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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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Impact of Payment Models on Medical Specialist Physician Practice PatternsThis article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.
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Social Determinants of Health: Are Colonoscopies Always Fit for Duty?Social determinants of health are associated with colonoscopy noncompletion in a Medicaid patient population at the Providence Community Health Centers.
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Organizational Capacity Among Hospitals in Medicare and Commercial Bundled PaymentsA national survey demonstrated differences in organizational capacity between hospitals participating in Medicare bundled payment programs and those coparticipating in both Medicare and commercial bundled payment programs.
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Medicaid Expansion, Managed Care Plan Composition, and Enrollee ExperienceMedicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.
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Evaluating Proactive Outreach for Prior Authorization Recertifications in Medicaid PatientsImplementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.
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Hospitalization Patterns Among Older Patients With Cancer With and Without DementiaDementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.
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Current Status and Influencing Factors of Nursing Interruption EventsThis study investigated the current status of nursing interruption events and analyzed the time costs, priority of events, and factors influencing interruptions.
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Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and CostsThe Diabetes Care Rewards program offers a business case for health plans to promote engagement through use of contingent incentives, thus improving health outcomes and lowering costs.
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OTC Treatment Options for Pesky Summer RashesThe American Skin Association estimated that 50 million Americans are exposed to urushiol yearly, the most common contact allergen in the United States.
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Impact of Expanded Carrier Screening on Health Care UtilizationThis study shows little evidence of harms or increased health care utilization for people receiving negative (normal) results of expanded carrier screening through genome sequencing.
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Coverage With Evidence Development Study Shows Benefits in Patients With Migraine Treated With Remote Electrical NeuromodulationA coverage with evidence development (CED) study demonstrated significant and clinically meaningful benefits in patients with migraine treated with remote electrical neuromodulation (REN). Health plans should support clinicians’ REN prescriptions by ensuring adequate coverage.
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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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Current Status and Influencing Factors of Nursing Interruption EventsThis study investigated the current status of nursing interruption events and analyzed the time costs, priority of events, and factors influencing interruptions.
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Diagnosis Patterns and Stress Testing Trends After Implementing High-Sensitivity Troponin AssayThis study found that switching from a conventional troponin assay to a high-sensitivity troponin assay resulted in changes to diagnosis patterns and stress testing trends.
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Development and Validation of the COVID-19 Hospitalized Patient Deterioration IndexThe authors developed and validated an accurate, well-calibrated, easy-to-implement COVID-19 hospitalized patient deterioration index to identify patients at high or low risk of clinical deterioration.
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Contributor: Empowering Endocrinologists With Technology for the Diagnosis, Management, and Treatment of NAFLDIn this column, an endocrinologist discusses the growing problem of liver disease and new options at their disposal, including vibration-controlled transient elastography.
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Building Research Capacity in Primary Care Practices That Serve Predominantly Racial and Ethnic Minority PopulationsThe successful collaboration between a primary care–based network of practices and academic researchers demonstrates feasibility and the need for more funding for primary care research.
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Small but Nimble: Measures Taken to Face the COVID-19 Pandemic in Small French Military HospitalsPrioritization, interunit collaboration, esprit de corps, and health workers’ adaptability are key factors in providing a coherent response to the coronavirus disease 2019 pandemic.
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A Kidney Diagnostic’s Impact on Physician Decision-making in Diabetic Kidney DiseaseThe KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.
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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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Potential Impact of Hospital at Home on Postoperative ReadmissionsMany postoperative readmissions are amenable to diversion to a hospital at home program for surgical patients, representing an opportunity to generate revenue and improve patient experience.
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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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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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Diabetes Associated With Higher Health Care Utilization and Poor Outcomes After COPD-Related HospitalizationsPatients with diabetes and chronic obstructive pulmonary disease (COPD) have worse outcomes when hospitalized and appear to be more vulnerable to respiratory and nonrespiratory complications after a COPD exacerbation, which highlights the need for targeted interventions in this population.
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Characterizing Telehealth Use in the US: Analysis of the 2022 Health Information National Trends SurveyPatients’ motivations for telehealth use require further investigation to develop appropriate policies.
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Patient-Centered Oncology Care: Impact on Utilization, Patient Experiences, and QualityPractices implementing a patient-centered oncology care pilot had improved quality, but utilization and patient experiences did not differ from comparison practices.
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Navigating Privacy and Security in Telemedicine for Primary CareThis qualitative study of patients and providers in primary care evaluated privacy and safety considerations in telemedicine following the COVID-19 pandemic.
