AJMC® Research Roundup: October 2019

Hi, I’m Christina Mattina for The American Journal of Managed Care^®. Here are 5 findings from research published in the October issue.

Variation in US Private Health Plans’ Coverage of Orphan Drugs

1. Health plans are less likely to restrict coverage of orphan drugs than nonorphan drugs, but the frequency of orphan drug restrictions varied widely across plans, from 11% to 65%. Orphan drugs that had higher annual costs and were indicated for diseases with a higher prevalence were more likely to have coverage restrictions.

Ease of Ordering High- and Low-Value Services in Various Electronic Health Records

2. A survey found no association between the clinical value of a service and how easy it is for a physician to order it in the electronic health record, suggesting that a redesign of these systems may change the workflow to facilitate the use of more high-value care and less low-value care.

Can Accountable Care Divert the Sources of Hospitalization?

3. Oregon’s Medicaid accountable care delivery model was linked to reductions in hospital admissions, especially preventable admissions, among women of reproductive age. The coordinated care organizations created by the model offer incentives to emphasize primary care and encourage quality improvement.

Physician Clinical Knowledge, Practice Infrastructure, and Quality of Care

4. The level of infrastructure within a physician practice is related to care quality outcomes, but that association is moderated by physicians’ score on the Maintenance of Certification exam, suggesting that physician skill and knowledge is important for translating infrastructure into better patient outcomes.

Real-World Outcomes Among Patients With Early Rapidly Progressive Rheumatoid Arthritis

5. For patients with early, rapidly progressive rheumatoid arthritis, treatment with first-line abatacept, compared with a first-line tumor necrosis factor inhibitor, was associated with lower healthcare resource use in the first 6 months of treatment and higher odds of achieving low disease activity within 100 days of treatment initiation.

To read all of these studies and more, visit AJMC.com.