Authors

Effects of Adjunctive Cariprazine Formulary Restrictions in Major Depressive Disorder

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Assessing Evidence for MTM Quality Measure Development: A Scoping Review

Quality evidence is needed to support a new Medicare Part D medication therapy management (MTM) program performance measure, prompting a scoping review on MTM services and associated outcomes.

Cost-effectiveness of Case Management: A Systematic Review

This systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results.

Varied Use of Step Therapy Among Medicare Advantage Plans

The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.

Predicting Mortality Risk Using the PREVENT Equation Across Diverse Racial Groups

This study validates the Predicting Risk of CVD Events (PREVENT) score across diverse racial and ethnic populations, highlighting its effectiveness in predicting cardiovascular risk and mortality, regardless of race or ethnicity.

Characterizing Obesity in a Large Health Care Delivery System.

The prevalence of obesity in the Sutter Health system between 2015 and 2020 was 35%. Differences by race/ethnicity, health insurance, smoking status, and comorbidities were examined.

Calibrating Medicaid Payment to Need for Long-term Services and Supports

Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.

Justified Billing Practices Can Improve Revenue for Weight-Focused Visits

Analysis of billing codes before and after implementation of a care process for weight-focused visits revealed increased primary care revenue for these encounters.

Evaluating and Improving the Delivery of Heart Care: The University of Michigan Experience

Factors Associated With Unplanned Admissions Among Patients With Chronic Conditions

This study identified risk factors for unplanned admissions among patients with multiple chronic conditions to inform focused interventions.

Avoiding Surgical Resection of Recurrent BRAF V600E–Mutated Iodine-Refractory Papillary Thyroid Cancer Involving Trachea/Thyroid Cartilage via Resensitization With Dabrafenib and Trametinib: Report of 3 Cases

Treatment Modification After Initiating Second-Line Medication for Type 2 Diabetes

Among adults with type 2 diabetes who started noninsulin second-line therapy, most modified treatment within 1 year. Discontinuation was by far the most common modification.

Scalable Strategies Boost Heart Failure Prescription Fills: Weston Blakeslee, PhD

Low-cost, scalable interventions can improve first-fill adherence, reduce avoidable hospitalizations, and support patient-centered strategies.

Insurance Coverage and Health Care Spending by State-Level Medigap Regulations

Despite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.

Impact of Psychiatric Follow-Up Frequency on Outcomes and Waiting Times

Naturally occurring variations in appointment frequencies do not appear to have a major impact on clinical outcomes, but they significantly affect waiting times.

Determinants of Hospital Charges and Costs in Acute Myocardial Infarction: A Report from the Myocardial Infarction Cost Study (MICS) Group

Improving Patient-Centered Care in Diabetes With Comparative Effectiveness Research

Navigating the Biosimilar Frontier: Opportunities and Challenges in 2024

Biosimilars offer substantial promise for a new era of accessibility and affordability for patients and the broader health care industry, but better understanding of these products from payers and providers is necessary for biosimilars to reach their full potential in the US.

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.

Why Even the Threat of a Twindemic Isn’t Swaying the Most Vulnerable: Black Women

The fall season was accompanied by an urgent warning from the CDC of an impending “twindemic” of coronavirus disease 2019 and influenza. Despite the warnings, Black women are not lining up for vaccinations.

Reducing Readmissions in the Safety Net Through AI and Automation

Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.

Care Transition Management and Patient Outcomes in Hospitalized Medicare Beneficiaries

Hospital care transition activity facilitates uptake of Medicare-reimbursed transitional care management, which is associated with lower spending and better patient outcomes.

Evaluating Alternative Methods of Comparing Antihypertensive Treatment Intensity

Medication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.

More Employers Offer Preventive Drug Lists Over Time

More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.

Immunotherapy Treatment Can Cause Skin-Related Toxicities

There are many immunotherapy-caused skin toxicities, but most can be easily managed.

Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare Beneficiaries

Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.

How English- and Spanish-Preferring Patients With Cancer Decide on Emergency Care

Care delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.

Operating Room Efficiency of Orthopedic Surgery During the COVID-19 Era

The authors analyzed the impacts of COVID-19 on orthopedic operating room efficiency via comparison of 14,856 surgeries performed before, during, and after the pandemic.

US Health Care Disparities in Immunology Biologics Access: A Systematic Review

This article presents a systematic review of US health care disparities in biologics access across immunology (ie, rheumatology, dermatology, and gastroenterology) and a call to action.

Assessment of Structured Data Elements for Social Risk Factors

An expert panel identified and assessed electronic health record and health information exchange structured data elements to support future development of social risk factor computable phenotyping.