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High Cost Sharing and Specialty Drug Initiation Under Medicare Part D: A Case Study in Patients With Newly Diagnosed Chronic Myeloid LeukemiaA Medicare claims analysis of patients newly diagnosed with chronic myeloid leukemia revealed that high cost sharing was associated with reduced and/or delayed tyrosine kinase inhibitor initiation under Part D.
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There's More Than One Way to Build a Medical HomeEven among practices reaching the highest level of PCMH achievement, there are variations in the implementation of key medical home capabilities.
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Medical Costs Associated With Type 2 Diabetes Complications and ComorbiditiesA large proportion of medical costs for type 2 diabetes are attributable to complications and comorbidities, especially end stage renal disease with dialysis or kidney transplantation.
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Colorectal Cancer Screening Use Among Insured Primary Care PatientsColorectal cancer screening use was similar in 2 divergent primary care populations. Colonoscopy was the most frequently used modality; FOBT was used inconsistently.
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The Social Value of Childhood Vaccination in the United StatesVaccination of children born in the United States in 2009 will save 1.2 million quality-adjusted life-years, generating $184 billion in social value net of vaccination costs.
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Claims-Based Risk Model for First Severe COPD ExacerbationA health insurance claims-based risk assessment tool to predict patients’ first severe chronic obstructive pulmonary disease exacerbation has been developed and validated.
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A Scoping Review of US Insurers’ Use of Patient-Reported OutcomesThis scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.
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Impact of Formulary Restrictions on Medication Use and CostsPlacing formulary restrictions on brand name drugs shifts use toward generics, lowers the cost per prescription fill, and has minimal impact on overall adherence for antidiabetes, antihyperlipidemia, and antihypertension medications among low-income subsidy recipients in Medicare Part D plans.
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Pattern of Statin Use Among 10 Cohorts of New Users From 1995 to 2004: A Register-Based Nationwide StudyOne-year persistence among new users of statins in Finland improved from 1995 to 1998, after which no substantial changes were observed up to 2004.
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Medicaid Managed Care Network Adequacy Standards and Mental Health Care AccessQuantitative Medicaid managed care network adequacy standards were not associated with improved mental health (MH) care access among adults and those with MH conditions.
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Excess Hospitalization Days in an Academic Medical Center: Perceptions of Hospitalists and Discharge PlannersWe assessed the frequency of and reasons for medically unnecessary hospital days, which affect patients, payers, hospitals, and healthcare providers.
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Palliative Care for Patients With Advanced Illness: A Changing Policy LandscapeA lag in policy changes has resulted in significant variation across palliative care programs for treating advanced illnesses. A recent shift in policy has, however, allowed small-scale testing of community-based palliative care delivery and some innovations in other delivery systems.
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Complying With State and Federal Regulations on Essential Drug Benefits: Implementing the Affordable Care ActEssential health benefits form a cornerstone of the Affordable Care Act. Our study shows that health plans in California and Massachusetts are not fully compliant with state and federal regulations on essential drug benefits.
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The Need for a Serious Illness Digital Ecosystem (SIDE) to Improve Outcomes for Patients Receiving Palliative and Hospice CarePalliative and hospice care services produce well-known benefits for patients living with serious illness and for their families. Benefits include improved quality of life and reduced symptom burden, spiritual and emotional distress, and caregiver distress.
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Assessment and Potential Determinants of Compliance and Persistence to Antiosteoporosis Therapy in ItalyThis analysis of antiosteoporosis therapy shows that 75% of patients have inadequate drug coverage and that adherence is strongly associated with age and administration regimen.
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Effective Implementation of Collaborative Care for Depression: What Is Needed?Factors most important for successful implementation of collaborative care for depression differ for patient activation versus achieving remission; both are critical to program success.
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Accountable Care Organization Hospitals Differ in Health IT CapabilitiesHospitals participating in accountable care organizations (ACOs) have greater adoption of health information technology, particularly patient-facing technology and health information exchange, than non-ACO hospitals.
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Inappropriate Wrist MRI: Did Guidelines Have an Impact?This article analyzes the use of MRI in a national sample of patients with wrist pain before and after consensus guideline publication.
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Low-Value Care for Acute Sinusitis Encounters: Who's Choosing Wisely?Acute sinusitis is a common acute illness and offers an opportunity to eliminate low-value care. The authors describe current practices, comparing primary care, urgent care, and the emergency department.
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Applying Weighting Methodologies to a Commercial Database to Project US Census Demographic DataThis study tests the feasibility of projecting commercial insurance demographic information to the US Census population, and creating the framework for a simple weighting scheme.
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Disparities in Diabetes and Hypertension Care for Individuals With Serious Mental IllnessThis study highlights disparities in care for diabetes and hypertension for individuals with serious mental illness compared with the general Medicaid and Medicare populations.
