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American Journal of Managed Care

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https://www.readbyqxmd.com/read/29668216/provider-and-patient-burdens-of-obtaining-oral-anticancer-medications
#1
Daniel M Geynisman, Caitlin R Meeker, Jamie L Doyle, Elizabeth A Handorf, Marijo Bilusic, Elizabeth R Plimack, Yu Ning Wong
Oral anticancer medications (OAMs) are frequently used to treat patients with cancer. Unlike intravenous chemotherapy, OAMs are covered by prescription drug plans. We examined barriers to initiation of OAMs in 116 patients with prostate or kidney cancer (149 unique prescriptions). We found that the median time from initial prescription to prior authorization was 3 days and the median time from initial prescription to patient receipt of drug was 12 days. Seventy-three percent of all prescriptions required 2 or more phone calls by clinic staff and 40% required 5 or more calls...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668215/limited-distribution-networks-stifle-competition-in-the-generic-and-biosimilar-drug-industries
#2
Laura Karas, Kenneth M Shermock, Celia Proctor, Mariana Socal, Gerard F Anderson
A limited distribution network (LDN) restricts the distribution channel for a pharmaceutical drug to 1 or a very small number of distributors. This strategy may allow for more effective allocation of drugs in shortage and is purported to help ensure the safe distribution of high-risk drugs to small patient populations. However, in recent years, some drug companies, including Turing Pharmaceuticals, have used LDNs to prevent generic and biosimilar companies from accessing samples of drug products necessary to perform testing required by the FDA for generic and biosimilar drug applications...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668214/financial-burden-of-healthcare-utilization-in-consumer-directed-health-plans
#3
Xinke Zhang, Erin Trish, Neeraj Sood
OBJECTIVES: To evaluate the impact of enrollment in a consumer-directed health plan (CDHP) on out-of-pocket (OOP) spending and on the financial burden associated with healthcare utilization. STUDY DESIGN: Using commercial claims data from 2011 through 2013, we estimated difference-in-differences models that compared changes in outcomes for individuals who switched to CDHPs (CDHP group) with outcome changes for individuals who remained in traditional plans (traditional plan group)...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668213/physician-and-patient-tools-to-improve-chronic-kidney-disease-care
#4
Thomas D Sequist, Alison M Holliday, E John Orav, David W Bates, Bradley M Denker
OBJECTIVES: To determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. STUDY DESIGN: Randomized controlled trial. METHODS: We enrolled 153 primary care physicians caring for 3947 high-risk and 3744 low-risk patients with stage III CKD across 13 ambulatory health centers in eastern Massachusetts. Intervention physicians received a set of electronic alerts during office visits recommending risk-appropriate CKD care...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668212/progress-of-diabetes-severity-associated-with-severe-hypoglycemia-in-taiwan
#5
Edy Kornelius, Yi Sun Yang, Shih Chang Lo, Chiung Huei Peng, Yung Rung Lai, Jeng Yuan Chiou, Chien Ning Huang
OBJECTIVES: The association between the progression of diabetes severity and risk of severe hypoglycemia is unknown. This study aimed to evaluate the association between the progression of diabetes severity and severe hypoglycemia in patients with diabetes. STUDY DESIGN: A 13-year population-based retrospective cohort study of patients with diabetes in Taiwan. METHODS: Diabetes progression was evaluated by the adapted Diabetes Complications Severity Index (aDCSI) score from index date to end of follow-up...
April 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668211/a-payer-provider-partnership-for-integrated-care-of-patients-receiving-dialysis
#6
Justin Kindy, David Roer, Robert Wanovich, Stephen McMurray
OBJECTIVES: Patients with end-stage renal disease (ESRD) are clinically complex, requiring intensive and costly care. Coordinated care may improve outcomes and reduce costs. The objective of this study was to determine the impact of a payer-provider care partnership on key clinical and economic outcomes in enrolled patients with ESRD. STUDY DESIGN:  Retrospective observational study. METHODS: Data on patient demographics and clinical outcomes were abstracted from the electronic health records of the dialysis provider...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668210/care-coordination-for-children-with-special-needs-in-medicaid-lessons-from-medicare
#7
Kate A Stewart, Katharine W V Bradley, Joseph S Zickafoose, Rachel Hildrich, Henry T Ireys, Randall S Brown
OBJECTIVES: To provide actionable recommendations for improving care coordination programs for children with special healthcare needs (CSHCN) in Medicaid managed care. STUDY DESIGN:  Literature review and interviews with stakeholders and policy experts to adapt lessons learned from Medicare care coordination programs for CSHCN in Medicaid managed care. METHODS: We reviewed syntheses of research on Medicare care coordination programs to identify lessons learned from successful programs...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668209/the-well-being-of-long-term-cancer-survivors
#8
Jeffrey Sullivan, Julia Thornton Snider, Emma van Eijndhoven, Tony Okoro, Katharine Batt, Thomas DeLeire
OBJECTIVES: To compare the well-being of long-term cancer survivors with that of US residents of similar age and demographic characteristics, patients recently diagnosed with cancer, and individuals with chronic illness. STUDY DESIGN: Retrospective observational study. METHODS: Using the Health and Retirement Study, a survey of US residents older than 50 years, we defined 4 cohorts: long-term cancer survivors (>4 years post diagnosis), individuals recently diagnosed with cancer (≤4 years post diagnosis), individuals with chronic illness, and US residents older than 50 years ("nationally representative cohort")...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668208/cost-sharing-and-branded-antidepressant-initiation-among-patients-treated-with-generics
#9
Jason D Buxbaum, Michael E Chernew, Machaon Bonafede, Anna Vlahiotis, Deborah Walter, Lisa Mucha, A Mark Fendrick
OBJECTIVES: To determine the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients with major depressive disorder (MDD) filling a prescription for generic MDD medication. STUDY DESIGN:  Retrospective cross-sectional analyses. METHODS: Patients aged 18 to 64 years with MDD who filled a generic antidepressant were identified in commercial claims data for 2012 to 2014. For each year-specific analysis, an average cost-sharing index for branded antidepressants at the level of the plan was computed...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29668207/delivering-on-the-value-proposition-of-precision-medicine-the-view-from-healthcare-payers
#10
Jane Null Kogan, Philip Empey, Justin Kanter, Donna J Keyser, William H Shrank
A long-held assumption and expectation has been that genomics-based precision medicine will provide clinicians with the tools and therapies they need to consistently deliver the right treatment to the right patient while simultaneously reducing waste and yielding cost savings for health systems. The pace of discovery within the field of precision medicine has been remarkable, yet optimal uptake of new genetic tests and genetically targeted therapies will occur only if payers recognize their value and opt to cover them...
April 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620817/evaluating-the-managed-care-implications-of-longer-acting-basal-insulin-analog-therapies
#11
Tripp Logan, Bianca Daisy
Diabetes, particularly type 2 diabetes (T2D), has become an epidemic in the United States, with a significant portion of patients unable to meet recommended glycemic targets. All individuals with type 1 diabetes (T1D) and a significant majority of those with T2D will ultimately require insulin therapy. However, there are several barriers to its use. The introduction of the new, ultra-long-acting basal insulins degludec and glargine U-300, and the single-injection combinations of insulin degludec/liraglutide and insulin glargine U-100/lixisenatide, offer options that may overcome several of those barriers, including the high risk of hypoglycemia, glycemic variability, and relatively short duration of action...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620816/introduction-to-basal-insulin-therapy-clinical-management-of-diabetes
#12
Jasmine D Gonzalvo
Diabetes is a series of metabolic conditions associated with many serious comorbidities, such as heart disease and stroke, peripheral arterial disease and lower-extremity amputations, retinopathy, nephropathy, and peripheral neuropathy. The American Diabetes Association, the American Association of Clinical Endocrinologists, and the International Diabetes Federation recommend that individuals with diabetes be as near to normoglycemic as possible. There are many glycemic management barriers among patients, such as cost, patient perceptions, and clinical inertia...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620815/a-descriptive-study-of-patients-receiving-foundational-financial-assistance-through-local-specialty-pharmacies
#13
Julia Zhu, Randall Odebralski, Safia Boghani, Clorinda Walley, Frank Koen, Chad Conley, Heather S Kirkham
OBJECTIVES: To describe the population of patients who received financial assistance from the Good Days Foundation (GDF) as facilitated by Walgreens local specialty pharmacies (LSPs). STUDY DESIGN: This was a retrospective descriptive study. METHODS: This study used a joint foundational and pharmacy claim database between January 1, 2014, and December 31, 2016. RESULTS: Among 1572 eligible patients who received GDF financial assistance as facilitated by Walgreens LSPs, 1524 had disease state information and 14 of these patients receveived financial assistance for 2 disease states (patient count denominator, 1538)...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620814/impact-of-trained-oncology-financial-navigators-on-patient-out-of-pocket-spending
#14
Todd Yezefski, Jordan Steelquist, Kate Watabayashi, Dan Sherman, Veena Shankaran
OBJECTIVES: Patients with cancer often face financial hardships, including loss of productivity, high out-of-pocket (OOP) costs, depletion of savings, and bankruptcy. By providing financial guidance and assistance through specially trained navigators, hospitals and cancer care clinics may be able mitigate the financial burdens to patients and also minimize financial losses for the treating institutions. STUDY DESIGN: Financial navigators at 4 hospitals were trained through The NaVectis Group, an organization that provides training to healthcare staff to increase patient access to care and assist with OOP expenses...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620813/ensuring-access-to-prescription-medications-in-the-post-aca-healthcare-access-landscape-the-essential-role-of-fqhcs-in-the-safety-net-for-the-underinsured
#15
Lizheng Shi, M Kristina Wharton, Alisha Monnette
OBJECTIVES: Federally qualified health centers (FQHCs) are essential to underinsured populations in the safety net by offering them several means of access to reduced cost medications. This study employed a 2-pronged approach to evaluate FQHCs' role, estimating both the need for patient assistance and the impact of the safety net. STUDY DESIGN: A multiyear panel data study for post-Affordable Care Act (ACA) years 2012 to 2016 and a 2016 cross-sectional analysis design were utilized to analyze FQHCs, their patient populations, and prescription assistance programs...
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29620812/rising-out-of-pocket-costs-threaten-an-already-vulnerable-population-an-introduction-to-the-pan-foundation-and-ajmc-collaborative-supplement
#16
Dan Klein
This supplement showcases the winning papers from the PAN Challenge, which aimed to foster conversations about how to rein in out-of-pocket costs to eliminate barriers between patients and their critical medical treatments.
March 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29553283/improving-quality-of-care-in-oncology-through-healthcare-payment-reform
#17
Lonnie Wen, Christine Divers, Melissa Lingohr-Smith, Jay Lin, Scott Ramsey
OBJECTIVES: To provide an overview of alternative payment models (APMs) and describe how leading national organizations involved with oncology care and payment are linking quality improvement initiatives and payment reform. STUDY DESIGN: Literature review. METHODS: For this review, we summarized the literature on APMs and their goals of improving healthcare quality while jointly controlling the cost of care. We described the types of APMs that have been examined in the real-world setting, specifically in the area of oncology, and how they have affected the quality of oncology care...
March 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29553282/patient-reported-denials-appeals-and-complaints-associations-with-overall-plan-ratings
#18
Denise D Quigley, Amelia M Haviland, Jacob W Dembosky, David J Klein, Marc N Elliott
OBJECTIVES: To assess whether Medicare patients' reports of denied care, appeals/complaints, and satisfactory resolution were associated with ratings of their health plan or care. STUDY DESIGN: Retrospective analysis of 2010 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data. METHODS: Multivariate linear regression of data from 154,766 respondents (61.1% response rate) tested the association of beneficiary ratings of plan and care with beneficiary reports of denied care, appeals, complaints, and complaint resolution, adjusting for beneficiary demographics...
March 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29553281/assessing-medical-home-mechanisms-certification-asthma-education-and-outcomes
#19
Nathan D Shippee, Michael Finch, Douglas R Wholey
OBJECTIVES: Patient-centered medical homes (PCMHs) represent a widespread model of healthcare transformation. Despite evidence that PCMHs can improve care quality, the mechanisms by which they improve outcomes are relatively unexamined. We aimed to assess the mechanisms linking certification as a Health Care Home (HCH), a statewide PCMH initiative, with asthma care quality and outcomes. We compared direct certification effects versus indirect clinical effects (via improved care process)...
March 1, 2018: American Journal of Managed Care
https://www.readbyqxmd.com/read/29553280/ambulatory-care-sensitive-emergency-visits-among-patients-with-medical-home-access
#20
Dina Hafez, Laurence F McMahon, Linda Balogh, Floyd John Brinley, John Crump, Mark Ealovega, Audrey Fan, Yeong Kwok, Kristen Krieger, Thomas O'Connor, Elisa Ostafin, Heidi Reichert, Jennifer Meddings
OBJECTIVES: To characterize patterns of emergency department (ED) utilization for ambulatory care-sensitive conditions (ACSCs) among patients with established care within a patient-centered medical home. STUDY DESIGN: Retrospective chart review using Michigan Medicine's (formerly University of Michigan Health System) electronic health record. METHODS: Ten general medicine (GM) physicians reviewed 256 ambulatory care-sensitive ED encounters that occurred between January 1, 2014, and December 31, 2014, among patients of a GM medical home...
March 1, 2018: American Journal of Managed Care
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