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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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Key Takeaways on Optimizing Glaucoma ManagementClosing out their discussion on glaucoma management, experts share practical advice for care providers and payers alike.
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COVID-19 Vaccine Hesitancy and Health Literacy in US Southern StatesCOVID-19 vaccine hesitancy is not associated with health literacy. Personal perception of threat was associated with reduced vaccine hesitancy.
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Racial/Ethnic Differences in Autoimmune Disease Prevalence in US Claims/EHR DataThis analysis uses claims and electronic health records from 2021 to examine racial and ethnic variations in immune-mediated inflammatory diseases in the United States.
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ACA Medicaid Expansion Association With Racial Disparity Reductions in Timely Cancer TreatmentMedicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.
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Multilevel Influences on Patient Engagement and Chronic Care ManagementHealth systems may be better able to support adoption of chronic care management processes, which have a strong evidence base for practice implementation, compared with patient engagement strategies, which have less evidence to guide effective implementation.
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Value-Based Management of Specialty Drugs: Practical Considerations and Implications for PharmacyPolicy makers and health plans seek value-based management of specialty drugs. This study examines real-world factors that favor some approaches over others and their potential impact.
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Hypoglycemia Upon Hospital Admission From Long-term Care: Health Care Resource UseThis analysis of a hospital billing database describes inpatient length of stay, intensive care unit length of stay, comorbidities, and costs for patients with diabetes after admission with hypoglycemia from long-term care or home.
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Contributor: COVID-19’s Impact on ACO REACH Deserves CMS' AttentionCMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.
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Potential Spillover Effects on Traditional Medicare When Physicians Bear Medicare Advantage RiskMedicare beneficiaries treated by physicians with high levels of Medicare Advantage risk exposure had higher care quality and efficiency outcomes compared with those treated by other physicians.
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Dosage and Outcomes in a Complex Care InterventionAssociations between intervention dosage and hospital use outcomes were observed among patients enrolled in a care management program serving individuals with complex needs.
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Economic Burden of Joint Disease in Psoriasis: US Claims AnalysisThis retrospective claims analysis found that concomitant joint disease in psoriasis is associated with greater health care resource utilization and health care costs than psoriasis alone.
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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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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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Strategies for Improving Transitions of Care for Patients With Diabetes: An Interview With Jennifer N. Clements, PharmDJennifer N. Clements, PharmD, is a clinical pharmacist in diabetes transition with Spartanburg Regional Healthcare System in Spartanburg, South Carolina. Clements is a board-certified pharmacotherapy specialist, board-certified ambulatory care pharmacist, and certified diabetes care and education specialist. She is currently developing a pharmacy service focused on the inpatient management of diabetes. An editor from The American Journal of Managed Care® recently conducted an interview with Clements to discuss strategies for improving transitions of care for patients with diabetes.
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Cost Savings From an mHealth Tool for Improving Medication AdherenceThe Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.
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Friedreich Ataxia: Looking Forward at the Treatment LandscapeA Friedreich ataxia specialist shares their optimistic outlook on future developments in the management of the condition.
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Removing Medicare’s Outpatient Ban and Medicare and Private Surgical TrendsThis article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.
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Quality, Health, and Spending in Medicare Advantage and Traditional MedicareIn a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.
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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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Insurer Costs of COVID-19 by Disease Severity and DurationPayer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.
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Agreement Among Measures Examining Low-Value Imaging for Low Back PainThis study demonstrates the need for additional consensus surrounding how to translate guideline recommendations to administrative measures assessing imaging overuse for acute low back pain.
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Alternative Payment Models Can Stabilize and Improve Practice Radiation ReimbursementHow Value-based Care Is Changing Radiation Oncology for the Better
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Coverage With Evidence Development: Where Are We Now?Review of CMS’ coverage with evidence development program exposes a need to improve program transparency and clarify requirements and timetables for reporting to improve access to novel therapies.
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Pharmacists and Transitions of Care From Emergency Department to HomePharmacists’ roles in transitions of care continue to evolve. Evaluation of pharmacist-led interventions as patients transition from emergency department to home is needed.
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Two Steps Forward, One Step Back: 50 Years of Societal Value From LDL-C–Lowering TherapiesLow-density lipoprotein cholesterol (LDL-C)–lowering therapies have yielded significant value to society through reduced costs for both fatal and nonfatal cardiovascular disease events. The vast majority of this value has accrued to patients.
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Contributor: The Critical Role of Patient Engagement in Patient-Centered Outcomes Research and Health Technology Assessment of Rare Disease TreatmentsPatient engagement is a necessity when performing health technology assessment to help better assess and identify the outcomes of a rare disease.
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Key Takeaways for the Management of HIV PrEPA panel of experts share closing thoughts and advice for the management and uptake of HIV PrEP therapy.
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Integrating Mental Health Care Services Into HIV Comprehensive CareDistinguishing between need and receipt of integrated services reveals that mental health care improves the likelihood of medication adherence among people living with HIV.
