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American Journal of Managed Care

Scott A Soefje
Managing chemotherapy-induced nausea and vomiting (CINV) is an opportunity for better clinical, economic, and humanistic outcomes. Clinicians working in managed care settings must understand background information about CINV's causes, likelihood, and treatment. They need to understand how CINV creates collateral damage (eg, psychological effects, electrolyte disturbances, dehydration, malnutrition, and esophageal injury). Patients with CINV are costly to treat and may be unable or unwilling to continue chemotherapy at doses needed...
October 2018: American Journal of Managed Care
James J Natale
The prevention of chemotherapy-induced nausea and vomiting (CINV) is critically important in reducing morbidity and total healthcare costs in patients receiving emetogenic chemotherapy. The different types of CINV (ie, acute, delayed, anticipatory, breakthrough, and refractory) are controlled through various pathways and neurotransmitters, so the pharmacologic approach to prevention and treatment varies based on the type of CINV. New therapeutic agents and combinations of agents have changed the dynamic of CINV control, and national guidelines have been recently updated based on current evidence...
October 2018: American Journal of Managed Care
Alan M Garber, Tej D Azad, Anjali Dixit, Monica Farid, Edward Sung, Daniel Vail, Jay Bhattacharya
OBJECTIVES: Low back pain (LBP) is a common and expensive clinical problem, resulting in tens of billions of dollars of direct medical expenditures in the United States each year. Although expensive imaging tests are commonly used, they do not improve outcomes when used in the initial management of idiopathic LBP. We estimated 1-year medical costs associated with early imaging of Medicare beneficiaries with idiopathic LBP. STUDY DESIGN: We used a 5% random sample of Medicare fee-for-service enrollees between 2006 and 2010 to determine 12-month costs following a diagnosis of idiopathic LBP...
October 1, 2018: American Journal of Managed Care
Nicholas Ballester, Pratik J Parikh, Michael Donlin, Elizabeth K May, Steven R Simon
OBJECTIVES: To develop an early warning discharge disposition prediction tool based on clinical and health services factors for hospitalized patients. Recent study results suggest that early prediction of discharge disposition (ie, whether patients can return home or require placement in a facility) can improve care coordination, expedite care planning, and reduce length of stay. STUDY DESIGN:  Retrospective analysis of inpatient data; development of multiple logistic regression model and an easy-to-use score...
October 1, 2018: American Journal of Managed Care
Hsueh-Fen Chen, J Mick Tilford, Fei Wan, Robert Schuldt
OBJECTIVES: To understand the association between agency-level CMS Hierarchical Condition Categories (HCC) risk scores and patient experience measures for home health. STUDY DESIGN: This was a cross-sectional study. METHODS: We extracted variables from the 2014 Medicare Provider Utilization and Payment Data for Home Health Agencies and Home Health Compare file. We applied fixed-effects models for the analyses. Our dependent variables included both global and composite patient experience measures...
October 1, 2018: American Journal of Managed Care
Michael L Barnett, Zirui Song, Asaf Bitton, Sherri Rose, Bruce E Landon
OBJECTIVES:  As US healthcare spending increases, insurers are focusing attention on decreasing potentially avoidable specialist care. Little recent research has assessed whether the design of modern health maintenance organization (HMO) insurance is associated with lower utilization of outpatient specialty care versus less restrictive preferred provider organization (PPO) plans. STUDY DESIGN: Observational study of Massachusetts residents aged 21 to 64 years with any HMO or PPO insurance coverage from 2010 to 2013...
October 1, 2018: American Journal of Managed Care
Peter W Crooks, Christopher O Thomas, Amy Compton-Phillips, Wendy Leith, Alvina Sundang, Yi Yvonne Zhou, Linda Radler
OBJECTIVES: To assess the association between optimal end-stage renal disease (ESRD) starts and clinical and utilization outcomes in an integrated healthcare delivery system. STUDY DESIGN: Retrospective observational cohort study in 6 regions of an integrated healthcare delivery system, 2011-2013. METHODS: Propensity score techniques were used to match 1826 patients who experienced an optimal start of renal replacement therapy (initial therapy of hemodialysis via an arteriovenous fistula or graft, peritoneal dialysis, or pre-emptive transplant) to 1826 patients who experienced a nonoptimal start (hemodialysis via a central venous catheter)...
October 1, 2018: American Journal of Managed Care
Laura Panattoni, Albert Chan, Yan Yang, Cliff Olson, Ming Tai-Seale
OBJECTIVES: To determine the impact on routine glycated hemoglobin (A1C) laboratory test completion of incorporating an autopend laboratory order functionality into clinical decision support, which (1) routed provider alerts to a separate electronic folder, (2) automatically populated preauthorization forms, and (3) linked the timing and content of electronic patient health maintenance topic (HMT) reminders to the provider authorization. STUDY DESIGN: Observational pre-post study from November 2011 (1 year before autopend) through June 2014 (1...
October 2018: American Journal of Managed Care
Amanda S Parsons, Varna Raman, Bronwyn Starr, Mark Zezza, Colin D Rehm
OBJECTIVES: To examine if Medicare reimbursements for the Diabetes Prevention Program (DPP) cover program costs. STUDY DESIGN: A retrospective modeling study. METHODS: A microcosting approach was used to calculate the costs of delivering DPP in 2016 to more than 300 patients from Montefiore Health System (MHS), a large healthcare system headquartered in Bronx, New York. Attendance and weight loss outcomes were used to estimate Medicare reimbursement...
October 2018: American Journal of Managed Care
Stephen M Shortell, Patricia P Ramsay, Laurence C Baker, Michael F Pesko, Lawrence P Casalino
OBJECTIVES: To assess whether the characteristics and capabilities of individual practices intending to join the early Medicare accountable care organization (ACO) programs differed from those of practices not intending to join. STUDY DESIGN: Data from a 2012-2013 national survey of 1398 physician practices were linked to 2012 Medicare beneficiary claims data to examine differences between practices intending to join a Medicare ACO and practices not intending to join a Medicare ACO...
October 2018: American Journal of Managed Care
Marlon P Mundt, Larissa I Zakletskaia
OBJECTIVES: This study seeks to determine how changes in electronic health record (EHR) communication patterns in primary care teams relate to quality of care and costs for patients with diabetes. STUDY DESIGN: EHR-extracted longitudinal observational study. METHODS: A total of 83 health professionals in 19 care teams at 4 primary care clinics associated with a large Midwestern university participated in the study. Counts of messages routed between any 2 team members in the EHR in the past 18 months were extracted...
October 2018: American Journal of Managed Care
Eva Chang, Diana S M Buist, Matt Handley, Eric Johnson, Sharon Fuller, Roy Pardee, Gabrielle Gundersen, Robert J Reid
OBJECTIVES: To measure changes in primary care physician (PCP) ordering rates for 4 global resource use measures before and after dissemination of physician feedback reports that provided peer-comparison resource use rates. We also explored whether physician practice characteristics (panel size, clinic size, and years of experience) were associated with resource use changes. STUDY DESIGN: Pre-post implementation study measuring physician resource use in an integrated healthcare system (2011-2014)...
October 2018: American Journal of Managed Care
Yamini Kalidindi, Jeah Jung, Roger Feldman
Our study provides the first evidence on site-specific Medicare spending on chemotherapy adjusting for patient comorbid illnesses, cancer type, and other cancer-related risks.
October 2018: American Journal of Managed Care
Lucio N Gordan, Debra Patt
The outpatient community oncology setting is consistently less costly for cancer treatment as opposed to the outpatient hospital setting.
October 2018: American Journal of Managed Care
Gary M Owens
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a symmetric demyelinating peripheral neuropathy with either a progressive or relapsing remitting course. CIDP is both debilitating and degenerative, leaving patients with functional impairment due to nerve damage in their extremities. Along with its medical burden, CIDP has a significant economic impact, with disease-related expenses and the often fairly high costs related to the immune therapies used to treat the disease. Costs for patients with this disorder often exceed those of other immune-mediated neuromuscular diseases...
September 2018: American Journal of Managed Care
Melody Ryan, Stephen J Ryan
First described almost 50 years ago, chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder characterized by progressive peripheral neuropathy. CIDP is difficult to diagnose, but early diagnosis can be crucial to prevent permanent nerve damage. Initial treatment options include corticosteroids, immunoglobulin given by intravenous administration, and therapeutic plasma exchange. Subcutaneous administration of immunoglobulin provides a new option for patients with CIDP that has the potential to increase independence and improve tolerability...
September 2018: American Journal of Managed Care
Reyan Ghany, Leonardo Tamariz, Gordon Chen, Elissa Dawkins, Alina Ghany, Emancia Forbes, Thiago Tajiri, Ana Palacio
OBJECTIVES: There are several models of primary care. A form of high-intensity care is a high-touch model that uses a high frequency of encounters to deliver preventive services. The aim of this study is to compare the healthcare utilization of patients receiving 2 models of primary care, ​1 with high-touch care and 1 without. STUDY DESIGN: Retrospective cohort study. METHODS: We conducted a retrospective cohort study of 2 models of care used among Medicare Advantage populations...
September 1, 2018: American Journal of Managed Care
Lisa M Kern, Joanna K Seirup, Mangala Rajan, Rachel Jawahar, Susan S Stuard
OBJECTIVES: We sought to determine the associations between fragmented ambulatory care and subsequent emergency department (ED) visits and hospital admissions, while considering possible interactions between fragmentation and number of chronic conditions. STUDY DESIGN: We conducted a cohort study over 3 years among 117,977 fee-for-service Medicare beneficiaries who were attributed to primary care physicians in a 7-county region of New York and had 4 or more ambulatory visits in the baseline year...
September 1, 2018: American Journal of Managed Care
Melony E Sorbero, Susan M Paddock, Cheryl L Damberg, Ann Haas, Mallika Kommareddi, Anagha Tolpadi, Megan Mathews, Marc N Elliott
OBJECTIVES: Studies have identified potential unintended effects of not adjusting clinical performance measures in value-based purchasing programs for socioeconomic status (SES) factors. We examine the impact of SES and disability adjustments on Medicare Advantage (MA) plans' and prescription drug plans' (PDPs') contract star ratings. These analyses informed the development of the Categorical Adjustment Index (CAI), which CMS implemented with the 2017 star ratings. STUDY DESIGN: Retrospective analyses of MA and PDP performance using 2012 Medicare beneficiary-level characteristics and performance data from the Star Rating Program...
September 1, 2018: American Journal of Managed Care
JaeJin An, Adrian Lau
OBJECTIVES: To evaluate the economic outcomes associated with patient perceptions of patient-centered medical home (PCMH) characteristics among long-term cancer survivors in the United States. STUDY DESIGN: A retrospective analysis of the 2008 to 2012 Medical Expenditure Panel Survey. METHODS: A nationally representative sample of adult long-term cancer survivors (≥3 years since diagnosis) was categorized into either patient-centered care (PCC) or non-PCC groups based on responses to PCMH model hallmark attributes of "comprehensive care," "whole-person orientation," and "accessible care...
September 1, 2018: American Journal of Managed Care
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