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Modeling Financial Outcomes and Quantifying Risk in Episode-Based Payment Models

This 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.

COVID-19 Vaccine Hesitancy and Health Literacy in US Southern States

COVID-19 vaccine hesitancy is not associated with health literacy. Personal perception of threat was associated with reduced vaccine hesitancy.

Provider Capacity During Medicaid Expansion and a Public Health Emergency

This survey study finds that most Missouri Medicaid providers had capacity for new patients, even during a period of unprecedented Medicaid enrollment growth.

Contributor: Roadmap to the Quadruple Aim—A Framework for Minimizing Physician Burnout During the Transition to Value-Based Care

As provider and payer organizations pursue the Quadruple Aim, it is important that they take into account not just the contracting but also the transformation in staffing, clinical workflows, and culture as these organizations evolve.

Affordable Care Act Enrollment in Texas After Rating Area Adjustments

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.

Understanding the Complexities of Equity Within the Emergence and Utilization of AI in Academic Medical Centers

This editorial discusses positions for academic medical centers to consider when designing and implementing artificial intelligence (AI) tools.

Reimbursement for Genetic Variant Reinterpretation: Five Questions Payers Should Ask

Periodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.

Glucose-Lowering Treatment Patterns in Patients With Diabetic Kidney Disease

Real-world treatment of diabetic kidney disease in the United States, based on national-level health care claims and electronic health records data, is inconsistent with the current guidelines.

Validation of the FINE-CKD Model for Future Health Technology Assessments for Finerenone in Patients With Chronic Kidney Disease And Type 2 Diabetes

Actions to Improve Quality: Results From a National Hospital Survey

Hospitals reported widespread adoption of quality improvement (QI) changes to improve on CMS quality measures, and QI adoption was associated with improved performance on quality measures.

Characterizing Telehealth Use in the US: Analysis of the 2022 Health Information National Trends Survey

Patients’ motivations for telehealth use require further investigation to develop appropriate policies.

Q&A: Dr Michael Ashley Stein Speaks on How Natural Disasters Can Affect Disabled Individuals

Michael Ashley Stein, PhD, JD, speaks about how disabled individuals are at a disadvantage when it comes to preparing for natural disasters, specifically during wildfires.

Adherence Patterns 1 Year After Initiation of SGLT2 Inhibitors: Results of a National Cohort Study

This article describes the trajectory of adherence patterns among users of sodium-glucose cotransporter 2 (SGLT2) inhibitors. The authors found that baseline factors were unable to predict the adherence trajectory groups.

Organizational Factors Associated With Variation in Primary Care Providers in ACOs

A higher percentage of accountable care organization (ACO) primary care providers was associated with physician leadership, upside financial risk, and financial compensation of physicians tied to performance measures.

Real-World Value of Direct-Acting Antivirals for Hepatitis C at Kaiser Permanente Southern California

This analysis demonstrates value and innovation of direct-acting antivirals for the treatment of chronic hepatitis C in the US Kaiser Permanente health system.

Telehealth User Experiences During COVID-19: A Case Study of Outpatient Cardiovascular Clinics Affiliated With a Large Academic Practice

In 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.

Budget Impact Analysis of Biosimilar Natalizumab in the US

Projected savings from biosimilar natalizumab were $452,611 over 3 years, driven by decreased drug acquisition costs and a utilization shift from reference to biosimilar natalizumab.

The Value of Virtual Physical Therapy for Musculoskeletal Care

This counterfactual simulation study on a nationally representative sample of the working population with musculoskeletal conditions estimated the value of patient-initiated virtual physical therapy.

Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and Costs

The 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.

Medicare Advantage–Pharmacy Partnership Improves Influenza and Pneumococcal Vaccination Rates

Patients whose pharmacy receives notification of their immunization gap have twice the odds of receiving immunizations compared with those whose pharmacy does not receive the notification.

An Assessment of Nurse Practitioner Low-Value Care Use in Primary Care

Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.

Sex Differences in Medicare Beneficiaries’ Experiences by Low-Income Status

Only low-income male Medicare beneficiaries had worse patient experience than their female counterparts. The authors discuss opportunities to improve experiences for all patients.

Implementing Clinical Informatics Tools for Primary Care–Based Diabetic Retinopathy Screening

The authors describe a primary care–based diabetic retinopathy screening program incorporating telemedicine, strong health information technology engagement, and development of clinical informatics tools.

Care Fragmentation Predicts 90-Day Durable Ventricular Assist Device Outcomes

This analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.

Tackling Mental Health in the Workplace

Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

Patients’ Access to 2018 FDA-Approved Drugs 1 Year Post Approval

2018 was a landmark year for new drug approvals. However, patients’ access to these novel drugs varied by drug category and enrolled health plan.

Impact of Telemedicine Use on Outpatient-Related CO2 Emissions: Estimate From a National Cohort

Telemedicine was associated with a monthly avoidance of greenhouse gas emissions equivalent to the emissions of 61,255 to 130,076 passenger vehicles.