February 2022

This study compares the impact of the 3 different out-of-pocket maximums proposed in Congress and by the Medicare Payment Advisory Commission.

This retrospective study evaluated real-world implementation of the updated CDC HIV algorithm in a large US laboratory.

Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.

Among a patient population defined by CMS postacute care transfer regulations, home health vs no postacute care was associated with reduced 30-day readmissions and costs.

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Although clinical trials have demonstrated the utility of procalcitonin (PCT) testing and potential benefit on antibiotic stewardship, findings suggest that clinicians do not order PCT testing with regularity and also prioritize clinical judgment over PCT results.

Up to one-fifth of Medicare beneficiaries were unable to access health care due to the COVID-19 pandemic in 2020.

This article evaluates the immediate and long-term efficacy of a group multidisciplinary program for chronic opioid analgesic therapy cessation in the setting of chronic, noncancer pain.

This paper utilizes latent class analysis to identify subgroups of complex conditions and of super-utilizers among health center patients to inform clinically tailored efforts.

Data-driven segmentation of high-risk patient populations may inform health system interventions, but results are dependent on the data sources and methods applied.

The authors of this editorial highlight some of the myths surrounding complex care management, identify areas where research could be most informative, and recommend best next steps in developing effective and efficient complex care management programs.

Health insurance records of patients using negative pressure wound therapy (NPWT) revealed lower adjusted 90-day wound-related costs with remote therapy monitoring vs NPWT alone.

One-third of health care in the United States is wasted. Despite this recognition, solutions are sparse. The Optimal Care model combines evidence-based medicine, patient-centered technology, and outcomes reporting to transform health care.