Authors
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Emergency Department Visit Classification Using the NYU AlgorithmThis article assesses a classification tool for categorizing emergency department visits as emergent and nonemergent.
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LACE+ Index as a Predictor of 90-Day Plastic Surgery OutcomesPatients with higher LACE+ index scores have significantly greater risk of unplanned readmission, emergency department visits, and reoperation after plastic surgery.
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Managed Care Reflections: Insights From Richard J. Gilfillan, MD; and Donald M. Berwick, MD, MPPTo mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The February issue features a retrospective by Richard J. Gilfillan, MD, former director of the Center for Medicare and Medicaid Innovation; and Donald M. Berwick, MD, MPP, former administrator of CMS.
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Simply Delivered Meals: A Tale of CollaborationOffering a meal delivery service to patients in a community-based care transition program was associated with cost savings and a 38% lower 30-day hospital readmission rate.
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EHRs in Primary Care Practices: Benefits, Challenges, and Successful StrategiesSmall primary care practices reap some organizational and quality of care improvements from electronic health records; however, challenges persist in achieving meaningful use standards.
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Patients' Perspectives of Care Management: A Qualitative StudyRisk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients’ perspectives of it are scarce. We explored patients’ experiences with care management, what they found useful, and what needs improvement.
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Ratio of Controller to Total Asthma Medications: Determinants of the MeasureThe ratio of controller to total asthma medications can be calculated using 1 or 2 quarters of data; high versus low ratios differentiate patient characteristics.
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An Introduction to the Health IT IssueRecent policy changes and technological innovation have led to the widespread adoption of electronic health record systems and other forms of health information technology, which are starting to play an increasingly important role in the US healthcare system to improve quality while reducing costs.
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Cost and Utilization Avoidance With Mail Prompts: A Randomized Controlled TrialBy mailing information to their members, health plans can affect rates of medical service utilization and generate cost savings.
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No Time to Waste: Decreasing Patient Wait Times for Chemotherapy Administration Using Automated Prioritization in an Oncology Pharmacy SystemUsing a prioritization algorithm in an oncology pharmacy system at the Johns Hopkins University, patient wait times for chemotherapy administration were significantly decreased.
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Higher 30-Day and 60-Day Readmissions Among Patients Who Refuse Post Acute Care ServicesAlthough patients who refuse post acute care services are relatively young, well educated, and healthy, they are twice as likely to have 30- and 60-day readmissions compared with acceptors of services.
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Effects of Health Savings Account Eligible Plans on Utilization and ExpendituresThe health savings account-eligible design may decrease costs and utilization, but it also may decrease use of preventive services.
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Cost-effectiveness of Diabetes Treatment Sequences to Inform Step Therapy PoliciesThis study assesses the cost-effectiveness of adding a sodium-glucose cotransporter 2 inhibitor versus switching to a glucagon-like peptide-1 receptor agonist in patients with diabetes on metformin and a dipeptidyl peptidase-4 inhibitor.
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Psychological Family Intervention for Poorly Controlled Type 2 DiabetesA family-based intervention targeting negative and/or inaccurate illness perceptions in patients with poorly controlled type 2 diabetes was effective in improving glycemic control.
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Claims-Based Risk Model for First Severe COPD ExacerbationA health insurance claims-based risk assessment tool to predict patients’ first severe chronic obstructive pulmonary disease exacerbation has been developed and validated.
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Integrating Behavioral Health Under an ACO Global Budget: Barriers and Progress in OregonFinancial barriers to behavioral health integration in Oregon Medicaid accountable care organizations (ACOs) limit opportunities to expand integrated care, but state and organizational opportunities exist.
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Cost of Dementia in Medicare Managed Care: A Systematic Literature ReviewA systematic review of the literature reporting the cost of dementia among Medicare managed care plans found a limited and dated body of evidence.
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Value-Based PurchasingPurchasers-employers and government programs-are primary actors for pushing for payment, benefit design, and transparency initiatives to get better value; health plans can partner.
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Survey Nonresponders Incurred Higher Medical Utilization and Lower Medication AdherenceIn a retrospective cohort analysis, diabetic nonresponders to a patient satisfaction survey had higher healthcare costs, clinic visits, and hospitalizations, but lower medication adherence.
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Will 2019 Kick Off a New Era in Person-Centered Care?New ratings for Medicare health plans should spur a renewed focus on patient experience.
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The Option Value of Innovative Treatments for Non–Small Cell Lung Cancer and Renal Cell CarcinomaOption value is the benefit a therapy provides patients by enabling them to survive to the next innovation.
