Authors
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Medicare Advantage Coverage Restrictions for the Costliest Physician-Administered DrugsFour large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.
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Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and CostsThe Diabetes Care Rewards program offers a business case for health plans to promote engagement through use of contingent incentives, thus improving health outcomes and lowering costs.
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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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Association Between Interhospital Care Fragmentation, Readmission Diagnosis, and OutcomesIn this analysis of the National Readmissions Database, the authors investigated the association between interhospital fragmentation of care, reason for readmission, and patient outcomes.
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Inappropriate Wrist MRI: Did Guidelines Have an Impact?This article analyzes the use of MRI in a national sample of patients with wrist pain before and after consensus guideline publication.
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Advancing Pulmonary Arterial Hypertension Care: Overcoming Challenges in Special Populations and Exploring Innovative ApproachesIoana Preston, MD, highlights treatment considerations for managing PAH in specific patient populations and discusses the unmet needs that can be addressed by novel therapeutic approaches or improved treatment strategies.
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A Machine Learning Technology for Addressing Medication-Related Risk in Older, Multimorbid PatientsA novel machine learning system effectively stratifies emergency department use and hospitalization risk of older patients with multimorbidity who take multiple medications and provides appropriate medication recommendations.
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Contributor: Addressing Physician Burnout—Work-Life Balance and Traditional Workplace Improvement InterventionsInitiatives to address physician burnout should be prioritized in a post-pandemic world, with physician shortages affecting the country.
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Covishield India: Demystifying Myths Through an Early Multicenter Safety StudyThis was a multicenter study carried out in India to study the adverse and systemic effects of the indigenously developed Covishield vaccine.
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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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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.
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Value Realization: An Unattained Challenge for Integrated Practice UnitsAs value realization eludes integrated practice units (IPUs), the authors examine 6 key value drivers for IPU teams to competitively drive volumes and hone their multidisciplinary competencies.
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Reply to “Industry-Informed Perspectives on the Benefits of Rideshare-Based Medical Transportation”The authors of “Rideshare Transportation to Health Care: Evidence From a Medicaid Implementation” respond to a letter to the editor.
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Provider and Patient Insights Into the Cancer Care JourneyA survey was conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient.
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Virtual Reality Is a Game-Changer During Blood Draws for Pediatric Patients With SMAIn honor of Spinal Muscular Atrophy (SMA) Awareness Month, Abraham Homer, MS, the gaming technology supervisor and creative technologist at Children's Hospital Colorado, shared how virtual reality transformed care for patients with SMA.
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The Role of Testing for C Difficile in Clinical PracticePaul Feuerstadt, MD, FACG, AGAF, discusses how testing for Clostridioides difficile is recommended for hospitalized patients or outpatients with new-onset, unexplained diarrhea who have risk factors such as recent antibiotic use, hospitalization, or older age, and how empiric treatment should be initiated while awaiting test results if there is high clinical suspension.
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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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Cost-Benefit Analysis of Sacubitril/Valsartan in a Medicaid PopulationThe cost avoidance of heart failure–related hospitalizations and emergency department visits may outweigh the additional drug cost in Medicaid members adherent to sacubitril/valsartan.
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Impact of Care Coordination on 30-Day Readmission, Mortality, and Costs for Heart FailureEnhancing coordination of care has the potential to increase the value of heart failure care.
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Differences in Savings and Quality by Type of ACO Model2016-2018 Next Generation Accountable Care Organization (ACO) and Medicare Shared Savings Program cost and quality data show similar performance, suggesting that increasing financial risk to health systems may not affect performance.
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Accountable Care Organizations and Use of Surgery Among Patients With Alzheimer Disease and Related DementiasThe decision to pursue surgery in patients with Alzheimer disease and related dementias is challenging. Accountable care organizations may influence decisions to pursue surgery in this population.
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Primary Care Practice Structural Capabilities in Health Professional Shortage AreasNurse practitioners are increasingly meeting primary care demands in underserved areas and are more likely to deliver structural capabilities related to chronic disease management.
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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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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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Contingency Management in a Perinatal Substance Exposure ClinicProject CARA, a perinatal substance exposure clinic, has implemented a contingency management program that targets appointment attendance for patients with any use disorder, regardless of substance or urine drug screen results.
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Value-Based Management of Specialty Drugs: Practical Considerations and Implications for PharmacyPolicy makers and health plans seek value-based management of specialty drugs. This study examines real-world factors that favor some approaches over others and their potential impact.
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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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Social Determinants of Health: Are Colonoscopies Always Fit for Duty?Social determinants of health are associated with colonoscopy noncompletion in a Medicaid patient population at the Providence Community Health Centers.
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Organizational Capacity Among Hospitals in Medicare and Commercial Bundled PaymentsA national survey demonstrated differences in organizational capacity between hospitals participating in Medicare bundled payment programs and those coparticipating in both Medicare and commercial bundled payment programs.
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Medicaid Expansion, Managed Care Plan Composition, and Enrollee ExperienceMedicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.
