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American Journal of Managed Care

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https://www.readbyqxmd.com/read/29182359/validation-of-a-claims-based-algorithm-to-characterize-episodes-of-care
#1
Chad Ellimoottil, John D Syrjamaki, Benedict Voit, Vinay Guduguntla, David C Miller, James M Dupree
OBJECTIVES: Although hospitals face increasing pressure from payers to improve the efficiency of healthcare delivery beyond the index hospitalization, they often lack information on postdischarge events. The Michigan Value Collaborative (MVC) developed a claims-based algorithm to provide hospitals with data on events that occur to patients beyond the hospitalization. Herein, we discuss the validation of MVC's claims-based algorithm. STUDY DESIGN: Retrospective analysis of a claims-based algorithm's ability to identify specific medical events, such as index hospitalizations, 30-day readmissions, emergency department visits, skilled nursing facility admissions, home health visits, and rehabilitation services...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182358/diabetes-care-improvement-in-pharmacist-versus-nurse-supported-patient-centered-medical-homes
#2
Lillian Min, Christine T Cigolle, Steven J Bernstein, Kathleen Ward, Tisha L Moore, Jinkyung Ha, Caroline S Blaum
OBJECTIVES: In 2009 and 2010, 17 primary care sites within 1 healthcare system became patient-centered medical homes (PCMHs), but the sites trained different personnel (pharmacists vs nurses) to improve diabetes care using self-management support (SMS). We report the challenges and successes of our efforts to: 1) assemble a new multipayer (Medicare, Medicaid, commercial) claims dataset linked to a clinical registry and 2) use the new dataset to perform comparative effectiveness research on implementation of the 2 SMS models...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182357/changes-in-cardiovascular-care-provision-after-the-affordable-care-act
#3
Joseph A Ladapo, Dave A Chokshi
OBJECTIVES: Physicians are gatekeepers to preventive care recommended by the US Preventive Services Task Force (USPSTF). We aimed to determine whether the Affordable Care Act (ACA) was associated with changes in physicians' provision of preventive cardiovascular services, focusing primarily on patients with employer-sponsored health plans. STUDY DESIGN: Quasi-experimental, difference-in-differences (DID) approach. METHODS: We analyzed National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data from 2006 to 2013...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182356/improving-antibiotic-stewardship-a-stepped-wedge-cluster-randomized-trial
#4
Adam L Sharp, Yi R Hu, Ernest Shen, Richard Chen, Ryan P Radecki, Michael H Kanter, Michael K Gould
OBJECTIVES: Antibiotic stewardship is key to optimizing patient outcomes and affordable care. The study objective was to examine the effect of provider education and clinical decision support (CDS) on antibiotic prescribing for acute sinusitis among providers of varying experience. STUDY DESIGN: A stepped-wedge cluster randomized intervention to evaluate antibiotic use for acute sinusitis encounters at 126 Kaiser Permanente Southern California clinics between September 2014 and April 2015...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182355/electronic-reminder-s-role-in-promoting-human-papillomavirus-vaccine-use
#5
Jaeyong Bae, Eric W Ford, Shannon Wu, Timothy Huerta
OBJECTIVES: To study the association of using an electronic health record (EHR)'s clinical reminder functionality with increased human papillomavirus (HPV) vaccine administration among US office-based physicians. STUDY DESIGN: National Ambulatory Medical Care Survey data from 2007-2012 were pooled together to determine if EHR systems that employ clinical reminders are associated with increased immunization rates in different populations. METHODS: The administration of HPV vaccine served as the dependent variable, with the EHR reminder being the primary independent variable of interest...
November 1, 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182354/reframing-the-unaffordability-debate-patient-responsibility-for-physician-care
#6
Katherine Hempstead, Josh Gray, Anna Zink
OBJECTIVES: Public discussion suggests that rising out-of-pocket costs have dramatically reduced the value of insurance and led to patients doing without needed care. Our aim was to ascertain trends in patient responsibility for cost sharing. STUDY DESIGN: We used data from an organization that serves over 78,000 healthcare providers and has access to visit-level data, including the amounts paid by patients. These practices are broadly representative of physicians and patients nationally...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182353/impact-of-health-reform-on-young-adult-prescription-medication-utilization
#7
Amy Pakyz, Hui Wang, Peter Cunningham
OBJECTIVES: To assess the impact of the Affordable Care Act dependent coverage provision on outpatient prescription expenditures among young adults and to characterize medication types that are prescribed for young adults. STUDY DESIGN: Quasi-experimental. METHODS: Using data from the Medical Expenditure Panel Survey from 2007 to 2009 and 2011 to 2013, difference-in-differences (DID) analyses estimated the provision's impact among young adults aged 19 to 25 years versus those aged 26 to 34 years...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182352/patients-perspectives-of-care-management-a-qualitative-study
#8
Ann S O'Malley, Deborah Peikes, Claire Wilson, Rachel Gaddes, Victoria Peebles, Timothy J Day, Janel Jin
OBJECTIVES: Risk-stratified care management is a cornerstone of patient-centered medical home models, but studies on patients' perspectives of care management are scarce. We explored patients' experiences with care management, what they found useful, and what needs improvement. STUDY DESIGN: Semi-structured qualitative telephone interviews. METHODS: We interviewed 43 high-risk patients or their caregivers who were receiving care management from 11 practices in CMS' Comprehensive Primary Care initiative, provided by nurse care managers (9 practices) or the physician (2 [solo] practices)...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182351/the-influence-of-provider-characteristics-and-market-forces-on-response-to-financial-incentives
#9
Brock O'Neil, Mark Tyson, Amy J Graves, Daniel A Barocas, Sam S Chang, David F Penson, Matthew J Resnick
OBJECTIVES: Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29182350/using-the-4-pillars-to-increase-vaccination-among-high-risk-adults-who-benefits
#10
Mary Patricia Nowalk, Krissy K Moehling, Song Zhang, Jonathan M Raviotta, Richard K Zimmerman, Chyongchiou J Lin
OBJECTIVES: To compare changes in vaccination rates (pneumococcal polysaccharide vaccine [PPSV]; tetanus, diphtheria, and pertussis [Tdap] vaccine; and influenza vaccine) among high-risk adults following an intervention (June 1, 2013, to January 31, 2015) that used the 4 Pillars Practice Transformation Program (4 Pillars Program). STUDY DESIGN: Post hoc analysis of data from a randomized controlled cluster trial. METHODS: Eighteen primary care practices received staff education, guidance for using the 4 Pillars Program, and support for a practice immunization champion...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144720/cost-effectiveness-of-gammacore-non-invasive-vagus-nerve-stimulation-for-acute-treatment-of-episodic-cluster-headache
#11
Mkaya Mwamburi, Eric J Liebler, Andrew T Tenaglia
Cluster headache is a debilitating disease characterized by excruciatingly painful attacks that affects 0.15% to 0.4% of the US population. Episodic cluster headache manifests as circadian and circannual seasonal bouts of attacks, each lasting 15 to 180 minutes, with periods of remission. In chronic cluster headache, the attacks occur throughout the year with no periods of remission. While existing treatments are effective for some patients, many patients continue to suffer. There are only 2 FDA-approved medications for episodic cluster headache in the United States, while others, such as high-flow oxygen, are used off-label...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144719/real-world-health-plan-claims-analysis-of-differences-in-healthcare-utilization-and-total-cost-in-patients-suffering-from-cluster-headaches-and-those-without-headache-related-conditions
#12
Michael Polson, Todd C Lord, Themmi M Evangelatos, Maria Lopes, Briana L Santaniello
BACKGROUND: According to the World Health Organization, headache disorders are underappreciated by many health systems. These disorders have a substantial impact on quality of life, yet the true correlation between headache conditions and increased total healthcare utilization is not well understood. This study further explores the impact of headache conditions on healthcare utilization. OBJECTIVES: To assess differences in healthcare utilization and total cost in patients suffering from cluster headaches (CH) compared with patients without headache-related conditions...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144718/the-emerging-role-of-gammacore%C3%A2-in-the-management-of-cluster-headache-expert-panel-recommendations
#13
Stephen D Silberstein, Anne H Calhoun, Christina Treppendahl, David W Dodick, Alan M Rapoport, Avinash Mamidi, Peter Vargas, Thomas H Ebert, Stewart J Tepper
A panel of 9 experts, including neurologists, other headache specialists, and medical and pharmacy directors, from 4 health plans (1 integrated delivery network and 3 plans with commercial, Medicare, and Medicaid lines of business), convened to discuss cluster headache (CH). Topics covered included the current treatment landscape, treatment challenges, economic impact of disease, and gaps in care for patients with CH. One major challenge in the management of CH is that it is underrecognized and frequently misdiagnosed, leading to delays in and suboptimal treatment for patients who suffer from this painful and disabling condition...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144717/review-of-non-invasive-vagus-nerve-stimulation-gammacore-efficacy-safety-potential-impact-on-comorbidities-and-economic-burden-for-episodic-and-chronic-cluster-headache
#14
Mkaya Mwamburi, Eric J Liebler, Andrew T Tenaglia
The FDA has cleared gammaCore (non-invasive vagus nerve stimulator [nVNS]) for the treatment of episodic cluster headache (eCH). With the exception of subcutaneous sumatriptan, all other treatments are used off label and have many limitations. The FDA approval process for devices differs from that of drugs. We performed a review of the literature to evaluate new evidence on various aspects of gammaCore treatment and impact. The ACute Treatment of Cluster Headache Studies (ACT1 and ACT2), both double-blind sham-controlled randomized trials, did not meet the primary endpoints of the trials but each demonstrated significant superiority of gammaCore among patients with eCH...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29144716/mechanism-of-action-of-non-invasive-cervical-vagus-nerve-stimulation-for-the-treatment-of-primary-headaches
#15
Bruce Simon, Justyna Blake
Stimulation of the cervical vagus nerve with implanted vagus nerve stimulation (iVNS) has been used clinically for more than 20 years to treat patients with epilepsy. More recently, a non-invasive cervical vagus nerve stimulation (nVNS), gammaCore, was developed, which has been purported to also stimulate the vagus nerve without the cost and morbidity associated with an iVNS system. gammaCore has been used to acutely treat various types of primary headaches, including migraine and cluster headaches (CH), and for the prevention of episodic, chronic, and menstrual migraines and CH...
November 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29087666/in-conversation-with-a-pharmacist-management-of-car-t-cell-treatment
#16
Surabhi Dangi-Garimella
No abstract text is available yet for this article.
October 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29087665/pharmacy-team-involvement-in-navigating-the-revenue-cycle-for-high-cost-medications-in-patients-with-cancer
#17
Brandon R Shank, Phuoc Anh Anne Nguyen, Emily C Pherson
No abstract text is available yet for this article.
October 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29087664/pharmacy-s-changing-role-as-care-transitions-from-infused-to-oral-therapies
#18
Stacey McCullough, Ricky Newton
No abstract text is available yet for this article.
October 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29087663/positive-quality-interventions-an-innovative-platform-for-oncology-practice-collaboration
#19
Joshua Nubla, Neal Dave, Michael Reff
No abstract text is available yet for this article.
October 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/29087662/pbms-their-role-the-problems-and-how-practices-can-work-with-pbms
#20
Ray Bailey, Ricky Newton
No abstract text is available yet for this article.
October 2017: American Journal of Managed Care
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