Authors

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.

Care Fragmentation Predicts 90-Day Durable Ventricular Assist Device Outcomes

This analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.

Tackling Mental Health in the Workplace

Health Outcomes Under Full-Risk Medicare Advantage vs Traditional Medicare

Physician groups under 2-sided risk–based Medicare Advantage provide care associated with higher quality and efficiency compared with care by these same groups under fee-for-service Medicare.

Patients’ Access to 2018 FDA-Approved Drugs 1 Year Post Approval

2018 was a landmark year for new drug approvals. However, patients’ access to these novel drugs varied by drug category and enrolled health plan.

Impact of Telemedicine Use on Outpatient-Related CO2 Emissions: Estimate From a National Cohort

Telemedicine was associated with a monthly avoidance of greenhouse gas emissions equivalent to the emissions of 61,255 to 130,076 passenger vehicles.

Medical Home Visit Programs During COVID-19 State of Emergency

This report highlights the unique challenges faced by home health programs in addition to discussing how technology and policy changes have helped the elderly homebound during the coronavirus disease 2019 (COVID-19) pandemic.

Long-Chain Fatty Acid Oxidation Disorders: Managed Care and Specialty Pharmacy Implications

Implementation of Early Follow-up Care After Heart Failure Hospitalization

An early heart failure follow-up intervention succeeded in increasing referral to and completion of cardiology appointments within 7 days of discharge. The intervention was associated with lower risk of 30-day all-cause emergency department visits, all-cause hospitalizations, or death.

Hospital Discharge Diagnosis Position: Impact on Adult Pneumonia Burden Estimates

Disease 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.

Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

Mortality Risk Stratification Helps Identify Patients With COVID-19 at Risk of Adverse Outcomes

Mortality risk stratification can identify patients with COVID-19 who are at higher risk of mortality, discharge to skilled nursing facility, and readmission, and may benefit from focused intervention strategies.

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

Contributor: How Medication Risk Scores Improve Health for Medicare Beneficiaries

Medication risk scores analyze an individual’s medication regimen to look for the potential for simultaneous, multi-drug interactions, which can cause adverse drug events and other medication-related harms.

A Machine Learning Technology for Addressing Medication-Related Risk in Older, Multimorbid Patients

A novel machine learning system effectively stratifies emergency department use and hospitalization risk of older patients with multimorbidity who take multiple medications and provides appropriate medication recommendations.

Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

Mandatory Medicare Bundled Payment and the Future of Hospital Reimbursement

The authors evaluate features of the Transforming Episode Accountability Model and discuss its benefits and limitations.

Association of the MedWise Risk Score With Health Care Outcomes

Factors That Increase Utilization Management Risk: A Proof of Concept

A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.

Reducing Readmissions in the Safety Net Through AI and Automation

Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.

Impact of Payment Models on Medical Specialist Physician Practice Patterns

This article explores the impact of payment models (fee for service vs salary based) on practice patterns, including wait times and care for patients with chronic diseases.

Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 Inhibitor

A collaboration between a drug plan and clinical pharmacists led to nearly 50% of members successfully switching to a preferred dipeptidyl-peptidase-4 inhibitor.

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.

Care Fragmentation Predicts 90-Day Durable Ventricular Assist Device Outcomes

This analysis evaluates the relationship between hospital care delivery network fragmentation and in-hospital and 90-day outcomes. These networks may be novel targets for improving outcomes.

Group Practice Strategies to Manage Pharmaceutical Cost in an HMO Network

Regulation of Provider Networks in Response to COVID-19

The authors describe federal and state provider network adequacy standards and discuss how regulators should adapt these standards and accompanying monitoring processes in response to coronavirus disease 2019 (COVID-19).

Activation, Physical Activity, and Outcomes Among Individuals With T2D

This study presents an integrated, exploratory assessment of physical activity, patient activation, health-related quality of life, and clinical outcomes among older adults with type 2 diabetes (T2D) using survey, wellness, and claims data.

Contributor: Data, Education, and Community: The Winning Formula for Addressing SDOH for Kidney Care Patients

Addressing patients with chronic kidney disease requires a commitment to data, education, and community, specifically in those affected by social determinants of health (SDOH).

Operating Room Efficiency of Orthopedic Surgery During the COVID-19 Era

The authors analyzed the impacts of COVID-19 on orthopedic operating room efficiency via comparison of 14,856 surgeries performed before, during, and after the pandemic.