Authors

Participating Faculty: Payer and Provider Solutions to Utilization Management Challenges in the Management of Rare Hematologic Cancers

How Health Systems, Industry Partnerships Advance Rare Disease Therapies: David Mitchell, PharmD, MBA

David Mitchell, PharmD, MBA, UC Davis, shares how collaboration between health systems and manufacturers is transforming patient access and outcomes for rare disease treatments.

Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

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.

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.

Burden of EPS in Commercial Patients With Schizophrenia Initiating Atypical Antipsychotics

This study investigated the 1-year incidence of extrapyramidal symptoms (EPS), as well as the incremental economic burden, in patients with schizophrenia initiating atypical antipsychotics.

Service Line Care Delivery Model for COVID-19 Patient-Centric Care

The authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Distinct Health Care Use Patterns of Patients With Chronic Gastrointestinal Diseases

Patients with complex chronic disease can be grouped by varying propensity for health care continuity patterns, which could be harnessed to personalize health care utilization interventions.

Effect of Care Coordination on Patients With Alzheimer Disease and Their Caregivers

The authors investigated whether patient coordination and caregiver support for Alzheimer disease reduced health care utilization and expenditures among enrollees in the Memory Program in South Carolina.

Cost Savings Associated With a Web-Based Physical Activity Intervention for COPD

The authors modeled costs associated with a pedometer-based, web-mediated physical activity intervention compared with a pedometer alone for chronic obstructive pulmonary disease (COPD) management. The intervention was cost-saving.

Temporal Shift in Prevalence of Heart Failure Diagnoses and Comorbidities Within 2 US Integrated Health Systems

The analysis highlighted a shift in heart failure diagnoses, with hypertensive heart disease with and without chronic kidney disease as prevalent diagnoses, underlining coding variability and implications for research.

Prospective or Retrospective ACO Attribution Matters for Seriously Ill Patients

This study compared beneficiary characteristics and Medicare per capita expenditures among seriously ill Medicare accountable care organization (ACO) populations defined using prospective and retrospective claims-based attribution methods.

Diabetes, Gaps in Care Coordination, and Preventable Adverse Events

The authors examined the association of diabetes with self-reported gaps in care coordination and self-reported preventable adverse events using data from a national sample of older adults.

Does Missing Trust Lead to Overuse or Underuse of Health Care Services?

Most trust literature investigates missing trust and health care underuse. The authors show that mistrust also leads to health care overuse, a rapidly growing problem in the United States.

Determinants of ICS Therapy Adherence in Patients With Asthma

This study describes determinants affecting disease control and inhaled glucocorticosteroid therapy adherence for patients with asthma in western China.

Impact of Primary Care Intensive Management on Medication Adherence and Adjustments

The Veterans Health Administration implemented primary care intensive management for high-risk patients. Impacts of this program on patients’ medication adherence and adjustments were modest.

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.

Baffled by NAFLD: The Horse Might Be Out of the Barn but Should Not Take Us for a Ride

As awareness of nonalcoholic fatty liver disease (NAFLD) rises, it is essential to develop and implement a rigorously determined approach to identify patients who will, or will not, benefit from diagnostic evaluation.

Continuity of Opioid Prescribing Among Older Adults on Long-term Opioids

Among older adults with chronic noncancer pain on long-term opioid therapy, greater continuity of opioid prescribing was significantly associated with fewer opioid-related adverse outcomes.

Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation

The authors present findings of a randomized evaluation of Medicaid patients at an academic medical center, which found that intensive care management was associated with reduced total medical expense.

How Value-Based Care With Provider Enablement Improves Maternal and Infant Outcomes in Medicaid

Supported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.

Variability of COPD Inhaler Coverage in Medicare Part D

Although most Medicare Part D plans cover guideline-recommended outpatient chronic obstructive pulmonary disease (COPD) inhalers, the utilization controls applied to these therapies vary by plan type.

Examining Developments in Multicancer Early Detection: Highlights of New Clinical Data from Recent Conferences

Cancer remains the second leading cause of death in the United States despite decades of treatment advances. While death rates have fallen for breast, cervical, and colorectal cancers, death rates remain high for the majority of malignancies, primarily given the late stage at which they are diagnosed. The US Preventive Services Task Force currently recommends routine screening for just 4 cancers: breast, cervical, colorectal, and lung (for high-risk individuals); for prostate cancer, recommendations support individual decision making. However, cancers without recommended screening tests account for 71% of cancer deaths in the United States. In addition, screening rates remain below national goals, with numerous barriers to population-based screening. Recently, initial results of studies on blood-based multicancer early detection tests, which rely on measurement of a range of analytes, demonstrate the potential to identify multiple cancers in a single blood test and detect many cancers for which no screening tests are currently recommended. Blood-based tests have the potential to be more accessible and easier to disseminate than organ-specific tests. However, it remains unclear if their use can reduce deaths from these cancers. Other issues include cost-effectiveness, the impact of false-positive and false-negative results on patients and costs, and uptake among individuals and clinicians. Research and development of blood-based multicancer early detection tests continue.

Medicare Expenditures in the First Year of Amyotrophic Lateral Sclerosis Diagnosis

Medicare expenditures for patients with amyotrophic lateral sclerosis are more than 3 times those of the average Medicare beneficiary, and drug therapies are an important cost driver.

Older Adults’ Perspectives on Emergency Department Costs During COVID-19

Most older US adults have concerns about emergency department visit affordability. Lower income, being uninsured, poor or fair physical/mental health, and younger age were associated with increased concerns.

Are Work Relative Value Units Correlated With Operative Duration of Common Surgical Procedures?

Work relative value units (wRVUs) correlate with operative duration of common surgical procedures. Reimbursement for physicians depending on wRVUs is fair for commonly performed surgeries.

Spending Patterns Among Commercially Insured Individuals During the COVID-19 Pandemic

In this analysis of more than 97 million commercially insured individuals, investigators found that the COVID-19 pandemic induced a spending shock in 2020 and that health care spending did not recover to baseline until mid-2021.

Patients’ Needs Following Emergency Care for Ambulatory Care–Sensitive Conditions

To inform intervention development, we assessed for medication changes and patient care needs following treat-and-release Veterans Affairs emergency department visits for chronic ambulatory care–sensitive conditions.

Office Procedures for Older Adults by Physician Associates and Nurse Practitioners

The authors probed Medicare Part B data to explore outpatient clinical procedures performed by physician associates and nurse practitioners and report the trends from 2014 through 2021.