Authors

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

Contributor: Roadmap to the Quadruple Aim—A Framework for Minimizing Physician Burnout During the Transition to Value-Based Care

As provider and payer organizations pursue the Quadruple Aim, it is important that they take into account not just the contracting but also the transformation in staffing, clinical workflows, and culture as these organizations evolve.

Modeling of an Alternative Reimbursement Method for Palliative Care

The authors modeled a version of the Patient and Caregiver Support for Serious Illness alternative reimbursement structure for palliative care using data from the Statin Trial.

Real-World Users of Triple Therapy for Asthma in the US

This retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.

Physician-Pharmacy Integration in Cancer Care: Pillars of Medically Integrated Pharmacy

The foundation of medically integrated pharmacy includes 7 critical pillars. This commentary focuses on the benefits of 3 of those pillars: abandonment, adherence, and access/affordability.

The Price of Progress: Understanding Innovation and Affordability of Prescription Drugs

Economic incentives and patent protections drive development of innovative medications. Drug prices are determined by consumer demand, not production costs. Therefore, governmental regulation risks future investment in research and development.

External Validation and Adaptation of the Cambridge Multimorbidity Score Using German Claims Data

The Cambridge Multimorbidity Score was adapted to ICD-10 and demonstrated better predictive performance than the Charlson Comorbidity Index in German primary care claims data.

Antibiotic Practice Patterns With Procalcitonin Levels in Patients With Acute Lower Respiratory Tract Infection

Although clinical trials have demonstrated the utility of procalcitonin (PCT) testing and potential benefit on antibiotic stewardship, findings suggest that clinicians do not order PCT testing with regularity and also prioritize clinical judgment over PCT results.

Hyperlipidemia: Effective Disease Management With a Focus on PCSK9 Inhibitors

Cost-effectiveness of Nivolumab in Patients With NSCLC in the United States

This article presents a cost-effectiveness analysis of nivolumab vs docetaxel from the US payer perspective in non–small cell lung cancer (NSCLC) based on randomized phase 3 studies with a minimum 5 years of follow-up.

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.

The Effect of Medicaid Reimbursement for Psychiatrists on the Health Care Burden of Serious Mental Illness

This analysis compared health care resource utilization and costs for Medicaid patients with serious mental illness between US states with low vs high reimbursement rates for psychiatric services.

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.

State Medicaid Budgetary Implications of New Cancers

The authors used Medicaid claims data to quantify program spending, use of services, and enrollment patterns among Medicaid beneficiaries newly diagnosed with a metastatic vs a nonmetastatic cancer.

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.

Blood Pressure Control Among Adherent vs Nonadherent Medicare Patients With Hypertension

This study evaluated whether adherence to a hypertension quality measure correlates with actual blood pressure control. Findings reveal misalignment between adherence metrics and clinical outcomes.

Musculoskeletal Quality Collaborative Improves Value-Based Health Care Delivery Across Hospital System

Implementation of surgeon-led Musculoskeletal Quality Collaborative protocols reduced high-cost consumable utilization without compromising patient safety. Systemwide collaboratives can reduce high-cost consumable utilization while maintaining low infection rates.

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