Authors

The Extent and Growth of Prior Authorization in Medicare Advantage

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

A Scoping Review of US Insurers’ Use of Patient-Reported Outcomes

This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.

Avoiding Surgical Resection of Recurrent BRAF V600E–Mutated Iodine-Refractory Papillary Thyroid Cancer Involving Trachea/Thyroid Cartilage via Resensitization With Dabrafenib and Trametinib: Report of 3 Cases

Physician Prices and Low-Value Services: Evidence From General Internal Medicine

This study found extensive variation in general internal medicine physician prices and that high-priced physicians provided fewer low-value services but had higher spending on these services.

The Impact of HDHPs on Service Use and Spending for Substance Use Disorders

Offering a high-deductible health plan (HDHP) led to a 6.6% reduction in the probability of using substance use disorder services and a shift in spending from the plan to the enrollee.

The Relationship Between Preventive Dental Care and Overall Medical Expenditures

Using an instrumental variable approach, this study is the first to present causal estimates of the effect of preventive dental visits on overall medical expenditures.

Potential Impact of Loss of Coverage for Health Care Screenings: Constance Blunt, MD

Constance Blunt, MD, medical oncologist, Mary Bird Perkins Cancer Center, discusses the potential consequences of losing free health care screening coverage.

At-Home Hemoglobin A1c Testing During COVID-19 Improved Glycemic Control

Providing at-home hemoglobin A1c test kits increases testing rates and facilitates hemoglobin A1c reduction over time among members of a large commercial health plan with diabetes.

Participating Faculty: Rethinking Heart Failure: Patient Classification and Treatment

Investigating Real-world Consequences of Biases in Commonly Used Clinical Calculators

Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.

Assessing Opportunities to Advance Quality Measures in Adult Obesity

Obesity is a serious chronic disease and risk factor for a broad range of outcomes. This study identifies opportunities for improving quality in obesity care.

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.

Contributor: Maintaining the Doctor-Patient Connection During the COVID-19 Pandemic

Christine Ko, MD, professor of dermatology and pathology at Yale University, reflects on her use of telehealth and how it allowed her to establish and maintain emotional connections with her patients, all at high risk of skin cancer.

Limited English Proficiency, Cardiovascular Risk Factors, Cardiovascular Disease, and In-Hospital COVID-19 Outcomes

This study evaluated whether limited English proficiency modifies the association between cardiovascular risk factors or cardiovascular disease and outcomes in patients hospitalized with COVID-19.

Factors Associated With Persistent High Health Care Utilization in Managed Medicaid

Schizophrenia, chronic pain, and multiple medical diagnoses at enrollment into a large managed Medicaid system are associated with long-term high health care utilization.

Access to Consultative Dermatologic Care via Physician-to-Physician Asynchronous Outpatient Teledermatology

Direct access of primary care physicians to dermatologists via asynchronous teledermatology improves a health system’s ability to increase patient access to dermatologic care.

Noninvasive Ventilation at Home Reduces Mortality in COPD With CRF

This study explores the association between receiving noninvasive ventilation at home and mortality, hospitalizations, and emergency department visits in patients with chronic obstructive pulmonary disease (COPD) with chronic respiratory failure (CRF).

Chronic Overlapping Pain Conditions and Long-term Opioid Treatment

Little is known about opioid prescribing patterns in patients with chronic overlapping pain conditions. This study suggests target populations for interventions to manage chronic pain.

Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical Care

The COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.

Treatment Patterns for Patients With Advanced/Metastatic Cancers by Site of Care

Treatment patterns and overall survival were similar regardless of site of care between patients receiving anticancer therapy in the hospital outpatient vs physician office setting.

Care Management Improves Total Cost of Care for Patients With Dementia

Compared with usual care, a dementia care management program improved various cost of care and utilization metrics in a Medicare managed care population at 12 months.

Impact of the Patient-Centered Medical Home on Consistently High-Cost Patients

Patient-centered medical homes in Maryland’s multipayer demonstration disrupted the pattern of recurrently high expenditure among the costliest patients and improved continuity of care.

Medical Costs for Managing Chronic Kidney Disease and Related Complications in Patients With Chronic Kidney Disease and Type 2 Diabetes

Psoriatic Arthritis Treatment Patterns and Costs Among Pharmacologic Treatment–Naïve Patients

We present results of an analysis of IBM MarketScan databases that evaluates treatment patterns and health care costs for treatment-naïve patients with psoriatic arthritis.

PQA Annual Meeting: Quality Emerges From the Pandemic, Focused on Access and Equity

The Pharmacy Quality Alliance's 2022 annual meeting will return to an in-person format after 2 years. The meeting with include timely topics: quality beyond the pandemic, health equity, and remote care

A Learning Health Care Community: Integrating Research and Practice at Scale

This article presents a case study of how stakeholders in one state came together to integrate practice and research that is a step beyond a learning health care system.

Out-of-Pocket Costs for Diabetes Medications in Employer-Sponsored Health Insurance Plans

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

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.

Remote Monitoring Saves Costs in Outpatient Negative Pressure Wound Therapy

Health insurance records of patients using negative pressure wound therapy (NPWT) revealed lower adjusted 90-day wound-related costs with remote therapy monitoring vs NPWT alone.

Diagnosis Patterns and Stress Testing Trends After Implementing High-Sensitivity Troponin Assay

This study found that switching from a conventional troponin assay to a high-sensitivity troponin assay resulted in changes to diagnosis patterns and stress testing trends.