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Medicare Part D Formulary Coverage Since Program Inception: Are Beneficiaries Choosing Wisely?Analysis of Medicare Part D formulary composition since program inception suggests beneficiaries may not be using their open-enrollment periods to reevaluate available plan offerings.
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Assessing Markers From Ambulatory Laboratory Tests for Predicting High-Risk PatientsAn evaluation of the added value of risk markers derived from ambulatory laboratory tests in the prediction of healthcare costs and identification of high-risk patients.
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Electronic Health Record Problem Lists: Accurate Enough for Risk Adjustment?Electronic health record (EHR)-based comorbidity assessment had low sensitivity for identifying major comorbidities and poorly predicted survival. EHR-based comorbidity data require validation prior to application to risk adjustment.
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Cost-Effectiveness of Collaborative Care for Depression and PTSD in Military PersonnelCentrally assisted collaborative telecare is a cost-effective strategy relative to usual care for treating posttraumatic stress disorder and depression in the Military Health System.
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Routine Pre-cesarean Staphylococcus aureus Screening and Decolonization: A Cost-Effectiveness AnalysisRoutinely screening pregnant women for Staphylococcus aureus colonization and decolonizing carriers before cesarean delivery are unlikely to be cost-effective under current epidemiologic circumstances.
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Personalized Preventive Care Leads to Significant Reductions in Hospital UtilizationWe assessed the impact of the MDVIP personalized preventive care model on hospital utilization and found the MDVIP members' rates were substantially lower than nonmembers'.
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Dental Care Coverage TransitionsThis study examines dental insurance transition dynamics in the context of changing employment and retirement status.
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Amid Increasing Breast Implant–Related EBV+ DLBCL Cases, Researchers Share Insights on the DiseaseRecognition of the association between breast implants and lymphomas has been notable since the 1990s, although the association has been limited to breast implant–associated anaplastic large cell lymphoma and not Epstein-Barr virus (EBV).
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Developing Evidence That Is Fit for Purpose: A Framework for Payer and Research DialogueA decision-making framework that can be used to harmonize the evidence payer's desire for coverage and formulary decisions with the evidence generated by researchers.
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Review of Veterans Health Administration Telemedicine InterventionsA review of exemplary VHA-sponsored telemedicine interventions indicates that telemedicine can efficiently address patient healthcare needs.
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Risk Adjusting Community-acquired Pneumonia Hospital Outcomes Using Automated DatabasesUsing laboratory and administrative data, large managed care organizations can assign severity of illness scores to patients with pneumonia for risk adjustment and reporting.
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Well-Child Care Visits and Risk of Ambulatory Care-Sensitive HospitalizationsTimely well-child care visits may play a role in decreasing unnecessary hospitalizations in children in integrated healthcare delivery systems.
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Medicare Underpayment for Diabetes Prevention Program: Implications for DPP SuppliersThe actual costs of implementing the evidence-based Diabetes Prevention Program (DPP) were compared with the latest reimbursement rates provided by CMS.
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Prior Authorization to Improve Testing of Glycosylated Hemoglobin in a Managed Care SettingPrior authorization was successfully implemented in a managed care setting to obtain 100.0% performance of A1C testing in patients with diabetes treated with expensive drugs.
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CHAPTER 5. Clinical Guideline for Pharmacological Management of Adults With Type 2 DiabetesFrom the Adult Diabetes and Clinical Research Sections, Joslin Diabetes Center, Harvard Medical School. Approved May 10, 2016; updated April 24, 2018. For the Figure and Tables, download the PDF at the end of the chapter.
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Patients' Preferences for Receiving Laboratory Test ResultsThe main reason given for receiving results online was time savings, reported by 77% of participants, followed by lowering the chance of missing the results (31%).
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Fragmented Ambulatory Care and Subsequent Emergency Department Visits and Hospital Admissions Among Medicaid BeneficiariesAmong Medicaid beneficiaries, having more fragmented ambulatory care was associated with a modest independent increase in the hazard of a subsequent emergency department visit.
