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Reduced Medical Spending Associated With Integrated Pharmacy BenefitsMembers covered by an integrated pharmacy benefit (as opposed to a pharmacy carve-out) experienced slower growth in medical spending.
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A Multistakeholder Effort in Pennsylvania to Improve the Accuracy of Reporting Fatal Drug OverdosesThe authors describe a novel training program for death certifiers in Pennsylvania, which has been designed to specifically focus on some of the main challenges in the death certification process and resulted in a useful model that can potentially be adopted by other states or municipalities.
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Care for Food-Insecure Enrollees in Medicare Advantage vs Traditional MedicareMedicare Advantage plans may deliver care more efficiently to food-insecure beneficiaries than traditional Medicare, but they are not better at reducing food insecurity.
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Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical CareThe COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.
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High-Risk Care Management Impact on Medicaid ACO Utilization and SpendingIn Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.
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Mental Health Concerns Prevalent in Patients With AD, Poster SaysA new study presented at this year’s American College of Allergy, Asthma and Immunology Annual Scientific Meeting highlights the need for mental health support in patients with atopic dermatitis (AD).
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Pediatric Oral Health Services in Medicaid Managed Care and Fee for ServiceRates of preventive oral health services among pediatric medical visits in Florida were similar whether visits were paid via Medicaid comprehensive managed care or fee for service.
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How Medicare Advantage Plans Use Data for Supplemental Benefits Decision-MakingThis article presents findings from interviews conducted with executives from 29 Medicare Advantage plans regarding plan decision-making processes related to new social risk factor–related benefits.
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The Impact of Nurse Practitioner Attribution in Medicare Shared Savings ACOsAllowing nurse practitioners to serve as attribution-eligible providers for Medicare Shared Savings Program accountable care organizations leads to no change in hierarchical condition category risk scores and modest growth in attributed beneficiaries.
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The Potential of Drug Repurposing for Inherited Dermatologic Diseases: Cory Simpson, MD, PhDCory Simpson, MD, PhD, assistant professor of dermatology at the University of Washington, spoke to the need for more treatment options in genetic skin conditions and the possibility of drug repurposing.
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End-of-Life Values and Value-Based CareAn editorial in response to the editor in chief’s December 2021 letter discusses evidence supporting the cost-effectiveness of an innovative advance care planning initiative.
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Screening for Health Literacy, Social Determinants, and Discrimination in Health PlansThis study provides insight on the experiences of patients of a national health plan with 2 structural determinants of health—health care discrimination and health literacy—and how those interact with social determinants of health and patient demographics.
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Final Thoughts on Bronchiectasis ManagementPanelists discuss how bronchiectasis is more common than previously thought, with growing awareness, research, and specialized centers improving diagnosis and treatment options, though challenges remain in standardizing care and securing insurance coverage for therapies.
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High-Risk Care Management Impact on Medicaid ACO Utilization and SpendingIn Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.
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Reducing Readmissions in the Safety Net Through AI and AutomationArtificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.
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Clinical and Economic Burden of Uncontrolled Severe Noneosinophilic AsthmaAmong patients with severe asthma with low eosinophils untreated with biologics, there is a high burden of disease among those who have suboptimal disease control.
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Social Determinants of Health and Emergency Department Utilization in Alabama Children’s Health Insurance ProgramCommunity social determinants of health such as rurality and low socioeconomic status moderate the association between an individual’s race and emergency care use.
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Employer-Sponsored Behavioral Health Program Impacts on Care Utilization and CostProvision of enhanced access to behavioral health services by a large employer to its employees is associated with reductions in all-cause care utilization and cost.
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Psychological Safety and Use of Incident Reporting SystemsIncident reporting systems, which are often computer based and require no in-person interactions, can enable health care staff who perceive low psychological safety to speak up.
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Quality, Health, and Spending in Medicare Advantage and Traditional MedicareIn a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.
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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.
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Is the QALY Fit for Purpose?The quality-adjusted life-year (QALY) is a popular tool for value assessment but is flawed. This paper highlights potential solutions.
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Appropriate ED Utilization Leading to Better Care CoordinationAddressing avoidable emergency department (ED) utilization takes interventions in partnership with providers.
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Contributor: Sustaining the “New Normal”—The Future Is Still Bright for Telehealth in the Wake of COVID-19Consumers want telehealth and telehealth can help achieve organizational goals of avoiding unplanned care, closing care gaps, and achieving care targets.
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Use of Second-Generation Antidiabetic Medication Among a Nationally Representative SampleAmong individuals with a diagnosis of type 2 diabetes across the United States, income level, hemoglobin A1c, and comorbidity burden were the primary patient-level drivers of the use of newer antidiabetic agents.
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ASCO 2024 Review and Needed Future Research in CDK4/6 inhibitors Early Breast CancerA panel of experts review ASCO 2024 and the need for future research in CDK4/6 inhibitors.
