Authors

Contributor: How to Become a Star Ratings “Triple Threat” With CAHPS, Medication Adherence, and an SDOH-First Approach to Member Engagement

Medicare Advantage plans can implement 3 simple steps to make sure that they are competitive in the modern Stars environment.

Impact of Medical Care Coordination Intervention on Patient Activation

This observational evaluation compared an adult medical care coordination intervention with usual care and found that the intervention was associated with significant improvements in patient activation.

Rapid Increase in Topical Diclofenac Use for Chronic Pain, 2011-2020

Topical diclofenac usage among Medicare beneficiaries rose 1621% (2015-2019) independent of marketing, potentially reflecting therapeutic substitution driven by national efforts to reduce opioid prescribing.

Addressing Finerenone Cost, Access in Heart Failure: Trejeeve Martyn, MD

Trejeeve Martyn, MD, shares why finerenone belongs on formulary, and how pharmacist-led access models can work in smaller health systems.

Physician-Pharmacy Integration in Cancer Care: Pillars of Medically Integrated Pharmacy

The foundation of medically integrated pharmacy includes 7 critical pillars. This commentary focuses on the benefits of 3 of those pillars: abandonment, adherence, and access/affordability.

Impact of Automated Insulin Delivery on Type 2 Diabetes Measures

Use of automated insulin delivery technology improves a Healthcare Effectiveness Data and Information Set quality measure in individuals with type 2 diabetes.

Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes

Receipt of an insurer-provided grocery benefit was associated with decreased rates of diabetes with complications and increased medication adherence among a population with diabetes.

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.

A Patient-Centered Reconstruction of 340B in Oncology: Transparency, Equity, and Site-of-Care Accountability

Community oncology leaders urge 340B overhaul so drug discounts follow vulnerable cancer patients, with audits, transparency, and tighter contract-pharmacy rules. This commentary will be featured on the Cover of the October issue of Evidence-Based Oncology.

High-Intensity Home-Based Rehabilitation in a Medicare Accountable Care Organization

High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.

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.

Effects of Maryland’s All-Payer Model on Elective Joint Replacement Surgery

The Maryland All-Payer Model was associated with an increase in population-based rates of elective major joint replacements, with a more pronounced effect observed in Maryland-only hospitals.

Prescription Drug Prior Authorization: Costs to Pharmacies and Physicians

Research indicates that prior authorizations for drugs take physician practices and pharmacies 15 to 64 minutes to complete and cost $15 to $63 each.

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.

Perspectives on Health-Related Social Needs for Medicare Advantage Beneficiaries

Medicare Advantage plans have varied motivations, strategies, and aspirations for addressing health-related social needs among home health beneficiaries, highlighting a need to expand the scope of supplemental benefits.

An Integrated Practice Unit Tool for the Military Health System

Researchers developed and tested an assessment tool to measure coordinated care for traumatic brain injury against the criteria of an integrated practice unit.

Disparities in Physician Access for Rheumatology, Dermatology, and Gastroenterology: A Systematic Review

This article presents a systematic review of US health care disparities in physician specialist access across rheumatology, dermatology, and gastroenterology and a call to action.

Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.

Rapid Increase in Topical Diclofenac Use for Chronic Pain, 2011-2020

Topical diclofenac usage among Medicare beneficiaries rose 1621% (2015-2019) independent of marketing, potentially reflecting therapeutic substitution driven by national efforts to reduce opioid prescribing.

Medicare Accountable Care Organizations: Clinical Performance for Patients With Heart Failure

Higher-performing Medicare accountable care organizations are smaller and characterized by real-time information sharing, regular performance feedback, primary care physician leaders, physician buy-in, and strong care management programs.

Health Outcomes of Socially Vulnerable Populations in Different Medicare Payment Arrangements

Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.

Hospitalization Patterns Among Older Patients With Cancer With and Without Dementia

Dementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.

Divergent Cost Trends for 3 Advanced Cancers, 2013 vs 2022: A Commercial Claims Analysis

A comparison of 2013 and 2022 data shows that cancer costs are not uniformly rising. Costs decreased for metastatic colorectal cancer but increased for both metastatic non–small cell lung cancer and multiple myeloma.

Review of the Clinical, Humanistic, and Economic Burden of Focal Segmental Glomerulosclerosis

Utilization by High-Cost, High-Need Medicaid Patients Receiving Social Worker Care Coordination

Complex Medicaid patients randomly assigned to receive outpatient social worker care coordination services experienced increased hospitalizations but no differences in emergency department visits or costs.

Enhancing NSCLC Brain Metastasis Treatment With MR-Guided Ultrasound: Manmeet Ahluwalia, MD, MBA, FASCO

Manmeet Ahluwalia, MD, MBA, FASCO, chief of medical oncology, chief scientific officer, and deputy director of the Miami Cancer Institute of Baptist Health South Florida, discusses a groundbreaking clinical trial for non-small cell lung cancer (NSCLC) brain metastases.

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.

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.

Telemedicine Utilization and Preventive Services Among a Rural Population

Telemedicine use in rural areas was associated with a higher likelihood of utilizing preventive services.

Effect of Remote Patient Monitoring on Stage 2 Hypertension

A community-based remote patient monitoring (RPM) program was associated with significant reduction in blood pressure in Medicare patients with stage 2 hypertension, highlighting the potential benefits of RPM with care coaching.