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Proposed Framework for Patient-Centered Outcomes-Based Measures in Alternative Payment Models

Synthesis of multistakeholder perspectives from a mixed-methods study identifies guiding characteristics for outcomes-based quality measures in future, more patient-centered alternative payment models.

Real-World Evidence Standards Bridge Research, Clinical Decision-Making: Cate Lockhart, PharmD, PhD

Real-world evidence helps pharmaceutical companies and payers communicate more effectively.

Contributor: How Health Care Companies Can Use Upskilling to Navigate the Great Resignation

The Great Resignation is sending health care workers out of the industry in massive numbers, and this, coupled with the ongoing transformation of health care, is creating the perfect storm. Alleviating their stress, burnout, and disengagement is a necessary first step. But the proper development, training, and upskilling is also crucial.

Knowledge, Attitude, and Practices Regarding ChatGPT Among Health Care Professionals

This web-based cross-sectional study indicated that health care professionals in China had poor knowledge, positive attitudes, and proactive practices in regard to ChatGPT.

Out-of-Pocket Spending for Cardiac Rehabilitation and Adherence Among US Adults

Among commercial and Medicare supplemental beneficiaries with cost sharing, higher out-of-pocket spending for the first cardiac rehabilitation session was associated with lower program adherence.

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.

AHA Telemetry Guidelines Improve Telemetry Utilization in the Inpatient Setting

Using Plan-Do-Study-Act cycles, the studied intervention reduced hospital inpatient telemetry time by 51.25% while increasing American Heart Association (AHA) guideline–based usage.

Challenges With Implementing the Diabetes Prevention Program for Medicare Beneficiaries in an Integrated Health System

This study presents challenges of implementing the CDC-approved Diabetes Prevention Program for Medicare beneficiaries at a large, integrated health care delivery system.

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.

Accountable Care Organizations and HPV Vaccine Uptake: A Multilevel Analysis

The authors evaluated whether adolescents receiving care at accountable care organizations (ACOs) vs non-ACOs were more likely to initiate and complete the human papillomavirus (HPV) vaccination series.

Pharmacists and Transitions of Care From Emergency Department to Home

Pharmacists’ roles in transitions of care continue to evolve. Evaluation of pharmacist-led interventions as patients transition from emergency department to home is needed.

Determinants of Hospital Charges and Costs in Acute Myocardial Infarction: A Report from the Myocardial Infarction Cost Study (MICS) Group

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

Endoscopist-Directed Sedation Rarely Fails: Implications for the Value of Anesthesia Assistance for Routine GI Endoscopy

Failed sedation for routine gastrointestinal (GI) endoscopy is extremely rare, warranting a return to endoscopist-directed sedation, rather than costly anesthesia-assisted sedation, as the default sedation standard.

The Hepatitis B Care Cascade Using Administrative Claims Data, 2016

Analysis of a large, nationally representative claims database to longitudinally monitor enrollees with hepatitis B showed that 36% received recommended care and 18% were prescribed treatment.

Interventional Analytics in Skilled Nursing Facilities Associated With Reduced Readmissions

A retrospective analysis of 30-day risk-adjusted readmission rates among skilled nursing facilities (SNFs) between 2017 and 2022 compared those that had implemented an interventional analytics platform and other SNFs.

Pharmacist Hypertension Management Using an Electronic Health Record–Based Approach

The authors studied the impact of a pharmacist intervention on blood pressure control compared with usual care.

Benefit Design and Consumer Information: Results From a Randomized Trial

Findings from a randomized controlled trial on reducing information barriers for consumers selecting primary care clinics in a tiered network design demonstrate limited marginal effect of the intervention.

Questions Linger About COVID-19’s Origin

Contributor: How Payers Are Applying AI to Solve the Problem of Incomplete Data—3 Use Cases

In this column, Calum Yacoubian, MD, outlines how artificial intelligence, specifically, natural language processing, can help address gaps in patient data.

Risk Adjusting for Medicaid Participation in Medicare Advantage

When comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.

Aligning Specialist Physicians With Accountable Care Organizations

An editorial in response to the editor in chief’s December 2021 letter discusses alignment of specialist physicians with value-based care initiatives.

Impact of Payment Models on Medical Specialist Physician Practice Patterns

This article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.

Industry-Informed Perspectives on the Benefits of Rideshare-Based Medical Transportation

Previous 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.

The Role of Managed Care Professionals in the Management of Neovascular Age-Related Macular Degeneration and Diabetic Macular Edema

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.

Readability of Hospital Patient Financial Policy Documents

In a cross-sectional study of US hospitals, patient financial assistance and billing policy documents averaged 10th-grade readability scores, with variation significantly associated with several attributes.

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 Socially Vulnerable Populations in Different Medicare Payment Arrangements

Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.