Authors

The Impact of Patient Assistance Programs and the 340B Drug Pricing Program on Medication Cost

Examining the financial impact that patient assistance programs and the 340B Drug Pricing Program have on improving medication cost.

Preventive Care for Chronically Ill Children in Medicaid Managed Care

The existence of chronic conditions did not adversely impact the ability of children in Medicaid managed care to access and utilize recommended preventive care services.

CancerLinQ - ASCO's Rapid Learning System to Improve Quality and Personalize Insights

CancerLinQ is a big data platform developed by the American Society of Clinical Oncology (ASCO) that aggregates clinical data from electronic health records for quality benchmarking and hypothesis generation. Such observational data can complement traditional evidence but must be used with caution.

Tracking Spending Among Commercially Insured Beneficiaries Using a Distributed Data Model

The authors demonstrate the utility of distributed data models for reporting of local trends and variation in utilization, pricing, and spending for commercially insured beneficiaries.

Case Study of Linking Dental and Medical Healthcare Records

An n - 1 deterministic linkage strategy was used successfully to merge dental and medical data from a healthcare plan and a dental insurance carrier.

The Future of Childhood Immunizations: Examining the European Experience

Labor Characteristics and Program Costs of a Successful Diabetes Disease Management Program

Focusing on Prediabetes Is the Key to Reversing the Rise in Diabetes

Evidence-Based Diabetes Management invited the YMCA's Jonathan Lever, vice president for health strategy and innovation, to comment on his organization's involvement with the National Diabetes Prevention Program.

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.

Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Impact of Medicaid Institution for Mental Diseases Exclusion on Serious Mental Illness Outcomes

Medicaid’s Institution for Mental Diseases (IMD) rule bars federal funding for psychiatric facilities with more than 16 beds, but findings indicate that state waivers allowing treatment of serious mental illness in IMDs do not increase overall psychiatric hospitalizations.

Impact of Therapeutic Switching in Long-Term Care

Switching medications for nonmedical (formulary) reasons in long-term care settings may increase Medicare Part D resident adverse effects and raise facility downstream costs.

ED-Based Care Coordination Reduces Costs for Frequent ED Users

Results of our pilot randomized controlled intervention involving emergency department (ED)-based care coordination and community health workers demonstrated a trend toward fewer ED visits, fewer hospitalizations, and lower costs among intervention patients.

Dental Care Coverage Transitions

This study examines dental insurance transition dynamics in the context of changing employment and retirement status.

Neonatology Pricing and Network Participation Under State Balance Billing Regulations

This national study of neonatology services found no clear evidence that state surprise billing regulations influenced prices or provider network participation for the commercially insured.

Low Screening and Follow-up for Unhealthy Alcohol Use Among Health Plan Beneficiaries

Screening and follow-up for unhealthy alcohol use are low among plan members. Use of standardized screening tools, documentation, and care for alcohol misuse need improvement.

Predictive Models for Low Birth Weight: A Comparative Analysis of Algorithmic Fairness–Improving Approaches

This study compared 6 algorithmic fairness–improving approaches for low-birth-weight predictive models and found that they improved accuracy but decreased sensitivity for Black populations.

Development of a Multidisciplinary, Multicampus Subspecialty Practice in Endocrine Cancers

The development of subspecialty tumor groups for uncommon malignancies represents an effective approach to building experience, increasing patient volumes and referrals, and fostering development of increased therapeutic options and clinical trials for patients afflicted with otherwise historically neglected cancers.

Better Bone Density Reporting: T-score Report Versus Fracture Risk Report With Outcome Analysis

Incremental Healthcare Costs for Persons With Treatment-resistant Depression in Managed Care Organizations

Polypharmacy With Oral Antidiabetic Agents: An Indicator of Poor Glycemic Control

Postpartum Depression

Longitudinal Adherence to Colorectal Cancer Screening Guidelines

Over a 10-year time frame, longitudinal adherence to current colorectal cancer (CRC) screening guidelines was less than ideal in a large, continuously insured US population at average risk for CRC.

Impact of the Affordable Care Act on Cancer Care

Effectiveness of Tegaserod Therapy on GI-related Resource Utilization in a Managed Care Population

Absenteeism and Productivity Among Employees Being Treated for Hepatitis C

Employees with hepatitis C (HCV) who underwent existing treatments had more absences and higher indirect costs than HCVinfected employees who did not undergo treatment.

Risk Adjusting Community-acquired Pneumonia Hospital Outcomes Using Automated Databases

Using laboratory and administrative data, large managed care organizations can assign severity of illness scores to patients with pneumonia for risk adjustment and reporting.

Relationship between Primary Payer and Use of Proactive Immunization Practices: A National Survey