Authors
Latest:
Projected US Savings From Biosimilars, 2021-2025Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.
Latest:
Transitional Care Management Visits to Improve Coordination of CareInspira Care Connect, LLC, an accountable care organization, incorporated transitional care management services into its postdischarge follow-up process to prevent avoidable utilization of health care services and costs.
Latest:
Diabetes, Gaps in Care Coordination, and Preventable Adverse EventsThe authors examined the association of diabetes with self-reported gaps in care coordination and self-reported preventable adverse events using data from a national sample of older adults.
Latest:
Medicare Accountable Care Organizations Reduce Spending on SurgeryMedicare Shared Savings Program accountable care organizations spent less on surgical care by reducing inpatient surgery, increasing outpatient surgery, and reducing spending on postacute care after inpatient surgery.
Latest:
How AI, Data Analytics, and Outcomes-Based Contracts Are Shaping Health Care: Laura Bobolts, PharmD, BCOPLaura Bobolts, PharmD, BCOP, senior vice president of clinical strategy and growth at OncoHealth, shares how health care leaders are advancing value-based care through improved data strategies, real-world evidence, and AI-driven efficiencies, without losing the human touch.
Latest:
Contributor: Transforming Prior Authorization to Facilitate Quality CarePayers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management.
Latest:
Gaps in the Coordination of Care for Older Adults With or at Risk for Cardiovascular DiseaseOlder adults with cardiovascular disease (CVD) or CVD risk factors report that gaps in communication among their providers are common and hazardous.
Latest:
A “Sludge Audit” for Health System Colorectal Cancer Screening ServicesA systematic, mixed methods “sludge audit” identified novel health system delivery targets for improving colorectal cancer screening services.
Latest:
Regional Market Factors and Patient Experience in Primary CarePatient-provider communication quality metrics at safety net hospitals are indirectly affected by changes in regional market factors that influence patients’ demand for care.
Latest:
An Outpatient Critical Care Transition Clinic Model Reduces Admissions/Readmissions in Medically Complex PatientsCritical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.
Latest:
Insurance Payer Is Associated With Length of Stay After Traumatic Brain InjuryAmong hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.
Latest:
Policy Solutions to Facilitate the New eCQM ACO Reporting and Advancement of InteroperabilityThis article describes the challenges associated with aggregating and reporting quality data via electronic health records and discusses corresponding policy solutions.
Latest:
Rheumatoid Arthritis Medication Adherence in a Health System Specialty PharmacyIntegrated health system specialty pharmacies provide specialized services to patients, resulting in high rates of adherence to and financial assistance with specialty disease-modifying antirheumatic drugs.
Latest:
Social Determinants of Health Score: Does It Help Identify Those at Higher Cardiovascular Risk?Calculating a social score is feasible and it predicts cardiovascular outcomes. In order to do this, institutions have to collect social determinants of health.
Latest:
Utilization Management and Physician BurnoutThis survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them.
Latest:
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.
Latest:
Rituximab Reference vs Biosimilar Utilization for Oncology vs Nononcology IndicationsReporting on the real-world utilization of reference rituximab and its biosimilars can help show prescribing habits and reveal cost-saving opportunities.
Latest:
Cost-effectiveness of Nivolumab in Patients With NSCLC in the United StatesThis article presents a cost-effectiveness analysis of nivolumab vs docetaxel from the US payer perspective in non–small cell lung cancer (NSCLC) based on randomized phase 3 studies with a minimum 5 years of follow-up.
Latest:
Transitions of Care: Supporting Patients and Physician PartnersAn emphasis on transitions of care should ensure the highest level of care for patients and provide support to physicians.
Latest:
Assessment of Structured Data Elements for Social Risk FactorsAn expert panel identified and assessed electronic health record and health information exchange structured data elements to support future development of social risk factor computable phenotyping.
Latest:
Rethinking Deprescribing: Who Should Monitor “Drug Overload”?Health plan pharmacists are in the perfect position to see overprescribing as it happens.
Latest:
Activation, Physical Activity, and Outcomes Among Individuals With T2DThis study presents an integrated, exploratory assessment of physical activity, patient activation, health-related quality of life, and clinical outcomes among older adults with type 2 diabetes (T2D) using survey, wellness, and claims data.
Latest:
HPV 16 and 18 Linked to Ovarian Cancer RiskIn a recent meta-analysis, the prevalence of human papillomavirus (HPV), especially types 16 and 18, was significantly increased among patients with ovarian cancer (OC) vs controls.
Latest:
Medical Loss Ratio’s Role in the Large Group Insurer MarketThe authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.
Latest:
Potential Health Literacy Resources for Health Plans: A Narrative ReviewSeveral evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.
Latest:
Managed Critical Care: Impact of Remote Decision-Making on Patient OutcomesThis work serves as a step toward better understanding the implications of remote critical care intervention by evaluating levels of tele–intensive care unit decision-making authority.
Latest:
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.
Latest:
Factors Associated With Lung Cancer Risk Factor DocumentationThis cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record.
