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American Journal of Managed Care

Kirk Moberg
Substance misuse is a critical and costly public health problem in the United States. Data as of 2016 show 11,517 cases of opioid analgesic misuse, with the majority (6924 cases) related to hydrocodone misuse. Substance misuse impacts our society significantly with high costs related to healthcare, crime, and lost productivity. Opioid analgesic pain relievers are one of the most prescribed classes of medications and are among the most common drugs related to misuse. Increases in emergency department visits of over 200% have been associated with a dramatic surge in written prescriptions for opioid pain relievers...
May 2018: American Journal of Managed Care
Courtney Kominek
Today's management of chronic pain presents a challenging clinical dilemma. Although clinicians wish to relieve a patient's suffering, they must do so without undertreating the pain or contributing to the drug abuse problem. Following a steady rise in opioid prescription rates from 2006 to 2012, increased national attention for the obioid abuse epidemic likely contributed to the decline in prescribing rates from 2012 to 2016. Although opioids have helped many patients, they are also associated with adverse events and a growing national crisis of misuse, abuse, and overdose...
May 2018: American Journal of Managed Care
Nicholas E Hagemeier
Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substantial...
May 2018: American Journal of Managed Care
Kim Ekblom, Annika Petersson
OBJECTIVES: To study the effects on the number of laboratory tests ordered after introduction of cost display (showing the cost in the computerized test ordering system at test ordering and test result delivery) and cost charge (requiring all primary healthcare centers to pay full laboratory costs of the ordered tests). STUDY DESIGN: The study included cost display for secondary healthcare centers (inpatient hospitals, emergency departments, and outpatient specialist providers) as well as publicly and privately operated primary healthcare centers (sites of nonemergency, nonspecialist healthcare)...
May 1, 2018: American Journal of Managed Care
Olena Mazurenko, Jay Shen, Guogen Shan, Joseph Greenway
OBJECTIVES: In January 2014, Nevada became 1 of the 32 states that have expanded Medicaid under the Affordable Care Act. As a result of the expansion, 276,400 additional Nevada residents received Medicaid insurance. The objectives of this paper were to examine the impact of Nevada's Medicaid expansion on changes in rates of hospital admissions for ambulatory care-sensitive conditions (ACSCs), which are potentially preventable with good access to outpatient medical care, and to examine the racial/ethnic disparities in such rates...
May 1, 2018: American Journal of Managed Care
Hsueh-Fen Chen, Adrienne Nevola, Tommy M Bird, Saleema A Karim, Michael E Morris, Fei Wan, J Mick Tilford
OBJECTIVES: To understand the factors that potentially account for differences in 30-day readmission ratios for pneumonia, heart failure, and acute myocardial infarction (AMI) among hospitals in the Mississippi Delta region (Delta region), in Delta states excluding the hospitals in the Delta region (Delta state), and in the rest of the nation (other). STUDY DESIGN: A longitudinal study design from 2013 to 2016. METHODS: The dependent variables were 30-day readmission ratios for AMI, heart failure, and pneumonia...
May 1, 2018: American Journal of Managed Care
Michael L Barnett, J Michael McWilliams
OBJECTIVES: Reducing leakage to outside specialists has been promoted as a key strategy for accountable care organizations (ACOs). We sought to examine changes in specialty care leakage and use associated with the Medicare Shared Savings Program (MSSP). STUDY DESIGN: Analyses of trends in ACOs from 2010 to 2014 and quasi-experimental difference-in-differences analyses comparing changes for ACOs versus local non-ACO providers from before until after the start of ACO contracts, stratified by ACO specialty composition and year of MSSP entry...
May 1, 2018: American Journal of Managed Care
Carla V Rodriguez, Kevin B Rubenstein, Benjamin Linas, Haihong Hu, Michael Horberg
OBJECTIVES: To evaluate whether the updated 2013 US Preventive Services Task Force (USPSTF) hepatitis C virus (HCV) screening recommendations, related Affordable Care Act provisions, and the impending availability of efficacious therapies were associated with increased screening in an integrated health system. STUDY DESIGN: We analyzed 665,339 records of adult patients visiting Kaiser Permanente Mid-Atlantic States clinics from 2003 to 2014. METHODS: We used Cox proportional hazards to estimate time to HCV screening and confirmation after June 1, 2013, compared with prior...
May 1, 2018: American Journal of Managed Care
Keith Kranker, Linda M Barterian, Rumin Sarwar, G Greg Peterson, Boyd Gilman, Laura Blue, Kate Allison Stewart, Sheila D Hoag, Timothy J Day, Lorenzo Moreno
OBJECTIVES: To evaluate impacts of a telephonic transitional care program on service use and spending for Medicare fee-for-service beneficiaries at a rural hospital. STUDY DESIGN: Observational cohort study. METHODS: Patients discharged from Atlantic General Hospital (AGH) with an AGH primary care provider were assigned a nurse care coordinator for 30 days. The nurse reviewed the patient's conditions, assessed needs for transition support, conducted weekly telephone calls (beginning 24-72 hours after discharge) to monitor adherence to treatment plans, and scheduled follow-up appointments...
May 2018: American Journal of Managed Care
Bruce C Stuart, Julia F Slejko, Juan-David Rueda, Catherine Cooke, Xian Shen, Pamela Roberto, Michael Ciarametaro, Robert Dubois
OBJECTIVES: To explore formulary restrictions on noninsulin antihyperglycemic drugs (NIADs) in Medicare Part D plans and to estimate the impact of formulary restrictions on use of NIADs among low-income subsidy (LIS) recipient enrollees with type 2 diabetes (T2D) undergoing treatment intensification. STUDY DESIGN: Retrospective cohort study. METHODS: A cohort of 2919 LIS enrollees with T2D receiving metformin monotherapy during the first quarter of 2012 who intensified treatment later in the year was tracked to assess selection of and days' supply with sulfonylureas, dipeptidyl peptidase-4 (DPP-4) inhibitors, and other NIADs...
May 2018: American Journal of Managed Care
Talar W Markossian, Katie J Suda, Lauren Abderhalden, Zhiping Huo, Bridget M Smith, Kevin T Stroupe
OBJECTIVES: To compare characteristics, health conditions, and medication acquisition patterns by fee-for-service (FFS) or Medicare Advantage (MA) plan enrollment status for Medicare-eligible veterans. STUDY DESIGN: Retrospective analysis of all female and a random 10% sample of male veterans. METHODS: Data were derived from the US Department of Veterans Affairs (VA) and Medicare administrative databases. Demographic, geographic, and RxRisk-V risk classes were ascertained in 2008...
May 2018: American Journal of Managed Care
Cheryl Isenhour, Susan Hariri, Claudia Vellozzi
OBJECTIVES: With the availability of curative therapies, it is important to ensure that individuals infected with hepatitis C virus (HCV) receive recommended testing, care, and treatment. We sought to evaluate insurance claims data as a source for monitoring progression along the HCV care cascade. STUDY DESIGN: Longitudinal evaluation of disease progression, from diagnosis to treatment, among commercially insured enrollees with chronic HCV. METHODS: We validated and used algorithms derived from standardized procedure and diagnosis codes to identify enrollees with chronic HCV in large insurance claims databases to describe the HCV care cascade, including the proportion engaged in HCV-specific care (13 possible definitions), the proportion prescribed HCV treatment, and the proportion who received an HCV RNA test 30 or more days after initiating treatment...
May 2018: American Journal of Managed Care
Pankaj B Patel, David R Vinson, Marla N Gardner, David A Wulf, Patricia Kipnis, Vincent Liu, Gabriel J Escobar
OBJECTIVES: Interventions that focus on educating patients appear to be the most effective in directing healthcare utilization to more appropriate venues. We sought to evaluate the effects of mailed information and a brief scripted educational phone call from an emergency physician (EP) on subsequent emergency department (ED) utilization by low-risk adults with a recent treat-and-release ED visit. STUDY DESIGN: Patients were randomized into 3 groups for post-ED follow-up: EP phone call with mailed information, mailed information only, and no educational intervention...
May 2018: American Journal of Managed Care
Adam Sharp, A Mark Fendrick
More consideration should be focused on consumer decision making and the quality and costs of acute care, and less attention should be paid to where care is delivered.
May 2018: American Journal of Managed Care
Peter Aran
No abstract text is available yet for this article.
April 2018: American Journal of Managed Care
Susan Dentzer
No abstract text is available yet for this article.
April 2018: American Journal of Managed Care
Kashyap Patel, Maharshi Patel, Asutosh Gor, Sashi Naidu, Niyati Nathwani, Radhee Kothadia, Saheli Parekh, Eric Singhi
No abstract text is available yet for this article.
April 2018: American Journal of Managed Care
Lani M Alison
No abstract text is available yet for this article.
April 2018: American Journal of Managed Care
Joseph Alvarnas
No abstract text is available yet for this article.
April 2018: American Journal of Managed Care
Benjamin Rix Brooks, James A Jorgenson, Barbara J Newhouse, Jeremy M Shefner, Wendy Agnese
Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neuromuscular disease affecting approximately 5 out of every 100,000 individuals living in the United States. ALS is associated with 50% mortality within 30 months of initial symptom onset. The rarity of the disease, along with the significant inter- and intra-patient variability in clinical course and a lack of reliable biomarkers, have rendered the development of effective agents to treat ALS a challenge. Because oxidative stress is considered a contributing factor to ALS onset and progression, drugs that eliminate free radicals may protect motor neurons from damage potentially caused by free-radical and oxidative stress...
April 2018: American Journal of Managed Care
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