Gandhi Bhattarai - Academia.edu (original) (raw)

Papers by Gandhi Bhattarai

Population Health Management, 2015

The objective was to develop a propensity to succeed (PTS) process for prioritizing outreach to i... more The objective was to develop a propensity to succeed (PTS) process for prioritizing outreach to individuals with Medicare Supplement (ie, Medigap) plans who qualified for a high-risk case management (HRCM) program. Demographic, socioeconomic, health status, and local health care supply data from previous HRCM program participants and nonparticipants were obtained from Medigap membership and health care claims data and public data sources. Three logistic regression models were estimated to find members with higher probabilities of engaging in the HRCM program, receiving high quality of care once engaged, and incurring enough monetary savings related to program participation to more than offset program costs. The logistic regression model intercepts and coefficients yielded the information required to build predictive models that were then applied to generate predicted probabilities of program engagement, high quality of care, and cost savings a priori for different members who later qualified for the HRCM program. Predicted probabilities from the engagement and cost models were then standardized and combined to obtain an overall PTS score, which was sorted from highest to lowest and used to prioritize outreach efforts to those newly eligible for the HRCM program. The validity of the predictive models also was estimated. The PTS models for engagement and financial savings were statistically valid. The combined PTS score based on those 2 components helped prioritize outreach to individuals who qualified for the HRCM program. Using PTS models may help increase program engagement and financial success of care coordination programs.

A bivariate probit model was used to determine public and private food assistance participation a... more A bivariate probit model was used to determine public and private food assistance participation among the population below 125 percent poverty level, using the Current Population Survey data. Food stamp use and food pantry use were complements. Household income, food insecurity status, household structure, and rural residence affected participation decisions.

Fertilizer consumption per cubic meter of freshwater is taken as a proxy for global water quality... more Fertilizer consumption per cubic meter of freshwater is taken as a proxy for global water quality indicator. A global model of environmental quality for 121 countries confirms the Kuznet's hypothesis. Global turning point is reached at nearly five times the average income of all countries. Foreign Direct Investment (FDI) was significant to increase the national income. Increased aid and larger farm size per capita favored higher environmental quality, albeit insignificant. A flow of better technology and possible non-agricultural employment might help improve water quality in developing countries when their net income increases.

Research Papers in Economics, 2004

Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in ... more Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in a watershed was modeled as an optimization problem faced by a single user. A multinomial logit model was used to estimate the effects of urbanization, demographic structure, personal income and spatial distribution of watersheds.

... I would like to express my thanks to Dr. Krishna Paudel for his friendly advice throughout my... more ... I would like to express my thanks to Dr. Krishna Paudel for his friendly advice throughout my study. I would like to show my appreciation for all the support I have received from my ... I appreciate the wonderful patience and understanding of two daughters Akriti and Asmita. Page 8. ...

Measuring the change in outcomes between post period and pre-period across intervention and contr... more Measuring the change in outcomes between post period and pre-period across intervention and control group (difference-of-difference) has been the standard approach in program impact evaluation studies. When the intervention involves initially contacting large number of its qualified members there may be a natural time lag between the qualified date and the final confirmation of engagement by the member. This will result in an unbalanced distribution of time and duration of follow-up period. This paper presents a SAS macro to systematically adjust for the index date in non-participants so that the follow-up time and duration is comparable.

HLRP: Health Literacy Research and Practice

Innovation in Aging

Loneliness and social isolation are major risk factors for poor physical and mental health among ... more Loneliness and social isolation are major risk factors for poor physical and mental health among older adults. Studies demonstrate that loneliness is associated with depression, impaired cognitive performance, increased chronic disease, and mortality. However, the impact on other psychosocial constructs and healthcare outcomes remain understudied. The purpose of this study was to estimate the prevalence of loneliness and examine associations with socio-demographic, medical, and psychosocial characteristics in a large national survey of older adults (N=4,525). Overall, 43% of participants reported either moderate or severe loneliness. Older age, female gender, income, depression, hearing difficulty, and poorer health were all associated with loneliness. Purpose of life, resilience, optimism, and a diverse social network were associated with low loneliness. On average, lonely participants had a higher rate of emergency department visits, inpatient admissions, and medical costs. Based ...

Wellness programs are designed to help individuals maintain or improve their health. This article... more Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Professional case management, Jan 11, 2015

Many adults 65 years or older have high health care needs and costs. Here, we describe their care... more Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures....

Population Health Management, 2016

Wellness programs are designed to help individuals maintain or improve their health. This article... more Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Professional case management, Jan 11, 2015

Many adults 65 years or older have high health care needs and costs. Here, we describe their care... more Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures....

Population health management, Jan 29, 2016

A two-stage hedonic price and demand model was developed to estimate the willingness to pay for s... more A two-stage hedonic price and demand model was developed to estimate the willingness to pay for school quality, neighborhood safety and environmental quality in six Ohio metropolitan areas. Environmental quality and public safety were complements while school quality and house size were substitutes for them.

The American Journal of Geriatric Psychiatry, 2013

To evaluate the impact of a predictive model to identify those most likely to succeed in a depres... more To evaluate the impact of a predictive model to identify those most likely to succeed in a depression management program.

The objective of this study is to assess the economic and water quality impact of land use change... more The objective of this study is to assess the economic and water quality impact of land use change in a small watershed in the Wiregrass region of Alabama. The study compares changes in water quality and revenue from agricultural and forest productions due to changes in land use between years 1992 and 2001. The study is completed in two stages. In the first stage, a biophysical model is used to estimate the effect of land use change on nitrogen and phosphorus runoff and sediment deposition in the main channel; in the second stage, farm enterprise budgeting tools are used to estimate the economic returns for the changes in land use condition. Both biophysical and economic results are discussed and a case for complex optimization to develop a decision support system is presented.

A bivariate probit model was used to determine public and private food assistance participation a... more A bivariate probit model was used to determine public and private food assistance participation among the population below 125 percent poverty level, using the Current Population Survey data. Food stamp use and food pantry use were complements. Household income, food insecurity status, household structure, and rural residence affected participation decisions.

Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in ... more Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in a watershed was modeled as an optimization problem faced by a single user. A multinomial logit model was used to estimate the effects of urbanization, demographic structure, personal income and spatial distribution of watersheds.

The purpose of this paper is to examine the use of food stamps and private food assistance in dif... more The purpose of this paper is to examine the use of food stamps and private food assistance in different regions of the country during 1999, a year when food stamp use dropped to its lowest point in the recent past. Our results show that impoverished families in the South are less likely than those in other regions to obtain private food assistance, although they are more likely than those in the West or Midwest to use food stamps. Low-income families in the Northeast are also more likely than those in the West or Midwest to use food stamps.

Population Health Management, 2015

The objective was to develop a propensity to succeed (PTS) process for prioritizing outreach to i... more The objective was to develop a propensity to succeed (PTS) process for prioritizing outreach to individuals with Medicare Supplement (ie, Medigap) plans who qualified for a high-risk case management (HRCM) program. Demographic, socioeconomic, health status, and local health care supply data from previous HRCM program participants and nonparticipants were obtained from Medigap membership and health care claims data and public data sources. Three logistic regression models were estimated to find members with higher probabilities of engaging in the HRCM program, receiving high quality of care once engaged, and incurring enough monetary savings related to program participation to more than offset program costs. The logistic regression model intercepts and coefficients yielded the information required to build predictive models that were then applied to generate predicted probabilities of program engagement, high quality of care, and cost savings a priori for different members who later qualified for the HRCM program. Predicted probabilities from the engagement and cost models were then standardized and combined to obtain an overall PTS score, which was sorted from highest to lowest and used to prioritize outreach efforts to those newly eligible for the HRCM program. The validity of the predictive models also was estimated. The PTS models for engagement and financial savings were statistically valid. The combined PTS score based on those 2 components helped prioritize outreach to individuals who qualified for the HRCM program. Using PTS models may help increase program engagement and financial success of care coordination programs.

A bivariate probit model was used to determine public and private food assistance participation a... more A bivariate probit model was used to determine public and private food assistance participation among the population below 125 percent poverty level, using the Current Population Survey data. Food stamp use and food pantry use were complements. Household income, food insecurity status, household structure, and rural residence affected participation decisions.

Fertilizer consumption per cubic meter of freshwater is taken as a proxy for global water quality... more Fertilizer consumption per cubic meter of freshwater is taken as a proxy for global water quality indicator. A global model of environmental quality for 121 countries confirms the Kuznet's hypothesis. Global turning point is reached at nearly five times the average income of all countries. Foreign Direct Investment (FDI) was significant to increase the national income. Increased aid and larger farm size per capita favored higher environmental quality, albeit insignificant. A flow of better technology and possible non-agricultural employment might help improve water quality in developing countries when their net income increases.

Research Papers in Economics, 2004

Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in ... more Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in a watershed was modeled as an optimization problem faced by a single user. A multinomial logit model was used to estimate the effects of urbanization, demographic structure, personal income and spatial distribution of watersheds.

... I would like to express my thanks to Dr. Krishna Paudel for his friendly advice throughout my... more ... I would like to express my thanks to Dr. Krishna Paudel for his friendly advice throughout my study. I would like to show my appreciation for all the support I have received from my ... I appreciate the wonderful patience and understanding of two daughters Akriti and Asmita. Page 8. ...

Measuring the change in outcomes between post period and pre-period across intervention and contr... more Measuring the change in outcomes between post period and pre-period across intervention and control group (difference-of-difference) has been the standard approach in program impact evaluation studies. When the intervention involves initially contacting large number of its qualified members there may be a natural time lag between the qualified date and the final confirmation of engagement by the member. This will result in an unbalanced distribution of time and duration of follow-up period. This paper presents a SAS macro to systematically adjust for the index date in non-participants so that the follow-up time and duration is comparable.

HLRP: Health Literacy Research and Practice

Innovation in Aging

Loneliness and social isolation are major risk factors for poor physical and mental health among ... more Loneliness and social isolation are major risk factors for poor physical and mental health among older adults. Studies demonstrate that loneliness is associated with depression, impaired cognitive performance, increased chronic disease, and mortality. However, the impact on other psychosocial constructs and healthcare outcomes remain understudied. The purpose of this study was to estimate the prevalence of loneliness and examine associations with socio-demographic, medical, and psychosocial characteristics in a large national survey of older adults (N=4,525). Overall, 43% of participants reported either moderate or severe loneliness. Older age, female gender, income, depression, hearing difficulty, and poorer health were all associated with loneliness. Purpose of life, resilience, optimism, and a diverse social network were associated with low loneliness. On average, lonely participants had a higher rate of emergency department visits, inpatient admissions, and medical costs. Based ...

Wellness programs are designed to help individuals maintain or improve their health. This article... more Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Professional case management, Jan 11, 2015

Many adults 65 years or older have high health care needs and costs. Here, we describe their care... more Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures....

Population Health Management, 2016

Wellness programs are designed to help individuals maintain or improve their health. This article... more Wellness programs are designed to help individuals maintain or improve their health. This article describes how a reporting process can be used to help manage and improve a wellness program. Beginning in 2014, a wellness pilot program became available in New Jersey for individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company. The program has since expanded to include Missouri, Texas, Alabama, and Washington. This wellness program includes an online health portal, one-on-one telephonic coaching, gym membership discounts, and local health events. To assure smooth program operations and alignment with program objectives, weekly and monthly reports are produced. The weekly report includes metrics on member engagement and utilization for the aforementioned 4 program offerings and reports on the last 4 weeks, as well as for the current month and the current year to date. The monthly report includes separate worksheets for each state and a summary worksheet that includes all states combined, and provides metrics on overall engagement as well as utilization of the 4 program components. Although the monthly reports were used to better manage the 4 program offerings, the weekly reports help management to gauge response to program marketing. Reporting can be a data-driven management tool to help manage wellness programs. Reports provide rapid feedback regarding program performance. In contrast, in-depth program evaluations serve a different purpose, such as to report program-related savings, return on investment, or to report other longer term program-related outcomes.

Professional case management, Jan 11, 2015

Many adults 65 years or older have high health care needs and costs. Here, we describe their care... more Many adults 65 years or older have high health care needs and costs. Here, we describe their care coordination challenges. Individuals with an AARP Medicare Supplement Insurance plan insured by UnitedHealthcare Insurance Company (for New York residents, UnitedHealthcare Insurance Company of New York). The three groups included the highest needs, highest costs (the "highest group"), the high needs, high costs (the "high group"), and the "all other group." Eligibility was determined by applying an internally developed algorithm based upon a number of criteria, including hierarchical condition category score, the Optum ImpactPro prospective risk score, as well as diagnoses of coronary artery disease, congestive heart failure, or diabetes. The highest group comprised 2%, although consumed 12% of health care expenditures. The high group comprised 20% and consumed 46% of expenditures, whereas the all other group comprised 78% and consumed 42% of expenditures....

Population health management, Jan 29, 2016

A two-stage hedonic price and demand model was developed to estimate the willingness to pay for s... more A two-stage hedonic price and demand model was developed to estimate the willingness to pay for school quality, neighborhood safety and environmental quality in six Ohio metropolitan areas. Environmental quality and public safety were complements while school quality and house size were substitutes for them.

The American Journal of Geriatric Psychiatry, 2013

To evaluate the impact of a predictive model to identify those most likely to succeed in a depres... more To evaluate the impact of a predictive model to identify those most likely to succeed in a depression management program.

The objective of this study is to assess the economic and water quality impact of land use change... more The objective of this study is to assess the economic and water quality impact of land use change in a small watershed in the Wiregrass region of Alabama. The study compares changes in water quality and revenue from agricultural and forest productions due to changes in land use between years 1992 and 2001. The study is completed in two stages. In the first stage, a biophysical model is used to estimate the effect of land use change on nitrogen and phosphorus runoff and sediment deposition in the main channel; in the second stage, farm enterprise budgeting tools are used to estimate the economic returns for the changes in land use condition. Both biophysical and economic results are discussed and a case for complex optimization to develop a decision support system is presented.

A bivariate probit model was used to determine public and private food assistance participation a... more A bivariate probit model was used to determine public and private food assistance participation among the population below 125 percent poverty level, using the Current Population Survey data. Food stamp use and food pantry use were complements. Household income, food insecurity status, household structure, and rural residence affected participation decisions.

Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in ... more Allocation of fixed proportion of land to developed, forest, agricultural and other land uses in a watershed was modeled as an optimization problem faced by a single user. A multinomial logit model was used to estimate the effects of urbanization, demographic structure, personal income and spatial distribution of watersheds.

The purpose of this paper is to examine the use of food stamps and private food assistance in dif... more The purpose of this paper is to examine the use of food stamps and private food assistance in different regions of the country during 1999, a year when food stamp use dropped to its lowest point in the recent past. Our results show that impoverished families in the South are less likely than those in other regions to obtain private food assistance, although they are more likely than those in the West or Midwest to use food stamps. Low-income families in the Northeast are also more likely than those in the West or Midwest to use food stamps.