Authors

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.

Clinical Setting of Initial Psychotic Spectrum Disorder Diagnoses in an Integrated Health System

This study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.

Cost Nudges Had Minimal Effect on Clinic Selection as Tiered Benefit Design May Already Drive Smarter Choices: Tim McDonald, PhD, MPP, and Bryan E. Dowd, PhD

Their study found cost nudges had minimal effect on clinic selection, as 85% already chose lower-cost tiers, suggesting tiered benefit design works.

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.

Impact of an Intensive Outpatient Clinic Model on Health Care Utilization and Cost

An intensive outpatient clinic model significantly reduced health care spending, hospital admissions, and emergency department visits among complex Medicaid patients over a 2-year period.

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.

Participating Factulty: Real-World Impact of Infliximab Precision-Guided Dosing on Management of Patients With IBD

Industry Payments to Cardiologists Are Associated With Higher Medicare Spending

This study of 26,805 cardiologists shows that industry payments (averaging $3958) are linked to increased Medicare costs, with each $10,000 in payment associated with $14.1 higher beneficiary spending.

Using Data Exchange to Improve Quality Reporting, Target Outreach, and Reduce Cost

Covered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.

Investigating Real-world Consequences of Biases in Commonly Used Clinical Calculators

Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.

Assessing Surveillance Utilization and Value in Commercially Insured Patients With Colorectal Cancer

Trends in surveillance testing after treatment for colorectal cancer remained relatively stable recently, and patients who overutilized surveillance measures had quicker recurrence detection but higher costs.

Industry Payments to Cardiologists Are Linked to Increased Medicare Spending: Michael I. Ellenbogen, MD, and Yubin Park, PhD

Industry payments to cardiologists are linked to higher Medicare spending, with $10,000 in payments tied to $14.10 more per beneficiary.

Continuously Updated Forecasting of SARS-CoV-2 in a Regional Health System

This study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.

The US Oncology Network Tackles Patients’ Health-Related Social Needs by Collaborating With Nation’s Largest Social Services Support Network

The Persistent Pandemic of Violence Against Health Care Workers

The problem of violence against health care workers has escalated across the world, and tackling this issue requires the support of administrators.

A Scoping Review of US Insurers’ Use of Patient-Reported Outcomes

This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.

Characteristics of Accountable Care Organizations’ Preferred Skilled Nursing Facility Networks

Medicare accountable care organizations use preferred skilled nursing facility networks for postacute care management, although the size, structure, and resource allocation of networks vary widely.

A Kidney Diagnostic’s Impact on Physician Decision-making in Diabetic Kidney Disease

The KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.

Cost-Effectiveness of Integrated Behavioral Health for Depression, Anxiety, and Chronic Pain

Integrating behavioral health into primary care is cost-effective from the US health system perspective, with reduced prescription drug expenses being a key driver of these savings.

Exploratory Study of Selected Stakeholder Insights Into Continuous Glucose Monitoring in T2D With Risk-Sharing Agreements

A small expert panel was selected to share professional experiences with risk-sharing agreements and advance the cost-effective utilization of continuous glucose monitoring–centered care in type 2 diabetes (T2D).

CMS Practice Assessment Tool Validity for Alternative Payment Models

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.