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American Journal of Managed Care

Joel S Weissman, Michael L Millenson, R Sterling Haring
Although patient-centered care (PCC) was proclaimed a core health system aim in a 2001 Institute of Medicine report, it remains one of the most-used and least-understood terms in healthcare. We interviewed leaders at 15 Medicare accountable care organizations (ACOs) across the country that have been the most successful in putting patient-centeredness into actual practice to develop an operational definition. The ACOs we spoke with had a 3-pronged practical approach of: 1) patients as partners, 2) proactive customer-service orientation, and 3) care coordination with a whole-person approach...
January 1, 2017: American Journal of Managed Care
Laura G Burke, Thomas C Tsai, Jie Zheng, E John Orav, Ashish K Jha
OBJECTIVES: To address concerns that expanding insurance coverage without expanding provider supply can lead to worse access for the previously insured, we examined whether previously insured Medicaid beneficiaries faced greater difficulties accessing primary care after statewide insurance expansion in Massachusetts. STUDY DESIGN: We used the Medicaid Analytic eXtract databases for Massachusetts and 3 New England control states for 2006 and 2009. We calculated rates of overall, acute, and chronic preventable admissions (or Prevention Quality Indicators [PQIs]) and a composite of control conditions for adults aged 21 to 64 years...
January 1, 2017: American Journal of Managed Care
Joanna P MacEwan, Wes Yin, Satyin Kaura, Zeba M Khan
OBJECTIVES: To measure the value of survival gains attributable to the introduction of 3 novel therapies for myelodysplastic syndromes (MDS). STUDY DESIGN: Retrospective study of patients diagnosed with MDS in the Surveillance, Epidemiology and End Results Program (SEER) registry, clinical trial evidence for MDS therapies, and claims data. METHODS: We used multivariate Cox proportional hazards models to estimate the increase in survival associated with the introduction of the 3 new therapies for patients diagnosed with MDS from 2001 to 2011 in the SEER cancer registry...
January 1, 2017: American Journal of Managed Care
Ibrahim Hakim, Sejal Hathi, Archana Nair, Trishna Narula, Jay Bhattacharya
OBJECTIVES: To determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings. STUDY DESIGN: We analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey. METHODS: We estimated logistic regressions to determine the relationship between EHR utilization and the volume of laboratory and imaging tests ordered in our study population, controlling for age, sex, race, clinic type, payer type, health status, comorbidities, and new patients...
January 1, 2017: American Journal of Managed Care
Justin Blackburn, David J Becker, Michael A Morrisey, Meredith L Kilgore, Bisakha Sen, Cathy Caldwell, Nir Menachemi
OBJECTIVES: We analyzed a standard children's quality measure for attention-deficit/hyperactivity disorder (ADHD) using data from a single state to understand the characteristics of those meeting the measure, potential barriers to meeting the measure, and how meeting the measure affected outcomes. STUDY DESIGN: Retrospective study using claims from Alabama's Children's Health Insurance Program from 1999 to 2012. METHODS: We calculated the quality measure for ADHD care, as specified within CMS' Child Core Set and with an expanded denominator...
January 1, 2017: American Journal of Managed Care
Thomas J Philipson, Julia Thornton Snider, Ayman Chit, Sarah Green, Philip Hosbach, Taylor Tinkham Schwartz, Yanyu Wu, Wade M Aubry
OBJECTIVES: To determine the lifetime social value of using the guideline-recommended vaccines for children born in the United States in 2009. STUDY DESIGN: This study utilized an economic model with parameter values sourced from clinical and observational data, as well as the literature. METHODS: The model quantified the health effects of routine vaccination for 14 diseases in terms of quality-adjusted life-years (QALYs) saved. The health effects were then valued by applying an economic value of a QALY...
January 2017: American Journal of Managed Care
Jennifer Karweit, Srividya Kotapati, Samuel Wagner, James W Shaw, Steffan W Wolfe, Amy P Abernethy
OBJECTIVES: With the introduction of more effective anticancer agents that prolong survival, there is a need for new methods to define the clinical value of treatments. The objective of this preliminary qualitative and quantitative analysis was to assess the utility of an expanded portfolio of survival metrics to differentiate the value of anticancer agents. STUDY DESIGN: A literature review was conducted of phase 3 trial data, reported in regulatory submissions within the last 10 years of agents for 6 metastatic cancers (breast cancer, colorectal cancer [CRC], melanoma, non-small cell lung cancer [NSCLC], prostate cancer [PC], and renal cell cancer [RCC])...
January 2017: American Journal of Managed Care
Patricia J Zettler, Erin C Fuse Brown
In this article, we consider the problem of financing highly effective and cost-effective prescription drugs within a value-based pricing system. Precisely because these drugs are highly effective, their value-based prices may be quite expensive; and moreover, the value-based price of a cure ought to be set high enough to create incentives for innovation, otherwise these beneficial therapies may be underdeveloped. However, in our fragmented health insurance system, where patients move frequently between payers, these payers generally lack the incentives to pay value-based prices for cures because they cannot ensure that they will reap the long-term economic benefits...
January 2017: American Journal of Managed Care
Yuhua Bao, Thomas G McGuire, Ya-Fen Chan, Ashley A Eggman, Andrew M Ryan, Martha L Bruce, Harold Alan Pincus, Erin Hafer, Jürgen Unützer
OBJECTIVES: To assess the role of value-based payment (VBP) in improving fidelity and patient outcomes in community implementation of an evidence-based mental health intervention, the Collaborative Care Model (CCM). STUDY DESIGN: Retrospective study based on a natural experiment. METHODS: We used the clinical tracking data of 1806 adult patients enrolled in a large implementation of the CCM in community health clinics in Washington state. VBP was initiated in year 2 of the program, creating a natural experiment...
January 2017: American Journal of Managed Care
Tracy Onega, Jennifer S Haas, Asaf Bitton, Charles Brackett, Julie Weiss, Martha Goodrich, Kimberly Harris, Steve Pyle, Anna N A Tosteson
OBJECTIVES: Breast cancer screening guidelines and metrics are inconsistent with each other and may differ from breast screening practice patterns in primary care. This study measured breast cancer screening practice patterns in relation to common evidence-based guidelines and accountability metrics. STUDY DESIGN: Cohort study using primary data collected from a regional breast cancer screening research network between 2011 and 2014. METHODS: Using information on women aged 30 to 89 years within 21 primary care practices of 2 large integrated health systems in New England, we measured the proportion of women screened overall and by age using 2 screening definition categories: any mammogram and screening mammogram...
January 2017: American Journal of Managed Care
A Jay Holmgren, Vaishali Patel, Dustin Charles, Julia Adler-Milstein
OBJECTIVES: To assess US hospital engagement in the 4 core domains of interoperability (find, send, receive, integrate) and whether engaging in these domains is associated with electronic availability of clinical data from outside providers. STUDY DESIGN: Retrospective analysis of survey data. METHODS: Analysis of the American Hospital Association (AHA) Annual Survey of Hospitals and the American Hospital Association (AHA) Annual Survey of Hospitals - IT Supplement datasets for 2014...
December 1, 2016: American Journal of Managed Care
Christopher A Harle, Nicole M Marlow, Siegfried O F Schmidt, Jonathan J Shuster, Alyson Listhaus, Roger B Fillingim, Robert W Hurley
OBJECTIVES: Given its complexity, chronic noncancer pain presents an opportunity to use health information technology (IT) to improve care experiences. The objective of this study was to assess whether integrating patient-reported outcomes (PROs) data in an electronic health record (EHR) affects provider and patient satisfaction with chronic noncancer pain care. STUDY DESIGN: We conducted a pragmatic cluster randomized trial involving 4 family medicine clinics. METHODS: We enrolled primary care providers (PCPs) and their patients with chronic noncancer pain...
December 1, 2016: American Journal of Managed Care
Michele Mesiano, Meghna Parthasarathy, Shari L Hutchison, David Salai, Suzanne Daub, Mary Doyle, James M Schuster
OBJECTIVES: As defined by the Affordable Care Act, health homes seek to improve healthcare coordination through data exchange and health information technologies; however, few examples of how to use such technology are available. The present effort describes a payer-provider patient registry for behavioral health home service. STUDY DESIGN: An observational study design was used to describe characteristics of individuals identified by the payer-provider patient registry...
December 1, 2016: American Journal of Managed Care
Brian J Miller, Derek W Moore, Chester W Schmidt
Telehealth platforms, which include both competitors and complements to traditional care delivery, will offer many benefits for both consumers and clinicians, and may promote increased specialization and competition in service delivery. Traditional medical services providers face a challenge similar to that faced by traditional taxicabs after Uber entered the marketplace: how to compete with a connection services platform that threatens to disrupt existing, regulated, and licensed service providers.
December 1, 2016: American Journal of Managed Care
Kitty S Chan, Hadig Kharrazi, Megha A Parikh, Eric W Ford
OBJECTIVES: To assess the importance of commonly identified issues in electronic health record (EHR) implementation using item response theory (IRT). STUDY DESIGN: Secondary data from the 2012 American Hospital Association's Annual Survey Information Technology Supplement were used in the analyses. Results were compared and contrasted with the standard descriptive statistic frequencies that have been used to guide most recommendations made using the same data. METHODS: IRT was used to measure the magnitude of difficulty that particular challenges pose in implementing EHRs that meet federal guidelines for Meaningful Use...
December 1, 2016: American Journal of Managed Care
Yiye Zhang, Rema Padman
OBJECTIVES: This study illustrates a systematic methodology to embed medical costs into the exact flow of clinical events associated with chronic care delivery. We summarized and visualized the results using clinical and cost data, with the goal of empowering patients and care providers with actionable information as they navigate through a multitude of clinical events and medical expenses. STUDY DESIGN: We analyzed the electronic health records (EHRs) and medication cost data of 288 patients from 2009 to 2011, whose initial diagnoses included chronic kidney disease stage 3, hypertension, and diabetes...
December 2016: American Journal of Managed Care
Daniel M Walker, Arthur M Mora, Ann Scheck McAlearney
OBJECTIVES: The aim of this study was to evaluate health information technology (IT) adoption in hospitals participating in accountable care organizations (ACOs) and compare this adoption to non-ACO hospitals. STUDY DESIGN: A cross-sectional sample of US nonfederal, acute care hospitals with data from 3 matched sources: the 2013 American Hospital Association (AHA) Annual Survey, the 2013 AHA Survey of Care Systems and Payments (CSP), and the 2014 AHA Information Technology Supplement...
December 2016: American Journal of Managed Care
Joshua R Vest, Christopher A Harle, Titus Schleyer, Brian E Dixon, Shaun J Grannis, Paul K Halverson, Nir Menachemi
The United States' decade-long transition from a paper- to technology-based information infrastructure has always been recognized as an initial step-a laying of the foundation-for future changes to the delivery of care. An increasingly important focal area for improvement is population health. Numerous policies and programs now require healthcare organizations to manage the risks, outcomes, utilization, and health of entire groups of individuals. Nonetheless, current health information technology (IT) systems are not ready to support population health improvements effectively and efficiently...
December 2016: American Journal of Managed Care
Hannah Rettler, Monina Klevens, Gillian Haney, Liisa Randall, Alfred DeMaria, Johanna Goderre
Eighty-six percent of those engaged in HIV medical care in Massachusetts achieved viral suppression, making Massachusetts's long-term goal of eliminating new infections of HIV a real possibility. In order to achieve this goal, Massachusetts is working to engage all individuals living with HIV/AIDS in HIV medical care, keep them retained in care, and render their viral load non-detectable. Currently, in Massachusetts, the data elements necessary to monitor the HIV care continuum are documented in siloed health information systems that do not communicate with each other...
December 2016: American Journal of Managed Care
Joshua R Vest
No abstract text is available yet for this article.
December 2016: American Journal of Managed Care
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