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Insurers’ Perspectives on MA Value-Based Insurance Design ModelThis article describes perspectives of Medicare Advantage (MA) insurers about participating in the CMS value-based insurance design model test launched in 2017.
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Overcoming Barriers to a Research-Ready National Commercial Claims DatabaseLessons learned about data governance and distribution from a voluntary healthcare claims repository, the Health Care Cost Institute, a nonprofit research organization
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Putting the Pieces Together: EHR Communication and Diabetes Patient OutcomesMore frequent electronic health record (EHR) message forwarding in primary care teams is associated with worse outcomes and higher medical costs for patients with diabetes.
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Compliance, Persistence, and Switching Patterns for ACE Inhibitors and ARBsThis drug-utilization study in a prescription database of more than 50,000 patients analyzed compliance, persistence, and switching behavior for ACE inhibitors and ARBs.
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A Medicare Appeal for CGM Coverage: One Patient's Never-Ending StoryThe author, who has lived with type 1 diabetes for more than 50 years, shares his account of a successful appeal of Medicare's policy of refusing to pay for continuous glucose monitoring (CGM).
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Changing Electronic Formats Is Associated With Changes in Number of Laboratory Tests OrderedA slight decrease in the convenience of ordering a laboratory test led to a dramatic decrease in test utilization.
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Humanistic and Economic Burden of Hepatocellular Carcinoma: Systematic Literature ReviewWorldwide, more than half a million new cases of hepatocellular carcinoma (HCC) are diagnosed annually. The incidence of HCC in the United States is rising with an estimated 31,000 new cases in 2018. Disease prognosis remains poor, with a 5-year survival rate across all disease stages estimated between 10%-20%, and 3% for those diagnosed with distant disease. Although morbidity is significant, especially among patients with advanced-stage disease, limited information exists on the humanistic and economic burden of HCC.
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Improving Influenza Immunization in Pregnant Women and Healthcare WorkersInfluenza vaccination rates in pregnant women and healthcare workers were increased with standing orders, vaccine advocates, and educational activities on influenza immunization.
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Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related AdmissionsA multivariable sensitivity analysis conducted on a pharmacy follow-up program of high-risk patients demonstrated cost savings to hospitals in 98.3% of head-to-head trials across 1000 hypothetical hospitals.
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Oral Anticoagulant Discontinuation in Patients With Nonvalvular Atrial FibrillationThe risk of discontinuation of oral anticoagulant therapy (both warfarin and direct oral anticoagulant therapies [DOACs]) among nonvalvular atrial fibrillation patients was high. Although the hazard ratio for discontinuation favors DOACs, it is unlikely that the small difference in discontinuation relative to warfarin is clinically meaningful.
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Health Plan Use of Immunization Information Systems for Quality MeasurementHealth plans may benefit from using a state immunization information system as the primary data source for HEDIS and physician incentive and quality programs.
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Targeting a High-Risk Group for Fall Prevention: Strategies for Health PlansThis study evaluates different strategies to identify high fall risk among community-dwelling elders using a combination of easily obtainable administrative data and patient screening questions.
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Accountable Care Organizations: How to Dress for SuccessAccountable care organizations will be more successful in taking on accountability for patient outcomes when market and firm organization get a balanced treatment.
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Pharmacy Team Engagement in Navigating the Revenue Cycle for High-Cost Medications in Patients With CancerWith the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle.
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Patients’ Expectations of Their AnesthesiologistsUnderstanding patients’ expectations, educating them about the role of an anesthesiologist, and involving them in decisions about their medical care can improve patient satisfaction.
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Complementary and Alternative Medicine Provider Use and Expenditures by Cancer Treatment PhaseMore than 26% of cancer patients see CAM providers, primarily for musculoskeletal problems; use does not vary by treatment phase, and associated expenditures are low.
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Functional Status and Readmissions in Unilateral Hip FracturesFunctional status is an important predictor of an acute care readmission in patients who have had a unilateral hip fracture.
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Safety Net Representation in Federal Payment and Care Delivery Reform InitiativesAlthough safety net organizations are eligible for some two-thirds of federal payment reform programs, fewer than 20% of these programs directly target the safety net.
