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Economic Outcomes of Insurer-Led Care Management for High-Cost Medicaid PatientsThis study evaluated economic outcomes of an insurer-led care management program for high-cost Medicaid patients using teams of community health care workers and nurses.
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Validation of a Claims-Based Algorithm to Characterize Episodes of CareThe Michigan Value Collaborative has created a claims-based algorithm that categorizes claims into episode components. This manuscript describes the validation of this algorithm.
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Evaluation of Value-Based Insurance Design With a Large Retail EmployerRetrospective analysis of value-based insurance design (VBID) showed the potential for VBID to improve adherence and reduce utilization and costs with active disease management counseling.
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Improving Population Health Through Multistakeholder PartnershipsImproving population health requires developing innovative multistakeholder partnerships to enable mining and cross-leveraging data sets, creating patient touchpoint “ecosystems,” and aligning investments with each stakeholder’s returns.
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Knowledge Gaps Inhibit Health IT Development for Coordinating Complex Patients' CareThis study examines the leading edge of health information technology used to coordinate the care of complex patients.
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Cost-Effectiveness Analysis of Vagal Nerve Blocking for Morbid ObesityThis lifetime economic analysis demonstrates vagal nerve blocking therapy to be a cost-effective alternative to conventional therapy in class 2 and 3 obesity patients.
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Aligning Evidence With Access: Disability Outcomes, Data, and Payer Decision-MakingPanelists discuss how emerging biomarkers like neurofilament light protein, glial fibrillary acidic protein (GFAP), cervical cord atrophy, and phase rim lesions could enable earlier identification of patients at risk for progression, supporting more effective treatment decisions and payer coverage determinations based on longitudinal disability data rather than just relapse activity.
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Impact of Celecoxib Restrictions in Medicare Beneficiaries With ArthritisA formulary restriction policy in a Medicare population was associated with lower celecoxib utilization; however, higher gastrointestinal- and arthritis-related medical costs were observed.
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Cancellations in Primary Care in the Veterans Affairs Health Care SystemThis article examines the prevalence of unused primary care appointments in the Veterans Affairs Health Care System.
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A Team Approach to Systematic Behavioral Screening and InterventionExpanding primary care teams with trained and supported paraprofessionals enables systematic delivery of widely recommended, evidence-based, cost-saving alcohol, drug, and depression screening and intervention services.
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Impact of Medical and/or Pharmacy Reimbursement on Adult Vaccination RatesBy covering vaccinations under both the medical and pharmacy benefit, rather than the medical benefit alone, health insurers can help improve adult vaccination rates.
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Potential Role of Comanagement in Rescue of Surgical PatientsMedical comanagement of patients who had perioperative complications was associated with lower mortality, suggesting that comanagement may facilitate effective rescue.
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USPSTF Colorectal Cancer Screening Guidelines: An Extended Look at Multi-Year Interval TestingRe-analysis of US Preventive Services Task Force colorectal cancer screening guidelines shows that every-3-year screening with multi-target sDNA could address poor performance of recommended annual testing.
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Depression Self-Management Assistance Using Automated Telephonic Assessments and Social SupportAutomated patient support calls with feedback to informal caregivers and clinicians represent a viable strategy for increasing access to depression monitoring and self-management assistance.
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US Employee Wellness Programs and Access to Obesity Treatment in Employer-Sponsored Health InsuranceEmployer policies for access to maximum benefits do not always match those for access to obesity therapy.
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Language Matters: Talking About Low-Value Healthcare With PatientsEnsuring that patients get high-value care is critical, but value can have different meanings to patients and providers. It is important to know what matters to patients and to use language that reflects those values.
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Collaborative Care Before Accountable Care: Achieving Low-Cost, High-Quality Care Through a Regional Collaborative in FloridaAs accountable care organizations proliferate across the nation, delivery systems still struggle to balance quality improvement, cost containment, and migration toward accountable care. This paper describes the phased approach where the University of Florida Health Science Center and Shands Teaching Hospital and Clinics, Inc, and Orlando Health have jointly developed a series of clinical and health services that are of the highest quality and are offered at the lowest cost. The result is a regional collaborative that will be the foundation for a regional accountable care organization, first leveraging clinical core competencies, then moving to a more integrated model.
