Authors
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Managed Care COVID-19 Outcomes in a Population Health ProgramData from 38,193 patients showed that managed care patients have COVID-19 risk factors similar to those of the general population and that a population health program decreased mortality.
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US Cost-effectiveness and Budget Impact of Point-of-Care NAAT for StreptococcusThis study evaluates the cost-effectiveness and budget impact to US payers of point-of-care nucleic acid amplification tests (NAAT) for group A streptococcus.
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Two-Step Testing Helps Predict and Treat Recurrent C difficile InfectionThis study explores the effectiveness of toxin testing in predicting Clostridioides difficile infection (CDI) outcomes, revealing that patients with negative toxin results were less likely to experience CDI recurrence within 30 days.
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mCRC Treatment Access: IRA Cost Cap Impact and Final InsightsMedical experts discuss how the Inflation Reduction Act’s out-of-pocket prescription drug cost cap, effective in 2025, may impact access to oral chemotherapy options for metastatic colorectal cancer.
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Care Transitions for Young Adults With Special Health Care NeedsA Medicaid managed care plan developed a pilot program to assist special needs youth with transition to adult care. Case studies and discussion present findings.
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Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims DataA statistical model based entirely on claims data can accurately predict 30-day hospital readmission in Medicaid patients with diabetes.
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Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 InhibitorA collaboration between a drug plan and clinical pharmacists led to nearly 50% of members successfully switching to a preferred dipeptidyl-peptidase-4 inhibitor.
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Lessons Learned From 15-Plus Years of Clinical Quality ImprovementThe author shares observations on several common factors across various clinical settings that can determine success or failure in quality improvement.
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COVID-19 and MCO-Community Partnerships to Address Enrollee Social NeedsCOVID-19 strained already-burdened community partners, affecting service delivery, communication, and partnerships. Managed care organization (MCO) partnerships with these organizations evolved in response to changing needs and resources.
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Intensive Care Management of a Complex Medicaid Population: A Randomized EvaluationThe authors present findings of a randomized evaluation of Medicaid patients at an academic medical center, which found that intensive care management was associated with reduced total medical expense.
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Association of 340B Contract Pharmacy Growth With County-Level CharacteristicsThe growth of 340B contract pharmacies since 2010 is unprecedented. This study’s findings suggest that patterns of growth differ between safety-net clinics and hospitals.
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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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Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification ToolIn this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.
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Association of 340B Contract Pharmacy Growth With County-Level CharacteristicsThe growth of 340B contract pharmacies since 2010 is unprecedented. This study’s findings suggest that patterns of growth differ between safety-net clinics and hospitals.
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Impact of Payment Models on Medical Specialist Physician Practice PatternsThis article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.
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Integrating Primary Care and Public Health for Advance Care PlanningThis article proposes a new model, Public-Primary ACP, that leverages coordination between primary care and public health workforces to improve delivery of advance care planning.
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People Experiencing Homelessness in Miami: Insurance Enrollment Rates, Hypertension TrendsPeople experiencing homelessness face significant barriers to health care access, leading to higher rates of hypertension even among those with health insurance.
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Reimbursement for Genetic Variant Reinterpretation: Five Questions Payers Should AskPeriodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.
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Contributor: The Connection Between Gout and CVD Requires Cross-Specialty CollaborationThe Panicos are on a mission to change how we think about gout. Why? As a husband-and-wife DO duo, the Panicos each have a unique perspective on gout and how physicians in their respective fields can better collaborate to help patients who live with this systemic disease.
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Financial Factors That Influenced Telemedicine Delivery During the COVID-19 PandemicThis study describes financial issues that influenced telemedicine provision and use for patients with chronic conditions and their providers during COVID-19.
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Telehealth User Experiences During COVID-19: A Case Study of Outpatient Cardiovascular Clinics Affiliated With a Large Academic PracticeIn cardiovascular clinics during COVID-19, notable barriers to successful telehealth use included obtaining diagnostic information needed to deliver high-quality care and technology-related challenges for patients.
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Proactive Care Management of AI-Identified At-Risk Patients Decreases Preventable AdmissionsProactive care management for artificial intelligence (AI)–identified at-risk patients reduced potentially preventable hospital admissions.
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To Report or Not Report Health Care Data BreachesThis study presents information regarding the decisions that health care privacy officers make about reporting a data breach, including factors that can affect the decision process, such as personal/organizational knowledge, prior breach status, and framed scenarios.
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Eliminating Defects in Value: Turnaround of an MSSP ACOA health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.
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Pharmacist Hypertension Management Using an Electronic Health Record–Based ApproachThe authors studied the impact of a pharmacist intervention on blood pressure control compared with usual care.
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A Clinical Pathway to Well-Being: Putting Patient Priorities at the Center of CareUsing patient priorities and converting them into treatment goals result in better primary care outcomes for Medicare patients.
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Rising Use of Surveillance Colonoscopy and Potential ImpactsThe proportion of colonoscopies performed for postpolypectomy surveillance has increased significantly, particularly among older patients with limited life expectancy, raising concern for possible overuse.
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Eliminating Defects in Value: Turnaround of an MSSP ACOA health system transformational leadership framework and management system made visible and eliminated defects in value and was associated with reduced annual Medicare expenditures and increased quality between 2017 and 2020.
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Tracking the Performance, Challenges, and Evolution of Value-Based Contracts: Neha Kashalikar, PharmDNeha Kashalikar, PharmD, director of strategic pharmacy consulting at MassHealth, breaks down the outcome measures often used in pharmacy and medical claims to evaluate the performance of value-based contracts.
