Authors

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.

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.

CDC Opioid Guidelines at 10: Impact, Misuse, and Lessons: Michael Lynch, MD

A decade after the CDC opioid guidelines, Michael Lynch, MD, examines misapplication, fentanyl’s role, and evolving pain management strategies.

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.