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American Journal of Managed Care

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https://www.readbyqxmd.com/read/28817783/the-association-between-insurance-type-and-cost-related-delay-in-care-a-survey
#1
Sora Al Rowas, Michael B Rothberg, Benjamin Johnson, Joel Miller, Mohanad AlMahmoud, Jennifer Friderici, Sarah L Goff, Tara Lagu
OBJECTIVES: Massachusetts has insurance rates similar to those projected under the Affordable Care Act, but many of the state's patients are insured through private insurance plans with high out-of-pocket costs. We aimed to explore the relationship between insurance type (private vs public) and delays in care due to cost, stratified by income. STUDY DESIGN: Cross-sectional study. METHODS: We conducted a study of English-speaking adults recruited from the waiting rooms of the emergency department or outpatient clinics of a large healthcare system in western Massachusetts...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817782/cost-effectiveness-of-a-patient-navigation-program-to-improve-cervical-cancer-screening
#2
Yan Li, Erin Carlson, Roberto Villarreal, Leah Meraz, José A Pagán
OBJECTIVES: To assess the cost-effectiveness of a community-based patient navigation program to improve cervical cancer screening among Hispanic women 18 or older in San Antonio, Texas. STUDY DESIGN: We used a microsimulation model of cervical cancer to project the long-term cost-effectiveness of a community-based patient navigation program compared with current practice. METHODS: We used program data from 2012 to 2015 and published data from the existing literature as model input...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817781/availability-and-variation-of-publicly-reported-prescription-drug-prices
#3
Jeffrey T Kullgren, Joel E Segel, Timothy A Peterson, A Mark Fendrick, Simone Singh
OBJECTIVES: To examine how often retail prices for prescription drugs are available on state public reporting websites, the variability of these reported prices, and zip code characteristics associated with greater price variation. STUDY DESIGN: Searches of state government-operated websites in Michigan, Missouri, New York, and Pennsylvania for retail prices for Advair Diskus (250/50 fluticasone propionate/salmeterol), Lyrica (pregabalin 50 mg), Nasonex (mometasone 50 mcg nasal spray), Spiriva (tiotropium 18 mcg cp-handihaler), Zetia (ezetimibe 10 mg), atorvastatin 20 mg, and metoprolol 50 mg...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817780/us-internists-awareness-and-use-of-overtreatment-guidelines-a-national-survey
#4
Kira L Ryskina, Eric S Holmboe, Elizabeth Bernabeo, Rachel M Werner, Judy A Shea, Judith A Long
OBJECTIVES: To assess physician views and perceived adoption of overtreatment guidelines and measure whether adoption of these guidelines influenced the recommendation of a targeted service. STUDY DESIGN: A cross-sectional survey mailed from July 2014 to January 2015 to 902 internists who completed residency between 2003 and 2013, randomly selected from the American Medical Association Masterfile. METHODS: Poisson regression was used to model the rate of recommending a targeted service included in the guidelines, based on the level of guideline adoption...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817779/the-price-may-not-be-right-the-value-of-comparison-shopping-for-prescription-drugs
#5
Sanjay Arora, Neeraj Sood, Sophie Terp, Geoffrey Joyce
OBJECTIVES: To measure variations in drug prices across and within zip codes that may reveal simple strategies to improve patients' access to prescribed medications. STUDY DESIGN: We compared drug prices at different types of pharmacies across and within local markets. In-store prices were compared with a Web-based service providing discount coupons for prescription medications. Prices were collected for 2 generic antibiotics because most patients have limited experience with them and are less likely to know the price ranges for them...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28727476/options-for-addressing-exocrine-pancreatic-insufficiency-in-patients-receiving-enteral-nutrition-supplementation
#6
Steven D Freedman
Patients with exocrine pancreatic insufficiency (EPI) have suboptimal secretion of pancreatic digestive enzymes and experience a range of clinical symptoms related to the malabsorption of fat. In patients with EPI unable to meet their nutritional requirements, enteral nutrition (EN) support is used to augment nutritional status. In addition to protein and carbohydrate, EN formulas contain fats as a calorie source, as well as vitamins and minerals to help prevent nutritional deficiencies related to malabsorption...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28727475/guidance-for-supplemental-enteral-nutrition-across-patient-populations
#7
Douglas L Nguyen
Enteral nutrition is preferred over parenteral nutrition as a result of the greater safety of enteral nutrition therapy and comparative convenience. A wide variety of enteral nutrition products have been developed, including disease-specific products to help manage the nutritional needs of patients with kidney failure, liver failure, lung disease, diabetes, and other conditions. An assessment of each patient's nutritional needs and digestive function should be conducted prior to initiation of enteral nutrition therapy...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28727474/a-primer-on-exocrine-pancreatic-insufficiency-fat-malabsorption-and-fatty-acid-abnormalities
#8
Samer Alkaade, Ashley A Vareedayah
Exocrine pancreatic insufficiency (EPI) is characterized by a deficiency of exocrine pancreatic enzymes, resulting in deficits in digestion of all macronutrients, with deficiencies in digestion of fats being the most clinically relevant. The leading cause of EPI is chronic pancreatitis. However, many other causes and conditions may be implicated, including cystic fibrosis, pancreatic duct obstruction, gastric and pancreatic surgery, diabetes mellitus and other conditions. Physical and biochemical causes of EPI include decreased production and secretion of lipase, increased lipase destruction, pancreatic duct obstruction, decreased lipase stimulation and degradation, as well as gastrointestinal motility disorders...
July 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817302/comparative-effectiveness-and-costs-of-insulin-pump-therapy-for-diabetes
#9
Ronald T Ackermann, Amisha Wallia, Raymond Kang, Andrew Cooper, Theodore A Prospect, Lewis G Sandy, Deneen Vojta
OBJECTIVES: Continuous subcutaneous insulin infusion (CSII), or "insulin pump" therapy, is an alternative to multiple daily insulin injections (MDII) for management of diabetes. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. STUDY DESIGN: Pre-post with propensity-matched comparison design involving commercially insured US adults (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII between July 1, 2009, and June 30, 2012 ("CSII initiators"; n = 2539), or who continued using MDI (n = 2539)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817301/patients-views-of-a-behavioral-intervention-including-financial-incentives
#10
Judy A Shea, Aderinola Adejare, Kevin G Volpp, Andrea B Troxel, Darra Finnerty, Karen Hoffer, Thomas Isaac, Meredith Rosenthal, Thomas D Sequist, David A Asch
OBJECTIVES: Clinical trials are increasingly testing the effectiveness of paying patients' financial incentives for achieving desired clinical outcomes. Some researchers and providers are concerned that patient financial incentives will harm the doctor-patient relationship. How patients feel about these approaches, and these trials, is largely unknown. This study examined patients' perceptions of a compound behavioral and financial incentive intervention used in a large multicenter trial to lower low-density lipoprotein cholesterol (LDL-C), including their perceptions of benefits and challenges and the study's effect on patients' relationship with their primary care physicians (PCPs)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817300/patient-ratings-of-veterans-affairs-and-affiliated-hospitals
#11
Paul A Heidenreich, Aimee Zapata, Lisa Shieh, Nancy Oliva, Anju Sahay
OBJECTIVES: Hospital Compare, a website maintained by CMS, allows comparisons of outcomes and processes of care but not of patient satisfaction for hospitals within the Veteran Affairs (VA) Healthcare System. Therefore, we sought to compare online hospital ratings between VA hospitals and their local affiliated hospitals. STUDY DESIGN: Observational analysis. METHODS: We identified 39 VA hospitals and a non-VA affiliated hospital with at least 2 online Yelp ratings...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817299/how-do-medicare-advantage-beneficiary-payments-vary-with-tenure
#12
Paul D Jacobs, Eamon Molloy
OBJECTIVES: To compare how premiums and expected out-of-pocket medical costs (OOPC) vary with the length of time Medicare Advantage (MA) beneficiaries have been enrolled in their plans. STUDY DESIGN: Descriptive and fixed effects regression analyses. METHODS: Using linked administrative enrollment and plan data, we compared the costs of the MA plans that beneficiaries chose with the costs of other plans available to them. We show predicted values adjusted for age, gender, race/ethnicity, disability, individual health risk, presence of mental health diagnoses, health plan quality, relative size of the plan's provider network, and the number of years continuously enrolled in the same plan...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817298/radical-prostatectomy-innovation-and-outcomes-at-military-and-civilian-institutions
#13
Jeffrey J Leow, Joel S Weissman, Linda Kimsey, Andrew Hoburg, Lorens A Helmchen, Wei Jiang, Nathanael Hevelone, Stuart R Lipsitz, Louis L Nguyen, Steven L Chang
OBJECTIVES: Limited data are available regarding the impact of the type of healthcare delivery system on technology diffusion and associated clinical outcomes. We assessed the adoption of minimally invasive radical prostatectomy (MIRP), a recent clinical innovation, and whether this adoption altered surgical morbidity for prostate cancer surgery. STUDY DESIGN: Retrospective review of administrative data from TRICARE, the healthcare program of the United States Military Health System...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817297/using-roll-up-measures-in-healthcare-quality-reports-perspectives-of-report-sponsors-and-national-alliances
#14
Jennifer L Cerully, Steven C Martino, Lise Rybowski, Melissa L Finucane, Rachel Grob, Andrew M Parker, Mark Schlesinger, Dale Shaller, Grant Martsolf
OBJECTIVES: To understand the views of prominent organizations in the field of healthcare quality on the topic of reporting roll-up measures that combine indicators of multiple, often disparate, dimensions of care to consumers. STUDY DESIGN: This study used a semi-structured, qualitative interview design. METHODS: We conducted 30- to 60-minute semi-structured telephone interviews with representatives of 10 organizations that sponsor public healthcare quality reports and 3 national alliances representing multiple stakeholder groups...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817296/patients-views-on-price-shopping-and-price-transparency
#15
Hannah L Semigran, Rebecca Gourevitch, Anna D Sinaiko, David Cowling, Ateev Mehrotra
OBJECTIVES: Driven by the growth of high deductibles and price transparency initiatives, patients are being encouraged to search for prices before seeking care, yet few do so. To understand why this is the case, we interviewed individuals who were offered access to a widely used price transparency website through their employer. STUDY DESIGN: Qualitative interviews. METHODS: We interviewed individuals enrolled in a preferred provider organization product through their health plan about their experience using the price transparency tool (if they had done so), their past medical experiences, and their opinions on shopping for care...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817295/does-the-offer-of-free-prescriptions-increase-generic-prescribing
#16
Bruce Stuart, Franklin Hendrick, J Samantha Dougherty, Jing Xu
OBJECTIVES: To test if offering zero generic co-pays for oral antidiabetic drugs (OADs) and statins increases generic dispensing for low-income subsidy (LIS) recipients with diabetes enrolled in Medicare Part D. STUDY DESIGN: We analyzed a natural experiment in which LIS recipients were randomized to Part D plans in 2008. Some plans placed selected generic OADs and statins on zero co-pay tiers whereas others did not. Randomization eliminated selection effects which could bias the study findings...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817294/heterogeneity-of-nonadherent-buprenorphine-patients-subgroup-characteristics-and-outcomes
#17
Charles Ruetsch, Joseph Tkacz, Vijay R Nadipelli, Brenna L Brady, Naoko Ronquest, Hyong Un, Joseph Volpicelli
OBJECTIVES: To examine patient characteristics and outcomes associated with nonadherence to buprenorphine and to identify specific patterns of nonadherent behavior. STUDY DESIGN: Cross-sectional, retrospective analysis of health claims data. METHODS: Aetna's administrative claims data were used to categorize incident opioid use disorder (OUD) patients based on buprenorphine medication possession ratio (MPR) into adherent (n = 172) and nonadherent (n = 305) groups...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28817293/a-comparison-of-retrospective-attribution-rules
#18
Lucas Higuera, Caroline Carlin
OBJECTIVES: To compare the performance of methods to retrospectively attribute patients to provider systems by comparing the fraction attributed and the stability of assignment over time. STUDY DESIGN: Retrospective cross-sectional study. METHODS: Descriptive statistics are used to measure the fraction of patients attributed and stability of attribution from year to year. This study uses a panel of administrative claims data (2010-2011). Attribution rules were defined by unit of measure (count of physician visits, dollars paid), type of providers (primary care physicians [PCPs], all physicians), type of encounters (all visits, evaluation and management visits only), and level of concentration of care (majority, plurality)...
June 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28810131/prescription-opioid-registry-protocol-in-an-integrated-health-system
#19
G Thomas Ray, Amber L Bahorik, Paul C VanVeldhuisen, Constance M Weisner, Andrea L Rubinstein, Cynthia I Campbell
OBJECTIVES: To establish a prescription opioid registry protocol in a large health system and to describe algorithms to characterize individuals using prescription opioids, opioid use episodes, and concurrent use of sedative/hypnotics. STUDY DESIGN: Protocol development and retrospective cohort study. METHODS: Using Kaiser Permanente Northern California (KPNC) electronic health record data, we selected patients using prescription opioids in 2011...
May 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28810130/the-cost-of-adherence-mismeasurement-in-serious-mental-illness-a-claims-based-analysis
#20
Jason Shafrin, Felicia Forma, Ethan Scherer, Ainslie Hatch, Edward Vytlacil, Darius Lakdawalla
OBJECTIVES: To quantify how adherence mismeasurement affects the estimated impact of adherence on inpatient costs among patients with serious mental illness (SMI). STUDY DESIGN: Proportion of days covered (PDC) is a common claims-based measure of medication adherence. Because PDC does not measure medication ingestion, however, it may inaccurately measure adherence. We derived a formula to correct the bias that occurs in adherence-utilization studies resulting from errors in claims-based measures of adherence...
May 1, 2017: American Journal of Managed Care
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