Authors

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Empiric Segmentation of High-risk Patients: A Structured Literature Review

Data-driven segmentation of high-risk patient populations may inform health system interventions, but results are dependent on the data sources and methods applied.

Rheumatoid Arthritis Medication Adherence in a Health System Specialty Pharmacy

Integrated 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.

Prevalence and Inclusiveness of Pay-for-Performance Incentives for HPV Vaccination

This article examines the prevalence of pay-for-performance incentives to promote human papillomavirus vaccination and other quality metrics as reported by frontline clinical staff.

Investigators Advocate for Ongoing Comparison of Cancer Outcomes Among MA, FFS Beneficiaries

Galen Shearn-Nance, BS, and Johnie Rose, MD, PhD, of Case Western Reserve University, acknowledge key limitations of their study and prioritize areas for further research.

Contributor: In a Fast-Growing and Competitive Dual-Eligible Market, Trust Will Be a Critical Differentiator

Building trust with patients who are dually eligible for Medicaid and Medicare can help to improve their lives as they navigate receiving care to address their clinical and behavioral health needs.

Considerations to Increase Rates of Breast Cancer Screening Across Populations

Authors from the Community Oncology Alliance and Avalere Health present data that show breast cancer screening rates recovered more slowly among some racial/ethnic groups following on the onset of the COVID-19 pandemic.

Impact of Travel Distance on Quality Outcomes in Colorectal Cancer

This study identified characteristics of patients with colorectal cancer who traveled farther for surgery and found that those who traveled tended to stay longer at the hospital.

Cost Savings From an mHealth Tool for Improving Medication Adherence

The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.

Reimbursement for Genetic Variant Reinterpretation: Five Questions Payers Should Ask

Periodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.

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.

Service Line Care Delivery Model for COVID-19 Patient-Centric Care

The authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.

Machine Intelligence for Early Targeted Precision Management and Response to Outbreaks of Respiratory Infections

This paper evaluates novel machine intelligence to predict patients at risk of severe respiratory infections and recommend postacute care providers likely to reduce infection risk.

Making the Most of Limited Resources: Predicting Food Insecurity

Lessons learned from developing an inferential model for predicting food insecurity yield essential insights and actionable steps for policy makers seeking to address health-related social needs.

Biosimilar Adoption and Provider Performance in Medicare Value-Based Payment Models

Evidence suggests that adoption of oncology biosimilars in Medicare value-based payment models has produced substantial cost savings and improved provider financial performance.

Contributor: The Connection Between Gout and CVD Requires Cross-Specialty Collaboration

The Panicos are on a mission to change how we think about gout. Why? As a husband-and-wife DO duo, the Panicos each have a unique perspective on gout and how physicians in their respective fields can better collaborate to help patients who live with this systemic disease.

Differences in Telehealth During COVID-19 Between Commercial and Medicaid Enrollees

Differences in use of telehealth between commercial and Medicaid populations during the COVID-19 pandemic are associated with managed care enrollment.

Key Federal Legislation Impacting Managed Care Pharmacy: Geni Tunstall, JD

Geni Tunstall, JD, discusses how pharmacy benefit manager reforms, Medicaid changes, and the MAHA initiative may impact managed care pharmacy operations.

How DNA Medicines Could Transform Treatment of Glioblastoma Multiforme

Better technology is rekindling the promise of DNA medicines in oncology, including the treatment of glioblastoma.

Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

Making the Most of Limited Resources: Predicting Food Insecurity

Lessons learned from developing an inferential model for predicting food insecurity yield essential insights and actionable steps for policy makers seeking to address health-related social needs.

Health Care Resource Utilization, Quality Metrics, and Costs of Bladder Cancer Within the Oncology Care Model

Spending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.

Demographic Disparities in Video Visit Telemetry: Understanding Telemedicine Utilization

A stratified demographics analysis of video visit telemetry data reveals that age older than 65 years and African American/Black race are associated with higher video visit failure rates, whereas language, sex, and ethnicity are not.

Whither CAR T? Will the FDA Being Under the Hood and the Availability of Bispecifics Make These Therapies Less Attractive?

Association of Dermatology Wait Times With Insurance Coverage in Michigan

Disparities in dermatologic care for patients with Medicaid exist, and delays in medical dermatologic care among Medicaid patients must be addressed.

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.