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Mortality Risk Stratification Can Predict Readmissions but Not Length of Stay

Mortality risk stratification can identify patients at higher risk of mortality and readmissions for prevention strategies. Other patients should be the focus of length-of-stay reduction strategies.

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.

Expert Perspectives on the Role of Real-World Evidence, Patient-Reported Outcomes, and Economic Models in Oncology Formulary Decision and Regulatory Submissions for FDA Approval

A Q&A With Bhakti Arondekar, PhD, MBA; Alexander Niyazov, PharmD, MPH; and Jay Weaver, PharmD, MPH

An Assessment of Nurse Practitioner Low-Value Care Use in Primary Care

Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.

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.

COVID-19 Vaccine Hesitancy and Health Literacy in US Southern States

COVID-19 vaccine hesitancy is not associated with health literacy. Personal perception of threat was associated with reduced vaccine hesitancy.

Racial/Ethnic Differences in Autoimmune Disease Prevalence in US Claims/EHR Data

This analysis uses claims and electronic health records from 2021 to examine racial and ethnic variations in immune-mediated inflammatory diseases in the United States.

ACA Medicaid Expansion Association With Racial Disparity Reductions in Timely Cancer Treatment

Medicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.

Multilevel Influences on Patient Engagement and Chronic Care Management

Health systems may be better able to support adoption of chronic care management processes, which have a strong evidence base for practice implementation, compared with patient engagement strategies, which have less evidence to guide effective implementation.

Value-Based Management of Specialty Drugs: Practical Considerations and Implications for Pharmacy

Policy makers and health plans seek value-based management of specialty drugs. This study examines real-world factors that favor some approaches over others and their potential impact.

Hypoglycemia Upon Hospital Admission From Long-term Care: Health Care Resource Use

This analysis of a hospital billing database describes inpatient length of stay, intensive care unit length of stay, comorbidities, and costs for patients with diabetes after admission with hypoglycemia from long-term care or home.

Contributor: COVID-19’s Impact on ACO REACH Deserves CMS' Attention

CMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.

Final Thoughts on Arrhythmia Management

Experts agree that developing value-based care models for atrial fibrillation requires collaborative, data-driven strategies—leveraging clinical pharmacists for personalized medication management and prioritizing stroke prevention and rhythm control—while embracing innovation and workforce redesign to balance quality, cost-effectiveness, and avoid overdiagnosis in an evolving health care landscape.

Challenges Faced by Medicaid Managed Care Coordinators Working With Members With Substance Use Disorder

Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.

Dosage and Outcomes in a Complex Care Intervention

Associations between intervention dosage and hospital use outcomes were observed among patients enrolled in a care management program serving individuals with complex needs.

Economic Burden of Joint Disease in Psoriasis: US Claims Analysis

This retrospective claims analysis found that concomitant joint disease in psoriasis is associated with greater health care resource utilization and health care costs than psoriasis alone.

An Accelerated Hospital Observation Pathway to Reduce Length of Stay for Patients With COVID-19

For 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.

Choosing Wisely Interventions to Reduce Antibiotic Overuse in the Safety Net

This study evaluates the impact of Choosing Wisely–based interventions on antibiotic prescribing for viral respiratory tract infections in a real-world safety-net setting.

Strategies for Improving Transitions of Care for Patients With Diabetes: An Interview With Jennifer N. Clements, PharmD

Jennifer N. Clements, PharmD, is a clinical pharmacist in diabetes transition with Spartanburg Regional Healthcare System in Spartanburg, South Carolina. Clements is a board-certified pharmacotherapy specialist, board-certified ambulatory care pharmacist, and certified diabetes care and education specialist. She is currently developing a pharmacy service focused on the inpatient management of diabetes. An editor from The American Journal of Managed Care® recently conducted an interview with Clements to discuss strategies for improving transitions of care for patients with diabetes.

Cost Savings From an mHealth Tool for Improving Medication Adherence

The Wellth smartphone app significantly increased medication adherence and lowered unnecessary health care utilization and costs over 9 months among Medicaid beneficiaries who were self-managing chronic conditions.

Removing Medicare’s Outpatient Ban and Medicare and Private Surgical Trends

This 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.

Quality, Health, and Spending in Medicare Advantage and Traditional Medicare

In a review of literature published since the Affordable Care Act’s passage, more than half of analyses find that Medicare Advantage outperforms traditional Medicare on quality, health, and cost outcomes.

Predicting Drug-Drug and Drug-Gene Interactions in a Community Pharmacy Population

The probability of drug interactions increases when genetic polymorphisms are considered, indicating that pharmacogenetic assessment may be useful in predicting the presence and severity of interactions.

Insurer Costs of COVID-19 by Disease Severity and Duration

Payer costs for COVID-19 ranged from a mean of $505 for asymptomatic cases to $126,094 for severe cases with post–COVID-19 condition.

Agreement Among Measures Examining Low-Value Imaging for Low Back Pain

This study demonstrates the need for additional consensus surrounding how to translate guideline recommendations to administrative measures assessing imaging overuse for acute low back pain.

Alternative Payment Models Can Stabilize and Improve Practice Radiation Reimbursement

How Value-based Care Is Changing Radiation Oncology for the Better

Coverage With Evidence Development: Where Are We Now?

Review of CMS’ coverage with evidence development program exposes a need to improve program transparency and clarify requirements and timetables for reporting to improve access to novel therapies.

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.

Participating Factulty: Real-World Impact of Infliximab Precision-Guided Dosing on Management of Patients With IBD

Two Steps Forward, One Step Back: 50 Years of Societal Value From LDL-C–Lowering Therapies

Low-density lipoprotein cholesterol (LDL-C)–lowering therapies have yielded significant value to society through reduced costs for both fatal and nonfatal cardiovascular disease events. The vast majority of this value has accrued to patients.