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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.

Aligning the Stars: Quality Metrics Must Evolve From Screening Rates to Diagnostic Resolution

Quality metrics for screening tests must evolve to mandate diagnostic resolution, ensuring financial and clinical incentives prioritize the complete screening continuum over initial test uptake.

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.

Factors Associated With Unplanned Admissions Among Patients With Chronic Conditions

This study identified risk factors for unplanned admissions among patients with multiple chronic conditions to inform focused interventions.

Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections

Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.

Outcomes of Antiviral Treatment for Influenza in Type 2 Diabetes

Antiviral treatment was associated with lower health care resource utilization and costs in patients with type 2 diabetes and a diagnosis of influenza.

A Cue-to-Action Pilot Project to Increase Screening Mammography

A targeted cue-to-action campaign of outreach, education, and incentive can improve uptake of screening mammography.

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.

Senate Introduces Bill to Extend 5% Incentives for APMs

The bipartisan bill would help lower Medicare costs and improve quality of care, according to the National Association of ACOs.

Medicare Advantage–Pharmacy Partnership Improves Influenza and Pneumococcal Vaccination Rates

Patients whose pharmacy receives notification of their immunization gap have twice the odds of receiving immunizations compared with those whose pharmacy does not receive the notification.

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary Rounds

Patients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.

Trends in Market Share Among Hospitals Participating in ACOs and Nonparticipants

Accountable care organization (ACO) participation was associated with an increase in hospitals’ mean market share and with additional market share gains in more concentrated markets.

Perspectives on Nonmedical Switching and the COVID-19 Pandemic: A Narrative Review

This review describes the impact of nonmedical switching of biologic therapies on US patients and providers, with a focus on switching to in-class alternatives.

Contributor: CMS Can Seize Opportunities to Fix the Rural Glitch, Risk Adjustment Caps in MSSP

The Medicare Shared Savings Program (MSSP) has seen its growth slow, but CMS has an opportunity to act on proposals that would address benchmarking and more fairly allocate savings to accountable care organizations in the program.

Appropriate ED Utilization Leading to Better Care Coordination

Addressing avoidable emergency department (ED) utilization takes interventions in partnership with providers.

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.

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.

Implementation and Cost Validation of a Real-time Benefit Tool

This study evaluates impact of a real-time benefit tool on medication access and physician and pharmacy workflows at a large academic medical center.

The Strategic Necessity of Pharma-MedTech Convergence in an Era of Precision Medicine

Better integration of pharma and medical technology is necessary to enhance patient outcomes and drive value-based care.