Authors

Care Transitions for Young Adults With Special Health Care Needs

A Medicaid managed care plan developed a pilot program to assist special needs youth with transition to adult care. Case studies and discussion present findings.

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.

Growth of Dual-Eligible Special Needs Plans Following Permanent Authorization

The 2018 permanent authorization of dual-eligible special needs plans marked a significant long-term commitment by policy makers and coincided with substantial growth in plan offerings and enrollment.

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.

Real-World Insights on Biomarker Testing Patterns and Implications for mNSCLC Therapy Selection

Impact of Medicaid Institution for Mental Diseases Exclusion on Serious Mental Illness Outcomes

Medicaid’s Institution for Mental Diseases (IMD) rule bars federal funding for psychiatric facilities with more than 16 beds, but findings indicate that state waivers allowing treatment of serious mental illness in IMDs do not increase overall psychiatric hospitalizations.

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.

Phase 3 Study to Evaluate Remibrutinib in Generalized Myasthenia Gravis

Remibrutinib shows promise in treating generalized myasthenia gravis, with ongoing trials assessing its efficacy and safety for patients.

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.

Contributor: Prioritizing Patient-Centered Value Over International Reference Pricing in US Drug Policy

The authors argue that sustainable drug pricing reform should focus on patient-centered value, not price alone.

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.

Oral JAK1 Inhibitor Povorcitinib Shows Durable 54-Week Efficacy, Favorable Safety in HS: Martina Porter, MD

Martina Porter, MD, discusses long-term results from the phase 3 STOP-HS program evaluating povorcitinib in patients with hidradenitis suppurativa.

Education and Referral Program for Inpatient Engagement in Dental Care

Many hospitalized adults could benefit from linkage to dental care. This article describes a planned study to refer inpatients to community dental providers.

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.