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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.

Mortality Gap Between Puerto Rico and the US Mainland Among Medicare Advantage Enrollees

Among Medicare Advantage enrollees, the mortality of Hispanic enrollees in Puerto Rico was significantly higher than that of Hispanic enrollees in the US during 2010-2022.

Integrating Primary Care and Public Health for Advance Care Planning

This article proposes a new model, Public-Primary ACP, that leverages coordination between primary care and public health workforces to improve delivery of advance care planning.

Addressing STIs Through Managed Care: Opportunities in Medicaid and Beyond

Medicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.

Perspectives on Nonmedical Switching and the COVID-19 Pandemic: A Narrative Review

This review describes the impact of nonmedical switching of biologic therapies on US patients and providers, with a focus on switching to in-class alternatives.

Understanding the Complexities of Equity Within the Emergence and Utilization of AI in Academic Medical Centers

This editorial discusses positions for academic medical centers to consider when designing and implementing artificial intelligence (AI) tools.

Dosage and Outcomes in a Complex Care Intervention

Associations between intervention dosage and hospital use outcomes were observed among patients enrolled in a care management program serving individuals with complex needs.

Insurer Costs of COVID-19 by Disease Severity and Duration

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

AI in Health Care: Closing the Revenue Cycle Gap

This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.

How Do Primary Community Hospitals Enact Early Response to COVID-19? The Experience From Chengdu, China

Our hospital is a primary hospital in Chengdu, China. Since February 5, our hospital has been listed as the primary designated medical unit for treating new patients with coronavirus disease 2019 (COVID-19) in Jinniu District. In this letter, we share our COVID-19 experience with readers.

Health Systems and Telemedicine Adoption for Diabetes and Hypertension Care

Small practices reduced their use of telemedicine during early stages of the COVID-19 pandemic. Technical support may help expand and maintain telemedicine in small practices.

Patient Experience After Modifying Visit Delivery During the COVID-19 Pandemic

Coronavirus disease 2019 (COVID-19) was associated with immediate weekly visit trend decreases for overall, primary care, and specialty care with long-term recovery trends; transformation to virtual visits; and increasing long-term trends for meeting patient scheduling and visit needs.

Addressing Complexities of Alzheimer Disease Care Coordination: Tara Carlisle, MD, PhD

Tara Carlisle, MD, PhD, University of Colorado, discusses how coordinated care efforts and frequent safety monitoring are transforming early Alzheimer disease management.

Determinants of ICS Therapy Adherence in Patients With Asthma

This study describes determinants affecting disease control and inhaled glucocorticosteroid therapy adherence for patients with asthma in western China.

Diabetes Care Quality: Do Large Medical Groups Perform Better?

Large medical groups perform better than medium- or small-sized groups on diabetes quality measures, perhaps because they have more care management processes in place.