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Cost-Benefit Analysis of Sacubitril/Valsartan in a Medicaid Population

The cost avoidance of heart failure–related hospitalizations and emergency department visits may outweigh the additional drug cost in Medicaid members adherent to sacubitril/valsartan.

Care Coordination in Primary Care: Mapping the Territory

A survey completed by 100% of leaders of diverse care systems in Minnesota participating in an observational study showed little difference in approach to care coordination.

A Health Economic Evaluation of Digital Digestive Care Management

Chronic gastrointestinal disorders are common and costly for employers. Use of a digital digestive care program was associated with reduced health care spending.

Social Determinants of Health and Emergency Department Utilization in Alabama Children’s Health Insurance Program

Community social determinants of health such as rurality and low socioeconomic status moderate the association between an individual’s race and emergency care use.

A Systematic Literature Search and Narrative Synthesis of Economic Drivers in Hospitalizations for Heart Failure With Preserved or Mildly Reduced Ejection Fraction in the United States

Provider and Patient Insights Into the Cancer Care Journey

A survey was conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient.

Diabetes Associated With Higher Health Care Utilization and Poor Outcomes After COPD-Related Hospitalizations

Patients with diabetes and chronic obstructive pulmonary disease (COPD) have worse outcomes when hospitalized and appear to be more vulnerable to respiratory and nonrespiratory complications after a COPD exacerbation, which highlights the need for targeted interventions in this population.

Insurer Costs of COVID-19 by Disease Severity and Duration

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

Transition-to-Dialysis Planning, Health Care Use, and Mortality in End-Stage Renal Disease

A planned transition to dialysis was associated with improved outcomes and lower mortality. These findings may inform care coordination policies for end-stage renal disease.

ACE Inhibitor or ARB Treatment Among Patients With Diabetes and Chronic Kidney Disease

Impact of Functional Recovery on Patients Having Heart Surgery

This article describes the positive impact that actively managing functional recovery has on postacute placement for patients undergoing coronary artery bypass surgery.

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.

Transitional Care Management Visits to Improve Coordination of Care

Inspira Care Connect, LLC, an accountable care organization, incorporated transitional care management services into its postdischarge follow-up process to prevent avoidable utilization of health care services and costs.

Perspectives on Nonmedical Switching and the COVID-19 Pandemic: A Narrative Review

This review describes the impact of nonmedical switching of biologic therapies on US patients and providers, with a focus on switching to in-class alternatives.

Participating Faculty: Perspectives in Bronchiectasis Management

Trends in Sepsis and Pneumonia During COVID-19: Lessons From BPCIA

The authors analyzed cost and utilization changes for sepsis and pneumonia non–COVID-19 episodes prior to and during the pandemic, and during the pandemic for patients with and without COVID-19.

Improving Risk Stratification Using AI and Social Determinants of Health

Prediction models combining claims data with social determinants of health and additional, more-timely data sources using artificial intelligence (AI) can better identify individuals with the highest future medical spending.

Impact of Functional Recovery on Patients Having Heart Surgery

This article describes the positive impact that actively managing functional recovery has on postacute placement for patients undergoing coronary artery bypass surgery.

Contributor: Internal Communication and How It Affects Engagement

Utilization Management and Physician Burnout

This survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them.

Bundled Payments Lead to Quality Improvements in Hospitals’ Skilled Nursing Facility Referral Networks

The Bundled Payments for Care Improvement program was associated with improved quality of skilled nursing facilities in hospital referral networks for patients undergoing surgery for joint replacement.

A Review of Current Guidelines for the Treatment of Obesity

Facilitators of and Barriers to Medicaid Investment in Electronic Consultation Services

In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.

Clinical Profile of COVID-19 Infection in Postvaccination Individuals

This 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.

Rethinking Prior Authorization: Bridging Clinical Needs and Administrative Burdens

This article highlights challenges in prior authorization and offers practical, experience-based strategies to streamline workflows, reduce delays, and improve patient access to necessary treatments.

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.

AI in Health Care: Closing the Revenue Cycle Gap

This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.

Disconnects Between Provider Network Directories and Patient Preferences

This study found widespread instances of disconnect in online provider directories between information needed by patients and data availability.

5 FAQs: Ebola Outbreaks and the Challenge of Public Trust

Distrust, misinformation, and conflict complicate Ebola response efforts in the DRC, highlighting broader challenges to public health trust.

Differences in Spending for Diabetes and Multiple Chronic Conditions in Michigan Medicare Beneficiaries

Diabetes and multiple chronic conditions increase overall Medicare spending, but spending increases even more in minority beneficiaries compared with White beneficiaries with similar comorbidity combinations.