{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:40:07Z","timestamp":1753890007543,"version":"3.41.2"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Moyamoya is a rare arteriopathy affecting the intracranial circulation with a risk of stroke in the pediatric population. High\u2010volume centers provide improved outcomes after surgical revascularization compared with low\u2010volume centers. However, private insurers are often reluctant to approve care out\u2010of\u2010network. We hypothesized that rare diseases that can be treated in a single procedure, such as revascularization for moyamoya, can yield improved clinical outcomes with substantial cost savings to insurance companies when approved for care at high\u2010volume centers of excellence.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Longitudinal deidentified data of pediatric patients undergoing surgical revascularization for moyamoya from January 2018 to December 2020 (N\u00a0=\u00a0125) were obtained from national commercial insurers by an independent third\u2010party analytics core. Patients were selected according to\n              <jats:italic>International Classification of Diseases, Tenth Revision<\/jats:italic>\n              (\n              <jats:italic>ICD\u201010<\/jats:italic>\n              ) diagnosis and procedure codes. For a 9\u2010month episode, clinical and cost outcome metrics were compared across centers, with patients from the highest volume center designated as the primary cohort.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Patients in the primary cohort were on average younger at time of surgery, with greater medical comorbidities, yet exhibited decreased postoperative complications and fewer unplanned readmissions. The primary cohort had an overall 42% lower expense compared with patients treated at other single institution health systems ($89\u00a0000 versus $153\u00a0000). The primary cohort minimized out\u2010of\u2010network costs with implementation of a partnership care model, using local resources for preoperative workup in 68% of episodes, compared with only 8% of episodes at a comparator high\u2010volume center.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p xml:lang=\"en\">Implementation of a partnership model takes advantages of the surgical resources of a high\u2010volume center while maximizing local resource use for preoperative and postoperative care. Referral to high\u2010volume centers for pediatric moyamoya revascularization provides both improved outcomes for the patients and substantial cost savings for the insurers. These data suggest the development of high\u2010volume centers of excellence for select conditions requiring neurosurgical treatment confer benefit to both patients and insurers, even in cases of out\u2010of\u2010network care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.123.001014","type":"journal-article","created":{"date-parts":[[2024,1,24]],"date-time":"2024-01-24T07:27:20Z","timestamp":1706081240000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Referral of Pediatric Moyamoya for Revascularization: Financial and Quality Data Supporting Private Insurer Approval for Out\u2010of\u2010Network Care"],"prefix":"10.1161","volume":"4","author":[{"given":"Shivani D.","family":"Rangwala","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikita","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Judge","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Isibor","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Craig D.","family":"McClain","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Critical Care and Pain Medicine Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura L.","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Neurology Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred P.","family":"See","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"},{"name":"Department of Neuroradiology Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darren B.","family":"Orbach","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6317-8450","authenticated-orcid":false,"given":"Edward R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Boston Children's Hospital Harvard Medical School Boston MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.115.012168"},{"key":"e_1_3_2_3_2","doi-asserted-by":"crossref","first-page":"599","DOI":"10.3171\/2022.1.PEDS226","article-title":"Editorial. A terrible border wall: a study of pediatric moyamoya exposes socioeconomic barriers to care in the United States","volume":"29","author":"Smith ER","year":"2022","unstructured":"Smith ER. Editorial. A terrible border wall: a study of pediatric moyamoya exposes socioeconomic barriers to care in the United States. J Neurosurg Pediatr. 2022;29:599\u2010601.","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_3_2_4_2","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1377\/hlthaff.2014.0273","article-title":"Inequities in health care needs for children with medical complexity","volume":"33","author":"Kuo DZ","year":"2014","unstructured":"Kuo DZ, Goudie A, Cohen E, Houtrow A, Agrawal R, Carle AC, Wells N. Inequities in health care needs for children with medical complexity. Health Aff Proj Hope. 2014;33:2190\u20102198.","journal-title":"Health Aff Proj Hope"},{"key":"e_1_3_2_5_2","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1097\/MLR.0000000000001705","article-title":"Out\u2010of\u2010network care in commercially insured pediatric patients according to medical complexity","volume":"60","author":"Xu WY","year":"2022","unstructured":"Xu WY, Li Y, Song C, Bose\u2010Brill S, Retchin SM. Out\u2010of\u2010network care in commercially insured pediatric patients according to medical complexity. Med Care. 2022;60:375\u2010380.","journal-title":"Med Care"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.g5376","article-title":"Obamacare: what the affordable care act means for patients and physicians","volume":"349","author":"Hall MA","year":"2014","unstructured":"Hall MA, Lord R. Obamacare: what the affordable care act means for patients and physicians. BMJ. 2014;349:g5376.","journal-title":"BMJ"},{"key":"e_1_3_2_7_2","volume-title":"Rare and Complex Childhood Conditions Analysis","author":"Optum Network Planning","year":"2022","unstructured":"Optum Network Planning . Rare and Complex Childhood Conditions Analysis. Optum Network Planning; 2022."},{"key":"e_1_3_2_8_2","volume-title":"Healthcare Cost and Utilization Project (HCUP)","author":"HCUP Kids Inpatient Database (KID)","year":"2019","unstructured":"HCUP Kids Inpatient Database (KID) . Healthcare Cost and Utilization Project (HCUP). [Internet]. Agency for Healthcare Research and Quality; 2019. https:\/\/www.hcup\u2010us.ahrq.gov\/kidoverview.jsp"},{"key":"e_1_3_2_9_2","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1097\/ANA.0b013e3181f84fac","article-title":"Moyamoya disease: a review of the disease and anesthetic management","volume":"23","author":"Parray T","year":"2011","unstructured":"Parray T, Martin TW, Siddiqui S. Moyamoya disease: a review of the disease and anesthetic management. J Neurosurg Anesthesiol. 2011;23:100\u2010109.","journal-title":"J Neurosurg Anesthesiol"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14001"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0804622"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2007.130666"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-004-1118-9"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0303-8467(97)00033-4"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.7461\/jcen.2021.E2020.07.002"},{"key":"e_1_3_2_16_2","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2015-1829","article-title":"Hospital utilization among children with the highest annual inpatient cost","volume":"137","author":"Peltz A","year":"2016","unstructured":"Peltz A, Hall M, Rubin DM, Mandl KD, Neff J, Brittan M, Cohen E, Hall DE, Kuo DZ, Agrawal R, et\u00a0al. Hospital utilization among children with the highest annual inpatient cost. Pediatrics. 2016;137:e20151829.","journal-title":"Pediatrics"},{"key":"e_1_3_2_17_2","doi-asserted-by":"crossref","first-page":"433","DOI":"10.3171\/ped.2005.103.5.0433","article-title":"Risk factors for postoperative ischemic complications in patients with moyamoya disease","volume":"103","author":"Kim S\u2010H","year":"2005","unstructured":"Kim S\u2010H, Choi J\u2010U, Yang K\u2010H, Kim T\u2010G, Kim D\u2010S. Risk factors for postoperative ischemic complications in patients with moyamoya disease. J Neurosurg Pediatr. 2005;103:433\u2010438.","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.01.212"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.3171\/2014.12.PEDS14563"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2021.03.002"},{"key":"e_1_3_2_21_2","first-page":"1","article-title":"Results of more than 20 years of follow\u2010up in pediatric patients with moyamoya disease undergoing pial synangiosis","author":"Riordan CP","year":"2019","unstructured":"Riordan CP, Storey A, Cote DJ, Smith ER, Scott RM. Results of more than 20 years of follow\u2010up in pediatric patients with moyamoya disease undergoing pial synangiosis. J Neurosurg Pediatr. 2019;1\u20107. doi:10.3171\/2019.1.PEDS18457","journal-title":"J Neurosurg Pediatr"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.3171\/2011.10.FOCUS11228"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2012.08.002"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.3171\/2016.5.PEDS16137"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.09.082"},{"key":"e_1_3_2_26_2","first-page":"1","article-title":"Readmission following extracranial\u2010intracranial bypass surgery in the United States: nationwide rates, causes, risk factors, and volume\u2010driven outcomes","author":"Rumalla K","year":"2020","unstructured":"Rumalla K, Srinivasan VM, Gaddis M, Kan P, Lawton MT, Burkhardt J\u2010K. Readmission following extracranial\u2010intracranial bypass surgery in the United States: nationwide rates, causes, risk factors, and volume\u2010driven outcomes. J Neurosurg. 2020;1\u20109. doi:10.3171\/2020.6.JNS202117","journal-title":"J Neurosurg"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2022.06.002"},{"key":"e_1_3_2_28_2","unstructured":"Corlette S Lucia K Ahn S. Implementation of the affordable care act: cross\u2010cutting issues. Center on Health Insurance Reforms Georgetown University Health Policy Institute September 2014."},{"key":"e_1_3_2_29_2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1056\/NEJMp1402705","article-title":"Adverse effects of prohibiting narrow provider networks","volume":"371","author":"Howard DH","year":"2014","unstructured":"Howard DH. Adverse effects of prohibiting narrow provider networks. N Engl J Med. 2014;371:591\u2010593.","journal-title":"N Engl J Med"}],"container-title":["Stroke: Vascular and Interventional Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/SVIN.123.001014","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,10]],"date-time":"2024-07-10T14:57:54Z","timestamp":1720623474000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/SVIN.123.001014"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":28,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1161\/SVIN.123.001014"],"URL":"https:\/\/doi.org\/10.1161\/svin.123.001014","relation":{},"ISSN":["2694-5746"],"issn-type":[{"type":"electronic","value":"2694-5746"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-01-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e001014"}}