Authors
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Two-Sided Risk in the Oncology Care ModelThe US healthcare system remains one of the most inefficient healthcare systems in the world. The Bloomberg Health-Care Efficiency Index ranked the United States 54th among 56 countries in 2018, tied with Azerbaijan and only ahead of Bulgaria. This occurs even though the United States spends $10,244 per capita annually on healthcare, a figure representing 17% of the gross domestic product.
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Medicaid Prior Authorization and Opioid Medication Abuse and OverdoseEnrollees in Medicaid plans employing prior authorization policies for opioid medications may have lower rates of opioid medication abuse and overdose.
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Asthma Expenditures in the United States Comparing 2004 to 2006 and 1996 to 1998Increased expenditures in US asthma are driven by increased medication spending that are not offset by decreases in emergency department and hospital spending.
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Getting From Here to There: Health IT Needs for Population HealthAligning health information technology with population health requires organizations to think differently about data needs, exchange partners, and how to leverage both for evidence-based action.
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Second-line and Third-line Chemotherapy for Lung Cancer: Use and CostUsing health insurance claims, we identified common first-, second-, and third-line chemotherapy regimens for patients with lung cancer and associated utilization and costs of care.
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Implications of DRG Classification in a Bundled Payment Initiative for COPDDiagnosis-related group coding determines eligibility for many Medicare bundled payment initiatives. This approach excluded many patients with chronic obstructive pulmonary disease likely to benefit while including others without the disease.
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How Pooling Fragmented Healthcare Encounter Data Affects Hospital ProfilingIncomplete records of patient history can bias hospital profiling. Completing health records for Medicare-covered patients in VA hospitals resulted in modest changes in hospital performance.
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Increasing Hepatitis C Screening in a Large Integrated Health System: Science and Policy in ConcertThe success of recommendations to improve screening often rests on the availability of efficacious therapies, coverage policies, and other factors that enable and justify screening.
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The Redesign of Consumer Cost Sharing for Specialty Drugs at the California Health Insurance ExchangePatients can be shielded from the most onerous cost-sharing burdens for specialty drugs while keeping premiums affordable for the entire enrolled population.
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US Internists' Awareness and Use of Overtreatment Guidelines: A National SurveyIn a national survey, US internists reported high levels of adoption of overtreatment guidelines; despite this fact, they also reported recommending services targeted by the overtreatment guidelines.
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Economic Evaluation of Plerixafor for Stem Cell MobilizationUse of granulocyte colony-stimulating factor plus plerixafor for stem cell mobilization is cost-effective in pretreated patients with non-Hodgkin lymphoma.
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Prescription Opioid Abuse: Challenges and Opportunities for PayersThis article outlines strategies insurers can use to mitigate their risks related to prescription opioid abuse by members, while addressing this serious public health problem.
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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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A Comparison of Retrospective Attribution RulesThe authors compare methods of retrospectively attributing patients to provider systems by the fraction of patients attributed and the stability of attribution over time.
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A Gray Area for Reimbursement: Medical Foods for Non–Inborn Errors of MetabolismMost non–inborn errors of metabolism (non-IEM) medical foods (MFs) do not meet the regulatory MF definition and lack scientific evidence for safety and efficacy. Non-IEM MFs are not yet ready for reimbursement by public insurers.
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A Cost-Effectiveness Analysis of Cardiology eConsults for Medicaid PatientsA randomized trial of eConsults for cardiology referrals from primary care resulted in significant reductions in total cost of care compared with traditional face-to-face consultations.
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Community as Part of the Prescription: Social Media in Diabetes CareThis commentary was adapted from an appearance by the authors at Patient-Centered Diabetes Care, a conference jointly presented by The American Journal of Managed Care and Joslin Diabetes Center.
