Authors

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.

Potentially Inappropriate Medication Use Following Hospital Discharge Among Medicare Beneficiaries

Despite financial incentives for Medicare Advantage (MA) plans to reduce potentially inappropriate medication use post hospitalization, this study found that MA does not provide a clear advantage over traditional Medicare.

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.

Participating Faculty: A Review of the Current Management and Burden of Prurigo Nodularis in the United States

Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History

A novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

Addressing Cancer Health Disparities in a Multilateral Collaboration in an Independent Community Cancer Clinic: Translating Words Into Action

No One Left Behind, a program to provide financial assistance and access to cancer care at Carolina Blood and Cancer Care Associates in South Carolina, will be discussed during a session of the Community Oncology Alliance 2022 Community Oncology Conference.

Should I Stay, or Should I Go? Provider Considerations for Leaving Medicaid Managed Care Organizations

This qualitative study examines the factors that provider organizations consider when contracting with managed care organizations under North Carolina’s Section 1115 demonstration waiver.

Glomerular Filtration Rate Change and Outcomes in Type 2 Diabetes

The Role of Specialty Pharmacies in Improving Prescription Drug Access and Affordability for Consumers

Telemedicine Catches On: Changes in the Utilization of Telemedicine Services During the COVID-19 Pandemic

This analysis of health insurance claims data demonstrates rapid increase and sustained high utilization of telemedicine services during the COVID-19 pandemic.

Preoperative Acute Care Spending Predicts Costs in Bundled Payment Programs

Preoperative acute care costs significantly predicted postoperative costs in Bundled Payments for Care Improvement model year 3 surgeries, suggesting that accounting for preoperative factors may improve bundled payment outcomes.

The Kidney Community Advances Innovative Solutions and Improves Patient Care—Even During a National Pandemic Crisis

Authors from the American Society of Nephrology and Kidney Care Partners discuss the response of the kidney care community to the COVID-19 pandemic.

The Impact of HDHPs on Service Use and Spending for Substance Use Disorders

Offering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.

Community Oncology Is Fighting Back, and Winning: Nicolas Ferreyros

Community oncology delivers top-tier cancer care close to home, said Nicolas Ferreyros, COA, championing research, advocacy, and innovation to prove it.

Linking Data to Determine Risk for 30-Day Readmissions in Dementia

This study found that certain characteristics in linked electronic health record data across episodes of care can help identify patients with Alzheimer disease and related dementias at high risk of 30-day readmissions.

Insights Into Patient Portal Engagement Leveraging Observational Electronic Health Data

This analysis of more than 250,000 adults at least 50 years old with chronic conditions showed lower portal use among older, non–English-speaking, and Black patients, underscoring digital health equity gaps.

Relationship Between Medication Adherence and Other Medicare Star Rating Measures

Performance on Medicare Star Ratings medication adherence measures is significantly tied to performance on the intermediate outcome and statin process measures.

Bleeds and Resource Use in Hemophilia B: Retrospective Observational Study

This real-world US study describes individuals with hemophilia B who experience bleeds despite factor replacement therapy and quantifies the associated comorbidity and health care resource utilization burden.