Authors

Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims Data

A statistical model based entirely on claims data can accurately predict 30-day hospital readmission in Medicaid patients with diabetes.

Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 Inhibitor

A collaboration between a drug plan and clinical pharmacists led to nearly 50% of members successfully switching to a preferred dipeptidyl-peptidase-4 inhibitor.

Lessons Learned From 15-Plus Years of Clinical Quality Improvement

The author shares observations on several common factors across various clinical settings that can determine success or failure in quality improvement.

COVID-19 and MCO-Community Partnerships to Address Enrollee Social Needs

COVID-19 strained already-burdened community partners, affecting service delivery, communication, and partnerships. Managed care organization (MCO) partnerships with these organizations evolved in response to changing needs and resources.

Intensive Care Management of a Complex Medicaid Population: A Randomized Evaluation

The authors present findings of a randomized evaluation of Medicaid patients at an academic medical center, which found that intensive care management was associated with reduced total medical expense.

Association of 340B Contract Pharmacy Growth With County-Level Characteristics

The growth of 340B contract pharmacies since 2010 is unprecedented. This study’s findings suggest that patterns of growth differ between safety-net clinics and hospitals.

Treatment Modification After Initiating Second-Line Medication for Type 2 Diabetes

Among adults with type 2 diabetes who started noninsulin second-line therapy, most modified treatment within 1 year. Discontinuation was by far the most common modification.

Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification Tool

In this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.

Association of 340B Contract Pharmacy Growth With County-Level Characteristics

The growth of 340B contract pharmacies since 2010 is unprecedented. This study’s findings suggest that patterns of growth differ between safety-net clinics and hospitals.

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.

Use of Voluntary Alignment in the Next Generation ACO Model

Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.

Integrating Primary Care and Public Health for Advance Care Planning

This article proposes a new model, Public-Primary ACP, that leverages coordination between primary care and public health workforces to improve delivery of advance care planning.

Prevalence and Inclusiveness of Pay-for-Performance Incentives for HPV Vaccination

This article examines the prevalence of pay-for-performance incentives to promote human papillomavirus vaccination and other quality metrics as reported by frontline clinical staff.

Reimbursement for Genetic Variant Reinterpretation: Five Questions Payers Should Ask

Periodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.

Contributor: The Connection Between Gout and CVD Requires Cross-Specialty Collaboration

The Panicos are on a mission to change how we think about gout. Why? As a husband-and-wife DO duo, the Panicos each have a unique perspective on gout and how physicians in their respective fields can better collaborate to help patients who live with this systemic disease.

Telehealth User Experiences During COVID-19: A Case Study of Outpatient Cardiovascular Clinics Affiliated With a Large Academic Practice

In cardiovascular clinics during COVID-19, notable barriers to successful telehealth use included obtaining diagnostic information needed to deliver high-quality care and technology-related challenges for patients.

Proactive Care Management of AI-Identified At-Risk Patients Decreases Preventable Admissions

Proactive care management for artificial intelligence (AI)–identified at-risk patients reduced potentially preventable hospital admissions.

To Report or Not Report Health Care Data Breaches

This study presents information regarding the decisions that health care privacy officers make about reporting a data breach, including factors that can affect the decision process, such as personal/organizational knowledge, prior breach status, and framed scenarios.

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.

Rising Use of Surveillance Colonoscopy and Potential Impacts

The proportion of colonoscopies performed for postpolypectomy surveillance has increased significantly, particularly among older patients with limited life expectancy, raising concern for possible overuse.

Association of the MedWise Risk Score With Health Care Outcomes

Tracking the Performance, Challenges, and Evolution of Value-Based Contracts: Neha Kashalikar, PharmD

Neha Kashalikar, PharmD, director of strategic pharmacy consulting at MassHealth, breaks down the outcome measures often used in pharmacy and medical claims to evaluate the performance of value-based contracts.

Challenges of Fracture Risk Assessment in Asian and Black Women

Differences in bone density and FRAX fracture risk scores among Black and Asian women yield greater discordance in fracture risk estimation compared with White women.

“Expanding Access Isn’t Just About Fairness—It’s About Building Better Treatments for Everyone”

Regina Barragan-Carrillo, MD, a postdoctoral fellow at City of Hope Comprehensive Cancer Center, discussed findings that show 76% of renal cell carcinoma trials take place in wealthy countries, amid news that clinical trial access for the world's poor may become even more challenging.

Value-Based Care Through Postacute Home Health Under CMS PACT Regulations

Among 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.

Potential Impact of Hospital at Home on Postoperative Readmissions

Many postoperative readmissions are amenable to diversion to a hospital at home program for surgical patients, representing an opportunity to generate revenue and improve patient experience.

Association of Wound Healing With Quality and Continuity of Care and Sociodemographic Characteristics

Based on the analysis of electronic health records from 480 clinics, we found that better care quality and continuity are associated with better-than-expected wound healing performance.

Medicare Expenditures in the First Year of Amyotrophic Lateral Sclerosis Diagnosis

Medicare expenditures for patients with amyotrophic lateral sclerosis are more than 3 times those of the average Medicare beneficiary, and drug therapies are an important cost driver.

Coordination Without Consolidation? Options for ACOs

Findings published in this issue add to the growing literature showing that multiple types of accountable care organizations (ACOs) can be successful, whether they are confederations of smaller, independent primary care practices or larger, integrated systems.

Contemporary Care Patterns in the Management of Small Renal Masses

An investigation of management patterns after initial radiographic diagnosis of small renal masses showed that early urologist referral was associated with guideline-concordant care.