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Mental Health Service Utilization Review Patterns in a Medicaid Managed Care ProgramMedicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.
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Implementing Clinical Informatics Tools for Primary Care–Based Diabetic Retinopathy ScreeningThe authors describe a primary care–based diabetic retinopathy screening program incorporating telemedicine, strong health information technology engagement, and development of clinical informatics tools.
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Improving Care Coordination and Reducing ED Utilization Through Patient NavigationA navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.
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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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Pharmacist-Led Review of Empagliflozin and Ertugliflozin Following Formulary UpdateManagement of empagliflozin and ertugliflozin may be suboptimal following an insurance carrier’s formulary updates. Pharmacists may improve the management.
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Managing Total Knee Replacement Under Value-Based PaymentsThis article describes the approach that a large primary care group at risk for value-based payments chose to deploy in managing clinical and financial outcomes of knee osteoarthritis jointly with orthopedic surgeons.
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Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary RoundsPatients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.
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Economic Burden of Osteoporotic Fractures: The Tip of the Iceberg?The economic burden of osteoporotic fractures may be much higher than estimated: just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.
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Hospitals’ Strategies to Reduce Costs and Improve Quality: Survey of Hospital LeadersHospitals pursue a broad range of efforts to improve quality, with those participating in bundled payments attempting to reduce postacute care to a greater degree than nonparticipants.
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Using a Brief Tool to Assess Healthy School Environments: A Pilot StudyThe authors evaluated a brief assessment tool that accountable care organizations can use to help elementary schools improve student nutrition and increase physical activity.
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Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth HistoryA novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.
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How English- and Spanish-Preferring Patients With Cancer Decide on Emergency CareCare delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.
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Social Determinants of Health and High-Cost Utilization Among Commercially Insured PopulationResidence in a more disadvantaged neighborhood was associated with higher likelihood of being a high-cost utilizer among older adults and lower likelihood among younger adults.
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Study Launches Exploring Peluntamig Combo in DLL3-Expressing TumorsDosing has started in a clinical evaluating peluntamig, which targets DLL3 and CD47, combined with chemotherapy in patients with DLL3-expressing small cell lung cancer and neuroendocrine carcinoma.
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Impact of Food Affordability on Diabetes-Related Preventable HospitalizationMedicaid enrollees residing in counties with greater food affordability had lower odds of preventable hospitalization related to diabetes.
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Evaluation of a Pediatric Asthma High-risk Scoring AlgorithmAn asthma risk score using 7 clinically relevant parameters evaluated in a pediatric Medicaid managed care population can stratify risk for following-year asthma hospitalization.
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Contingency Management in a Perinatal Substance Exposure ClinicProject CARA, a perinatal substance exposure clinic, has implemented a contingency management program that targets appointment attendance for patients with any use disorder, regardless of substance or urine drug screen results.
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Operating Room Efficiency of Orthopedic Surgery During the COVID-19 EraThe authors analyzed the impacts of COVID-19 on orthopedic operating room efficiency via comparison of 14,856 surgeries performed before, during, and after the pandemic.
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How Nipocalimab Targets Unmet Needs in Autoimmune CareIn part 4 of our interview, we learn more about nipocalimab’s safety profile and how this investigative agent might address unmet needs for patients with generalized myasthenia gravis.
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Choosing Wisely Interventions to Reduce Antibiotic Overuse in the Safety NetThis study evaluates the impact of Choosing Wisely–based interventions on antibiotic prescribing for viral respiratory tract infections in a real-world safety-net setting.
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Evaluation of Biosimilar Trastuzumab MYL-1401O in HER2-Positive Breast CancerThe authors evaluate the effect and safety of biosimilar trastuzumab MYL-1401O in human epidermal growth factor receptor 2 (HER2)–positive early-stage (neoadjuvant and adjuvant therapy) and metastatic (palliative therapy) breast cancer using real-world data.
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Predicting Drug-Drug and Drug-Gene Interactions in a Community Pharmacy PopulationThe probability of drug interactions increases when genetic polymorphisms are considered, indicating that pharmacogenetic assessment may be useful in predicting the presence and severity of interactions.
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Comparing Newer With Traditional Agents in Uncomplicated UTIsPanelists discuss how newer urinary tract infection (UTI) therapies such as pivmecillinam, sulopenem etzadroxil/probenecid, and gepotidacin demonstrate significantly lower resistance rates (below 5%) compared with traditional first-line antibiotics (10%-30% for trimethoprim/sulfamethoxazole), with improved clinical and microbiological cure rates particularly for resistant pathogens, anticipating their integration into treatment algorithms as second-line options after nitrofurantoin and fosfomycin for patients with risk factors for resistance, prior treatment failures, recurrent infections, or confirmed resistant pathogens, although limited by higher costs and need for antimicrobial stewardship until more real-world effectiveness data become available.
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Telemedicine Catches On: Changes in the Utilization of Telemedicine Services During the COVID-19 PandemicThis analysis of health insurance claims data demonstrates rapid increase and sustained high utilization of telemedicine services during the COVID-19 pandemic.
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An Accelerated Hospital Observation Pathway to Reduce Length of Stay for Patients With COVID-19For select patients hospitalized due to COVID-19, an academic urban hospital implemented an observation pathway that incorporated mobile health technology, reducing hospital length of stay by more than 2 days.
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Hospitals’ Strategies to Reduce Costs and Improve Quality: Survey of Hospital LeadersHospitals pursue a broad range of efforts to improve quality, with those participating in bundled payments attempting to reduce postacute care to a greater degree than nonparticipants.
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Hospital Stays and Probable Dementia as Predictors of Relocation to Long-Term Care FacilitiesThis article explores late-life relocations in patients with dementia, hospital stays, and their implications for health care policy, geriatric care, and future research priorities.
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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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Contributor: Providers and Patients Push Back, Payers Push Forward—Co-pay Mitigation ProgramsResearch shows how commercial health plans impact payer trends in the co-pay landscape and provides key areas that pharmaceutical and biotech manufacturers can explore to ensure patient access.
