From the Editorial Board, July 2019: Robert W. Dubois, MD, PhD
Insurers’ Perspectives on MA Value-Based Insurance Design Model
This article describes perspectives of Medicare Advantage (MA) insurers about participating in the CMS value-based insurance design model test launched in 2017.
Physician Satisfaction With Health Plans: Results From a National Survey
Several physician and payer characteristics are associated with physician satisfaction with health plans. There is opportunity to improve physician satisfaction with payers, specifically in pharmacy.
Precision Medicines Need Precision Patient Assistance Programs
The competing strategies of patient assistance programs and co-pay accumulator adjustment programs create confusion and administrative burden for clinicians and patients, potentially reducing adherence to clinically indicated services and worsening patient outcomes.
Impact of a Co-pay Accumulator Adjustment Program on Specialty Drug Adherence
Commercial health plan initiation of a co-pay accumulator adjustment program for specialty medications treating autoimmune diseases was associated with significant reductions in medication adherence and persistence.
Evaluation of Interdisciplinary Geriatric Transitions of Care on Readmission Rates
An interdisciplinary transitions of care service composed of nurse navigators, pharmacists, and medical providers reduced 30-day hospital readmissions among patients who received all components of the intervention.
Real-Time Video Detection of Falls in Dementia Care Facility and Reduced Emergency Care
An artificial intelligence–enabled video fall detection system using visual science reduced emergency department visits by 80% in 6 communities over 3 months.
Medicare’s Bundled Payment Model Did Not Change Skilled Nursing Facility Discharge Patterns
Hospital participation in Medicare’s Bundled Payments for Care Improvement model was not associated with changes in number of skilled nursing facility (SNF) partners or in SNF discharge concentration.
Number of Manufacturers and Generic Drug Pricing From 2005 to 2017
Regardless of the number of manufacturers, generic drug prices presented double-digit average increases from 2012 to 2015.
Changing Demographics Among Populations Prescribed HCV Treatment, 2013-2017
From 2013 to 2017, the population of US patients prescribed treatment for chronic hepatitis C virus (HCV) changed, becoming predominantly treatment-naïve and having received care in nonacademic centers.
Heroin and Healthcare: Patient Characteristics and Healthcare Prior to Overdose
An analysis of administrative claims showed increasing rates of heroin overdose among an insured population and opportunities for interventions during healthcare encounters before overdose.
What Are the Potential Savings From Steering Patients to Lower-Priced Providers? A Static Analysis
Steering patients who visit providers with above-median prices to their market’s median-priced provider would save 42%, 45%, and 15% of laboratory, imaging, and durable medical equipment spending, respectively.
Healthcare Network Analysis of Patients With Diabetes and Their Physicians
Network analyses of patients with diabetes in Hawaii illustrate structures and links that health plans could leverage to strengthen quality improvement and disease management programs.
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