Background/Purpose: The American College of Rheumatology and National Quality Forum (NQF) recommend monitoring quality measures among rheumatoid arthritis (RA) patients. Previously we described the proportion of RA patients within a large managed care population meeting the criteria of RA specific NQF quality measures^1-2. This study examines the relationship between NQF measure attainment and healthcare expenditure.

Methods: Using the Optum^TM Clinformatics^TM database of insured individuals, 8 NQF RA quality measures (0054, 0589, 0590, 0592, 0597-0599, and 0601) were assessed among a sample of RA patients during calendar year 2011.  NQF definitions may be found at http://www.qualityforum.org/QPS/.  Mean specific healthcare costs, in addition to total healthcare costs, were calculated for all members eligible for analyses.  The standard cost field, which is an estimate of the allowed payment for all provider services, was selected as the primary outcome of interest. Results: The majority of individuals were female and in their mid-fifties (mean age of 52.8). Measure achievement ranged from 55.9% (measure 0592) to 80.8% (measure 0054). The mean cost of care for individuals meeting the measure was $18,642, range 12,488-$21,300. Those patients who did not meet the measures had an average cost of care of $14,923, range $13,013 – $19,293. The primary drivers of cost were pharmacy and office expenses, accounting for 42.3% and 28.6% of total costs, respectively.

Conclusion: In general, meeting quality measures was associated with an increased cost of care. Pharmacy costs were similar between patients who did and did not meet the measures. Individuals who met the measures had higher office costs while those individuals who did not meet the measure trended towards higher inpatient costs and had significantly higher outpatient costs. These findings suggest that increased quality in healthcare may lead to lower inpatient and outpatient hospital costs, but that the overall cost of care for RA patients is likely to remain high due to intensive pharmacotherapy regimens.

1. Meyer, R., Ellis, L., Bolge, S., Tkacz, J., Kardel, P., and Ruetsch, C.  (2013).  National quality forum measures among rheumatoid arthritis patients in a large managed care population.  Poster presented at the American College of Rheumatology 2013 Annual Meeting, San Diego, CA (abstract # 182).
2. Tkacz, J., Ellis, L., Meyer, R., Bolge, S., Brady, B., and Ruetsch, C.  (2014).  National Quality Forum measures for rheumatoid arthritis: Performance from members enrolled in a national health plan.  Manuscript under review: Journal of Managed Care & Specialty Pharmacy.