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Medical Utilization Surrounding Initial Opioid-Related Diagnoses by Coding MethodMedical utilization profiles of commercially insured members with opioid-related disorders differ depending on the code used to document the initial diagnosis in administrative claims.
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Did Medicare Advantage Payment Cuts Affect Beneficiary Access and Affordability?The Affordable Care Act’s reductions to Medicare Advantage plan payments were not significantly associated with healthcare access or affordability for enrollees.
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Opportunity Costs of Ambulatory Medical Care in the United StatesAn analysis of the opportunity cost associated with ambulatory medical care in the United States demonstrates substantial time costs for individuals and society.
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Real-World Outcomes Among Patients With Early Rapidly Progressive Rheumatoid ArthritisThis study suggests that lower healthcare resource use and achieving low disease activity are associated with first-line abatacept compared with a first-line tumor necrosis factor-α inhibitor for patients with early rapidly progressive rheumatoid arthritis.
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Automated Phone and Mail Population Outreach to Promote Colorectal Cancer ScreeningAutomated phone and mail population outreach resulted in an almost 4-fold increase in the rate of screening for colorectal cancer even without an office visit.
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Prescription Rebate Guarantees: Employer InsightsThis study examined employers’ understanding of rebate guarantees, dependency upon rebate dollars, and the role that pharmaceutical rebates or employer benefits consultants play in their pharmacy benefits manager selection.
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Cost Utility of Hub-and-Spoke Telestroke Networks From Societal PerspectiveA cost-utility analysis of a hub-and-spoke telestroke network showed that it was economically dominant over routine care.
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An Expanded Portfolio of Survival Metrics for Assessing Anticancer AgentsA novel, simplified cost-value analysis tool was created to better differentiate the value of anticancer agents and further characterize the expected survival benefit of all patients.
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Projected US Savings From Biosimilars, 2021-2025Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.
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Implications of DRG Classification in a Bundled Payment Initiative for COPDDiagnosis-related group coding determines eligibility for many Medicare bundled payment initiatives. This approach excluded many patients with chronic obstructive pulmonary disease likely to benefit while including others without the disease.
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False-Positive Mammography and Its Association With Health Service UseThis study demonstrated that a false-positive mammogram was associated with increases in outpatient visits, but not provider referrals, for 1 year post mammogram.
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Effects of Nonadherence With Prescription Drugs Among Older AdultsPrescription nonadherence in older patients with chronic health conditions resulted in more emergency department use.
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Change to FIT Increased CRC Screening Rates: Evaluation of a US Screening Outreach ProgramFecal immunochemical testing resulted in higher colorectal cancer screening rates than did guaiac fecal occult blood tests, with less dependence on office visits.
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Relationship of Diabetes Complications Severity to Healthcare Utilization and Costs Among Medicare Advantage BeneficiariesThis retrospective cohort study in a Medicare Advantage population posits that type 2 diabetes mellitus complications pose an excess burden on healthcare resource use and related costs.
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Predictive Factors of Discharge Navigation Lag TimeExamination of factors associated with discharge lag time and how this metric plays an important role in managing hospital throughput.
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Health Care Resource Utilization Among Patients With T2D and Cardiovascular-, Heart Failure–, or Renal-Related HospitalizationsAmong patients with type 2 diabetes (T2D), concurrent cardiovascular-, heart failure–, or renal-related hospitalization presents significant disease burden leading to poor quality of life.
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To Report or Not Report Health Care Data BreachesThis study presents information regarding the decisions that health care privacy officers make about reporting a data breach, including factors that can affect the decision process, such as personal/organizational knowledge, prior breach status, and framed scenarios.
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Prescription Opioid Abuse: Challenges and Opportunities for PayersThis article outlines strategies insurers can use to mitigate their risks related to prescription opioid abuse by members, while addressing this serious public health problem.
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Adding Glucose-Lowering Agents Delays Insulin Initiation and Prolongs HyperglycemiaA review of national Veterans Health Administration data has identified how the number of glucose-lowering agents used prior to insulin initiation impacts glycemic control.
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Cost Analysis of COPD Exacerbations and Cardiovascular Events in SUMMITThis cost analysis using data from the Study to Understand Mortality and Morbidity in COPD (SUMMIT) trial found that fluticasone furoate/vilanterol reduced the rates and costs of combined chronic obstructive pulmonary disease (COPD) exacerbations and revascularization/cardiovascular events versus placebo.
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Examining Differential Performance of 3 Medical Home Recognition ProgramsWe examine utilization, quality, and expenditures among Medicare beneficiaries receiving care at federally qualified health centers and compare outcomes among those attributed to 1 of 3 recognition programs versus none.
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A Managed Care Organization's Call Center–Based Social Support RoleThis study describes an alternative approach to linking patients to community resources, such as food banks, housing, and medical transport, using a call center–based layperson role.
