Authors

Proactive Care Management of AI-Identified At-Risk Patients Decreases Preventable Admissions

Proactive care management for artificial intelligence (AI)–identified at-risk patients reduced potentially preventable hospital admissions.

Coverage With Evidence Development: Where Are We Now?

Review of CMS’ coverage with evidence development program exposes a need to improve program transparency and clarify requirements and timetables for reporting to improve access to novel therapies.

Improving Care Coordination and Reducing ED Utilization Through Patient Navigation

A navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.

Striving for Health Equity: Antoine Keller, MD

Antoine Keller, MD, argued the value of grounding health care policy in equity as clinicians prepare for a changing health care landscape in the coming years.

Outcomes in Patients With IBD Stratified by Risk of Disease Progression

This study validates criteria to identify patients with inflammatory bowel disease (IBD) at risk of worsening disease who may benefit from early treatment with advanced therapies.

Variation in Fracture Risk Estimation Among East Asian Women

Fracture prediction tools for East Asian individuals vary by country. In the United States, the US-Asian Fracture Risk Assessment Tool provides hip fracture probabilities that correspond to observed estimates.

Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children

Among publicly insured children with mental health–related encounters, racial and ethnic disparities in telemental health use widened following the onset of the COVID-19 pandemic.

Activation, Physical Activity, and Outcomes Among Individuals With T2D

This 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.

Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical Care

The COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.

Provider and Patient Insights Into the Cancer Care Journey

A survey was conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient.

Choosing Wisely Interventions to Reduce Antibiotic Overuse in the Safety Net

This study evaluates the impact of Choosing Wisely–based interventions on antibiotic prescribing for viral respiratory tract infections in a real-world safety-net setting.

Implementation of Early Follow-up Care After Heart Failure Hospitalization

An 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.

Trends in Medicare Part D Coverage of Generics With Equivalent Brand-Name Drugs

High-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.

Projected US Savings From Biosimilars, 2021-2025

Projected 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.

A Value Proposition for Pragmatic Clinical Trials

The authors examine the origin, benefits, and challenges of pragmatic clinical trials to assess the ultimate value of this research design.

Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims Data

A statistical model based entirely on claims data can accurately predict 30-day hospital readmission in Medicaid patients with diabetes.

US Cost-effectiveness and Budget Impact of Point-of-Care NAAT for Streptococcus

This study evaluates the cost-effectiveness and budget impact to US payers of point-of-care nucleic acid amplification tests (NAAT) for group A streptococcus.

Predicting Opioid Use Disorder and Associated Risk Factors in a Medicaid Managed Care Population

A Medicaid managed care organization developed a machine learning model to identify opioid use disorder (OUD) risk factors and predict OUD incidence in its multistate population.

Digital Health Implementation Among Older Adults: Health Technology Navigators’ Perspectives

Health technology navigators share perspectives on barriers to and facilitators of digital health access for older, linguistically diverse patients in a Los Angeles safety-net system.

Choosing Wisely Interventions to Reduce Antibiotic Overuse in the Safety Net

This study evaluates the impact of Choosing Wisely–based interventions on antibiotic prescribing for viral respiratory tract infections in a real-world safety-net setting.

Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Optimizing Pharmacologic Treatment for ALS to Improve Outcomes and Quality of Life

Are Work Relative Value Units Correlated With Operative Duration of Common Surgical Procedures?

Work relative value units (wRVUs) correlate with operative duration of common surgical procedures. Reimbursement for physicians depending on wRVUs is fair for commonly performed surgeries.

The Essential Role of Population Health During and Beyond COVID-19

The authors detail how population health management enables health systems to promote public health, strengthen health system resiliency, and support financial recovery during and beyond coronavirus disease 2019 (COVID-19).

Impact of Electronic Information Exchange on Repeat Imaging During 30-Day Readmissions Among Medicare Beneficiaries

This analysis of Medicare data examines the relationships between fragmented readmission, health information exchange, and repeat imaging in older adults with and without Alzheimer disease.

Development and Validation of the COVID-19 Hospitalized Patient Deterioration Index

The authors developed and validated an accurate, well-calibrated, easy-to-implement COVID-19 hospitalized patient deterioration index to identify patients at high or low risk of clinical deterioration.

Tacking Upwind: Reducing Spending Among High-risk Commercially Insured Patients

Although commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.

Racial/Ethnic Disparities in Cost-Related Barriers to Care Among Near-Poor Beneficiaries in Medicare Advantage vs Traditional Medicare

Among near-poor Black and Hispanic individuals, Medicare Advantage was associated with increased vision care and some, although not uniform, reductions in access disparities vs traditional Medicare.

Interventions Addressing Cost-Related Medication Nonadherence in Diabetes: A Scoping Review

Many US patients with diabetes cannot afford their medical care. The authors review the impact of interventions that reduced and/or eliminated diabetes-related costs.

Increased Payments to Medicare Advantage Plans for Dually Eligible Beneficiaries

Increasing Medicare Advantage payments for full Medicaid enrollees was not associated with meaningful changes in inpatient or nursing home use.