Authors
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Financial Impact of Telehealth: Rural Chief Financial Officer PerspectivesInterviews with chief financial officers of rural hospitals revealed that they perceived telehealth to have some financial advantages; however, they did not believe that telehealth improved their hospitals’ financial situations.
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Cost-effectiveness of Case Management: A Systematic ReviewThis systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results.
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Varied Use of Step Therapy Among Medicare Advantage PlansThe frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.
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States Call for Managed Care to Prioritize Rural HealthMolly Dean, MSW, policy advisor at Siftwell, discusses how states have encouraged managed care entities to invest in local communities, build partnerships with nonprofits, and support social determinants of health initiatives.
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Characterizing Obesity in a Large Health Care Delivery System.The prevalence of obesity in the Sutter Health system between 2015 and 2020 was 35%. Differences by race/ethnicity, health insurance, smoking status, and comorbidities were examined.
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Calibrating Medicaid Payment to Need for Long-term Services and SupportsIncorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.
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Treatment Modification After Initiating Second-Line Medication for Type 2 DiabetesAmong adults with type 2 diabetes who started noninsulin second-line therapy, most modified treatment within 1 year. Discontinuation was by far the most common modification.
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Insurance Coverage and Health Care Spending by State-Level Medigap RegulationsDespite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.
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Impact of Psychiatric Follow-Up Frequency on Outcomes and Waiting TimesNaturally occurring variations in appointment frequencies do not appear to have a major impact on clinical outcomes, but they significantly affect waiting times.
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Navigating the Biosimilar Frontier: Opportunities and Challenges in 2024Biosimilars offer substantial promise for a new era of accessibility and affordability for patients and the broader health care industry, but better understanding of these products from payers and providers is necessary for biosimilars to reach their full potential in the US.
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Why Even the Threat of a Twindemic Isn’t Swaying the Most Vulnerable: Black WomenThe fall season was accompanied by an urgent warning from the CDC of an impending “twindemic” of coronavirus disease 2019 and influenza. Despite the warnings, Black women are not lining up for vaccinations.
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Reducing Readmissions in the Safety Net Through AI and AutomationArtificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.
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Care Transition Management and Patient Outcomes in Hospitalized Medicare BeneficiariesHospital care transition activity facilitates uptake of Medicare-reimbursed transitional care management, which is associated with lower spending and better patient outcomes.
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Evaluating Alternative Methods of Comparing Antihypertensive Treatment IntensityMedication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.
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Immunotherapy Treatment Can Cause Skin-Related ToxicitiesThere are many immunotherapy-caused skin toxicities, but most can be easily managed.
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Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare BeneficiariesInfluenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.
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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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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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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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Initial Maintenance Therapy Adherence Among Older Adults With Asthma-COPD OverlapOlder adults with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap, who take fixed-dose combinations of inhaled corticosteroids and long-acting β agonists may be less likely to have persistent low adherence to initial maintenance therapy.
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Evaluating Alternative Methods of Comparing Antihypertensive Treatment IntensityMedication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.
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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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Bleeds and Resource Use in Hemophilia B: Retrospective Observational StudyThis real-world US study describes individuals with hemophilia B who experience bleeds despite factor replacement therapy and quantifies the associated comorbidity and health care resource utilization burden.
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Medicare Accountable Care Organizations Reduce Spending on SurgeryMedicare Shared Savings Program accountable care organizations spent less on surgical care by reducing inpatient surgery, increasing outpatient surgery, and reducing spending on postacute care after inpatient surgery.
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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.
