Authors

Health Care Leader Perspectives on State Government–Sponsored Accountable Care for Public Employees

Qualitative interviews reveal health care leader perspectives on how state governments influenced payment reform by developing an accountable care program for public employees.

Use of Diabetes Medications in Traditional Medicare and Medicare Advantage

Medicare Advantage enrollees are more likely to be treated with metformin and sulfonylureas and less likely to receive costly newer medications than those in traditional Medicare.

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.

Rideshare Transportation to Health Care: Evidence From a Medicaid Implementation

Our study on ridesharing by a managed care transportation broker found no change in ride quality compared with traditional nonemergency medical transportation, but differences were observed for access-to-care measures.

Variation in Spending Associated With Primary Care Practices

Physician practices account for a significant amount of variation in spending.

Diagnosis Patterns and Stress Testing Trends After Implementing High-Sensitivity Troponin Assay

This study found that switching from a conventional troponin assay to a high-sensitivity troponin assay resulted in changes to diagnosis patterns and stress testing trends.

Better Data Is Needed to Tackle Health Equity

The US federal government is finally updating its standards for reporting data on race and ethnicity – and it’s an urgently needed chance to enable a national overview of crucial data on health inequities

Differences in Spending for Diabetes and Multiple Chronic Conditions in Michigan Medicare Beneficiaries

Diabetes and multiple chronic conditions increase overall Medicare spending, but spending increases even more in minority beneficiaries compared with White beneficiaries with similar comorbidity combinations.

Challenges of Fracture Risk Assessment in Asian and Black Women

Differences in bone density and FRAX fracture risk scores among Black and Asian women yield greater discordance in fracture risk estimation compared with White women.

Bundled Payment Impacts Uptake of Prescribed Home Health Care

The Comprehensive Care for Joint Replacement Model mitigated a trend of lower home health uptake for Black and White patients but not for other populations.

Dialysis Costs for a Health System Participating in Value-Based Care

In a large, integrated health system participating in value-based care, higher costs and utilization were observed before and after unplanned dialysis initiation.

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.

Identifying Chronic Kidney Disease Stage 3 With Excess Disease Burden

A high-risk cohort of beneficiaries with chronic kidney disease (CKD) stage 3 have a profile similar to patients with CKD stages 4 and 5, indicating potential benefit of earlier nephrology intervention.

Contributor: How Payers Can Be Effective in New Value-Based Models for CKD

The author discusses how value-based payment models in chronic kidney disease can improve total cost and quality of care for patienst with chronic kidney disease (CKD).

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.

Evaluating Proactive Outreach for Prior Authorization Recertifications in Medicaid Patients

Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.

Health Care Resource Utilization, Quality Metrics, and Costs of Bladder Cancer Within the Oncology Care Model

Spending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.

Hospital Strategies in Commercial Episode-Based Reimbursement

This study reports qualitative findings from an explanatory sequential mixed-methods investigation to understand hospitals’ approaches to a novel commercial episode-based reimbursement incentive program.

Successes and Failures With Bundled Payments in the Commercial Market

The relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.

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.

Current Status and Influencing Factors of Nursing Interruption Events

This study investigated the current status of nursing interruption events and analyzed the time costs, priority of events, and factors influencing interruptions.

Community Health Workers’ Critical Role in Trust Building Between the Medical System and Communities of Color

The authors interrogate elements of routine medical practice in New York City to argue for reforms of hospital culture through relational trust-building capabilities of community health workers.

The Implementation of Opioid Prescribing Report Cards in Medicaid Managed Care: A Community Quality Collaborative

This article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.

Charitable Medication Distribution Improves Care for Uninsured Patients With Diabetes

This report illustrates how providing vital diabetes medications to uninsured patients through a charitable medication distributor improves clinical outcomes.

Social Determinants of Health Score: Does It Help Identify Those at Higher Cardiovascular Risk?

Calculating a social score is feasible and it predicts cardiovascular outcomes. In order to do this, institutions have to collect social determinants of health.

Intersection of Complexity and High Utilization Among Health Center Patients Aged 18 to 64 Years

This paper utilizes latent class analysis to identify subgroups of complex conditions and of super-utilizers among health center patients to inform clinically tailored efforts.

Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History

A novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

Defining Appropriate Quality Performance Metrics for Pharmacies Dispensing Oral Oncology Therapies

Medicaid Expansion, Managed Care Plan Composition, and Enrollee Experience

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.

Prior Authorization Requirements for Calcitonin Gene-Related Peptide Antagonists

This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.