Authors
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Contributor: How Payers Can Be Effective in New Value-Based Models for CKDThe author discusses how value-based payment models in chronic kidney disease can improve total cost and quality of care for patienst with chronic kidney disease (CKD).
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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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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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Health Care Resource Utilization, Quality Metrics, and Costs of Bladder Cancer Within the Oncology Care ModelSpending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.
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Hospital Strategies in Commercial Episode-Based ReimbursementThis study reports qualitative findings from an explanatory sequential mixed-methods investigation to understand hospitals’ approaches to a novel commercial episode-based reimbursement incentive program.
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Successes and Failures With Bundled Payments in the Commercial MarketThe relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.
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Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional MedicarePatients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.
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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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Community Health Workers’ Critical Role in Trust Building Between the Medical System and Communities of ColorThe authors interrogate elements of routine medical practice in New York City to argue for reforms of hospital culture through relational trust-building capabilities of community health workers.
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The Implementation of Opioid Prescribing Report Cards in Medicaid Managed Care: A Community Quality CollaborativeThis article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.
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Charitable Medication Distribution Improves Care for Uninsured Patients With DiabetesThis report illustrates how providing vital diabetes medications to uninsured patients through a charitable medication distributor improves clinical outcomes.
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Social Determinants of Health Score: Does It Help Identify Those at Higher Cardiovascular Risk?Calculating a social score is feasible and it predicts cardiovascular outcomes. In order to do this, institutions have to collect social determinants of health.
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Intersection of Complexity and High Utilization Among Health Center Patients Aged 18 to 64 YearsThis paper utilizes latent class analysis to identify subgroups of complex conditions and of super-utilizers among health center patients to inform clinically tailored efforts.
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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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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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Prior Authorization Requirements for Calcitonin Gene-Related Peptide AntagonistsThis quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.
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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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Differences in Spending for Diabetes and Multiple Chronic Conditions in Michigan Medicare BeneficiariesDiabetes and multiple chronic conditions increase overall Medicare spending, but spending increases even more in minority beneficiaries compared with White beneficiaries with similar comorbidity combinations.
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Rituximab Reference vs Biosimilar Utilization for Oncology vs Nononcology IndicationsReporting on the real-world utilization of reference rituximab and its biosimilars can help show prescribing habits and reveal cost-saving opportunities.
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Relationships Between Patient Portal Activation and Patient Satisfaction Scores Among CG-CAHPS and HCAHPS RespondentsPatients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.
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Patient-Centered Communication, Disparities, and Patient Portals in the US, 2017-2022From 2017 to 2022, patients with better communication with providers were more likely to report being offered and accessing a patient portal, but disparities persist.
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Higher Risk of ILD in Patients With RA, PsA Initiating bDMARDsThere were no differences in risk between patients with RA or PsA using or not using methotrexate.
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Management of MPN: Benchmarks For Quality CareRuben Mesa, MD, leads a discussion on key benchmarks and final thoughts about good-quality care programs for patients with MPNs, including parameters for judging efficacy and safety.
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Managed Care Has Experienced Numerous Changes Since the First Publication of AJMC®: John M. O'Brien, PharmD, MPHJohn Michael O'Brien, PharmD, MPH, discussed the changes in managed care over the past 30 years to commemorate the 30th anniversary of The American Journal of Managed Care®.
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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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2025 GPBCH Employer Symposia Set to Address Cardiovascular, MSK ChallengesTom Belmont, president and CEO, Greater Philadelphia Business Coalition on Health (GPBCH) previews the upcoming employer symposia, which seeks to help employers navigate solutions for the management and prevention of cardiovascular and musculoskeletal disease.
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Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal CareCollaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.
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Biosimilar Adoption, Legislative Action With PBMs: JC ScottJC Scott, CEO and president of The Pharmaceutical Care Management Association, discusses current efforts in increasing biosimilar adoption and pharmacy benefit manager (PBM) reform.
