
5 Findings From the August 2019 Issue of AJMC®
The August issue of The American Journal of Managed Care® (AJMC®) featured research on surprise medical billing policies, social determinants of health, and the value of chimeric antigen receptor T-cell therapies, among other topics. Here are 5 findings from research published in the issue.
The August issue of The American Journal of Managed Care® featured research on surprise medical billing policies, social determinants of health, and the value of chimeric antigen receptor (CAR) T-cell therapies, among other topics. Here are 5 findings from research published in the issue.
1. CAR T-cell treatment delays result in loss of social value
Treatment with CAR T-cell therapy provides significant benefit to patients with 2 types of cancers and results in billions of dollars gained in social value, according to this
The study authors wrote that current barriers to CAR T-cell treatment, including lack of coverage and manufacturing challenges, should be eliminated to enable prompt patient access to curative therapies. “Efficient payment mechanisms, sufficient technological capabilities, adequate capital and human capital, and payment policy reform are required to minimize treatment delays for patients,” they concluded.
2. California’s policy to address surprise medical billing affected bargaining dynamics
With the problem of surprise medical billing receiving nationwide attention, a
This change in contracting dynamics is accelerating the trend of physician consolidation, interviewees reported, and has prompted concerns about access to care if specialists stop practicing in the state due to lower payments. The author noted that these experiences can inform policy making as several proposals to stop surprise billing are being debated at the federal level.
3. Patients with self-identified social needs have higher odds of hospital readmission
By examining claims data and data collected from a social health surveillance system, the authors of this
The investigators wrote that the social health surveillance function discussed in the study, which is a managed care organization’s call center—based social service referral program, “highlights the potential for nonclinical organizations to support medical and social care integration.” They called for further research on the relationship between social health needs and readmissions.
4. Moving to an area with less access to chiropractic care linked to higher spine care spending
Back pain and neck pain represent a significant source of healthcare visits and costs in the United States, and this
Although the savings per person were small, the study authors noted that they could accumulate into significant savings, considering the large volume of older Americans with spine conditions. Because chiropractors deliver more conservative management of back pain, future studies could determine if chiropractic care access “breaks the pathway to care that is discordant with practice guidelines.”
5. Late diagnosis of hepatitis C represents missed opportunities for intervention
Prompt detection and treatment of hepatitis C virus (HCV) is key to achieving improved outcomes, but many infections are not diagnosed until cirrhosis or end-stage liver disease occurs, representing missed opportunities to intervene earlier in the disease process, according to this
“This study supports the finding that patients with undiagnosed cirrhosis are being followed in health systems for years prior to receiving a diagnosis of HCV, but waiting until it is clear that severe liver disease is present is a failed strategy for reducing morbidity and health costs,” the authors concluded. They pointed to opportunities for payers and providers to take an active role in facilitating recommended HCV screening in hopes of alleviating the economic and health burdens of late diagnosis.
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