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5 Findings From the June 2019 Issue of AJMC®

Christina Mattina

The June issue of The American Journal of Managed Care® featured research on care coordination and low back pain therapy in addition to studies on its theme of oncology. Here are 5 findings from research published in the issue.

1. Care pathways continue to influence patient care and begin to integrate with other value-based initiatives

An update to a 2016 study assessing the care pathway landscape reviewed the newest evidence on the development and implementation of pathways and how they integrate with value-based care initiatives. The investigators reviewed the literature for relevant publications and conducted a targeted survey of individuals with pathway experience.

They found increased knowledge of and adherence to codified best practices, and they determined that high-quality evidence is being prioritized in pathway development. There is more evidence of integration with value-based initiatives, but more efforts are needed in that area and in educating patients on the significance of care pathways.

2. Care coordination programs reduce readmissions, improve HIV suppression rates

Two studies in this issue assessed the impacts of care coordination programs in different settings. A cohort study of a Medicaid managed care plan program found that targeting members with HIV using intensified outreach, care coordination, and peer support was associated with a greater likelihood of achieving viral load suppression than those who did not receive the intervention.

A study of a care transitions program for patients who underwent percutaneous coronary intervention found that the program improved rehospitalization rates for patients with Medicaid in the wealthiest zip codes, but patients with Medicaid in poorer zip codes and those with dual Medicare/Medicaid status had higher rates of rehospitalization.

3. Patients in restrictive plans less likely to choose conservative therapy for low back pain

Benefit design can affect whether patients with new-onset low back pain choose primary care or more conservative treatment, such as physical therapy or chiropractic care, according to this observational study of commercially insured adults. Patients with the most restrictive plan types and those with higher out-of-pocket costs were more likely to seek a primary care physician instead of conservative therapy. Conversely, patients with the least restrictive plan type were more likely to choose conservative therapy.

The study authors recommended that insurance benefits be designed to align with evidence-based guidelines that recommend early conservative therapy for low back pain. Such designs and policies should be “aimed at encouraging behaviors that will result in the largest long-term economic and social benefits.”

4. Medicare cancer care spending varies by site of chemotherapy

A retrospective claims analysis examined cancer-related spending and utilization based on whether a Medicare beneficiary initiated provider-administered chemotherapy in a hospital outpatient department (HOPD) or physician office (PO). Among other findings, the researchers determined that risk-adjusted spending on nonchemotherapy outpatient services was slightly lower for the HOPD group, but this group had higher inpatient spending than the PO group.

These differences in spending partially reflect care utilization, the authors noted. “As the number of patients receiving chemotherapy in HOPDs increases in Medicare, it will be important to continue examining differences in care patterns by care site and their implications for patient care and outcomes,” they concluded.

5. Following decision support recommendations for hospital discharge linked to improved outcomes

When clinicians followed the recommendation of a clinical decision support (CDS) algorithm that suggests a location for hospital discharge (ie, home, home with home healthcare services, or a postacute facility), patients had lower spending and fewer readmissions, with no change in emergency department use, according to the findings of this retrospective study. In particular, patients who were discharged to a more intense level of care than the recommendation had greater associated spending and readmissions.

The investigators called this study “an example of an innovative approach to care redesign under a bundled payment model.” In this context, CDS can help achieve judicious use of postacute resources, they wrote, which is especially important as postacute care spending constitutes a large portion of healthcare costs and is growing quickly.
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