Authors
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Exploring Patient Spending in an ACO-Sponsored Care Management Program: A Case StudyThe authors’ multidisciplinary care management program shows promise, as the reduction in per-patient per-month spending was $116. However, these financial benefits took time to materialize.
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Journey to Anticoagulant Access Following Payer Rejection of ApixabanFormulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.
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Sex Differences in Medicare Beneficiaries’ Experiences by Low-Income StatusOnly low-income male Medicare beneficiaries had worse patient experience than their female counterparts. The authors discuss opportunities to improve experiences for all patients.
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Medicaid Redeterminations Create New Financial Challenges for HospitalsHospitals and health systems have been operating in the most challenging financial environment in history, and now they face another looming headwind—the impact of Medicaid redeterminations.
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Building Better Collaboration: Reducing Care Delays in Managing mCRCExperts discuss proactive steps health care teams, including pharmacists, can take to minimize delays and overcome payer-related barriers when prescribing third-line therapies for metastatic colorectal cancer (mCRC) and how collaboration between health care teams, payers, and manufacturers can be improved to reduce care delays.
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COVID-19 and Clinic Workflow Optimization Using Lean Six SigmaThe authors report an approach of outpatient clinic workflow reorganization utilizing simple, inexpensive measures to improve patient engagement and experience in addition to providing a safe setting for patients for clinic visits in the wake of COVID-19.
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Service Line Care Delivery Model for COVID-19 Patient-Centric CareThe authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.
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Availability of Prices for Shoppable Services on Hospital Internet SitesOnly 60% of hospitals display their cash prices and 5% display their minimum negotiated charges on their public websites; many hospitals are in violation of new federal legislation.
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The Essential Role of Population Health During and Beyond COVID-19The authors detail how population health management enables health systems to promote public health, strengthen health system resiliency, and support financial recovery during and beyond coronavirus disease 2019 (COVID-19).
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Risk Adjusting for Medicaid Participation in Medicare AdvantageWhen comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.
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Future of MS ManagementKey opinion leaders in MS provide closing thoughts on the future of MS treatment including digital therapeutics, new generics, and pipeline drugs on the horizon.
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Closing Thoughts: Evolving Treatment Paradigms in Menopause ManagementPanelists express their gratitude for the informative discussion and share their final thoughts on the evolving landscape of menopause management and the potential impact of new therapies on improving patient outcomes.
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Continuously Updated Forecasting of SARS-CoV-2 in a Regional Health SystemThis study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.
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Provider Barriers in Uptake of Biosimilars: Case Study on FilgrastimPrevious studies have found modest uptake of biosimilars in both commercial and Medicare populations. This study finds that the uptake varies between the rural and urban provider settings.
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Nearly All Patients Who Received Exa-Cel for SCD Are Hospital Free After a Year, Data ShowHaydar Frangoul, MD, MS, medical director, Pediatric Hematology/Oncology for Sarah Cannon Research Institute at TriStar Centennial Children’s Hospital, Nashville, presented the data on the long-term efficacy and safety for participants with sickle cell disease (SCD) who received exa-cel.
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Personalized Care Key as Tirzepatide Use Expands RapidlyUsing commercial insurance claims data and the US launch of tirzepatide as their dividing point, John Ostrominski, MD, Harvard Medical School, and his team studied trends in the use of both glucose-lowering and weight-lowering medications, comparing outcomes between adults with and without type 2 diabetes.
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The Impacts of Supplemental Benefits on Medicare Advantage Plan CompositionAfter evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.
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Contributor: Advancing Health Care Consumerism Begins With Adopting a Retail MindsetAdopting a retail mindset, where patients are the primary focus of innovations, could help advance health care consumerism in the future.
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Real-world HIV Diagnostic Testing Patterns in the United StatesThis retrospective study evaluated real-world implementation of the updated CDC HIV algorithm in a large US laboratory.
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Antibiotic Practice Patterns With Procalcitonin Levels in Patients With Acute Lower Respiratory Tract InfectionAlthough clinical trials have demonstrated the utility of procalcitonin (PCT) testing and potential benefit on antibiotic stewardship, findings suggest that clinicians do not order PCT testing with regularity and also prioritize clinical judgment over PCT results.
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Measuring Continuity of Care for Diabetes: Which Visits to Include?This study examined how inclusion of different provider specialties affected Continuity of Care Index values, year-to-year stability, and association with emergency department visits.
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COVID-19 Vaccine Hesitancy and Health Literacy in US Southern StatesCOVID-19 vaccine hesitancy is not associated with health literacy. Personal perception of threat was associated with reduced vaccine hesitancy.
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Predicting Opioid Use Disorder and Associated Risk Factors in a Medicaid Managed Care PopulationA Medicaid managed care organization developed a machine learning model to identify opioid use disorder (OUD) risk factors and predict OUD incidence in its multistate population.
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Oncology Alternative Payment Models: Lessons From Commercial InsuranceDeveloping alternative payment models for commercial populations in specialties such as oncology is rife with practical challenges. Leading payers and practices share lessons to date.
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Redefining Long COVID Care With Personalized TreatmentTo mark the 5-year anniversary of the COVID pandemic, The American Journal of Managed Care® spoke with Noah Greenspan, DPT, PT, CCS, EMT-B, cardiopulmonary physical therapist and director of the Pulmonary Wellness and Rehabilitation Center in New York City.
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Impact of Advance Care Planning Consults on Advance Directives CompletionImplementing advance care planning consults can increase advance directive completion rates. The authors demonstrate the impact of consults on completed advance directives in the medical record.
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ASCO 2024 Review and Needed Future Research in CDK4/6 inhibitors Early Breast CancerA panel of experts review ASCO 2024 and the need for future research in CDK4/6 inhibitors.
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Machine Intelligence for Early Targeted Precision Management and Response to Outbreaks of Respiratory InfectionsThis paper evaluates novel machine intelligence to predict patients at risk of severe respiratory infections and recommend postacute care providers likely to reduce infection risk.
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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.
