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Doctors Hate Deductibles: Physicians Pay Thousands to Avoid High Deductibles

Ninety percent of physicians did not select a high-deductible health plan although it would save them $1500 to $4000 per year regardless of health spending.

Contributor: Profit Over People—Medicare Advantage Plans Are Denying Vital NIV Therapy Coverage

A longtime respiratory therapist calls for reform of Medicare Advantage in light of denials of coverage for patients who need non-invasive ventilation.

Ambulatory Care Fragmentation and Hospitalization Among Veterans With Diabetes

Having highly fragmented ambulatory care and a usual provider of care outside the Veterans Health Administration increased the odds of hospitalization among veterans with diabetes.

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.

Entering Peak Norovirus Season as Cases Rise Across the US

Nationwide norovirus cases have recently increased, followed by an FDA warning for consumers to avoid oysters contaminated in a recent outbreak.

The Essential Role of Population Health During and Beyond COVID-19

The authors detail how population health management enables health systems to promote public health, strengthen health system resiliency, and support financial recovery during and beyond coronavirus disease 2019 (COVID-19).

Discharge Timing and Associations With Outcomes Following Heart Failure Hospitalization

A retrospective multicenter study found that patients with heart failure discharged by noon had higher short- and long-term mortality and increased early readmission rates compared with afternoon discharges.

Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage Members

Medicare Advantage members referred to home health after acute hospitalization who did not receive home health services had higher mortality at 30, 90, and 180 days.

Transforming Addiction Care: From Stigma to Support

On this episode of Managed Care Cast, experts discuss behavioral health services, stigma reduction, and the 4 dimensions of recovery.

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.

Association of Physician Coordination With Interfacility Transfer Acceptance Timeliness

The authors reviewed physician-to-physician conversations during emergency transfer of patients with ST-segment elevation myocardial infarction and found that higher-quality physician coordination was associated with faster time to acceptance.

Patient-Reported QOL Outcomes of Initial CLL Treatments: ASH 2024

Quality-of-life (QOL) outcomes vary widely for patients receiving first-line treatment for chronic lymphocytic leukemia (CLL), according to research presented at the 2024 American Society of Hematology (ASH) meeting.

Emergency Department Risk Model: Timely Identification of Patients for Outpatient Care Coordination

The authors created a machine learning–based model to identify patients with major depressive disorder in the primary care setting at high risk of frequent emergency department visits, enabling prioritization for a care coordination program.

Conversations on Equity in Cancer Care: Meet the Leaders of NCCN’s DEI Directors Forum

Contributor: What’s Driving Consumers to Switch Away From Health Care Payers

Health care payers need to establish trust and transparency in consumers to ensure consumers remain on their plans.

Association of Physician Specialty With Psoriatic Arthritis Treatment and Costs

In this retrospective cohort study of patients with newly diagnosed psoriatic arthritis, the authors examine the association of treatment selection and costs with physician specialty.

Initial Maintenance Therapy Adherence Among Older Adults With Asthma-COPD Overlap

Older adults with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap, who take fixed-dose combinations of inhaled corticosteroids and long-acting β agonists may be less likely to have persistent low adherence to initial maintenance therapy.

Care Management Improves Total Cost of Care for Patients With Dementia

Compared with usual care, a dementia care management program improved various cost of care and utilization metrics in a Medicare managed care population at 12 months.

The Price Paradox of Biosimilar-Like Long-Acting Insulin

Findings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.

Impact of Expanded Carrier Screening on Health Care Utilization

This study shows little evidence of harms or increased health care utilization for people receiving negative (normal) results of expanded carrier screening through genome sequencing.

Preventive Care: Vaccines Matter

A database of information about more than 30,000 patients verified improved morbidity and mortality due to vaccines and preventive health care in prospective trials.

Contributor: A Fresh Approach to Medication Adherence—Best Practices for Improving Outcomes and Star Ratings

Best practices can help MA plans improve their Star Ratings performance while allow for strategies for medication adherence to grow.

COVID-19 and Clinic Workflow Optimization Using Lean Six Sigma

The authors report an approach of outpatient clinic workflow reorganization utilizing simple, inexpensive measures to improve patient engagement and experience in addition to providing a safe setting for patients for clinic visits in the wake of COVID-19.

Primary Care Nurse Practitioner Management of Adolescent Behavioral Health

Personnel costs ($90,514) of a primary care–embedded adolescent behavioral health nurse practitioner over 2 years were 63% of the potential revenue generated ($144,449).

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.

Predictors of Discharge From the VA Caregiver Support Program

The year of application predicts discharge from the Department of Veterans Affairs (VA) caregiver program. Unexpected, disallowed criteria also predict discharge, with significant others facing higher discharge risk than spouses.

Imposing a Health Insurance Surcharge on the Unvaccinated

Imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications.

COVID-19 Telehealth Expansion Can Help Solve the Health Care Underutilization Challenge

The telehealth policy changes enacted for short-term control of the coronavirus disease 2019 (COVID-19) pandemic present an opportunity to address the fundamental gap in health care underutilization.

Contributor: Medicare Needs to Ensure People With ALS Have Access to Clinically Appropriate Respiratory Care

The pandemic has shown a spotlight on how critically important respiratory care is to Americans who struggle to breathe on their own. Yet, Medicare policy must be updated to ensure that access to lifesaving equipment will never be disrupted.

Impact of Delayed Adoption of Novel Atrial Fibrillation Treatments

Using direct oral anticoagulants as a case study, the authors examined how delayed adoption of novel treatments could impact patient health outcomes and cost.