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Contributor: The Future of Prior Authorization Under the Improving Seniors’ Timely Access to Care ActStreamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.
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Preventive Care: Vaccines MatterA database of information about more than 30,000 patients verified improved morbidity and mortality due to vaccines and preventive health care in prospective trials.
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Value-Based Care Through Postacute Home Health Under CMS PACT RegulationsAmong a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.
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Clinical Profile of COVID-19 Infection in Postvaccination IndividualsThis article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.
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Association Between Use of Clinician Performance Information and Patient ExperienceHigh patient experience scores were associated with the collection and use of any clinician performance information, especially with whether the practice shared this information internally to compare.
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Continuity of Opioid Prescribing Among Older Adults on Long-term OpioidsAmong 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.
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Rising Use of Surveillance Colonoscopy and Potential ImpactsThe proportion of colonoscopies performed for postpolypectomy surveillance has increased significantly, particularly among older patients with limited life expectancy, raising concern for possible overuse.
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Industry-Informed Perspectives on the Benefits of Rideshare-Based Medical TransportationPrevious research on rideshare-based nonemergency medical transportation has limited generalizability due to the specific model studied, and the lack of trip-level data raises concerns of ecological fallacy.
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Evaluating Satisfaction With Pharmacist-Provided MTM Services in a Medicaid PopulationMedication therapy management (MTM) services were performed with a cohort of Medicaid patients, and their satisfaction with the program was assessed as part of a quality improvement initiative.
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Consumer-Centric Approach to Enhance Access to Pediatric Specialty CareThe authors’ organization optimized scheduling techniques that improved patient access to pediatric specialists to within 7 calendar days for new patients.
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Primary Care Nurse Practitioner Management of Adolescent Behavioral HealthPersonnel 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).
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Estimating the Economic Burden of Migraine on US EmployersThe Migraine Impact Model is an interactive calculator that estimates migraine prevalence within a workforce and the associated economic burden of migraine on the employer.
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Characteristics of Home-Based Care Provided by Accountable Care OrganizationsAccountable care organizations (ACOs) deliver a diverse array of home-based services, but many of the services are not reimbursed. ACOs may not expand these programs without strong evidence of cost savings.
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Effects of an Out-of-Pocket Maximum in Medicare Part DThis study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.
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The Impact of Immune Checkpoint Inhibitors on Cost and Quality of Life in the Initial Treatment of Patients With Advanced or Metastatic NSCLCImmune checkpoint inhibitors (ICIs) represent a significant benefit for the initial treatment of patients with advanced or metastatic non−small cell lung cancer (NSCLC). Beyond clinical benefit of increased overall survival, it represents a class of medications with a favorable adverse effect profile compared with chemotherapy. Drugs that target programmed cell death protein 1 (PD-1) receptor and its ligand PD-L1 are ICIs that work by taking the brakes off the immune system and promote T-cell−mediated cancer cell destruction. Current NCCN guidelines recommend that all patients with advanced or metastatic NSCLC have their PD-L1 status (amount of PD-L1 on cancer cells) assessed to guide treatment section. However, this recommendation is not always followed and may lead to inappropriate treatment selection and potential increased cost. Through appropriate biomarker testing, subsequent appropriate utilization of ICIs may help to drive down other costs and improve health-related quality of life. Managed care pharmacists should continue to focus on promotion of guideline concordant care that includes appropriate biomarker testing and selection of an evidence-based preferred treatment option.
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Evaluating Smoking Cessation Service at an Emergency Department Clinical Observation UnitThis study aimed to evaluate the impact of a smoking cessation service in a group of patients admitted to a short-stay unit in the emergency department.
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The Price Paradox of Biosimilar-Like Long-Acting InsulinFindings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.
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Optimizing the Management of TRDDrs Steven Levine, Patricia Ares-Romero, Samuel Nordberg, Martin Rosenzweig, and Carrie Jardine share insight on the future treatment landscape for TRD.
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Care Fragmentation Predicts 90-Day Durable Ventricular Assist Device OutcomesThis analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.
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Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical CareThe COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.
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US Cost-effectiveness and Budget Impact of Point-of-Care NAAT for StreptococcusThis study evaluates the cost-effectiveness and budget impact to US payers of point-of-care nucleic acid amplification tests (NAAT) for group A streptococcus.
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Researchers Propose Model to Replicate Patient Experience in Artificial Pancreas SystemA methodology to monitor patient-in-the-loop modes and faults was examined using a hybrid automata model that was able to replicate patient’s real-life operation modes.
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Real-world HIV Diagnostic Testing Patterns in the United StatesThis retrospective study evaluated real-world implementation of the updated CDC HIV algorithm in a large US laboratory.
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Growth of Electronic Consultations in the Veterans Health AdministrationThis study evaluates the growth in electronic consultation use over the first 7 years after its implementation across the entire Veterans Health Administration system.
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Ensuring Access to Health Care by FQHCs as States Reopen Amid COVID-19Federally qualified health centers (FQHCs) must focus on enhancing the nonemergency medical transportation Medicaid benefit to improve patient access during the coronavirus disease 2019 (COVID-19) emergency as states reopen.
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Considerations to Increase Rates of Breast Cancer Screening Across PopulationsAuthors from the Community Oncology Alliance and Avalere Health present data that show breast cancer screening rates recovered more slowly among some racial/ethnic groups following on the onset of the COVID-19 pandemic.
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Perspectives on Nonmedical Switching and the COVID-19 Pandemic: A Narrative ReviewThis review describes the impact of nonmedical switching of biologic therapies on US patients and providers, with a focus on switching to in-class alternatives.
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Cost-effectiveness of Case Management: A Systematic ReviewThis systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results.
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Physician Prices and Low-Value Services: Evidence From General Internal MedicineThis study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.
