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Implementation of Early Follow-up Care After Heart Failure HospitalizationAn early heart failure follow-up intervention succeeded in increasing referral to and completion of cardiology appointments within 7 days of discharge. The intervention was associated with lower risk of 30-day all-cause emergency department visits, all-cause hospitalizations, or death.
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Hospital Discharge Diagnosis Position: Impact on Adult Pneumonia Burden EstimatesDisease burden estimates of pneumonia-associated hospitalizations are more sensitive when including pneumonia coded in any diagnosis field vs in only the first discharge diagnosis field.
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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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Mortality Risk Stratification Helps Identify Patients With COVID-19 at Risk of Adverse OutcomesMortality risk stratification can identify patients with COVID-19 who are at higher risk of mortality, discharge to skilled nursing facility, and readmission, and may benefit from focused intervention strategies.
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How Do Infusion Pharmacies Support Financial Sustainability in Oncology?Jorge García, PharmD, MS, MBA, MHA, highlights the need for infusion pharmacy optimization to sustain oncology care amid rising costs and evolving value-based reimbursement models.
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Contributor: How Medication Risk Scores Improve Health for Medicare BeneficiariesMedication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.
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A Machine Learning Technology for Addressing Medication-Related Risk in Older, Multimorbid PatientsA novel machine learning system effectively stratifies emergency department use and hospitalization risk of older patients with multimorbidity who take multiple medications and provides appropriate medication recommendations.
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Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal CareCollaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.
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Mandatory Medicare Bundled Payment and the Future of Hospital ReimbursementThe authors evaluate features of the Transforming Episode Accountability Model and discuss its benefits and limitations.
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Factors That Increase Utilization Management Risk: A Proof of ConceptA score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.
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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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Impact of Payment Models on Medical Specialist Physician Practice PatternsThis article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.
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Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 InhibitorA collaboration between a drug plan and clinical pharmacists led to nearly 50% of members successfully switching to a preferred dipeptidyl-peptidase-4 inhibitor.
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Care Fragmentation Predicts 90-Day Durable Ventricular Assist Device OutcomesThis analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.
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Regulation of Provider Networks in Response to COVID-19The authors describe federal and state provider network adequacy standards and discuss how regulators should adapt these standards and accompanying monitoring processes in response to coronavirus disease 2019 (COVID-19).
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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.
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Improving Lupus Care Requires Addressing Social Determinants, Expanding Access: Margrit Wiesendanger, MD, PhDIn the final part of her interview, Margrit Wiesendanger, MD, PhD, discusses the need to improve lupus care by addressing social determinants of health and expanding access to treatment.
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Contributor: Data, Education, and Community: The Winning Formula for Addressing SDOH for Kidney Care PatientsAddressing patients with chronic kidney disease requires a commitment to data, education, and community, specifically in those affected by social determinants of health (SDOH).
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Operating Room Efficiency of Orthopedic Surgery During the COVID-19 EraThe authors analyzed the impacts of COVID-19 on orthopedic operating room efficiency via comparison of 14,856 surgeries performed before, during, and after the pandemic.
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Factors Associated With Unplanned Admissions Among Patients With Chronic ConditionsThis study identified risk factors for unplanned admissions among patients with multiple chronic conditions to inform focused interventions.
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Outcomes of Antiviral Treatment for Influenza in Type 2 DiabetesAntiviral treatment was associated with lower health care resource utilization and costs in patients with type 2 diabetes and a diagnosis of influenza.
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A Cue-to-Action Pilot Project to Increase Screening MammographyA targeted cue-to-action campaign of outreach, education, and incentive can improve uptake of screening mammography.
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Medical Home Visit Programs During COVID-19 State of EmergencyThis report highlights the unique challenges faced by home health programs in addition to discussing how technology and policy changes have helped the elderly homebound during the coronavirus disease 2019 (COVID-19) pandemic.
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Senate Introduces Bill to Extend 5% Incentives for APMsThe bipartisan bill would help lower Medicare costs and improve quality of care, according to the National Association of ACOs.
