Authors

Health-Related Social Needs, Methods, and Concerns for a Polysocial Risk Score: An Expert Panel

A polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address health-related social needs.

Coverage With Evidence Development Study Shows Benefits in Patients With Migraine Treated With Remote Electrical Neuromodulation

A coverage with evidence development (CED) study demonstrated significant and clinically meaningful benefits in patients with migraine treated with remote electrical neuromodulation (REN). Health plans should support clinicians’ REN prescriptions by ensuring adequate coverage.

Leveraging Health Plan Infrastructure, Patient Voices to Improve Food Insecurity Identification: Jonathan Wrathall, PhD

Health plan infrastructure and patient reporting are underutilized, powerful tools for identifying food insecurity, Jonathan Wrathall, PhD, argues.

Prior Authorization Requirements in Medicare Advantage and County Social Vulnerability

This study links county-level social vulnerability to variation in Medicare Advantage prior authorization policies.

Neonatology Pricing and Network Participation Under State Balance Billing Regulations

This national study of neonatology services found no clear evidence that state surprise billing regulations influenced prices or provider network participation for the commercially insured.

A Standardized Care Pathway Increases Optimal Dialysis Starts

The authors observed a significant increase in optimal starts for dialysis and in peritoneal dialysis rates after implementing a standardized end-stage renal disease transition pathway.

The Spectrum of Progressive Fibrosing Interstitial Lung Disease: Clinical and Managed Care Considerations

Population-Based Return on Investment of Deploying Transient Elastography

Deploying vibration-controlled transient elastography/controlled attenuation parameter devices at the population level is a financially advantageous solution to address the epidemic of fatty liver disease.

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.

Contributor: It’s Important to Prioritize HIV Care During the COVID-19 Pandemic

Not all barriers to HIV-related care and services have been eliminated, and these gaps in care were exacerbated by treatment disruptions brought on by the COVIDC-19 pandemic.

Contributor: How Pediatric Mental Health May Influence the Risk of Heart Disease in Adulthood

In this contributor piece, the connection between the complexities of mental health and heart disease in at-risk communities is explored, with the authors stressing the importance of risk factor evaluation and multidisciplinary patient education from both mental and physical health providers.

Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing Readmissions

This evaluation looks at a postdischarge digital engagement (PDDE) program using causal inference methods to examine the impact of PDDE on readmission.

Differences in the Use of Telephone and Video Telemedicine Visits During the COVID-19 Pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, we found lower use of video vs telephone visits among older, Black, Hispanic, and Spanish-speaking patients, driven largely by clinician and practice factors.

Grocery Assistance Shows Potential in Diabetes Care and Beyond

August authors Jeff Romine, PhD, and Kofi Essel, MD, MPH, found grocery assistance linked to fewer diabetes complications and better medication adherence.

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.

Health Care Utilization in Veterans With Alzheimer Disease

Veterans with Alzheimer disease (AD), identified using clinical notes, have higher health care utilization than veterans without AD.

RAISE: Elevating Person-Centered Data for Healthy Communities

The RAISE program provides awareness and shares comprehensive solutions to address the multifaceted reasons for missing and incomplete data across the real-world data continuum.

Use of Voluntary Alignment in the Next Generation ACO Model

Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.

Combined Pharmacotherapy and Psychotherapy Impact on Opioid Use Disorder Treatment

The combination of pharmacotherapy and psychotherapy is associated with reductions in emergency department visits and inpatient admissions along with lower total cost of care relative to either therapy alone.

Combined Pharmacotherapy and Psychotherapy Impact on Opioid Use Disorder Treatment

The combination of pharmacotherapy and psychotherapy is associated with reductions in emergency department visits and inpatient admissions along with lower total cost of care relative to either therapy alone.

Coordinating Specialty Care Across Health Systems: Primary Care Provider Survey

Even with significant organizational investment in cross-system coordination, primary care providers report a range of challenges in coordinating care with specialists in other health systems.

Medication Use for Patients With Obesity: Trends and Characteristics for US Employees

This retrospective analysis examines employees with obesity and reports on glucagon-like peptide-1 receptor agonist use, comorbidities, and work outcomes over time.

Potential Health Literacy Resources for Health Plans: A Narrative Review

Several evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.

A Learning Health Care Community: Integrating Research and Practice at Scale

This article presents a case study of how stakeholders in one state came together to integrate practice and research that is a step beyond a learning health care system.

Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Navigating Compounded Semaglutide: What Health Care Providers Need to Know

This article reviews the safety, efficacy, and regulatory concerns related to compounded semaglutide, with a focus on how health care providers can offer guidance and education to patients.

The Societal Costs of Food Insecurity: Implications for Managed Care Strategies

Food insecurity among working-age US adults has significant economic consequences, primarily driven by increased job instability and income insecurity.

Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

Optimizing Revisit Intervals: Reducing Variability to Enhance Health Care Efficiency

The authors explore the limitations of the current system of revisit interval assignment and discuss the importance of standardization to optimize patient health care outcomes.

Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.