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Translating Clinical Evidence Into Value-Based Payment Models: Pooled Analyses of Innovative Real-World Outcomes Agreements for Ticagrelor in the United States

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.

Pharmacists and Transitions of Care From Emergency Department to Home

Pharmacists’ roles in transitions of care continue to evolve. Evaluation of pharmacist-led interventions as patients transition from emergency department to home is needed.

Contributor: Vulnerable Seniors Are at Risk With Looming Medicare Advantage Cuts—Income-Based Programs Can Minimize the Damage

In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering.

Repricing Fairly: Balancing MFN and Domestic Reforms

This commentary proposes a hybrid drug pricing reform model balancing most favored nation (MFN) benchmarking with domestic negotiation strategies that drive equity-focused valuation frameworks.

Impact of Food Affordability on Diabetes-Related Preventable Hospitalization

Medicaid enrollees residing in counties with greater food affordability had lower odds of preventable hospitalization related to diabetes.

Contributor: Association Between Social Deprivation, Race/Ethnicity, and Unplanned 30-Day Hospital Readmissions for Medicare Beneficiaries

Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical Care

The COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.

Reimagining the Inpatient Palliative Care Consult: Lessons From COVID-19

Digital innovations in palliative care during COVID-19 have changed how hospitalized patients receive palliative care. We propose an approach to implement new models at scale.

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.

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.

Adolescent Anterior Cruciate Ligament Reconstruction: A Decade of Rising Surgical Cost

Adolescent anterior cruciate ligament reconstruction surgery can preserve health and restore function of the knee joint, but the surgical cost has outpaced inflation.

Out-of-Pocket Spending for Cardiac Rehabilitation and Adherence Among US Adults

Among commercial and Medicare supplemental beneficiaries with cost sharing, higher out-of-pocket spending for the first cardiac rehabilitation session was associated with lower program adherence.

Value-Based Care Interventions and Management of CKD Progression

Patients with chronic kidney disease (CKD) stages 3b or 4 experienced slower decline in estimated glomerular filtration rate 20 months after enrollment in a value-based kidney care program.

Home Health Care Delivery, Outcomes Vary by Payment Model: Rachel A. Prusynski, DPT, PhD

Rachel A. Prusynski, DPT, PhD, discusses her study on how payment models affect home health care delivery and patient outcomes.

Temporal Shift in Prevalence of Heart Failure Diagnoses and Comorbidities Within 2 US Integrated Health Systems

The analysis highlighted a shift in heart failure diagnoses, with hypertensive heart disease with and without chronic kidney disease as prevalent diagnoses, underlining coding variability and implications for research.

Improving Outcomes and Mitigating Costs Associated With CAR T-Cell Therapy

Safety vs Price in the Generic Drug Market: Metformin

The generic drug market focuses on price. However, multiple generic metformin drugs have been recalled due to poor drug quality. The authors examine price and quality after these recalls.

Hospital Partnership and Patient Outcomes Among Postacute Patients With Stroke

This article explores the patient-sharing relationships between acute hospitals and postacute hospitals and how these relationships influence patient discharge outcomes.

Factors Associated With Unplanned Admissions Among Patients With Chronic Conditions

This study identified risk factors for unplanned admissions among patients with multiple chronic conditions to inform focused interventions.

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.

How AI and Machine Learning Can Bring Quality Improvements in Biopharma

Association Between Screening for Suspected COVID-19 Cases and Outcomes of Patients Revisiting the Emergency Department

Patients who revisit the emergency department shortly after discharge are at high risk for complications and death, exacerbated by COVID-19 screening workload. Detection efforts impact outcomes.

Medicare Coverage of Buprenorphine-Naloxone Film Surrounding Generic Entry

Medicare plans are replacing brand-name buprenorphine-naloxone film with its generic equivalents, resulting in a decrease in out-of-pocket cost faced by enrollees with opioid use disorder.

Medicare Advantage in Rural Areas: Implications for Hospital Sustainability

This retrospective cohort study of rural hospitals found that Medicare Advantage penetration increased substantially from 2008 to 2019 and was associated with greater hospital sustainability.

Contributor: A Crisis in Public Health—Addressing the Exodus From Our Essential Workforce

Public health professionals are the backbone of our health system, and their contributions are vital to the well-being of our communities. As a society, we must value their work, provide the support they need, and ensure that public health remains a rewarding and viable career choice.

Premium Tax Credits in the American Rescue Plan and Off-Marketplace Enrollees

We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.

Investigating Real-world Consequences of Biases in Commonly Used Clinical Calculators

Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.

Hospitalization Patterns Among Older Patients With Cancer With and Without Dementia

Dementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.

Choosing Wisely Interventions to Reduce Antibiotic Overuse in the Safety Net

This study evaluates the impact of Choosing Wisely–based interventions on antibiotic prescribing for viral respiratory tract infections in a real-world safety-net setting.