July 2019

This article describes perspectives of Medicare Advantage (MA) insurers about participating in the CMS value-based insurance design model test launched in 2017.

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.

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.

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.

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.

An artificial intelligence–enabled video fall detection system using visual science reduced emergency department visits by 80% in 6 communities over 3 months.

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.

Regardless of the number of manufacturers, generic drug prices presented double-digit average increases from 2012 to 2015.

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.

An analysis of administrative claims showed increasing rates of heroin overdose among an insured population and opportunities for interventions during healthcare encounters before overdose.

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.

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.