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What Value Do Teaching Hospitals Provide Commercial Beneficiaries When in an ACO?Accountable care organizations (ACOs) with a major teaching hospital were associated with lower mortality, lower inpatient spending, lower emergency department utilization, and higher overall outpatient spending.
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Removing Medicare’s Outpatient Ban and Medicare and Private Surgical TrendsThis article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.
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Considerations to Increase Rates of Breast Cancer Screening Across PopulationsAuthors from the Community Oncology Alliance and Avalere Health present data that show breast cancer screening rates recovered more slowly among some racial/ethnic groups following on the onset of the COVID-19 pandemic.
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Primary Care Visit Cadence and Hospital Admissions in High-Risk PatientsPatients with congestive heart failure and/or chronic obstructive pulmonary disease who had more quarterly primary care visits had lower rates of hospitalizations during the COVID-19 pandemic.
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Contributor: Providers and Patients Push Back, Payers Push Forward—Co-pay Mitigation ProgramsResearch shows how commercial health plans impact payer trends in the co-pay landscape and provides key areas that pharmaceutical and biotech manufacturers can explore to ensure patient access.
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Clinical Profile of COVID-19 Infection in Postvaccination IndividualsThis article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.
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TCD Screening and Spending Among Children With Sickle Cell AnemiaA substantial proportion of families of privately insured children with sickle cell anemia pay more than $100 for essential stroke screenings, a high-value service.
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Neulasta Onpro: A Coup de Grâce?With the rapid decline in average sales price of reference pegfilgrastim products due to biosimilar competition, health care institutions and payers may grapple with coverage of Neulasta Onpro.
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Health Insurance, Blood Cancer Care, and Outcomes: A Literature Reviewdoi: 10.37765/ajmc.2021.88733
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Fezolinetant in Focus: Key Findings From the SKYLIGHT TrialsPanelists discuss the methodologies of the SKYLIGHT 1, SKYLIGHT 2, and SKYLIGHT 4 trials that supported the approval of fezolinetant for moderate to severe vasomotor symptoms (VMS) and examine the key safety and efficacy results derived from these studies.
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Mobile Health Clinic: Lessons Learned Building Partnerships Across Health SystemsEstablishing mobile health clinics in rural settings requires collaboration across health systems by aligning missions, building infrastructure to support research, and demonstrating proof of concept.
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Hospital Discharge Diagnosis Position: Impact on Adult Pneumonia Burden EstimatesDisease burden estimates of pneumonia-associated hospitalizations are more sensitive when including pneumonia coded in any diagnosis field vs in only the first discharge diagnosis field.
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Incentivizing Data Sharing Among Health Plans, Hospitals, and Providers to Improve QualityHealth plans can gain efficiencies and improve quality by connecting to health information networks and incentivizing hospital and provider participation as part of pay-for-performance programs.
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Financial Crossroads of Care: Physicians’ Struggle and Patient OutcomesIn 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.
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Statin Prescribing Patterns in Patient-Centered Medical Home Patients With NAFLDIn this study, authors assessed the proportion of patients with nonalcoholic fatty liver disease (NAFLD) receiving prescriptions for statins in primary care.
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When Does Nonadherence Indicate a Deviation From Patient-Centered Care?The authors suggest that assessment of patient-centered care may be improved by flagging probable discordance between a patient’s preferences and their treatment care plan.
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Primary Care Referrals to Nephrology in Patients With Advanced Kidney DiseasePrimary care physicians did not refer the majority of patients with severe nephropathy to specialists; nonreferred patients had fewer comorbidities and might be better kidney transplant candidates.
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Interest in and Concerns About Telehealth Among Adults Aged 50 to 80 YearsIn this survey of adults aged 50 to 80 years, sociodemographic factors, as well as experience with video chat, were associated with interest in and concerns about telehealth video visits.
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Financial Considerations Influencing Treatment Strategies in PNH Treatment PathwayThe panelists provide their final thoughts, highlighting financial considerations in PNH treatment.
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Evaluating Alternative Methods of Comparing Antihypertensive Treatment IntensityMedication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.
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Evaluation of a Collaborative Model Between Managed Care and Affordable Housing on Acute Care CostsA collaborative service model between a managed care organization and an affordable housing provider reduced acute care use and costs.
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Cost of Home vs Clinic Administration of Paclitaxel in Metastatic Breast CancerHome administration of oral paclitaxel and encequidar is associated with potential cost savings for payers compared with clinic administration of intravenous chemotherapy in metastatic breast cancer patients.
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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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Leveraging Patient Activation to Improve Kidney Health in High-Risk PatientsFrequency of patient-provider conversations and patient activation are the 2 most significant predictors of a high-risk patient’s behaviors to prevent kidney disease.
