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https://www.readbyqxmd.com/read/29790162/getting-what-we-pay-for-how-do-risk-based-payments-to-medicare-advantage-plans-compare-with-alternative-measures-of-beneficiary-health-risk
#1
Paul D Jacobs, Richard Kronick
OBJECTIVE: To estimate the relative health risk of Medicare Advantage (MA) beneficiaries compared to those in Traditional Medicare (TM). DATA SOURCES/STUDY SETTING: Medicare claims and enrollment records for the sample of beneficiaries enrolled in Part D between 2008 and 2015. STUDY DESIGN: We assigned therapeutic classes to Medicare beneficiaries based on their prescription drug utilization. We then regressed nondrug health spending for TM beneficiaries in 2015 on demographic and therapeutic class identifiers for 2014 and used coefficients from this regression to predict relative risk of both MA and TM beneficiaries...
May 22, 2018: Health Services Research
https://www.readbyqxmd.com/read/29777380/investigating-the-prognostic-ability-of-health-related-quality-of-life-on-survival-a-prospective-cohort-study-of-adults-with-lung-cancer
#2
Laura C Pinheiro, Bryce B Reeve
BACKGROUND: Health-related quality of life (HRQOL) is an important predictor for overall survival (OS). To date, no studies compared associations between HRQOL assessed before and after a cancer diagnosis for OS. Our objectives were to (1) investigate associations between HRQOL changes and OS and (2) identify the best HRQOL assessment time point to predict OS. METHODS: We used the Surveillance, Epidemiology and End Results linked with the Medicare Health Outcomes Survey data...
May 18, 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29774589/healthcare-cost-and-utilization-in-nonalcoholic-fatty-liver-disease-real-world-data-from-a-large-us-claims-database
#3
Alina M Allen, Holly K Van Houten, Lindsey R Sangaralingham, Jayant A Talwalkar, Rozalina G McCoy
The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing. The health care burden resulting from the multidisciplinary management of this complex disease is unknown. We assessed the total health care cost and resource utilization associated with a new NAFLD diagnosis, compared to controls with similar comorbidities. We used OptumLabs Data Warehouse, a large national administrative claims database with longitudinal health data of over 100 million individuals enrolled in private and Medicare Advantage health plans...
May 18, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29767472/the-impact-of-real-world-cardiovascular-related-pharmacogenetic-testing-in-an-insured-population
#4
Jennifer Billings, Patrick N Racsa, Kristine Bordenave, Charron L Long, Jeffrey J Ellis
BACKGROUND: Pharmacogenomics is intended to help clinicians provide the right drug to the right patient at an appropriate dose. However, limited evidence of clinical utility has slowed uptake of pharmacogenomic testing (PGT). OBJECTIVE: To evaluate the impact of real-world cardiovascular (CV)-related PGT on clinical outcomes, healthcare resource utilisation (HCRU) and cost in a large, heterogeneous population. METHODS: Individuals with Medicare Advantage Prescription Drug, Medicaid, or commercial coverage between 1/1/2011 and 9/30/2015 and ≥1 atherosclerotic CV-related diagnosis were identified...
May 16, 2018: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/29757813/estimating-the-economic-burden-related-to-older-adult-falls-by-state
#5
Yara K Haddad, Gwen Bergen, Curtis S Florence
OBJECTIVE: Unintentional falls in older adults (persons 65 years of age and older) impose a significant economic burden on the health care system. Methods for calculating state-specific health care costs are limited. This study describes 2 methods to estimate state-level direct medical spending due to older adult falls and explains their differences, advantages, and limitations. DESIGN: The first method, partial attributable fraction, applied a national attributable fraction to the total state health expenditure accounts in 2014 by payer type (Medicare, Medicaid, and private insurance)...
May 5, 2018: Journal of Public Health Management and Practice: JPHMP
https://www.readbyqxmd.com/read/29752327/adherence-to-guidelines-for-breast-surveillance-in-breast-cancer-survivors
#6
Kathryn J Ruddy, Lindsey Sangaralingham, Rachel A Freedman, Sarah Mougalian, Heather Neuman, Caprice Greenberg, Ahmedin Jemal, Narjust Duma, Tufia C Haddad, Valerie Lemaine, Karthik Ghosh, Tina J Hieken, Katie Hunt, Celine Vachon, Cary Gross, Nilay D Shah
Background: Guidelines recommend annual mammography after curative-intent treatment for breast cancer. The goal of this study was to assess contemporary patterns of breast imaging after breast cancer treatment. Methods: Administrative claims data were used to identify privately insured and Medicare Advantage beneficiaries with nonmetastatic breast cancer who had residual breast tissue (not bilateral mastectomy) after breast surgery between January 2005 and May 2015. We calculated the proportion of patients who had a mammogram, MRI, both, or neither during each of 5 subsequent 13-month periods...
May 2018: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/29722547/adherence-and-economic-impact-of-paliperidone-palmitate-versus-oral-atypical-antipsychotics-in-a-medicare-population
#7
Kruti Joshi, Erik Muser, Yihua Xu, Phil Schwab, Manasi Datar, Brandon Suehs
AIM: To compare adherence, healthcare utilization and costs among real world, Medicare-eligible patients with schizophrenia using long-acting injectable paliperidone palmitate (PP) versus oral atypical antipsychotics. Patients & methods: Historical cohort study used Medicare Advantage claims data. Inverse probability of treatment weighting was applied to adjust for baseline differences. 12-month adherence, healthcare utilization and costs were compared. RESULTS: Patients using PP were more adherent (proportion of days covered ≥0...
May 3, 2018: Journal of Comparative Effectiveness Research
https://www.readbyqxmd.com/read/29717902/disparities-in-nursing-home-use-and-quality-among-african-american-hispanic-and-white-medicare-residents-with-alzheimer-s-disease-and-related-dementias
#8
Maricruz Rivera-Hernandez, Amit Kumar, Gary Epstein-Lubow, Kali S Thomas
OBJECTIVE: This article examines differences in nursing home use and quality among Medicare beneficiaries, in both Medicare Advantage and fee-for-service, newly admitted to nursing homes with Alzheimer's disease and related dementias (ADRD). METHOD: Retrospective, national, population-based study of Medicare residents newly admitted to nursing homes with ADRD by race and ethnic group. Our analytic sample included 1,302,099 nursing home residents-268,181 with a diagnosis of ADRD-in 13,532 nursing homes from 2014...
April 1, 2018: Journal of Aging and Health
https://www.readbyqxmd.com/read/29697778/quality-of-post-acute-care-in-skilled-nursing-facilities-that-disproportionately-serve-black-and-hispanic-patients
#9
Maricruz Rivera-Hernandez, Momotazur Rahman, Dana B Mukamel, Vincent Mor, Amal N Trivedi
Background: Understanding and addressing racial and ethnic disparities in the quality of post-acute care in skilled nursing facilities is an important health policy issue, particularly as the Medicare program initiates value-based payments for these institutions. Methods: Our final cohort included 649,187 Medicare beneficiaries in either the fee-for-service or Medicare Advantage programs, who were 65 and older and were admitted to a skilled nursing facility following an acute hospital stay, from 8,375 skilled nursing facilities...
April 25, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
https://www.readbyqxmd.com/read/29694292/the-effect-of-plan-type-and-comprehensive-medication-reviews-on-high-risk-medication-use
#10
Armando Silva Almodovar, David Rhys Axon, Ashley M Coleman, Terri Warholak, Milap C Nahata
BACKGROUND: In 2007, the Centers for Medicare & Medicaid Services (CMS) instituted a star rating system using performance outcome measures to assess Medicare Advantage Prescription Drug (MAPD) and Prescription Drug Plan (PDP) providers. OBJECTIVE: To assess the relationship between 2 performance outcome measures for Medicare insurance providers, comprehensive medication reviews (CMRs), and high-risk medication use. METHODS: This cross-sectional study included Medicare Part C and Part D performance data from the 2014 and 2015 calendar years...
May 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29693334/rural-urban-enrollment-in-part-d-prescription-drug-plans-june-2017-update
#11
Paula Weigel, Fred Ullrich, Keith Mueller
Purpose: Rural enrollment of Medicare beneficiaries in the Medicare Part D prescription drug program has historically lagged urban enrollment. Rural Part D enrollees are overwhelmingly in standalone prescription drug plans (PDPs), whereas urban beneficiaries are more likely to be enrolled in Medicare Advantage with Prescription Drug (MA-PD) plans. This analysis updates prior briefs on the rural-urban enrollment differential in Medicare Part D plans, and highlights state-to-state variation in PDP and MA-PD enrollment by rural-urban residence...
December 1, 2017: Rural Policy Brief
https://www.readbyqxmd.com/read/29688663/medicare-advantage-enrollment-update-2017
#12
Fred Ullrich, Keith Mueller
Purpose: The RUPRI Center for Rural Health Policy Analysis reports annually on rural beneficiary enrollment in Medicare Advantage (MA) plans, noting any trends or new developments evident in the data. These reports are based on data through March of each year, capturing results of open enrollment periods. Key Findings: (1) Nationally, 1 in 3 Medicare beneficiaries is enrolled in an MA plan. In non-metropolitan areas, nearly 1 in 4 (23.5 percent) beneficiaries is enrolled in an MA plan...
August 1, 2017: Rural Policy Brief
https://www.readbyqxmd.com/read/29687743/clinical-outcomes-of-treatment-with-filgrastim-versus-a-filgrastim-biosimilar-and-febrile-neutropenia-associated-costs-among-patients-with-nonmyeloid-cancer-undergoing-chemotherapy
#13
Lee S Schwartzberg, Lincy S Lal, Sanjeev Balu, Kim Campbell, Lee Brekke, Andrew DeLeon, Caitlin Elliott, Stephanie Korrer
BACKGROUND: Granulocyte colony-stimulating factors such as filgrastim are used to decrease the incidence of febrile neutropenia (FN) among patients with nonmyeloid cancers undergoing chemotherapy treatment. Although the biosimilar filgrastim-sndz has been approved in the United States since 2015, limited real-world comparisons of filgrastim-sndz versus reference filgrastim (filgrastim-ref) have been conducted. OBJECTIVE: To compare FN incidence and assess overall FN-related health care resource utilization and medical costs among U...
April 24, 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29687467/estimating-lead-time-bias-in-lung-cancer-diagnosis-of-patients-with-previous-cancers
#14
Zhiyun Ge, Daniel F Heitjan, David E Gerber, Lei Xuan, Sandi L Pruitt
Surprisingly, survival from a diagnosis of lung cancer has been found to be longer for those who experienced a previous cancer than for those with no previous cancer. A possible explanation is lead-time bias, which, by advancing the time of diagnosis, apparently extends survival among those with a previous cancer even when they enjoy no real clinical advantage. We propose a discrete parametric model to jointly describe survival in a no-previous-cancer group (where, by definition, lead-time bias cannot exist) and in a previous-cancer group (where lead-time bias is possible)...
April 23, 2018: Statistics in Medicine
https://www.readbyqxmd.com/read/29683880/economic-analysis-of-neoadjuvant-chemotherapy-versus-primary-debulking-surgery-for-advanced-epithelial-ovarian-cancer-using-an-aggressive-surgical-paradigm
#15
Ashley L Cole, Emma L Barber, Anagha Gogate, Arthur-Quan Tran, Stephanie B Wheeler
OBJECTIVES: Neoadjuvant chemotherapy (NACT) versus primary debulking surgery (PDS) for advanced epithelial ovarian cancer (AEOC) remains controversial in the United States. Generalizability of existing trial results has been criticized because of less aggressive debulking procedures than commonly used in the United States. As a result, economic evaluations using input data from these trials may not accurately reflect costs and outcomes associated with more aggressive primary surgery. Using data from an ongoing trial performing aggressive debulking, we investigated the cost-effectiveness and cost-utility of NACT versus PDS for AEOC...
April 21, 2018: International Journal of Gynecological Cancer
https://www.readbyqxmd.com/read/29669452/association-between-provider-specialty-and-healthcare-costs-and-glycemic-control-for-patients-with-diabetes
#16
Max Gill, Harmeet Chhabra, Mona Shah, Cyrus Zhu, Howard Lando, Felice Caldarella
AIMS: To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM). MATERIALS AND METHODS: This cross-sectional study identified adults with type 1 or 2 DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider...
April 19, 2018: Journal of Medical Economics
https://www.readbyqxmd.com/read/29668211/a-payer-provider-partnership-for-integrated-care-of-patients-receiving-dialysis
#17
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/29661135/the-relative-burden-of-community-acquired-pneumonia-hospitalizations-in-older-adults-a-retrospective-observational-study-in-the-united-states
#18
Joshua D Brown, James Harnett, Richard Chambers, Reiko Sato
BACKGROUND: The risk of community-acquired pneumonia (CAP) increases with age and significantly impacts morbidity and mortality in the elderly population. The burden of illness and cost of preventing CAP has not been compared to other serious diseases. METHODS: This retrospective analysis used claims data from 2014 to 2015 and compared hospitalizations for CAP, myocardial infarction (MI), stroke, and osteoporotic fractures (OF) in adults aged ≥65 years enrolled in a Medicare Advantage insurance plan...
April 16, 2018: BMC Geriatrics
https://www.readbyqxmd.com/read/29655642/estimating-medicare-and-patient-savings-from-the-use-of-bevacizumab-for-the-treatment-of-exudative-age-related-macular-degeneration
#19
Philip J Rosenfeld, Matthew A Windsor, William J Feuer, Sissi J J Sun, Kevin D Frick, Eric A Swanson, David Huang
PURPOSE: The Medicare cost savings from the use of bevacizumab in the United States for the treatment of exudative age-related macular degeneration (AMD) were estimated by replacing the use of bevacizumab with ranibizumab and aflibercept. DESIGN: Retrospective trend study. METHODS: Main outcome measures were spending by Medicare as tracked by Current Procedural Terminology (CPT) codes for intravitreal injections (67028) and treatment-specific J-codes (J0178, J2778, J9035, J3490 and J3590) for inhibitors of vascular endothelial growth factor...
April 12, 2018: American Journal of Ophthalmology
https://www.readbyqxmd.com/read/29648934/understanding-prediabetes-in-a-medicare-advantage-population-using-data-adaptive-techniques
#20
Pravin S Kamble, Jenna Collins, Raymond A Harvey, Todd Prewitt, Ed Kimball, Tony Deluzio, Elsie Allen, Jonathan R Bouchard
The objective was to identify individuals with undiagnosed prediabetes from administrative data using adaptive techniques. The data source was a national Medicare Advantage Prescription Drug (MAPD) plan administrative data set. A retrospective, cross-sectional study developed and evaluated data adaptive logistic regression, decision tree, neural network, and ensemble predictive models for metabolic syndrome and prediabetes using 3 mutually exclusive cohorts (N = 279,903). The misclassification rate (MCR), average squared error (ASE), c-statistics, sensitivity (SN), and false positive (FP) rates were compared to select the final predictive models...
April 12, 2018: Population Health Management
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