Diagnosis-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.
Opioid use incidence and prevalence rates decreased with implementation of an opioid safety initiative, whereas nonsteroidal anti-inflammatory drug rates remained constant. Rates of adverse events were higher among opioid users.
As oncology practices transition to value-based care, they are challenged to take on more holistic responsibility for their patient. Fortunately, the examples of practices participating in CMS’ Oncology Care Model can offer valuable insight into the most impactful workflow changes providers can implement as they strive to achieve cost and quality improvements.
Disease management programs for diabetes care based on bundled payment did not slow down the cost growth. Multimorbid adult patients with diabetes had largest cost growth.
The ACA eliminated patient cost sharing for evidence-based preventive care, yet this policy has not resulted in substantial increases in colonoscopy and mammography utilization.
Economic evaluations of adjuvant trastuzumab were reviewed. Three primary shortcomings were identified including incorporation of local data and estimation and representation (visual) of decision uncertainty.
Discharge before noon was associated with longer length of stay in patients with medical diagnoses and shorter length of stay in surgical patients.
This paper illustrates how Medicare Advantage plans and accountable care organizations could benefit from adopting innovative care delivery models, and suggests policy changes to accelerate spread.
A growing body of evidence is demonstrating how the benefits of Connected Care, electronic communication between patient and caregiver, are improving healthcare access and quality and reducing costs for payers-without passing through Congress.
Analyzes whether hospital participation in accountable care organizations is associated with a hospital’s quality and cost improvement outcomes in other Medicare value-based payment programs.
Among Medicare enrollees with metastatic colorectal cancer, the use of newer chemotherapy agents was lower for African American patients and for older patients.
Availability of electronic health records among advanced practice nurses and physicians in California is concentrated among large practices with fewer Medicaid patients.
A polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address health-related social needs.
Quality improvement methodology was implemented to ensure that patients receiving medications for attention-deficit/hyperactivity disorder (ADHD) returned for an appointment within 30 days of initiating medication.
This article identifies patient-, provider-, and system-level factors associated with the problem of self-monitoring blood glucose without use of the results.
In patients with type 2 diabetes, compliance and persistence were generally low for both statin and antihyperglycemic therapy, but they were significantly lower with statin therapy.
Patients with rheumatoid arthritis self-report a moderate rate of any previous pneumococcal vaccination (54%) and a very low rate of herpes zoster vaccination (8%).
Health systems are important in driving electronic health record adoption in ambulatory clinics, although the uptake of key functionalities varies across systems.
Conventional individualized diabetes self-management education resulted in sustained improvement in self-efficacy and diabetes distress. Short-term improvements in A1C, nutrition, and physical activity were not sustained.
A longitudinal case-control design was used to evaluate the effects of the patient-centered medical home model on medical costs and utilization among chronically ill patients.
This paper describes results from a patient survey regarding treatment-related financial experiences and interest in a financial literacy course.
The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.