Authors
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Patient Assignment and Quality Performance: A Misaligned SystemThis article explores the congruence between payer patient assignment and quality performance and the implications for incentive payments in alternative payment models.
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Trends in Medicare Part D Coverage of Generics With Equivalent Brand-Name DrugsHigh-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.
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Spending Patterns Among Commercially Insured Individuals During the COVID-19 PandemicIn this analysis of more than 97 million commercially insured individuals, investigators found that the COVID-19 pandemic induced a spending shock in 2020 and that health care spending did not recover to baseline until mid-2021.
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Why Collaborative Care Is the Path Forward for Mental Health Care: Anna Bob, MPHExplore how the Collaborative Care Model enhances mental health access in this episode featuring Anna Bob, MPH, executive director of the Path Forward coalition.
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What Value Do Teaching Hospitals Provide Commercial Beneficiaries When in an ACO?Accountable care organizations (ACOs) with a major teaching hospital were associated with lower mortality, lower inpatient spending, lower emergency department utilization, and higher overall outpatient spending.
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High-Intensity Home-Based Rehabilitation in a Medicare Accountable Care OrganizationHigh-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.
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Future Research Directions for Revakinagene Taroretcel in MacTelCharles C. Wykoff, MD, PhD, Retinal Consultants of Texas, spoke to the current state of research on revakinagene taroretcel in macular telangiectasia type 2 (MacTel), as well as the importance of patient groups for the rare condition.
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Removing Medicare’s Outpatient Ban and Medicare and Private Surgical TrendsThis article documents a 100% increase in privately insured outpatient knee replacement surgeries following Medicare’s decision to remove knee replacements from its Inpatient Only list.
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Considerations to Increase Rates of Breast Cancer Screening Across PopulationsAuthors from the Community Oncology Alliance and Avalere Health present data that show breast cancer screening rates recovered more slowly among some racial/ethnic groups following on the onset of the COVID-19 pandemic.
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Primary Care Visit Cadence and Hospital Admissions in High-Risk PatientsPatients with congestive heart failure and/or chronic obstructive pulmonary disease who had more quarterly primary care visits had lower rates of hospitalizations during the COVID-19 pandemic.
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Contributor: Providers and Patients Push Back, Payers Push Forward—Co-pay Mitigation ProgramsResearch shows how commercial health plans impact payer trends in the co-pay landscape and provides key areas that pharmaceutical and biotech manufacturers can explore to ensure patient access.
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AI-Driven Clinical Support Tools Show Promise in Alleviating Provider Burnout and Workflow ChallengesStephen Speicher, MD, and Kate Estep, from Flatiron Health, discuss the future of oncology care with artificial intelligence (AI).
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Clinical Profile of COVID-19 Infection in Postvaccination IndividualsThis article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.
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TCD Screening and Spending Among Children With Sickle Cell AnemiaA substantial proportion of families of privately insured children with sickle cell anemia pay more than $100 for essential stroke screenings, a high-value service.
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Neulasta Onpro: A Coup de Grâce?With the rapid decline in average sales price of reference pegfilgrastim products due to biosimilar competition, health care institutions and payers may grapple with coverage of Neulasta Onpro.
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Educating on Menin InhibitorsPanelists emphasize that effective use of menin inhibitors for KMT2A-rearranged acute myeloid leukemia (AML) requires dispelling common misconceptions about oral targeted therapy, ensuring close monitoring for adverse effects, clarifying treatment goals—especially the role of transplant—and supporting patients through comprehensive education and multidisciplinary care.
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Health Insurance, Blood Cancer Care, and Outcomes: A Literature Reviewdoi: 10.37765/ajmc.2021.88733
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Closing Thoughts: Evolving Treatment Paradigms in Menopause ManagementPanelists express their gratitude for the informative discussion and share their final thoughts on the evolving landscape of menopause management and the potential impact of new therapies on improving patient outcomes.
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Mobile Health Clinic: Lessons Learned Building Partnerships Across Health SystemsEstablishing mobile health clinics in rural settings requires collaboration across health systems by aligning missions, building infrastructure to support research, and demonstrating proof of concept.
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Hospital Discharge Diagnosis Position: Impact on Adult Pneumonia Burden EstimatesDisease burden estimates of pneumonia-associated hospitalizations are more sensitive when including pneumonia coded in any diagnosis field vs in only the first discharge diagnosis field.
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Contributor: Beyond a One-Size-Fits-All for Managed Care Plan BenchmarksComparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.
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Financial Crossroads of Care: Physicians’ Struggle and Patient OutcomesIn 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.
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Statin Prescribing Patterns in Patient-Centered Medical Home Patients With NAFLDIn this study, authors assessed the proportion of patients with nonalcoholic fatty liver disease (NAFLD) receiving prescriptions for statins in primary care.
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When Does Nonadherence Indicate a Deviation From Patient-Centered Care?The authors suggest that assessment of patient-centered care may be improved by flagging probable discordance between a patient’s preferences and their treatment care plan.
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Primary Care Referrals to Nephrology in Patients With Advanced Kidney DiseasePrimary care physicians did not refer the majority of patients with severe nephropathy to specialists; nonreferred patients had fewer comorbidities and might be better kidney transplant candidates.
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Navigation and Clinician Payment Investments Enhance Colorectal Cancer Screening BenefitsInvesting in patient navigation and clinician incentives ensures colorectal cancer screening completion, improves early detection, reduces disparities, achieves cost savings, and advances population health for all stakeholders.
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Closing Thoughts on Iron Deficiency AnemiaPanelists discuss how the successful management of iron deficiency anemia requires a comprehensive approach combining early detection, appropriate choice of iron formulation, careful monitoring of treatment response, and addressing barriers to care while emphasizing the importance of patient education and health care system support in achieving optimal outcomes.
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Evaluating Alternative Methods of Comparing Antihypertensive Treatment IntensityMedication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.
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Evaluation of a Collaborative Model Between Managed Care and Affordable Housing on Acute Care CostsA collaborative service model between a managed care organization and an affordable housing provider reduced acute care use and costs.
