Authors
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ACA Marketplace Premiums and Competition Among Hospitals and Physician PracticesPremiums in federally facilitated Affordable Care Act Health Insurance Marketplaces are higher in geographic areas with more concentrated hospitals and physician practices and fewer insurers.
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Care Coordination for Children With Special Needs in Medicaid: Lessons From MedicareAs increasing numbers of children with special healthcare needs move into Medicaid managed care, health plans can improve care coordination using evidence from Medicare.
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Physician-Specific Variation in Medication Adherence Among Diabetes PatientsPhysician-specific, aggregate patient medication adherence data vary significantly and provide an expanded focus for interventions to improve patient adherence to treatment.
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Opportunities to Improve the Value of Outpatient Surgical CareOutpatient surgeries in the United States account for roughly 7% of annual healthcare expenditures. To exploit substantial opportunities to improve the value of outpatient surgical care, the authors composed an evidence-based care delivery composite for national discussion and pilot testing.
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The Presurgical Episode: An Untapped Opportunity to Improve ValueExpansion of episode of care measurement models to include presurgical care is an added opportunity to improve quality, value, and efficiency in healthcare delivery.
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Shared Medical Appointments for Patients with Type 2 DiabetesGlycemic control in patients with type 2 diabetes was improved through a shared medical appointment program focusing on lifestyle education and behavior change.
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Will Regional Differences in Family Practice Procedures Impact Reimbursement Rates? A National Study of Medicare Part BAnalysis of 77,462 family practice providers showed large regional differences in types of procedures performed, and significant differences in submitted charges and payments, across regions.
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Cost-Effectiveness of 21-Gene Assay in Node-Positive, Early-Stage Breast CancerA decision-analytic model was used to estimate cost-effectiveness of adopting a 21-gene assay in treatment decisions for women with early-stage N (1-3)/ER HER2-negative breast cancer.
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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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Health Information Technology and Physicians' Knowledge of Drug CostsHigh rates of health information technology use by physicians were only modestly associated with better knowledge of drug costs.
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Making Measurement MeaningfulA discussion on meaningful measurement and driving greater value in healthcare, and the role of the National Quality Forum.
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Improving Pneumococcal and Herpes Zoster Vaccination Uptake: Expanding Pharmacist PrivilegesStates offering pharmacists full immunization privileges have significantly higher vaccination uptake rates for pneumococcal disease and herpes zoster than states with restricted or no authorization.
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A Comparison of Relative Resource Use and Quality in Medicare Advantage Health Plans Versus Traditional MedicareCompared with traditional Medicare, relative resource use for those with diabetes or cardiovascular disease is lower in Medicare Advantage, while quality of care is higher.
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Rising Out-of-Pocket Costs Threaten an Already Vulnerable Population: An Introduction to the PAN Foundation and AJMC® Collaborative SupplementThis supplement showcases the winning papers from the PAN Challenge, which aimed to foster conversations about how to rein in out-of-pocket costs to eliminate barriers between patients and their critical medical treatments.
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Oncology Alternative Payment Models: Lessons From Commercial InsuranceDeveloping alternative payment models for commercial populations in specialties such as oncology is rife with practical challenges. Leading payers and practices share lessons to date.
