Authors

Estimating Angina Prevalence in a Managed Care Population

Development of Multipayer Claims-Based Emergency Department Episodes of Care

Thirty-day episodes of care initialized by emergency department visits can inform future quality improvement efforts.

Performance Measurement for People With Multiple Chronic Conditions: Conceptual Model

The Performance Measurement for People with Multiple Chronic Conditions conceptual model can facilitate development and refinement of quality measures for a medically complex population.

Senate Backs Bipartisan Bill to Speed Drugs and Avert Shortages

Treating to Target: Implementing an Effective Diabetes Care Paradigm for Managed Care

Pharmacy Team Engagement in Navigating the Revenue Cycle for High-Cost Medications in Patients With Cancer

With the clinical and financial implications of high-cost medications, and their impact on health system revenue, it is of utmost importance for all key stakeholders to be engaged in the complex revenue cycle.

General Medical Claims for Behavioral Health Patients in Japan

This Japanese cohort shows that behavioral health service users had health care costs higher than those of individuals who did not use behavioral health services, yet lower than the costs demonstrated by studies in US populations.

Oncology Practice Transformation Helps Deliver Patient-Centered Cancer Care in a Community Oncology Practice

One possible way to reduce overall cost, improve patient experience, and improve outcomes in cancer care is to shift the focus of healthcare delivery away from volume and toward value. Patient-centered cancer care holds the promise of addressing these issues.

Strategies for Individualizing Management of Patients With Metastatic Melanoma: A Managed Care Perspective

Leading Multi-sector Collaboration: Lessons From the Aligning Forces for Quality National Program Office

Early Clinical Experience With Networked System for Promoting Patient Self-Management

A networked system designed to promote patient self-management appears to be safe and effective in capturing, integrating, and presenting medication adherence and physiologic information.

Changing Demographics Among Populations Prescribed HCV Treatment, 2013-2017

From 2013 to 2017, the population of US patients prescribed treatment for chronic hepatitis C virus (HCV) changed, becoming predominantly treatment-naïve and having received care in nonacademic centers.

Understanding and Improving Value Frameworks With Real-World Patient Outcomes

New value frameworks should incorporate real-world evidence that reflects patient treatment behavior, adherence to medication, and equity concerns arising from disparities in care.

A Deep Learning Model for Pediatric Patient Risk Stratification

Artificial intelligence based on medical claims data outperforms traditional models in stratifying patient risk.

Rountable Discussion: Glycemic Control and Economic Issues

Development of a Financial Literacy Course for Patients With Newly Diagnosed Cancer

This paper describes results from a patient survey regarding treatment-related financial experiences and interest in a financial literacy course.

Developing a Managed Care Delivery System for People with HIV/AIDS

Health Information Exchange Among US Hospitals

Few US hospitals exchange data electronically with unaffiliated providers. Factors associated with competitiveness appear to influence hospitals' decisions to engage in clinical data exchange.

Cost-effectiveness of Intensification With SGLT2 Inhibitors for Type 2 Diabetes

Adding a sodium-glucose co-transporter 2 (SGLT2) inhibitor dominated switching to a glucagon-like peptide 1 receptor agonist over the lifetimes of patients with type 2 diabetes not at glycated hemoglobin A1c target after treatment with metformin plus a dipeptidyl peptidase-4 inhibitor.

Treatment Patterns for Heart Failure in a Primary Care Environment

Impact of Insurance Type on Receipt of Medical Care by HIV-Infected Men

Integrated Care Organizations: Medicare Financing for Care at Home

This paper presents a policy proposal to integrate care for Medicare beneficiaries through creation of integrated care organizations and a Medicare home care benefit.

Is There a Relationship Between Early Statin Compliance and a Reduction in Healthcare Utilization?

Statin therapy compliance of 80% or higher during the first 2 years of treatment is associated with reduced healthcare resource utilization in the following year.

Moving from Reacting to Health Crises to Stopping Them Before They Happen

Head Lice Treatment Costs and the Impact on Managed Care

Costs of Care for HIV Infection in a Managed Care Population from 1995 to 1997

Exploring Indications for the Use of Direct Oral Anticoagulants and the Associated Risks of Major Bleeding

This supplement to The American Journal of Managed Care® describes the burden of thrombosis in terms of strokes and venous thromboembolism and highlights indications for the use of direct oral anticoagulants (DOACs) for the treatment of these conditions. The burden of DOAC-associated bleeding and unmet needs regarding reversal agents are also discussed.

Automating Care Quality Measurement With Health Information Technology

The authors discuss the design and evaluation of a health information technology platform that enables comprehensive, automated assessment of care quality in electronic medical records.