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Managing Total Knee Replacement Under Value-Based PaymentsThis article describes the approach that a large primary care group at risk for value-based payments chose to deploy in managing clinical and financial outcomes of knee osteoarthritis jointly with orthopedic surgeons.
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Implementation and Cost Validation of a Real-time Benefit ToolThis study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.
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Factors Associated With Persistent High Health Care Utilization in Managed MedicaidSchizophrenia, chronic pain, and multiple medical diagnoses at enrollment into a large managed Medicaid system are associated with long-term high health care utilization.
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The Impact of Health Benefit Design on Patients With InfertilityThis retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy outcomes.
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Potential Health Literacy Resources for Health Plans: A Narrative ReviewSeveral evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.
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A Learning Health Care Community: Integrating Research and Practice at ScaleThis article presents a case study of how stakeholders in one state came together to integrate practice and research that is a step beyond a learning health care system.
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Medical Policy Determinations for Pharmacogenetic Tests Among US Health PlansThis analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.
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Actions to Improve Quality: Results From a National Hospital SurveyHospitals reported widespread adoption of quality improvement (QI) changes to improve on CMS quality measures, and QI adoption was associated with improved performance on quality measures.
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Factors Associated With Lung Cancer Risk Factor DocumentationThis cross-sectional observational study found several factors associated with whether a patient had sufficient lung cancer risk factor documentation in the electronic health record.
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Cardiovascular Disease Risk Management During COVID-19: In-Person vs Virtual VisitsThis article compares cardiovascular disease risk management in community clinics during the COVID-19 pandemic among patients for whom primary care was delivered mostly in person vs mostly virtually.
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Patterns of Opioid Use in Commercially Insured Patients With CancerAmong the fewer than half of patients with cancer who received opioid fills, a relatively small proportion (2.5%) had potentially problematic opioid use.
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5 Key Takeaways on Medicaid Policy Changes From Savista’s Chief Strategy OfficerLaxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.
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Projected US Savings From Biosimilars, 2021-2025Projected 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.
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Transitional Care Management Visits to Improve Coordination of CareInspira 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.
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Diabetes, Gaps in Care Coordination, and Preventable Adverse EventsThe authors examined the association of diabetes with self-reported gaps in care coordination and self-reported preventable adverse events using data from a national sample of older adults.
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Medicare Accountable Care Organizations Reduce Spending on SurgeryMedicare Shared Savings Program accountable care organizations spent less on surgical care by reducing inpatient surgery, increasing outpatient surgery, and reducing spending on postacute care after inpatient surgery.
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How AI, Data Analytics, and Outcomes-Based Contracts Are Shaping Health Care: Laura Bobolts, PharmD, BCOPLaura Bobolts, PharmD, BCOP, senior vice president of clinical strategy and growth at OncoHealth, shares how health care leaders are advancing value-based care through improved data strategies, real-world evidence, and AI-driven efficiencies, without losing the human touch.
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Navigating Compounded Semaglutide: What Health Care Providers Need to KnowThis article reviews the safety, efficacy, and regulatory concerns related to compounded semaglutide, with a focus on how health care providers can offer guidance and education to patients.
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Contributor: Transforming Prior Authorization to Facilitate Quality CarePayers must continue to assess their prior authorization practices to uphold the goals of clinical quality, safety, and utilization management.
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Gaps in the Coordination of Care for Older Adults With or at Risk for Cardiovascular DiseaseOlder adults with cardiovascular disease (CVD) or CVD risk factors report that gaps in communication among their providers are common and hazardous.
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A “Sludge Audit” for Health System Colorectal Cancer Screening ServicesA systematic, mixed methods “sludge audit” identified novel health system delivery targets for improving colorectal cancer screening services.
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Regional Market Factors and Patient Experience in Primary CarePatient-provider communication quality metrics at safety net hospitals are indirectly affected by changes in regional market factors that influence patients’ demand for care.
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An Outpatient Critical Care Transition Clinic Model Reduces Admissions/Readmissions in Medically Complex PatientsCritical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.
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Insurance Payer Is Associated With Length of Stay After Traumatic Brain InjuryAmong hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.
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Policy Solutions to Facilitate the New eCQM ACO Reporting and Advancement of InteroperabilityThis article describes the challenges associated with aggregating and reporting quality data via electronic health records and discusses corresponding policy solutions.
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Preventive Cardiology Through Fresh Eyes: Highlights From ASPC’s 2025 CongressThe American Society for Preventive Cardiology (ASPC) marked its 40th anniversary this year at the ASPC Congress on CVD Prevention in Boston, held August 1-3, with 3 days of debates, presentations, oral abstracts, and posters.
