Authors
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Variability of COPD Inhaler Coverage in Medicare Part DAlthough most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.
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Therapists’ Perspectives on Access to Telemental Health Among Medicaid-Enrolled YouthThis qualitative study elucidates therapists’ perspectives on barriers to and facilitators of access to telemental health among Medicaid-enrolled youth served by a large safety-net organization.
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Having Someone Who Cares: Patient Perspectives of Care Management ProgramsThis article presents a single-organization qualitative case description of the perspectives of patients with high-need, high-cost illnesses who participated in care management programs.
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Understanding Insurance Coverage Policies for Incretin Mimetics for Weight ManagementThe high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
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Pharmacist Hypertension Management Using an Electronic Health Record–Based ApproachThe authors studied the impact of a pharmacist intervention on blood pressure control compared with usual care.
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A Kidney Diagnostic’s Impact on Physician Decision-making in Diabetic Kidney DiseaseThe KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.
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The Impact of Hidradenitis Suppurativa on FamiliesIltefat Hamzavi, MD, discusses the importance of support groups and other helpful resources for families and caregivers of patients with hidradenitis suppurativa and provides closing thoughts for clinical providers.
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Telemedicine for Cancer Care: Implementation Across a Multicenter Community Oncology PracticeTexas Oncology physicians discuss utilization of telemedicine, evaluating trends, barriers, and opportunities in care delivery during the coronavirus disease 2019 pandemic.
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Searching for the Policy-Relevant Treatment Effect in Medicare’s ACO EvaluationsThe authors discuss multiple challenges to the production of policy-relevant results from evaluation of Medicare accountable care organizations (ACOs).
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Contributor: Providers and Patients Push Back, Payers Push Forward—Co-pay Mitigation ProgramsResearch shows how commercial health plans impact payer trends in the co-pay landscape and provides key areas that pharmaceutical and biotech manufacturers can explore to ensure patient access.
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Treatment Patterns for Patients With Advanced/Metastatic Cancers by Site of CareTreatment patterns and overall survival were similar regardless of site of care between patients receiving anticancer therapy in the hospital outpatient vs physician office setting.
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Physician Prices and Low-Value Services: Evidence From General Internal MedicineThis study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.
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Antibiotic Practice Patterns With Procalcitonin Levels in Patients With Acute Lower Respiratory Tract InfectionAlthough clinical trials have demonstrated the utility of procalcitonin (PCT) testing and potential benefit on antibiotic stewardship, findings suggest that clinicians do not order PCT testing with regularity and also prioritize clinical judgment over PCT results.
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Health Care Costs Associated With Unrecognized Progression to Late-Stage Kidney DiseaseUnrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.
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Effect of Care Coordination on Patients With Alzheimer Disease and Their CaregiversThe authors investigated whether patient coordination and caregiver support for Alzheimer disease reduced health care utilization and expenditures among enrollees in the Memory Program in South Carolina.
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COVID-19 and Clinic Workflow Optimization Using Lean Six SigmaThe authors report an approach of outpatient clinic workflow reorganization utilizing simple, inexpensive measures to improve patient engagement and experience in addition to providing a safe setting for patients for clinic visits in the wake of COVID-19.
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Primary Care Moonshot: A Policy Proposal for Addressing Underinvestment in Primary CareA Primary Care Moonshot could reorient the US health care system to a system of wellness and prevention, with long-term savings in care expenditures and better health outcomes.
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Impact of Electronic Information Exchange on Repeat Imaging During 30-Day Readmissions Among Medicare BeneficiariesThis analysis of Medicare data examines the relationships between fragmented readmission, health information exchange, and repeat imaging in older adults with and without Alzheimer disease.
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Incidence and Cost of Potentially Avoidable Emergency Department Visits for UrolithiasisThis study characterizes the incidence and associated factors of urolithiasis-related emergency department visits that are potentially preventable with appropriate ambulatory care and calculates their cumulative costs.
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Determinants of ICS Therapy Adherence in Patients With AsthmaThis study describes determinants affecting disease control and inhaled glucocorticosteroid therapy adherence for patients with asthma in western China.
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Intensive Care Management of a Complex Medicaid Population: A Randomized EvaluationThe authors present findings of a randomized evaluation of Medicaid patients at an academic medical center, which found that intensive care management was associated with reduced total medical expense.
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Provider Capacity During Medicaid Expansion and a Public Health EmergencyThis survey study finds that most Missouri Medicaid providers had capacity for new patients, even during a period of unprecedented Medicaid enrollment growth.
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Dallas Nephrology Associates’ Journey to Value-Based CarePreventing or delaying the onset of end-stage kidney disease is vital. By implementing a results-driven, value-based approach, Dallas Nephrology Associates has demonstrated improved patient outcomes and value for payers.
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Access Denied: CMS’ Action Hurts Patients With Cancer in Rural AmericaCMS rules hindered the access of rural patients with cancer to medically integrated pharmacies in 2023. The authors discuss the impact on equity in health care, emphasizing the need for regulatory change.
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Initial Maintenance Therapy Adherence Among Older Adults With Asthma-COPD OverlapOlder adults with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap, who take fixed-dose combinations of inhaled corticosteroids and long-acting β agonists may be less likely to have persistent low adherence to initial maintenance therapy.
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Provider Barriers in Uptake of Biosimilars: Case Study on FilgrastimPrevious studies have found modest uptake of biosimilars in both commercial and Medicare populations. This study finds that the uptake varies between the rural and urban provider settings.
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Bridging to Value With Codes That Promote Care ManagementFee-for-service billing codes can serve as bridges for organizations to build care management capabilities and transition from volume- to value-based payment and care delivery.
