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A Case Report of the Analytic Development of Bundled Payments for the Commercial MarketThis case report of a novel methodology for the analytic development of bundled payments addresses statistical analysis, data visualization, and clinical consultation.
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Modeling Financial Outcomes and Quantifying Risk in Episode-Based Payment ModelsThis article provides a description of prospective financial simulation methodology and use cases with empirical data for episode-based bundled payments, including implications for contract negotiations and value-based care redesign.
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Consumer Data Transparency Is More Important Than Ever as the Battle Against COVID Rages OnOn January 1, CMS implemented the Hospital Price Transparency final rule, but by July, it was clear that many hospitals were noncompliant. Even with a proposed rule for penalties, requirements still only fall on certain parts of the health care industry.
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Sunvozertinib NDA Submitted to FDA for NSCLCA new drug application (NDA) has been submitted to the FDA for sunvozertinib in pretreated EGFR exon 20–positive advanced non–small cell lung cancer (NSCLC).
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Cost Savings Associated With Electronic Specialty ConsultationsThis retrospective cohort evaluation found that patients receiving electronic, compared with face-to-face, specialty consultation had significantly lower health care costs for at least 3 months.
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Hospital at Home: Paying for What It’s WorthA framework centered around cost, quality, and equity is essential to define the value of hospital-at-home programs.
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Varied Use of Step Therapy Among Medicare Advantage PlansThe frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.
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Chemotherapy-Induced Peripheral Neuropathy in Metastatic Breast Cancer Patients Initiating Intravenous Paclitaxel/nab-PaclitaxelWe examine the incidence and impact of chemotherapy induced peripheral neuropathy on clinical and economic outcomes in women with metastatic breast cancer initiating intravenous paclitaxel/nab-paclitaxel.
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Sacubitril/Valsartan in Medicare Alternative Payment ModelsOptimizing utilization of sacubitril/valsartan for treatment of heart failure could improve provider performance in the Bundled Payments for Care Improvement initiative and the Medicare Shared Savings Program.
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Variation in Fracture Risk Estimation Among East Asian WomenFracture prediction tools for East Asian individuals vary by country. In the United States, the US-Asian Fracture Risk Assessment Tool provides hip fracture probabilities that correspond to observed estimates.
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How Do Primary Community Hospitals Enact Early Response to COVID-19? The Experience From Chengdu, ChinaOur hospital is a primary hospital in Chengdu, China. Since February 5, our hospital has been listed as the primary designated medical unit for treating new patients with coronavirus disease 2019 (COVID-19) in Jinniu District. In this letter, we share our COVID-19 experience with readers.
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Implementation and Cost Validation of a Real-time Benefit ToolThis study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.
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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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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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Sacubitril/Valsartan in Medicare Alternative Payment ModelsOptimizing utilization of sacubitril/valsartan for treatment of heart failure could improve provider performance in the Bundled Payments for Care Improvement initiative and the Medicare Shared Savings Program.
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Relationships Between Patient Portal Activation and Patient Satisfaction Scores Among CG-CAHPS and HCAHPS RespondentsPatients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.
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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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Provider Perceptions of Pharmacists in Primary Care–Based Accountable Care OrganizationsIn this article, the authors describe their experiences addressing provider perceptions and methods to overcome several challenges to clinical pharmacist integration in primary care–based accountable care organizations.
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Implementing Team-Based Telemedicine Workflows in Safety-Net Primary CareTelemedicine in safety-net primary care faces particular challenges. Consistent, team-based workflows can support video visit implementation and health care maintenance in telemedicine visits.
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OneOncology’s Platform Approach to Deliver CAR T Therapies in Community PracticesOneOncology is using a community-based platform approach to catalyze broader access to care for patients with cancer while also advancing scientific discovery.
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Real-World Users of Triple Therapy for Asthma in the USThis retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.
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Teamwork Enhances Patient Experience: Linking TEAM and Net Promoter ScoresIn 1386 providers, better teamwork related to higher patient Net Promoter Score (NPS), and the relationship between provider experience and NPS was mediated by teamwork.
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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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Mental Health Service Utilization Review Patterns in a Medicaid Managed Care ProgramMedicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.
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Implementing Clinical Informatics Tools for Primary Care–Based Diabetic Retinopathy ScreeningThe authors describe a primary care–based diabetic retinopathy screening program incorporating telemedicine, strong health information technology engagement, and development of clinical informatics tools.
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Improving Care Coordination and Reducing ED Utilization Through Patient NavigationA navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.
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Understanding Insurance Coverage Policies for Incretin Mimetics for Weight ManagementThe high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
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Pharmacist-Led Review of Empagliflozin and Ertugliflozin Following Formulary UpdateManagement of empagliflozin and ertugliflozin may be suboptimal following an insurance carrier’s formulary updates. Pharmacists may improve the management.
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Managing Total Knee Replacement Under Value-Based PaymentsThis article describes the approach that a large primary care group at risk for value-based payments chose to deploy in managing clinical and financial outcomes of knee osteoarthritis jointly with orthopedic surgeons.
