Authors

Scenario Analysis When Conducting Budget Impact Analyses for Rare Diseases

The authors propose conducting a scenario analysis for interventions to treat rare diseases by varying health plan size to demonstrate the variability of potential budget impact.

Impact of Medical Care Coordination Intervention on Patient Activation

This observational evaluation compared an adult medical care coordination intervention with usual care and found that the intervention was associated with significant improvements in patient activation.

Economics of a Health System’s Direct-to-Consumer Telemedicine for Its Employees

A direct-to-consumer telemedicine service resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services overall.

Using Electronic Health Records and Claims Data to Identify High-risk Patients Likely to Benefit From Palliative Care

Deep learning algorithms could improve palliative care by predicting mortality from electronic health records and claims data.

Cost-Benefit Analysis of Sacubitril/Valsartan in a Medicaid Population

The cost avoidance of heart failure–related hospitalizations and emergency department visits may outweigh the additional drug cost in Medicaid members adherent to sacubitril/valsartan.

Effects of Individualized Nurse-Led Care Plans on Olaparib Treatment Duration

A nurse-led personalized care program conducted through a specialty pharmacy prolonged medication persistence among patients with cancer receiving olaparib.

Evaluation of Biosimilar Trastuzumab MYL-1401O in HER2-Positive Breast Cancer

The authors evaluate the effect and safety of biosimilar trastuzumab MYL-1401O in human epidermal growth factor receptor 2 (HER2)–positive early-stage (neoadjuvant and adjuvant therapy) and metastatic (palliative therapy) breast cancer using real-world data.

The Impact of Health Benefit Design on Patients With Infertility

This retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy outcomes.

Reimagining the Inpatient Palliative Care Consult: Lessons From COVID-19

Digital innovations in palliative care during COVID-19 have changed how hospitalized patients receive palliative care. We propose an approach to implement new models at scale.

Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification Tool

In this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.

Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.

Patients’ Needs Following Emergency Care for Ambulatory Care–Sensitive Conditions

To inform intervention development, we assessed for medication changes and patient care needs following treat-and-release Veterans Affairs emergency department visits for chronic ambulatory care–sensitive conditions.

Final PICCOLO Data Highlight Efficacy of Mirvetuximab Soravtansine in Later-Line Frα+ Platinum-Sensitive Ovarian Cancer

Mirvetuximab soravtansine continues to show efficacy and safety in the final analysis of the phase 2 PICCOLO study.

Lp(a): Evidence of a Link to Major Adverse Cardiovascular Events

Impact of Telemedicine Use on Outpatient-Related CO2 Emissions: Estimate From a National Cohort

Telemedicine was associated with a monthly avoidance of greenhouse gas emissions equivalent to the emissions of 61,255 to 130,076 passenger vehicles.

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.

Cost-Effectiveness of a Multicancer Early Detection Test in the US

Multicancer early detection testing results in extended life-years and reduced cancer treatment costs through earlier diagnosis, leading to a cost-effective option in cancer screening.

Participating Faculty: Payer and Provider Solutions to Utilization Management Challenges in the Management of Rare Hematologic Cancers

Risk Adjusting for Medicaid Participation in Medicare Advantage

When comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.

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.

Variation in Spending Associated With Primary Care Practices

Physician practices account for a significant amount of variation in spending.

Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

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.

Contributor: The Case for Education and Clinical Decision Support With Pharmacogenetics

Prescribing is a complex process with multiple factors to consider on top of the 3 primary questions about effectiveness, harm, and cost. Pharmacogenetics has put this complexity under the spotlight and prompted educational programs and the development of new clinical decision support systems.

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.

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.

Cost Analysis of Self-Monitoring Blood Glucose in Nonintensively Managed Type 2 Diabetes

Analysis of claims data showed reduced utilization and costs among patients with nonintensively managed type 2 diabetes using self-monitoring of blood glucose compared with continuous glucose monitoring.

The Effect of Medicare Eligibility on Diagnosis of Chronic Conditions

Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions.

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.

Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer

The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.