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American Journal of Managed Care

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https://www.readbyqxmd.com/read/27870547/prescribers-perceptions-of-medication-discontinuation-survey-instrument-development-and-validation
#1
Amy Linsky, Steven R Simon, Kelly Stolzmann, Barbara G Bokhour, Mark Meterko
OBJECTIVES: Primary care providers (PCPs) and clinical pharmacists have concerns about the adverse consequences of using medications inappropriately and generally support the notion of reducing unnecessary drugs. Despite this attitude, many factors impede clinicians' ability to discontinue medication in clinical settings. We sought to develop a survey instrument that assesses PCPs' and pharmacists' experiences, attitudes, and beliefs toward medication discontinuation. STUDY DESIGN: Survey development and psychometric assessment...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870546/integrated-care-organizations-medicare-financing-for-care-at-home
#2
Karen Davis, Amber Willink, Cathy Schoen
OBJECTIVES: As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use. METHODS: This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870545/does-medicare-advantage-enrollment-affect-home-healthcare-use
#3
Daniel A Waxman, Lillian Min, Claude M Setodji, Mark Hanson, Neil S Wenger, David A Ganz
OBJECTIVES: To compare home health utilization and clinical outcomes between Medicare beneficiaries in the fee-for-service (FFS) and Medicare Advantage (MA) programs, and to compare regional variation. STUDY DESIGN: We used the 2010 and 2011 Outcome and Assessment Information Set to identify all home health episodes begun in 2010 and to measure 7 clinical home health outcomes that are defined by CMS for public reporting. METHODS: We modeled the probability of home health use, the duration of home health episodes, and each clinical outcome measure as a function of MA versus FFS enrollment and model-specific risk adjustors...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870544/referrals-and-the-pcmh-how-well-do-we-know-our-neighborhood
#4
Andrew Schreiner, Patrick Mauldin, Jingwen Zhang, Justin Marsden, William Moran
OBJECTIVES: Characterize patterns of referral from a patient-centered medical home (PCMH) and observe the association of provider experience, patient chronic disease burden, and risk of utilization on referral placement. STUDY DESIGN: Descriptive analysis of referral patterns in an academic, internal medicine PCMH. METHODS: We examined referrals (eg, specialist visit, testing, ancillary services) placed between July and December of 2014 in an academic PCMH caring for a total of 12,000 patients...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870543/enhancing-patient-and-family-engagement-through-meaningful-use-stage-3-opportunities-and-barriers-to-implementation
#5
Jaclyn Rappaport, Sara Galantowicz, Andrea Hassol, Anisha Illa, Sid Thornton, Shan He, Jean Adams, Charlie Sawyer
OBJECTIVES: The proposed Patient and Family Engagement objectives for Meaningful Use Stage 3 (MU3) seek to provide patients with increased access to, and control over, the content and dissemination of their electronic health record (EHR) information. STUDY DESIGN: Implementation study conducted from 2013-2014. METHODS: In this study, 2 leading US health systems attempted to implement 4 draft MU3 objectives within their current EHR system. Senior staff provided qualitative feedback on their implementation experience; researchers used content analysis to identify major themes and implementation challenges...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27870542/a-new-chapter-in-health-reform
#6
Michael E Chernew, A Mark Fendrick
No abstract text is available yet for this article.
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849352/medical-home-transformation-and-breast-cancer-screening
#7
Amy W Baughman, Phyllis Brawarsky, Tracy Onega, Tor D Tosteson, Qianfei Wang, Anna N A Tosteson, Jennifer S Haas
OBJECTIVES: The patient-centered medical home (PCMH) continues to gain momentum as a primary care delivery system. We evaluated whether medical home transformation of primary care practices is associated with the use of breast cancer screening, a broadly endorsed preventive service. STUDY DESIGN: Retrospective cohort study evaluating 12 Brigham and Women's Hospital (BWH)-affiliated primary care clinics in greater Boston, Massachusetts. METHODS: Practice transformation was measured quarterly using a continuous PCMH transformation score (range = 0-100) modeled after National Committee for Quality Assurance recognition requirements...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849351/the-role-of-internal-medicine-subspecialists-in-patient-care-management
#8
Jonathan L Vandergrift, Bradley M Gray, James D Reschovsky, Eric S Holmboe, Rebecca D Lipner
OBJECTIVES: To understand the clinical roles in which internal medicine (IM) subspecialists engage, especially those involving ongoing patient management. STUDY DESIGN: Measures of physician clinical roles were based on survey responses collected from 8020 mid-career IM subspecialists who registered for the American Board of Internal Medicine maintenance of certification program (86% registration/response rate) between 2009 and 2013. METHODS: Each subspecialist reported their percentage of clinical time in 5 clinical roles: primary, principal, longitudinal consultative, medical consultative, and procedural care...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849350/maternal-mental-health-and-infant-mortality-for-healthy-weight-infants
#9
Susan E White, Robert W Gladden
OBJECTIVES: The objective of this study was to determine if severe mental illness and/or a history of substance use in mothers of babies of a healthy weight was associated with infant mortality. STUDY DESIGN: This was a cross-sectional observational study using CareSource historical billed Medicaid Managed Care plan (MMC) claims in Ohio. METHODS: CareSource is Ohio's largest MMCP, serving approximately 1.2 million Medicaid consumers. Claims from 89,159 babies of a healthy weight (≥ 2500 grams) and their mothers were selected from the CareSource Ohio MMCP population from January 2011 through December 2014...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849349/health-systems-tackling-social-determinants-of-health-promises-pitfalls-and-opportunities-of-current-policies
#10
Krisda H Chaiyachati, David T Grande, Jaya Aysola
Although improving the quality and delivery of clinical care is a critical mission for health systems, they are increasingly being tasked with improving the overall health of patients. This new directive is reflected in the growing number of health sector efforts in population health-a concept intertwined with social forces that impact patient care and health outcomes: the social determinants of health. Three policies that have the potential to help health systems intervene on social determinants of health are: 1) the Internal Revenue Service-mandated Community Health Needs Assessment for nonprofit hospitals, 2) value-based payment reform, and 3) CMS' Accountable Health Communities program...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849348/reconsidering-the-economic-value-of-multiple-sclerosis-therapies
#11
Tiffany Shih, Craig Wakeford, Dennis Meletiche, Jesse Sussell, Adrienne Chung, Yanmei Liu, Jin Joo Shim, Darius Lakdawalla
OBJECTIVES: To illustrate a more comprehensive view of value associated with medicines treating a highly severe illness and to apply these insights to estimate the costs and benefits of 3 treatments for multiple sclerosis (MS): Avonex, Tysabri, and Tecfidera. STUDY DESIGN: Retrospective study spanning 2002 to 2013. We used economic theory to derive the value of therapy to patients with MS and to individuals who face the risk of contracting MS in the future, under the alternative assumptions that therapies were fully insured or paid for out of pocket...
November 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27849353/evaluating-dose-ratio-of-subcutaneous-to-intravenous-immunoglobulin-therapy-among-patients-with-primary-immunodeficiency-disease-switching-to-20-subcutaneous-immunoglobulin-therapy
#12
Girishanthy Krishnarajah, Jee-Yeon K Lehmann, Brian Ellman, Rachel H Bhak, Maral DerSarkissian, Deane Leader, Ann L Bullinger, Mei Sheng Duh
BACKGROUND: Current prescribing information recommends that physicians apply a dose ratio of 1.37:1 (1.53:1 prior to January 2015) in the United States (US) when switching patients with primary immunodeficiency disease (PI) from intravenous (IVIG) therapy to most subcutaneous therapy ([SCIG], except the 10% SCIG human hyaluronidase and immune globulin). However, a dose ratio of 1:1 was studied and approved for the European Union (EU). The dose-adjustment ratio used by prescribers in real-world US clinical practice is unknown...
October 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662394/managing-inappropriate-requests-of-laboratory-tests-from-detection-to-monitoring
#13
Maria Salinas, Maite López-Garrigós, Emilio Flores, Maria Leiva-Salinas, Alberto Asencio, Javier Lugo, Carlos Leiva-Salinas
OBJECTIVES: The main objectives of this study were to show a simple approach to detect inappropriate requests of laboratory tests and to monitor success after establishing interventions. These objectives were monitored through process and outcome indicators customized according to the type and phase of the appropriateness strategy. STUDY DESIGN: Quasi-experimental design. METHODS: Based on evidence regarding laboratory test utilization differences among different geographical areas of Spain, we identified serum calcium (s-Ca) testing to be underrequested and total bilirubin (tBil) testing to be overrequested in primary care patients who undergo testing at the Public University Hospital of San Juan, in San Juan de Alicante, Alicante, Spain...
September 1, 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662223/new-strategies-for-aligning-physicians-with-health-system-incentives
#14
Amol S Navathe, Aditi P Sen, Meredith B Rosenthal, Robert M Pearl, Peter A Ubel, Ezekiel J Emanuel, Kevin G Volpp
No abstract text is available yet for this article.
September 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662222/geographic-variation-in-surgical-outcomes-and-cost-between-the-united-states-and-japan
#15
Michael P Hurley, Lena Schoemaker, John M Morton, Sherry M Wren, William B Vogt, Sachiko Watanabe, Aki Yoshikawa, Jay Bhattacharya
OBJECTIVES: Unwarranted geographic variation in spending has received intense scrutiny in the United States. However, few studies have compared variation in spending and surgical outcomes between the United States healthcare system and those of other nations. In this study, we compare the geographic variation in postsurgical outcomes and cost between the United States and Japan. STUDY DESIGN: This retrospective cohort study uses Medicare Part A data from the United States (2010-2011) and similar inpatient data from Japan (2012)...
September 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662221/cost-benefit-of-appointment-based-medication-synchronization-in-community-pharmacies
#16
Julie A Patterson, David A Holdford, Kunai Saxena
OBJECTIVES: To evaluate the cost-benefit of appointment-based medication synchronization (ABMS) offered in community pharmacies for patients taking chronic medications to prevent negative outcomes associated with hyperlipidemia, hypertension, and diabetes. STUDY DESIGN: Decision-tree analysis based on published literature and publicly available data. METHODS: Program benefits were based on linking published findings of improvements in medication adherence due to the implementation of an ABMS program to a claims-based study of disease-related medical costs associated with different levels of adherence...
September 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662220/implications-of-evolving-delivery-system-reforms-for-prostate-cancer-care
#17
Brent K Hollenbeck, Maggie J Bierlein, Samuel R Kaufman, Lindsey Herrel, Ted A Skolarus, David C Miller, Vahakn B Shahinian
OBJECTIVES: Prostate cancer treatment is a significant source of morbidity and healthcare spending. Evolving clinical data have supported expanding surveillance as a means to "right-size" treatment. Integrated delivery systems afford the possibility of hastening this objective. STUDY DESIGN: Retrospective cohort study of Medicare beneficiaries. METHODS: We used a 20% sample of national Medicare claims to assess the impact of healthcare integration on rates of treatment and potential overtreatment in men newly diagnosed with prostate cancer between 2007 and 2011...
September 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27662219/the-opportunities-and-challenges-of-the-mssp-aco-program-a-report-from-the-field
#18
Farzad Mostashari, Travis Broome
In this article, we seek to provide the first detailed description of a Medicare Shared Savings Program (MSSP) accountable care organization (ACO)'s actions and results to help increase understanding of the challenges and opportunities facing ACOs, and in particular, those comprised of a network of independent practices. Whether ACOs have been successful in delivering value has been the subject of much debate and speculation. What has been missing from this discussion is a look at the program from the frontlines and those who are launching and running MSSP ACOs...
September 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27668789/evaluation-of-clinical-outcomes-and-costs-based-on-prescribed-dose-level-of-renin-angiotensin-aldosterone-system-inhibitors
#19
Murray Epstein, Paula J Alvarez, Nancy L Reaven, Susan E Funk, Karen J McGaughey, Melanie S Brenner, Wade Benton, Ladan Golestaneh
No abstract text is available yet for this article.
August 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27567516/aligning-forces-for-quality-multi-stakeholder-healthcare-alliances-do-they-have-a-sustainable-future
#20
Jeffrey A Alexander, Larry R Hearld, Laura J Wolf, Jocelyn M Vanderbrink
OBJECTIVES: Multi-stakeholder healthcare alliances in the Robert Wood Johnson Foundation's Aligning Forces for Quality (AF4Q) program brought together diverse stakeholders to work collaboratively to improve healthcare in their local communities. This article evaluates how well the AF4Q alliances were collectively positioned to sustain themselves as AF4Q program support ended. METHODS: This analysis relied on a mixed-methods design using data from a survey of more than 700 participants in 15 of the 16 AF4Q alliances (1 alliance was unable to participate because it was in the process of closing down operations at the time of survey implementation), qualitative interviews with leaders in all 16 of the alliances, and secondary sources...
August 2016: American Journal of Managed Care
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