Authors

Influence of Prior Authorization Requirements on Provider Clinical Decision-Making

An online survey identified that documentation requirements and communication issues with health plans are associated with providers modifying clinical decisions to avoid medication prior authorization.

Increasing Medicare Annual Wellness Visits in Accountable Care Organizations

Through innovations increasing the ease of scheduling and the efficiency of conducting annual wellness visits (AWVs), a large Medicare accountable care organization has been able to increase AWV rates among eligible beneficiaries.

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.

Inpatient-Outpatient Shared Electronic Health Records: Telemedicine and Laboratory Follow-up After Hospital Discharge

Using a seamlessly shared inpatient-outpatient electronic health record was associated with greater rates of postdischarge follow-up delivered through telemedicine or laboratory monitoring and without an in-person office visit.

Pharmacist Hypertension Management Using an Electronic Health Record–Based Approach

The authors studied the impact of a pharmacist intervention on blood pressure control compared with usual care.

Potential Health Literacy Resources for Health Plans: A Narrative Review

Several evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.

Clinical and Economic Outcomes of a Collaborative Cardiology Care Program

Patients with chronic cardiac conditions benefited from a health care program that strengthened collaboration between general practitioners and cardiology specialists in Baden-Wuerttemberg, Germany.

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.

Opportunities for Advancing Alopecia Areata Care Through Equitable Access

ACE Inhibitor or ARB Treatment Among Patients With Diabetes and Chronic Kidney Disease

Impact of Medical Care Coordination Intervention on Patient Activation

This observational evaluation compared an adult medical care coordination intervention with usual care and found that the intervention was associated with significant improvements in patient activation.

High-Need Beneficiary Enrollment Patterns in Medicare Advantage and Traditional Medicare

Accounting for 32% of all Medicare enrollees in 2019, high-need beneficiaries were more likely to be in traditional Medicare than Medicare Advantage.

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.

Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment Arrangements

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

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.