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American Journal of Managed Care

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https://www.readbyqxmd.com/read/28385031/does-paid-versus-unpaid-supplementary-caregiving-matter-in-preventable-readmissions
#1
Hsueh-Fen Chen, Taiye Oluyomi Popoola, Sumihiro Suzuki
OBJECTIVES: To examine the impact of paid and unpaid supplementary caregiving on preventable readmissions among Medicare home health beneficiaries with diabetes. STUDY DESIGN: A retrospective cohort study with a home health episode as the unit of analysis. METHODS: We gathered multiple 2009 Medicare data and national datasets (eg, Area Health Resources File). We used propensity score matching based on beneficiaries' predisposing, enabling, and health need factors to create matched cohorts for episodes solely assisted by paid supplementary caregivers versus those solely assisted by unpaid supplementary caregivers...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385030/consumer-directed-health-plans-do-doctors-and-nurses-buy-in
#2
Lucinda B Leung, José J Escarce
OBJECTIVES: Aiming to increase healthcare value, consumer-directed health plans (CDHPs)-high-deductible health insurance plus a personal spending account-equip enrollees with decision-support tools and expose them to the financial implications of their medical decisions. This study examines whether medically knowledgeable consumers are more or less likely to select a CDHP than individuals without medical knowledge. STUDY DESIGN: Using University of California Los Angeles (UCLA) human resources data, our observational cross-sectional study analyzed the health plan enrollment choices of 3552 faculty and 8429 staff employees...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385029/improvements-in-access-and-care-through-the-affordable-care-act
#3
Julie A Schmittdiel, Jennifer C Barrow, Deanne Wiley, Lin Ma, Danny Sam, Christopher V Chau, Susan M Shetterly
OBJECTIVES: To examine the impact of enrolling in a healthcare plan through the Affordable Care Act (ACA) healthcare exchanges on self-reported access to care. STUDY DESIGN: Cohort study using self-reported data of patients newly enrolled in Kaiser Permanente California and Kaiser Permanente Colorado through the ACA healthcare exchanges for coverage beginning January 1, 2014. METHODS: Baseline and follow-up surveys conducted via mail and telephone, with response rates of 45% and 51%, respectively...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385028/effects-of-an-enhanced-primary-care-program-on-diabetes-outcomes
#4
Sarah L Goff, Lorna Murphy, Alexander B Knee, Haley Guhn-Knight, Audrey Guhn, Peter K Lindenauer
OBJECTIVES: To evaluate the effectiveness of Buena Salud, a multidisciplinary enhanced primary care program for Medicaid Managed Care patients at a community health center serving a low-income Hispanic community. STUDY DESIGN: Controlled before-and-after observational study. METHODS: We extracted data from the electronic health record for patients aged 18 to 64 years with a) type 2 diabetes (T2D) enrolled in the Buena Salud program between August 2011 and January 2012 and b) randomly selected control patients with T2D who had been seen at the study health center during the same time frame...
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385027/a-better-way-leveraging-a-proven-and-utilized-system-for-improving-current-medication-reconciliation-processes
#5
Ajit A Dhavle, Seth Joseph, Yuze Yang, Chris DiBlasi, Ken Whittemore
In this reply to the commentary, "A Call for a Statewide Medication Reconciliation Program," published in the October 2016 issue of The American Journal of Managed Care®, authors note that although they agree with the authors' assessment of the problem, they believe there is a proven and scalable solution to improve medication reconciliation that is already available to, and used by, clinicians.
March 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385026/scaling-lean-in-primary-care-impacts-on-system-performance
#6
Dorothy Y Hung, Michael I Harrison, Meghan C Martinez, Harold S Luft
OBJECTIVES: We examined a wide range of performance outcomes after Lean methodology-a leading strategy to enhance efficiency and patient value-was implemented and scaled across all primary care clinics in a nonprofit, ambulatory care delivery system. STUDY DESIGN: Using a stepped wedge approach, we assessed changes associated with the phased introduction of Lean-based redesigns across 46 primary care departments in 17 different clinic locations. Longitudinal analysis of operational metrics included: workflow efficiency, physician productivity, operating expenses, clinical quality, and satisfaction among patients, physicians, and staff...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385025/private-sector-accountable-care-organization-development-a-qualitative-study
#7
Ann Scheck McAlearney, Brian Hilligoss, Paula H Song
OBJECTIVES: To explore accountable care organizations (ACOs) as they develop in the private sector, including their motivation for development, perspectives from consumers regarding these emerging ACOs, and the critical success factors associated with ACO development. STUDY DESIGN: Comprehensive organizational case studies of 4 full-risk private sector ACOs that included in-person interviews with providers and administrators and focus groups with local consumers...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385024/patient-experience-midway-through-a-large-primary-care-practice-transformation-initiative
#8
Kaylyn E Swankoski, Deborah N Peikes, Stacy B Dale, Nancy A Clusen, Nikkilyn Morrison, John J Holland, Timothy J Day, Randall S Brown
OBJECTIVES: To determine how the multipayer Comprehensive Primary Care (CPC) initiative that transforms primary care delivery affects the patient experience of Medicare fee-for-service beneficiaries. The study examines how experience changed between the first and second years of CPC, how ratings of CPC practices have changed relative to ratings of comparison practices, and areas in which practices still have opportunities to improve patient experience. STUDY DESIGN: Prospective study using 2 serial cross-sectional samples of more than 25,000 Medicare fee-for-service beneficiaries attributed to 496 CPC practices and nearly 9000 beneficiaries attributed to 792 comparison practices...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385023/impact-of-a-pharmacy-based-transitional-care-program-on-hospital-readmissions
#9
Weiyi Ni, Danielle Colayco, Jonathan Hashimoto, Kevin Komoto, Chandrakala Gowda, Bruce Wearda, Jeffrey McCombs
OBJECTIVES: Avoidable readmissions of patients discharged from hospitals are a major concern. This study evaluates the impact of pharmacist-provided postdischarge services on hospital readmissions for members of a US managed Medicaid health plan. STUDY DESIGN: Prospective cohort study. METHODS: Synergy Pharmacy Solutions (SPS) initiated a transition of care (TOC) service for high-risk members of the Kern Health Systems (KHS) managed Medicaid plan...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28385022/applying-organizational-behavior-theory-to-primary-care
#10
Samyukta Mullangi, Sanjay Saint
Addressing the mounting primary care shortage in the United States has been a focus of educators and policy makers, especially with the passage of the Affordable Care Act in 2010 and the Medicare Access and CHIP Reauthorization Act in 2015, placing increased pressure on the system. The Association of American Medical Colleges recently projected a shortage of as many as 65,000 primary care physicians by 2025, in part because fewer than 20% of medical students are picking primary care for a career. We examined the issue of attracting medical students to primary care through the lens of organizational behavior theory...
March 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298136/managing-patient-expectations-with-immuno-oncology
#11
Surabhi Dangi-Garimella
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298135/from-bench-to-community-oncology-clinic-the-promise-of-immunotherapy
#12
Sumeet Chandra
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298134/car-t-cells-the-next-era-in-immuno-oncology
#13
Bruce A Feinberg, Jennifer Fillman, Justin Simoncini, Chadi Nabhan
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298133/patient-navigation-in-immuno-oncology
#14
Shawn M Regis
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298132/q-a-with-dr-jae-park-on-the-promise-of-car-t-cells-in-cancer-care
#15
Surabhi Dangi-Garimella
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298131/helping-cancer-patients-and-caregivers-navigate-immunotherapy-treatment
#16
Claire Saxton, Joanne Buzaglo, Sue Rochman, Alexandra Zaleta
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28298130/advanced-apms-and-the-emerging-role-of-immuno-oncology-agents-balancing-innovation-and-value
#17
Michael V Seiden, Marcus Neubauer, Diana Verrilli
No abstract text is available yet for this article.
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28245662/sustained-participation-in-a-pay-for-value-program-impact-on-high-need-patients
#18
Dori A Cross, Genna R Cohen, Christy Harris Lemak, Julia Adler-Milstein
OBJECTIVE: To assess whether multi-year engagement by primary care practices in a pay-for-value program was associated with improved care for high-need patients. STUDY DESIGN: Longitudinal cohort study of 17,443 patients with 2 or more conditions who were assigned to primary care providers (PCPs) within 1582 practices that did and did not continuously participate in Blue Cross Blue Shield of Michigan's pay-for-value program (the Physician Group Incentive Program [PGIP]) between 2010 and 2013...
February 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28245661/value-based-contracting-innovated-medicare-advantage-healthcare-delivery-and-improved-survival
#19
Aloke K Mandal, Gene K Tagomori, Randell V Felix, Scott C Howell
OBJECTIVES: In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. STUDY DESIGN: A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area...
February 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28245660/patients-with-diabetes-in-pay-for-performance-programs-have-better-physician-continuity-of-care-and-survival
#20
Chien-Chou Pan, Pei-Tseng Kung, Li-Ting Chiu, Yu Pei Liao, Wen-Chen Tsai
OBJECTIVES: This study investigated the effects of physician continuity, measured as the Continuity of Care Index (COCI) score, on the survival of patients with diabetes, including both pay-for-performance (P4P) participants and nonparticipants. STUDY DESIGN: This was a retrospective, nationwide population-based analysis of 396,838 patients with diabetes, with 198,419 subjects each in the P4P participant and nonparticipant groups, from 1997 to 2009, in Taiwan. METHODS: The data presented in this study are secondary data obtained from the 1997 to 2009 National Health Insurance Research Database published by the Taiwan National Health Research Institute...
February 1, 2017: American Journal of Managed Care
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