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An Outpatient Critical Care Transition Clinic Model Reduces Admissions/Readmissions in Medically Complex PatientsCritical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.
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Insurance Payer Is Associated With Length of Stay After Traumatic Brain InjuryAmong hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.
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Policy Solutions to Facilitate the New eCQM ACO Reporting and Advancement of InteroperabilityThis article describes the challenges associated with aggregating and reporting quality data via electronic health records and discusses corresponding policy solutions.
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Rheumatoid Arthritis Medication Adherence in a Health System Specialty PharmacyIntegrated health system specialty pharmacies provide specialized services to patients, resulting in high rates of adherence to and financial assistance with specialty disease-modifying antirheumatic drugs.
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Social Determinants of Health Score: Does It Help Identify Those at Higher Cardiovascular Risk?Calculating a social score is feasible and it predicts cardiovascular outcomes. In order to do this, institutions have to collect social determinants of health.
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Utilization Management and Physician BurnoutThis survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them.
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Understanding Insurance Coverage Policies for Incretin Mimetics for Weight ManagementThe high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
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Rituximab Reference vs Biosimilar Utilization for Oncology vs Nononcology IndicationsReporting on the real-world utilization of reference rituximab and its biosimilars can help show prescribing habits and reveal cost-saving opportunities.
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Cost-effectiveness of Nivolumab in Patients With NSCLC in the United StatesThis article presents a cost-effectiveness analysis of nivolumab vs docetaxel from the US payer perspective in non–small cell lung cancer (NSCLC) based on randomized phase 3 studies with a minimum 5 years of follow-up.
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Transitions of Care: Supporting Patients and Physician PartnersAn emphasis on transitions of care should ensure the highest level of care for patients and provide support to physicians.
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Assessment of Structured Data Elements for Social Risk FactorsAn expert panel identified and assessed electronic health record and health information exchange structured data elements to support future development of social risk factor computable phenotyping.
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Rethinking Deprescribing: Who Should Monitor “Drug Overload”?Health plan pharmacists are in the perfect position to see overprescribing as it happens.
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Activation, Physical Activity, and Outcomes Among Individuals With T2DThis study presents an integrated, exploratory assessment of physical activity, patient activation, health-related quality of life, and clinical outcomes among older adults with type 2 diabetes (T2D) using survey, wellness, and claims data.
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HPV 16 and 18 Linked to Ovarian Cancer RiskIn a recent meta-analysis, the prevalence of human papillomavirus (HPV), especially types 16 and 18, was significantly increased among patients with ovarian cancer (OC) vs controls.
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Medical Loss Ratio’s Role in the Large Group Insurer MarketThe authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.
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Managed Critical Care: Impact of Remote Decision-Making on Patient OutcomesThis work serves as a step toward better understanding the implications of remote critical care intervention by evaluating levels of tele–intensive care unit decision-making authority.
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Oncology Alternative Payment Models: Lessons From Commercial InsuranceDeveloping alternative payment models for commercial populations in specialties such as oncology is rife with practical challenges. Leading payers and practices share lessons to date.
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Factors Associated With Lung Cancer Risk Factor DocumentationThis cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record.
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Real-World Users of Triple Therapy for Asthma in the USThis retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.
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Advancing Multiple Myeloma Care: Insights From ASH 2024 and BeyondSaad Z. Usmani, MD, MBA, FACP, discusses noteworthy data presented at ASH 2024, including the IFM2017-03 trial, and shares his excitement for ongoing research efforts in multiple myeloma, emphasizing key areas where further investigation is needed to improve patient outcomes and refine treatment strategies.
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Low-Cost Insulin for Socially At-Risk Patients: Evidence for EffectivenessHuman synthetic insulin may offer low-cost, effective treatment for certain patients with diabetes and financial constraints.
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Harnessing AI for Population Health: A Call to Action for Policy Makers and Health Care LeadersThe authors detail how artificial intelligence could be used in primary, secondary, and tertiary prevention to improve health outcomes and provide better value-based care.
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Discharge Prescribing and Subsequent Opioid Use After Traumatic Musculoskeletal InjuryThe authors use surgical resident assignment as an instrumental variable for discharge opioid prescribing and estimate the impact of discharge opioid supply on subsequent use.
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High-Intensity Home-Based Rehabilitation in a Medicare Accountable Care OrganizationHigh-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.
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Geographic Variability of Medicaid Acceptance Among Allergists in the USThe proportion of allergists accepting Medicaid in the US varied significantly among and within states.
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Racial and Ethnic Disparities in Prior Authorizations for Patients With CancerThe prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.
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Cost Analysis of Self-Monitoring Blood Glucose in Nonintensively Managed Type 2 DiabetesAnalysis of claims data showed reduced utilization and costs among patients with nonintensively managed type 2 diabetes using self-monitoring of blood glucose compared with continuous glucose monitoring.
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Improving Risk Stratification Using AI and Social Determinants of HealthPrediction models combining claims data with social determinants of health and additional, more-timely data sources using artificial intelligence (AI) can better identify individuals with the highest future medical spending.
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Stakeholder Insights on rtCGM in T2D Population Health ManagementLeading payer and health system stakeholders reviewed literature and shared insights on the value of real-time continuous glucose monitoring (rtCGM) in type 2 diabetes (T2D) population health.
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Population Health Strategies to Advance Health Equity: A Q&A With Dr Paul G. AlexanderPaul G. Alexander, MD, MPH, executive vice president and chief health equity and transformation officer, RWJBarnabas Health, speaks on strategies his organization implemented during the COVID-19 pandemic to address continuity of care and communication challenges in underserved communities and further efforts to improve health equity.
