Authors

A Kidney Diagnostic’s Impact on Physician Decision-making in Diabetic Kidney Disease

The KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.

Coordinating Specialty Care Across Health Systems: Primary Care Provider Survey

Even with significant organizational investment in cross-system coordination, primary care providers report a range of challenges in coordinating care with specialists in other health systems.

The Biosimilar Shift: Trending Infliximab Biosimilar Utilization and Associated Cost Savings for Commercial Insurance

Infliximab biosimilars created price competition causing insurance claims costs for infliximab originator and infliximab biosimilars to decrease, generating significant savings to the health care system.

Telemedicine Catches On: Changes in the Utilization of Telemedicine Services During the COVID-19 Pandemic

This analysis of health insurance claims data demonstrates rapid increase and sustained high utilization of telemedicine services during the COVID-19 pandemic.

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.

Potential Impact of Hospital at Home on Postoperative Readmissions

Many postoperative readmissions are amenable to diversion to a hospital at home program for surgical patients, representing an opportunity to generate revenue and improve patient experience.

Mental Health Service Utilization Review Patterns in a Medicaid Managed Care Program

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Assessment of Structured Data Elements for Social Risk Factors

An expert panel identified and assessed electronic health record and health information exchange structured data elements to support future development of social risk factor computable phenotyping.

Diabetes Associated With Higher Health Care Utilization and Poor Outcomes After COPD-Related Hospitalizations

Patients with diabetes and chronic obstructive pulmonary disease (COPD) have worse outcomes when hospitalized and appear to be more vulnerable to respiratory and nonrespiratory complications after a COPD exacerbation, which highlights the need for targeted interventions in this population.

Characterizing Telehealth Use in the US: Analysis of the 2022 Health Information National Trends Survey

Patients’ motivations for telehealth use require further investigation to develop appropriate policies.

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.

Patient-Centered Oncology Care: Impact on Utilization, Patient Experiences, and Quality

Practices implementing a patient-centered oncology care pilot had improved quality, but utilization and patient experiences did not differ from comparison practices.

Evaluating Smoking Cessation Service at an Emergency Department Clinical Observation Unit

This study aimed to evaluate the impact of a smoking cessation service in a group of patients admitted to a short-stay unit in the emergency department.

Evaluation of Institutional Practices for Medication Access for Uninsured Patients

The authors assessed charitable care spending for a 1-month supply of medications at discharge. One-third of the cost was spent on medications for which a more sustainable coverage method exists.

“Can You Hear Me Now?”: Postoperative Patient-Initiated Communication With Providers

Patient-provider communication after surgery is critical for patient safety. The growth of patient-provider communication technologies has created opportunities to study postoperative patient-initiated communication.

Association Between Use of Clinician Performance Information and Patient Experience

High patient experience scores were associated with the collection and use of any clinician performance information, especially with whether the practice shared this information internally to compare.

Integrating Predictive Models Into Care: Facilitating Informed Decision-Making and Communicating Equity Issues

As predictive models proliferate, providers and decision makers require accessible information to guide their use. Preventing and combating bias must also be priorities in model development and in communication with providers and decision makers.

An Outpatient Critical Care Transition Clinic Model Reduces Admissions/Readmissions in Medically Complex Patients

Critical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.

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.

Medication Persistence and Its Impact on Type 2 Diabetes

Most newly treated patients with type 2 diabetes exhibit suboptimal medication persistence, which is associated with higher risk of hospitalization and increased medical costs.

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

HEDIS Glycemic Goal Achieved Using Control-IQ Technology

A greater proportion of patients with type 1 diabetes who used automated insulin delivery systems vs multiple daily injections achieved the Healthcare Effectiveness Data and Information Set (HEDIS) glycemic measure.

Contributor: Medicare Policy Proposal Jeopardizes Care for Those on Dialysis

CEOs of 3 kidney care organizations explain flaws in CMS' recent reimbursement proposal.

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.

Modeling Financial Outcomes and Quantifying Risk in Episode-Based Payment Models

This article provides a description of prospective financial simulation methodology and use cases with empirical data for episode-based bundled payments, including implications for contract negotiations and value-based care redesign.

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.

Review of the Clinical, Humanistic, and Economic Burden of Focal Segmental Glomerulosclerosis

Provider Capacity During Medicaid Expansion and a Public Health Emergency

This survey study finds that most Missouri Medicaid providers had capacity for new patients, even during a period of unprecedented Medicaid enrollment growth.

Contributor: Roadmap to the Quadruple Aim—A Framework for Minimizing Physician Burnout During the Transition to Value-Based Care

As provider and payer organizations pursue the Quadruple Aim, it is important that they take into account not just the contracting but also the transformation in staffing, clinical workflows, and culture as these organizations evolve.

Affordable Care Act Enrollment in Texas After Rating Area Adjustments

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.