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Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.
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 is not associated with health literacy. Personal perception of threat was associated with reduced vaccine hesitancy.
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.
Medicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.
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.
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.
In a cross-sectional study of US hospitals, patient financial assistance and billing policy documents averaged 10th-grade readability scores, with variation significantly associated with several attributes.
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.
CMS must account for inclusion of COVID years in 2023 ACO REACH benchmarks to avoid unfairly penalizing REACH ACOs.
Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.
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.
Associations between intervention dosage and hospital use outcomes were observed among patients enrolled in a care management program serving individuals with complex needs.
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.
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.
This supplement was supported by AstraZeneca.
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.
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.
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.
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.
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.
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.
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.
Although the vast majority of physicians using an artificial intelligence (AI) scribe perceived a reduction in documentation time, those with the most actual time savings had higher relative baseline levels of documentation time.
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.
Courtney Dean, MBA, is managed care contracting regional director for TheUS Oncology Network.
How Value-based Care Is Changing Radiation Oncology for the Better
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’ roles in transitions of care continue to evolve. Evaluation of pharmacist-led interventions as patients transition from emergency department to home is needed.
