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Insurance-Related Differences in Chronic Conditions Data Warehouse Comorbidities of Medicare Beneficiaries

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

Workforce Innovation Reduces Medicaid Costs in Chronic Care

This study of community health workers as clinical extenders demonstrates significant cost savings in managing chronic conditions among Medicaid beneficiaries.

Predicting Hospital Readmission in Medicaid Patients With Diabetes Using Administrative and Claims Data

A statistical model based entirely on claims data can accurately predict 30-day hospital readmission in Medicaid patients with diabetes.

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.

Relationships Between Patient Portal Activation and Patient Satisfaction Scores Among CG-CAHPS and HCAHPS Respondents

Patients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.

Care Transitions for Young Adults With Special Health Care Needs

A Medicaid managed care plan developed a pilot program to assist special needs youth with transition to adult care. Case studies and discussion present findings.

Provider Perceptions of Pharmacists in Primary Care–Based Accountable Care Organizations

In this article, the authors describe their experiences addressing provider perceptions and methods to overcome several challenges to clinical pharmacist integration in primary care–based accountable care organizations.

Implementing Team-Based Telemedicine Workflows in Safety-Net Primary Care

Telemedicine in safety-net primary care faces particular challenges. Consistent, team-based workflows can support video visit implementation and health care maintenance in telemedicine visits.

Managed Care Considerations for the Treatment of Chronic Cough

OneOncology’s Platform Approach to Deliver CAR T Therapies in Community Practices

OneOncology is using a community-based platform approach to catalyze broader access to care for patients with cancer while also advancing scientific discovery.

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.

Teamwork Enhances Patient Experience: Linking TEAM and Net Promoter Scores

In 1386 providers, better teamwork related to higher patient Net Promoter Score (NPS), and the relationship between provider experience and NPS was mediated by teamwork.

Effects of Adjunctive Cariprazine Formulary Restrictions in Major Depressive Disorder

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Mental Health Service Utilization Review Patterns in a Medicaid Managed Care Program

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Implementing Clinical Informatics Tools for Primary Care–Based Diabetic Retinopathy Screening

The authors describe a primary care–based diabetic retinopathy screening program incorporating telemedicine, strong health information technology engagement, and development of clinical informatics tools.

Improving Care Coordination and Reducing ED Utilization Through Patient Navigation

A navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.

Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Pharmacist-Led Review of Empagliflozin and Ertugliflozin Following Formulary Update

Management of empagliflozin and ertugliflozin may be suboptimal following an insurance carrier’s formulary updates. Pharmacists may improve the management.

Managing Total Knee Replacement Under Value-Based Payments

This 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.

Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary Rounds

Patients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.

Pharmacogenomics for Improved Outcomes and Decreased Costs in Health Care

Economic Burden of Osteoporotic Fractures: The Tip of the Iceberg?

The economic burden of osteoporotic fractures may be much higher than estimated: just the tip of the iceberg. In this letter, we suggest that the cost of these fractures might be underestimated by considering only direct medical cost.

Hospitals’ Strategies to Reduce Costs and Improve Quality: Survey of Hospital Leaders

Hospitals pursue a broad range of efforts to improve quality, with those participating in bundled payments attempting to reduce postacute care to a greater degree than nonparticipants.

Using a Brief Tool to Assess Healthy School Environments: A Pilot Study

The authors evaluated a brief assessment tool that accountable care organizations can use to help elementary schools improve student nutrition and increase physical activity.

Impact of an Intensive Outpatient Clinic Model on Health Care Utilization and Cost

An intensive outpatient clinic model significantly reduced health care spending, hospital admissions, and emergency department visits among complex Medicaid patients over a 2-year period.

Top Reasons Dermatologists Value the AAD 2026 Annual Meeting

Key session speakers and abstract presenters share their highlights of attending AAD 2026.

Dual-Eligible Beneficiaries’ Grocery Supplemental Benefit Use and Health Care Utilization

Medicare Advantage grocery supplemental benefit use is associated with increased outpatient care, suggesting that policy changes allowing for nonmedical supplemental benefits could improve beneficiaries’ health, especially for dual-eligible beneficiaries.

Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History

A novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

How English- and Spanish-Preferring Patients With Cancer Decide on Emergency Care

Care delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.