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American Journal of Managed Care

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https://www.readbyqxmd.com/read/30020759/inpatient-placement-associations-with-mortality-cost-and-length-of-stay
#1
Daniel A Handel, Zemin Su, Nancy Hendry, Patrick Mauldin
OBJECTIVES: Tertiary referral centers have created inpatient units to meet the needs of specific patient populations but sometimes are forced to place patients on other units that, although having the basic necessary skillsets for treating the patient, are not focused on that diagnosis area. The objective of this study was to look at outcomes of patients admitted to these different inpatient settings. STUDY DESIGN: Retrospective review of patient data from a single tertiary academic medical center from August 1, 2014, to June 30, 2015, comparing patients admitted to primary versus secondary inpatient services...
July 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020758/trends-in-primary-care-encounters-across-professional-roles-in-pcmh
#2
Ann M Annis, Marcelline Harris, Hyungjin Myra Kim, Ann-Marie Rosland, Sarah L Krein
OBJECTIVES: Team-based care models, including the patient-centered medical home (PCMH), are increasingly promoted to improve the delivery of primary care. However, evaluation measures are often reported at a clinic or primary care provider (PCP) level, creating challenges in describing and analyzing the use and impact of non-PCP clinician team members. Thus, we aimed to measure clinician-specific care delivery trends and determine whether trends were responsive to systemwide PCMH implementation...
July 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020757/acos-with-risk-bearing-experience-are-likely-taking-steps-to-reduce-low-value-medical-services
#3
Margje H Haverkamp, David Peiris, Alexander J Mainor, Gert P Westert, Meredith B Rosenthal, Thomas D Sequist, Carrie H Colla
OBJECTIVES: Accountable care organizations (ACOs) are groups of healthcare providers responsible for quality of care and spending for a defined patient population. The elimination of low-value medical services will improve quality and reduce costs and, therefore, ACOs should actively work to reduce the use of low-value services. We set out to identify ACO characteristics associated with implementation of strategies to reduce overuse. STUDY DESIGN: Survey analysis...
July 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020756/postdischarge-engagement-decreased-hospital-readmissions-in-medicaid-populations
#4
Wanzhen Gao, David Keleti, Thomas P Donia, Jim Jones, Karen E Michael, Andrea D Gelzer
OBJECTIVES: To investigate the effect of managed care organization (MCO)-implemented postdischarge engagement, supported by other broadly focused interventions, on 30-day hospital readmissions in 6 at-risk Medicaid populations. STUDY DESIGN: Prospective cohort study. METHODS: One-year follow-up analysis of member claims data was performed following an intervention period from January 1, 2014, to December 31, 2014. Postdischarge engagement, supported by additional MCO-initiated interventions, was implemented to reduce 30-day hospital readmissions in Medicaid members having 1 or more dominant chronic conditions...
July 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020755/forgotten-patients-aco-attribution-omits-those-with-low-service-use-and-the-dying
#5
Mariétou H Ouayogodé, Ellen Meara, Chiang-Hua Chang, Stephanie R Raymond, Julie P W Bynum, Valerie A Lewis, Carrie H Colla
OBJECTIVES: Alternative payment models, such as accountable care organizations, hold provider groups accountable for an assigned patient population, but little is known about unassigned patients. We compared clinical and utilization profiles of patients attributable to a provider group with those of patients not attributable to any provider group. STUDY DESIGN: Cross-sectional study of 2012 Medicare fee-for-service beneficiaries 21 years and older. METHODS: We applied the Medicare Shared Savings Program attribution approach to assign beneficiaries to 2 mutually exclusive categories: attributable or unattributable...
July 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020754/prices-for-physician-services-in-medicare-advantage-versus-traditional-medicare
#6
Julius L Chen, Andrew L Hicks, Michael E Chernew
OBJECTIVES: To compare the prices paid to physicians by employer-sponsored Medicare Advantage (MA) plans with those paid by traditional Medicare (TM) and to determine whether the relationship between MA and TM prices is affected by the generosity of MA benchmarks. STUDY DESIGN: Descriptive analysis of medical claims data from the 2014-2015 MarketScan Medicare Claims Database. METHODS: We focus on claims for low-complexity office visits with an established patient (Current Procedural Terminology [CPT] code 99213) and electrocardiograms (CPT code 93000)...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020753/examining-differential-performance-of-3-medical-home-recognition-programs
#7
Ammarah Mahmud, Justin W Timbie, Rosalie Malsberger, Claude M Setodji, Amii Kress, Liisa Hiatt, Peter Mendel, Katherine L Kahn
OBJECTIVES: We examined differences in patient outcomes associated with 3 patient-centered medical home (PCMH) recognition programs-National Committee for Quality Assurance (NCQA) Level 3, The Joint Commission (TJC), and Accreditation Association for Ambulatory Health Care (AAAHC)-among Medicare beneficiaries receiving care at federally qualified health centers (FQHCs). STUDY DESIGN: We used data from CMS' FQHC Advanced Primary Care Practice Demonstration, in which participating FQHCs received assistance to achieve NCQA Level 3 PCMH recognition...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020752/differences-in-spending-on-provider-administered-chemotherapy-by-site-of-care-in-medicare
#8
Yamini Kalidindi, Jeah Jung, Roger Feldman
OBJECTIVES: To compare Medicare spending on provider-administered chemotherapy in hospital outpatient departments (HOPDs) and physician offices after controlling for cancer type. STUDY DESIGN: Secondary data analysis. METHODS: We used 2010-2013 claims data for a random sample of Medicare fee-for-service beneficiaries who had cancer and received chemotherapy services either in physician offices or in HOPDs. We constructed 2 spending measures: (1) spending on chemotherapy drugs and (2) spending on chemotherapy administration...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020751/the-development-of-diabetes-complications-in-gp-centered-healthcare
#9
Kateryna Karimova, Lorenz Uhlmann, Marc Hammer, Corina Guethlin, Ferdinand M Gerlach, Martin Beyer
OBJECTIVES: To compare the development of diabetes complications, measured in terms of clinical end points, of patients enrolled in general practitioner (GP)-centered healthcare (Hausarztzentrierte Versorgung [HZV]) and patients in usual GP care (non-HZV) over 4 years. STUDY DESIGN: Retrospective closed cohort study based on German claims data. METHODS: The main end points in our evaluation were dialysis, blindness, amputation, stroke, myocardial infarction, cardiovascular disease, hypoglycemia, and mortality...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020750/value-based-health-insurance-design-how-much-does-socioeconomic-status-matter
#10
Bruce W Sherman, Carol Addy
Socioeconomic status (SES), an important determinant of individual health status, has not been widely incorporated into employer benefits strategies. Recent research has characterized significant differences in healthcare utilization patterns and cost among workers in different wage categories, raising the possibility that SES does influence individual healthcare utilization behaviors. In particular, SES may have appreciable impact on the effectiveness of benefits tactics, including value-based insurance design (VBID)...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020749/insights-on-site-of-care-cancer-research-both-quality-and-cost-information-are-necessary-to-guide-policy
#11
Kavita Patel, A Mark Fendrick
The implementation of alternative payment models that successfully capture clinical heterogeneity-without adding unacceptable levels of administrative complexity-may be equally (if not more) important than site-neutral payment policies.
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020748/treatment-patterns-among-adults-with-adhd-receiving-long-acting-therapy
#12
Zhou Zhou, Zheng-Yi Zhou, Sneha S Kellar, Vanja Sikirica, Jipan Xie, Regina Grebla
OBJECTIVES:  To evaluate the treatment patterns among commercially insured adults in the United States with attention-deficit/hyperactivity disorder (ADHD) who received long-acting (LA) combination therapy (CT) or monotherapy for ADHD. STUDY DESIGN:  Retrospective observational study. METHODS:  Adults with at least 1 ADHD diagnosis and at least 1 LA ADHD medication were identified from the MarketScan claims database (April 1, 2009, to March 31, 2014)...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020747/modeling-the-impacts-of-restrictive-formularies-on-patients-with-hiv
#13
James Baumgardner, Caroline Huber, Mina Kabiri, Lara Yoon, Jacki Chou, John Romley
OBJECTIVES:  To model the impacts of restrictive formulary designs on outcomes for patients with HIV and to demonstrate the costs of restricting access to novel HIV regimens with better safety and efficacy profiles. STUDY DESIGN:  We modified an epidemiological model of HIV incidence, progression, and treatment to simulate the effects of 5 formulary scenarios on patient outcomes in the United States. METHODS:  Using a cohort of HIV-susceptible individuals, we followed patients through HIV infection, disease progression, and death...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020746/impact-of-medical-and-or-pharmacy-reimbursement-on-adult-vaccination-rates
#14
Gaurav Deshpande, Jay Visaria, Joseph Singer, Kelly D Johnson
OBJECTIVES:  To evaluate whether adults enrolled in commercial health insurance plans that provide reimbursement for herpes zoster vaccine (HZV) and pneumococcal vaccine (PV) through the medical and pharmacy benefits have higher vaccination rates compared with those whose health plans cover vaccines under the medical benefit alone. STUDY DESIGN:  Retrospective claims analysis using medical and pharmacy claims data from January 1, 2012, through December 31, 2014...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020745/cost-of-biologic-treatment-persistence-or-switching-in-rheumatoid-arthritis
#15
Tao Gu, Alex Mutebi, Bradley S Stolshek, Hiangkiat Tan
OBJECTIVES: To estimate total costs among patients with rheumatoid arthritis (RA) who persisted on or switched from newly initiated biologic therapy. STUDY DESIGN: A retrospective claims database analysis. METHODS: This analysis included adults in the HealthCore Integrated Research Database with RA who initiated treatment with a biologic for RA (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, or tocilizumab) between January 2009 and November 2014...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020744/two-year-adherence-and-costs-for-biologic-therapy-for-rheumatoid-arthritis
#16
Bradley S Stolshek, Sally Wade, Alex Mutebi, Ajita P De, Rolin L Wade, Jason Yeaw
OBJECTIVES: To evaluate adherence to newly initiated biologic disease-modifying antirheumatic drugs (bDMARDs) in effectively treated patients with rheumatoid arthritis (RA). STUDY DESIGN: Retrospective cohort study of administrative claims data (IMS PharMetrics Plus) for services incurred from July 1, 2008, to December 31, 2014. METHODS: Data from patients with RA aged 18 to 64 years with continuous enrollment for at least 30 months and initiating abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab were analyzed...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020743/direct-oral-anticoagulant-prescription-trends-switching-patterns-and-adherence-in-texas-medicaid
#17
Shui Ling Wong, Landon Z Marshall, Kenneth A Lawson
OBJECTIVES: To compare prescription trends, costs, switch patterns, and mean adherence among oral anticoagulants in the Texas Medicaid population. STUDY DESIGN: Secondary analysis of Medicaid prescription claims data. METHODS: All oral anticoagulant prescriptions for patients aged 18 to 63 years with 1 or more prescription claims for an oral anticoagulant from July 1, 2010, to December 31, 2015, were included in utilization and expenditure trend analyses...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020742/5-asa-to-sulfasalazine-drug-switch-program-in-patients-with-ulcerative-colitis
#18
Jason R Goldsmith, Akbar K Waljee, Tom George, Alexandra Brown, Hae Mi Choe, Mohamed Noureldin, Steven J Bernstein, Peter D R Higgins
OBJECTIVES: To switch patients with ulcerative colitis (UC) from costlier 5-aminosalicylic acid compounds to sulfasalazine and assess (1) the cost savings, (2) the barriers to switching, and (3) adverse events (AEs) and adherence at 3 months after the drug switch. STUDY DESIGN: An open-label, pharmacist-administered drug switch program coordinated at an academic inflammatory bowel disease center. METHODS: A clinical pharmacist contacted patients with UC who were prescreened by physicians and covered by specific insurers to enroll them in the drug switch program...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020741/cost-per-response-analysis-of-strategies-for-chronic-immune-thrombocytopenia
#19
Kelly Fust, Anju Parthan, Xiaoyan Li, Anjali Sharma, Xinke Zhang, Marco Campioni, Junji Lin, Xuena Wang, Richard Zur, Karynsa Cetin, Melissa Eisen, David Chandler
OBJECTIVES: This analysis estimated the cost per response and the incremental cost per additional responder of romplostim, eltrombopag, and the "watch-and-rescue" (monitoring until rescue therapies are required) strategy in adults with chronic immune thrombocytopenia (ITP). STUDY DESIGN: The decision tree is designed to estimate the total cost per response for romiplostim, eltrombopag, and watch and rescue over a 24-week time horizon; cost-effectiveness was evaluated in terms of incremental cost per additional responder...
July 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/30020740/disease-modifying-antirheumatic-drug-initiation-among-patients-newly-diagnosed-with-rheumatoid-arthritis
#20
Machaon Bonafede, Barbara H Johnson, Neel Shah, David J Harrison, Derek Tang, Bradley S Stolshek
OBJECTIVES: To determine the rate of timely disease-modifying antirheumatic drug (DMARD) initiation in patients newly diagnosed with rheumatoid arthritis (RA), as recommended per a quality measure endorsed by the National Quality Forum. STUDY DESIGN: Retrospective analysis of claims data from the Truven Health MarketScan commercial and Medicare claims databases. METHODS: Patients newly diagnosed with RA were identified in the claims databases...
July 2018: American Journal of Managed Care
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