Authors
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Forward-Thinking Insurers Adopt Genomics, Medicare Makes Perilous, Costly Leap BackwardAuthors from My Gene Counsel discuss gaps in CMS reimbursement policy for genetic testing and counseling, in light of advances in guidelines from groups that include the National Comprehensive Cancer Network.
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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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HITECH Spurs EHR Vendor Competition and Innovation, Resulting in Increased AdoptionThis is the first empirical evidence to demonstrate increased competition and innovation in the EHR industry as a result of the HITECH program.
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Finally: CMS to Address Allowing Hospitals More Say in Selecting Post Acute Care ProvidersHospital CEO and former SNF administrator, Dr Josh Luke, who founded the National Readmission Prevention Collaborative, discusses MEDPAC's recommendation to CMS that anti-steering regulations for hospitals be done away with.
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Thirty-Day Readmissions: Relationship to Physician Attending Type and Social ConnectednessThis study examined patient clinical and demographic characteristics, healthcare system factors, and patients’ experiences of care associated with 30-day readmissions in a hospital with a Pioneer Accountable Care Organization.
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Cost Comparison of Peritoneal Dialysis Versus Hemodialysis in End-Stage Renal DiseasePatients with end-stage renal disease who began peritoneal dialysis had lower 1-year hospitalization rates and lower total healthcare costs than those who began therapy with hemodialysis.
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Behavioral Health Disorders and Adherence to Measures of Diabetes Care QualityPersons with substance use disorders were less likely and persons with schizophrenia/paranoia were more likely to be adherent to measures of diabetes care quality.
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Leveraging Remote Behavioral Health Interventions to Improve Medical Outcomes and Reduce CostsSuccessful patient engagement in a nationally available, remotely delivered behavioral health intervention can significantly improve medical outcomes and lower healthcare costs.
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Payer—Provider Patient Registry Utilized in a Behavioral Health HomeA payer—provider, patient registry to identify individuals with serious mental illness and chronic physical health conditions for utilization in behavioral health homes is described.
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Patient-Reported Denials, Appeals, and Complaints: Associations With Overall Plan RatingsPatient ratings of plans and care were lower among beneficiaries filing complaints or reporting denied care. Appeals did not further predict ratings, but successful complaint resolution did.
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Community Pharmacy Automatic Refill Program Improves Adherence to Maintenance Therapy and Reduces Wasted MedicationEvaluation of a national retail pharmacy automatic refill program for patients on medication for chronic disease demonstrated significantly improved patient adherence and reduced medication oversupply.
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Adherence to Osteoporosis Medications After Patient and Physician Brief Education: Post Hoc Analysis of a Randomized Controlled TrialPost hoc analysis of a randomized controlled trial found that a 1-session educational intervention targeted at patients and primary care physicians did not improve osteoporosis medication adherence.
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Molecular Testing Patterns in Metastatic Non—Small Cell Lung CancerAssessment of the timing of histologic and molecular testing indicates that testing occurred prior to treatment initiation for most patients with metastatic non—small cell lung cancer.
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Health Equity in the Era of Large Language ModelsThis article presents challenges and solutions regarding health care–focused large language models (LLMs) and summarizes key recommendations from major regulatory and governance bodies for LLM development, implementation, and maintenance.
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Economic Evaluation of Plerixafor for Stem Cell MobilizationUse of granulocyte colony-stimulating factor plus plerixafor for stem cell mobilization is cost-effective in pretreated patients with non-Hodgkin lymphoma.
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Multi-Payer Advanced Primary Care Practice Demonstration on Quality of CareAn evaluation of the Multi-Payer Advanced Primary Care Practice Demonstration found mixed results in terms of quality of care provided to Medicare and Medicaid beneficiaries.
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Real-World Economic Value of a 21-Gene Assay in Early-Stage Breast CancerUniversal gene expression profiling of patients with stage II breast cancer resulted in outpatient savings of $11,000 (inclusive of testing costs) within 6 months of initiation of medical therapy.
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Preventive Care and Health Behaviors Among Overweight/Obese Men in HMOsHealthcare organizations may reduce weight-related health risks and disparities in care among overweight/obese patients through promoting cancer screening exams, healthier diets, and physical activity.
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The Relationship Between Adherence and Total Spending Among Medicare Beneficiaries With Type 2 DiabetesThis study describes a widespread variation in medication adherence, pharmacy cost sharing, and medical spending. Increased cost sharing may decrease adherence and increase total diabetes spending.
