guard?

[jawalonoski]

Is the accepted practice in this scenario to use a basic state in the module to act as a coverage/insurance_plan guard?

@nblake989 I'm not entirely sure what you are asking.

If you are asking how to determine if there is coverage or not... then you probably want to guard (e.g. wait until some condition is met) with the Guard State: https://github.com/synthetichealth/synthea/wiki/Generic-Module-Framework%3A-States#guard

Unfortunately, currently there is no patient attribute accessible in the modules that identifies insurance coverage (there used to be, but that was dropped when the insurance coverage was recently refactored and updated. That is probably something that needs to be fixed). At the moment, the data currently resides in the org.mitre.synthea.world.agents.Person.payerHistory field.

If you are asking about how wellness encounters are scheduled and performed, then look at the wellness encounters module: https://synthetichealth.github.io/module-builder/#wellness_encounters. The scheduling is here: https://github.com/synthetichealth/synthea/blob/master/src/main/java/org/mitre/synthea/modules/EncounterModule.java

[jawalonoski]

There is a patient attribute called insurance_status with legal values currently being PRIVATE, GOVERNMENT, or NO_INSURANCE. This attribute can be used within modules if desired.