Impact of the Patient-Centered Medical Home on Consistently High-Cost Patients
Patient-centered medical homes in Maryland’s multipayer demonstration disrupted the pattern of recurrently high expenditure among the costliest patients and improved continuity of care.
Geriatric Syndrome Risk Factors Among Hospitalized Postacute Medicare Patients
Geriatric syndrome risk factors play a role in understanding postacute destination within and between Medicare Advantage and fee-for-service Medicare cohorts.
A Revised Classification Algorithm for Assessing Emergency Department Visit Severity of Populations
An updated emergency visit classification tool enables managers to make valid inferences about levels of appropriateness of emergency department utilization and healthcare needs within a population.
Assessing Markers From Ambulatory Laboratory Tests for Predicting High-Risk Patients
An evaluation of the added value of risk markers derived from ambulatory laboratory tests in the prediction of healthcare costs and identification of high-risk patients.
Encouraging Value-Based Insurance Designs in State Health Insurance Exchanges
Change in Claims-Based Diabetes Medications Is a Diabetes Improvement Indicator
Without clinical information, a decrease in use of medications can serve as a proxy for clinical improvement.
Validating the Adapted Diabetes Complications Severity Index in Claims Data
The aDCSI without the inclusion of laboratory data performs similarly to the DCSI with laboratory results, and is a good measure of diabetes severity.
Predicting Costs With Diabetes Complications Severity Index in Claims Data
The Diabetes Complications Severity Index without laboratory test results is a good measure of diabetes severity, given its ability to explain costs.
The Promise and Peril of Healthcare Forecasting
Healthcare forecasting could facilitate personalized insurance benefit design and clinical decision support systems, although increased socioeconomic disparities could result from selective disease management programs.
Medication, Diagnostic, and Cost Information as Predictors of High-Risk Patients in Need of Care Management
Predictive models from diagnostic or medication data identify care management candidates who are more amenable to clinical interventions than groups identified using prior cost alone.
Health of Medicare Advantage Plan Enrollees at 1 Year After Hurricane Katrina
At 1 year after Hurricane Katrina, the health burden of enrollees increased significantly more versus a comparison group. Emergency department visits and hospitalizations remained elevated.
Is Quality Free? The Relationship Between Cost and Quality Across 18 Provider Groups
"Carving Out" Conditions From Global Capitation Rates: Protecting High-Cost Patients, Physicians, and Health Plans in a Managed Care Environment
2 Clarke Drive Cranbury, NJ 08512