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Comparing Spending Across Medicare ProgramsAs Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.
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Addressing STIs Through Managed Care: Opportunities in Medicaid and BeyondMedicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.
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Inappropriate Wrist MRI: Did Guidelines Have an Impact?This article analyzes the use of MRI in a national sample of patients with wrist pain before and after consensus guideline publication.
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Tailoring HS Treatment: The Path to Better Patient OutcomesA panelist discusses how clinicians should systematically adopt evidence-based hidradenitis suppurativa (HS) guidelines while maintaining flexibility to tailor treatments to individual patient needs, severity levels, and comorbidities. This involves regular monitoring of updated recommendations, implementing standardized assessment tools, and considering patient-specific factors such as lifestyle, preferences, and treatment response history to optimize therapeutic outcomes through a personalized medicine approach.
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Use of Voluntary Alignment in the Next Generation ACO ModelUse of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.
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COVID-19 Control in the United States: The Case for MaskingIn the control of COVID-19, the future perfect of the vaccine should not be the enemy of the present good, which is masking.
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Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and CostsThe Diabetes Care Rewards program offers a business case for health plans to promote engagement through use of contingent incentives, thus improving health outcomes and lowering costs.
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An Accelerated Hospital Observation Pathway to Reduce Length of Stay for Patients With COVID-19For select patients hospitalized due to COVID-19, an academic urban hospital implemented an observation pathway that incorporated mobile health technology, reducing hospital length of stay by more than 2 days.
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Contributor: The Future of Prior Authorization Under the Improving Seniors’ Timely Access to Care ActStreamlining the prior authorization process can improve care accuracy and patient access to care, writes Siva Namasivayam, CEO of Cohere Health.
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Preventive Care: Vaccines MatterA database of information about more than 30,000 patients verified improved morbidity and mortality due to vaccines and preventive health care in prospective trials.
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Cost-effectiveness of a 3-Year Tele-Messaging Intervention for Positive Airway Pressure UseLong-term tele-messaging was more effective than no messaging and short-term messaging for positive airway pressure use, and it was highly likely to be cost-effective with an acceptable willingness-to-pay threshold.
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Understanding Insurance Coverage Policies for Incretin Mimetics for Weight ManagementThe high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
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Budget Impact Analysis of Biosimilar Natalizumab in the USProjected savings from biosimilar natalizumab were $452,611 over 3 years, driven by decreased drug acquisition costs and a utilization shift from reference to biosimilar natalizumab.
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Value-Based Care Through Postacute Home Health Under CMS PACT RegulationsAmong 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.
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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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Association Between Use of Clinician Performance Information and Patient ExperienceHigh patient experience scores were associated with the collection and use of any clinician performance information, especially with whether the practice shared this information internally to compare.
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Continuity of Opioid Prescribing Among Older Adults on Long-term OpioidsAmong older adults with chronic noncancer pain on long-term opioid therapy, greater continuity of opioid prescribing was significantly associated with fewer opioid-related adverse outcomes.
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Rising Use of Surveillance Colonoscopy and Potential ImpactsThe proportion of colonoscopies performed for postpolypectomy surveillance has increased significantly, particularly among older patients with limited life expectancy, raising concern for possible overuse.
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Industry-Informed Perspectives on the Benefits of Rideshare-Based Medical TransportationPrevious research on rideshare-based nonemergency medical transportation has limited generalizability due to the specific model studied, and the lack of trip-level data raises concerns of ecological fallacy.
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Evaluating Satisfaction With Pharmacist-Provided MTM Services in a Medicaid PopulationMedication therapy management (MTM) services were performed with a cohort of Medicaid patients, and their satisfaction with the program was assessed as part of a quality improvement initiative.
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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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Closing PerspectivesExperts discuss how to evaluate the cost-effectiveness of continuous glucose monitoring (CGM) compared to traditional monitoring, considering both clinical and quality outcomes, and what combination of economic and quality data would most effectively support broader CGM adoption across health systems and payer organizations.
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Consumer-Centric Approach to Enhance Access to Pediatric Specialty CareThe authors’ organization optimized scheduling techniques that improved patient access to pediatric specialists to within 7 calendar days for new patients.
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An Assessment of Nurse Practitioner Low-Value Care Use in Primary CarePrimary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.
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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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Primary Care Nurse Practitioner Management of Adolescent Behavioral HealthPersonnel costs ($90,514) of a primary care–embedded adolescent behavioral health nurse practitioner over 2 years were 63% of the potential revenue generated ($144,449).
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How Value-Based Care With Provider Enablement Improves Maternal and Infant Outcomes in MedicaidSupported value-based care improves prenatal care while reducing neonatal intensive care unit stays, preterm birth rates, low birth weight rates, and costs for mothers and infants.
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Addressing Cancer Care Barriers Through Community Outreach and SupportFebruary 4 is World Cancer Day, and in these interviews with our Strategic Alliance Partner, NYU Langone Health, we learn about the importance of forming strong relationships with the communities you are located in and with whom you work to optimize cancer-related outcomes.
