Authors
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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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The PANDEMIC Framework for Encouraging COVID-19 VaccinationsThis commentary offers 8 promising approaches forming a framework known as PANDEMIC to address COVID-19 vaccination hesitancy.
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Health Care Costs Associated With Unrecognized Progression to Late-Stage Kidney DiseaseUnrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.
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CMS Practice Assessment Tool Validity for Alternative Payment ModelsUsing data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.
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Economic Burden of Nonadherence to Standards of Diabetes CareUsing propensity score matching in a US nationally representative sample, authors found the effect of nonadherence to diabetes guidelines on health care expenditures of patients with diabetes.
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Impact of Including Drug Spending in Oncology Alternative Payment ModelsThis study demonstrates a method for understanding the effects of drug spending in the design of alternative payment models.
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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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Future of PrEPExperts in HIV provide closing thoughts on the future of PrEP, including improvement of uptake and addressing access disparities.
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Contributor: Navigating Health Equity in 2024: The Evolution of Accountability, Part 2The article emphasizes the significance of accreditations in addressing health disparities and promoting health equity, highlighting programs for achieving accreditation and advocating for the integration of social determinants of health (SDOH) and health equity practices within pharmacy and health care.
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ACA Medicaid Expansion Association With Racial Disparity Reductions in Timely Cancer TreatmentMedicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.
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Long-term Medication Adherence and Preventive vs Reactive Care Utilization Among Older Adults With DiabetesThis study using Medical Expenditure Panel Survey data found greater health care utilization and expenditure among adults 65 years and older who were adherent to oral hypoglycemic agents.
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Impact of Primary Care Intensive Management on Medication Adherence and AdjustmentsThe Veterans Health Administration implemented primary care intensive management for high-risk patients. Impacts of this program on patients’ medication adherence and adjustments were modest.
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Applying Upstream Problem-Solving to Value-Based Payment Reform in Specialty Care: Blue Cross Blue Shield of North Carolina’s ApproachEffectively designing and implementing value-based payment reform for specialty care is challenging. The authors describe a commercial payer’s strategic approach to specialty value transformation.
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Mental Health Diagnoses and Services Utilization Vary by Wage LevelInsured lower-wage employees had lower prevalence of mental health conditions but greater severity, with more hospital admissions and emergency department visits than high-wage employees.
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The Extent and Growth of Prior Authorization in Medicare AdvantagePrior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.
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A Scoping Review of US Insurers’ Use of Patient-Reported OutcomesThis scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.
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Physician Prices and Low-Value Services: Evidence From General Internal MedicineThis study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.
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The Impact of HDHPs on Service Use and Spending for Substance Use DisordersOffering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.
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The Relationship Between Preventive Dental Care and Overall Medical ExpendituresUsing an instrumental variable approach, this study is the first to present causal estimates of the effect of preventive dental visits on overall medical expenditures.
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At-Home Hemoglobin A1c Testing During COVID-19 Improved Glycemic ControlProviding at-home hemoglobin A1c test kits increases testing rates and facilitates hemoglobin A1c reduction over time among members of a large commercial health plan with diabetes.
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Investigating Real-world Consequences of Biases in Commonly Used Clinical CalculatorsClinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.
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Assessing Opportunities to Advance Quality Measures in Adult ObesityObesity is a serious chronic disease and risk factor for a broad range of outcomes. This study identifies opportunities for improving quality in obesity care.
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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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Contributor: Maintaining the Doctor-Patient Connection During the COVID-19 PandemicChristine Ko, MD, professor of dermatology and pathology at Yale University, reflects on her use of telehealth and how it allowed her to establish and maintain emotional connections with her patients, all at high risk of skin cancer.
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Limited English Proficiency, Cardiovascular Risk Factors, Cardiovascular Disease, and In-Hospital COVID-19 OutcomesThis study evaluated whether limited English proficiency modifies the association between cardiovascular risk factors or cardiovascular disease and outcomes in patients hospitalized with COVID-19.
