Authors

The Health Care Price Crisis Needs Policy Solutions

This commentary, part of the Price Crisis campaign, calls for state and federal policy interventions that are needed to rebalance the market to enhance competition and provide value in health care.

Understanding the Role of the Pharmacist in Clinical Oncology: Jody Agena, PharmD, MBA

Jody Agena, PharmD, MBA, director of pharmacy operations, Virginia Cancer Specialists, discusses the various responsibilities of the pharmacist within community oncology settings.

Evaluating Racial Concordance in a Telephonic Care Management Program Among Black Patients

The race of a telephonic care manager did not impact closure rates for gaps in care among Black Medicare Advantage beneficiaries.

Hands Down, COVID-19 Will Change Medical Practice

Coronavirus disease 2019 (COVID-19) has challenged us to incorporate technology into engaging, interacting with, and caring for patients, using televisits and video conferencing in ways that have previously been resisted or derided.

Clinical Outcomes in Heart Failure Monitoring: A Pooled Rates Analysis

This systematic literature review and pooled rates analysis investigated the standard of care for patients with heart failure in the US post hospital discharge.

Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary Rounds

Patients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.

Health Care Costs Associated With Unrecognized Progression to Late-Stage Kidney Disease

Unrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.

A Multistakeholder Effort in Pennsylvania to Improve the Accuracy of Reporting Fatal Drug Overdoses

The authors describe a novel training program for death certifiers in Pennsylvania, which has been designed to specifically focus on some of the main challenges in the death certification process and resulted in a useful model that can potentially be adopted by other states or municipalities.

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.

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.

Predicting Mortality Risk Using the PREVENT Equation Across Diverse Racial Groups

This study validates the Predicting Risk of CVD Events (PREVENT) score across diverse racial and ethnic populations, highlighting its effectiveness in predicting cardiovascular risk and mortality, regardless of race or ethnicity.

Coverage With Evidence Development: Where Are We Now?

Review of CMS’ coverage with evidence development program exposes a need to improve program transparency and clarify requirements and timetables for reporting to improve access to novel therapies.

Scaling Early Palliative Care in Value-Based Community Oncology: A Technology-Enabled Approach

Value-Based Payment, the Safety Net, and Rethinking Risk

Safety-net providers can benefit from demonstrations of condition-specific and defined-scope-of-practice alternative payment models that account for the nonfinancial as well as financial risks that providers face.

Utilization Management and Physician Burnout

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

The Unintended Consequences of Medicare’s Wage Index Adjustment on Device-Intensive Hospital Procedures

The authors found an association between Medicare’s wage index adjustment and the differential use of labor-intensive surgical procedures and medical device–intensive minimally invasive clinical procedures across the United States.

Final Panel Thoughts on the Management of SMA

Panelists discuss how spinal muscular atrophy (SMA) treatment will evolve over the next 5 years, likely incorporating improved gene therapy delivery systems, combination therapies, and rehabilitation models, while maintaining individualized approaches for each patient.

Contributor: 3 Ways Technology Empowers PCPs and Patients to Transform the Health Care Experience and Improve Outcomes

Tech-driven connectivity and collaboration tools empower primary care providers (PCPs) to shepherd patient care, while simultaneously empowering patients to make more informed and strategic decisions about their own health and care journey.

How AI-Driven Integration of Data Improves Preclinical Studies, Reduces Drug Trial Failures: Jo Varshney, PhD, DVM

Jo Varshney, PhD, DVM, discusses how VeriSIM Life’s innovative approach leverages artificial intelligence and multispecies data.

Inability to Access Health Care Due to COVID-19 Among Medicare Beneficiaries

Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.

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.

High-Risk Care Management Impact on Medicaid ACO Utilization and Spending

In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.

Differences in Savings and Quality by Type of ACO Model

2016-2018 Next Generation Accountable Care Organization (ACO) and Medicare Shared Savings Program cost and quality data show similar performance, suggesting that increasing financial risk to health systems may not affect performance.

Projected US Savings From Biosimilars, 2021-2025

Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.

Workforce Innovation Reduces Medicaid Costs in Chronic Care

This study of community health workers as clinical extenders demonstrates significant cost savings in managing chronic conditions among Medicaid beneficiaries.

Insurance-Related Differences in Chronic Conditions Data Warehouse Comorbidities of Medicare Beneficiaries

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

Are Work Relative Value Units Correlated With Operative Duration of Common Surgical Procedures?

Work relative value units (wRVUs) correlate with operative duration of common surgical procedures. Reimbursement for physicians depending on wRVUs is fair for commonly performed surgeries.

Utilization Management and Physician Burnout

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

A Novel Approach to Attribute Responsible Physicians Using Inpatient Claims

The authors propose a novel approach in which physicians’ responsibility for inpatient stays is expressed through physician-specific attribution ratios informed by patient characteristics.

A “Sludge Audit” for Health System Colorectal Cancer Screening Services

A systematic, mixed methods “sludge audit” identified novel health system delivery targets for improving colorectal cancer screening services.