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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.

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.

RSV Vaccines Demonstrate Sustained Effectiveness for Older Adults

RSV vaccines protected older adults against RSV-related hospitalization over 2 seasons, although with less effectiveness for those with immunocompromise or cardiovascular disease.

AI’s Promise in Ophthalmology Comes With Responsibilities: Ravi D. Goel, MD

Ambient AI and analytics may ease clinical workloads and uncover insights, but safety, validated data, HIPAA compliance, and equity must guide adoption.

Geographical Variation in Kidney Function Testing and Associations With Health Care Costs Among Patients With Chronic Kidney Disease and Type 2 Diabetes

Neulasta Onpro: A Coup de Grâce?

With the rapid decline in average sales price of reference pegfilgrastim products due to biosimilar competition, health care institutions and payers may grapple with coverage of Neulasta Onpro.

Disparities in Surgical Outcomes in Medicare Advantage vs Traditional Medicare

This study evaluated differences in racial and ethnic disparities in surgical outcomes between Medicare Advantage and traditional Medicare beneficiaries, finding consistent but nonuniform smaller disparities within Medicare Advantage.

Using Natural Language Processing to Classify Social Work Interventions

Natural language processing can be used for automated extraction of social work interventions from electronic health records, thereby supporting social work staffing and resource allocation decisions.

Longitudinal, Relationship-Based Case Management: A Prospective Cohort Trial

A longitudinal, relationship-based case management approach significantly reduced health care costs and improved quality of life for Medicaid enrollees with complex needs over 1 year.

Cost Analysis of Self-Monitoring Blood Glucose in Nonintensively Managed Type 2 Diabetes

Analysis of claims data showed reduced utilization and costs among patients with nonintensively managed type 2 diabetes using self-monitoring of blood glucose compared with continuous glucose monitoring.

Containing Chronic Disease Costs With the Ambulatory Specialty Model

The Ambulatory Specialty Model aims to reduce chronic disease costs by mandating specialist participation and tying payments to quality and cost, while posing nationwide risk challenges.

A Conceptual Framework for Addressing Social Needs Through the Accountable Health Communities Model

No published studies exist on use of intervention design, implementation strategies, and theory in the CMS Accountable Health Communities Model, the largest-scale test of social prescribing in the United States.

Addressing Evolving Patient Concerns Around Telehealth in the COVID-19 Era

With a rapid shift to telehealth during the coronavirus disease 2019 (COVID-19) pandemic, clinicians, health care organizations, and policy makers must consider and address patients’ evolving needs, concerns, and expectations.

Charitable Medication Distribution Improves Care for Uninsured Patients With Diabetes

This report illustrates how providing vital diabetes medications to uninsured patients through a charitable medication distributor improves clinical outcomes.

Patient Perspectives on Technology-Based Approaches to Social Needs Screening

Patients are essential stakeholders in designing systems to capture social needs. The authors present key findings from patient interviews regarding social needs screening through technology-based modalities.

Cost of Behavioral Messaging Interventions for Cardiovascular Medication Adherence

This article evaluates the programmatic cost of 3 behavioral mobile messaging interventions aimed at improving cardiovascular medication adherence in The Nudge Study.

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.

High-Risk Care Management Impact on Medicaid ACO Utilization and Spending

In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.

Potentially Inappropriate Medication Use Following Hospital Discharge Among Medicare Beneficiaries

Despite financial incentives for Medicare Advantage (MA) plans to reduce potentially inappropriate medication use post hospitalization, this study found that MA does not provide a clear advantage over traditional Medicare.

Development and Validation of the COVID-19 Hospitalized Patient Deterioration Index

The authors developed and validated an accurate, well-calibrated, easy-to-implement COVID-19 hospitalized patient deterioration index to identify patients at high or low risk of clinical deterioration.

How Will Provider-Focused Payment Reform Impact Geographic Variation in Medicare Spending?

Unlike ACOs or P4P, implementation of bundled payment for inpatient and post acute care in Medicare would modestly reduce geographic variation in spending.

Effectiveness and Cost-Effectiveness of Diabetes Prevention Among Adherent Participants

Over 10 years, among adherent participants, lifestyle intervention and metformin were effective and cost-effective for diabetes prevention compared with placebo.

The Arkansas Payment Improvement Initiative: Early Perceptions of Multi-Payer Reform in a Fragmented Provider Landscape

Arkansas has implemented multi-payer payment reform incorporating both episodic and Patient-Centered Medical Home models. Early perceptions of a sample of stakeholders were largely positive to date.

Work-up for Diverticulitis

The Community Assessment Risk Screen (CARS): Identifying Elderly Persons at Risk for Hospitalization or Emergency Department Visit

In Controlling Diabetes and Obesity, Employers Have Opportunities

A Nurse-Based Pilot Program to Reduce Cardiovascular Risk Factors in a Primary Care Setting

Effective Implementation of Collaborative Care for Depression: What Is Needed?

Factors most important for successful implementation of collaborative care for depression differ for patient activation versus achieving remission; both are critical to program success.