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https://www.readbyqxmd.com/read/28345441/prevalence-and-cost-of-subsequent-fractures-among-u-s-patients-with-an-incident-fracture
#1
Jessica Weaver, Shiva Sajjan, E Michael Lewiecki, Steven T Harris, Panagiotis Marvos
BACKGROUND: The prevalence and cost of subsequent fractures among patients with an incident fracture are not well defined. OBJECTIVE: To assess the prevalence of, and costs associated with, subsequent fractures in the year after an incident fracture. METHODS: This was a retrospective claims database analysis using data from Humana Medicare Advantage claims (Medicare group) and Optum Insight Clinformatics Data Mart commercial claims (commercial group)...
April 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28345144/adapting-evaluations-of-alternative-payment-models-to-a-changing-environment
#2
Thomas W Grannemann, Randall S Brown
OBJECTIVE: To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. STUDY DESIGN (APPROACH): We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. PRINCIPAL FINDINGS: The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions...
March 27, 2017: Health Services Research
https://www.readbyqxmd.com/read/28318667/paying-medicare-advantage-plans-to-level-or-tilt-the-playing-field
#3
Jacob Glazer, Thomas G McGuire
Medicare beneficiaries are eligible for health insurance through the public option of traditional Medicare (TM) or may join a private Medicare Advantage (MA) plan. Both are highly subsidized but in different ways. Medicare pays for most of costs directly in TM, and subsidizes MA plans based on a "benchmark" for each beneficiary choosing a private plan. The level of this benchmark is arguably the most important policy decision Medicare makes about the MA program. Many analysts recommend equalizing Medicare's subsidy across the options - referred to in policy circles as a "level playing field...
December 29, 2016: Journal of Health Economics
https://www.readbyqxmd.com/read/28314797/effect-of-2013-acc-aha-blood-cholesterol-guidelines-on-statin-treatment-patterns-and-low-density-lipoprotein-cholesterol-in-atherosclerotic-cardiovascular-disease-patients
#4
Ted Okerson, Jeetvan Patel, Stefan DiMario, Tanya Burton, Jerald Seare, David J Harrison
BACKGROUND: Preceding release of the 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol guidelines, prescribers aimed for specific low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD). The 2013 guidelines changed this focus to treating patients with appropriate statin intensity given their ASCVD risk. We examined statin use and LDL-C levels before and after the 2013 ACC/AHA guidelines in patients with clinical ASCVD as defined in the guidelines...
March 17, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28295261/the-role-of-medicare-s-inpatient-cost-sharing-in-medicaid-entry
#5
Laura M Keohane, Amal N Trivedi, Vincent Mor
OBJECTIVE: To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. DATA SOURCES: Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. STUDY DESIGN: Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge...
March 13, 2017: Health Services Research
https://www.readbyqxmd.com/read/28264957/provider-offered-medicare-advantage-plans-recent-growth-and-care-quality
#6
Garret Johnson, Zoe M Lyon, Austin Frakt
Hospitals and health systems are increasingly offering their own insurance products, a type of consolidation known as "vertical integration." The relationship between plan-provider vertical integration and quality of care has not been examined extensively or over time. We created a new data set of all vertically integrated Medicare Advantage contracts operating in the period 2011-15 and tracked their characteristics and quality over time. While the percentage of vertically integrated contracts increased slightly between 2011 and 2015, the percentage of all Medicare Advantage enrollees in them declined from 24...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28251556/retrospective-study-on-the-impact-of-adherence-in-achieving-glycemic-goals-in-type-2-diabetes-mellitus-patients-receiving-canagliflozin
#7
Erin K Buysman, Amy Anderson, Shaffeeulah Bacchus, Mike Ingham
INTRODUCTION: Adherence is poor among patients taking antihyperglycemic agents (AHAs) for type 2 diabetes mellitus (T2DM). Inadequate adherence has been linked to decreased glycemic control and increased healthcare costs and hospitalizations. We examined the impact of real-world adherence on glycemic control in T2DM patients treated with canagliflozin. METHODS: This retrospective study used US administrative claims data from commercial and Medicare Advantage healthcare enrollees...
March 1, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28245661/value-based-contracting-innovated-medicare-advantage-healthcare-delivery-and-improved-survival
#8
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/28245655/economic-burden-of-hypoglycemia-with-basal-insulin-in-type-2-diabetes
#9
Vivian Fonseca, Engels Chou, Hsing-Wen Chung, Charles Gerrits
OBJECTIVES: To assess the impact of hypoglycemia and potential underlying factors of economic burden in patients with type 2 diabetes (T2D) who are initiating basal insulin therapy. STUDY DESIGN: This retrospective cohort study combined commercial insurance and Medicare Advantage data from the Clinformatics Data Mart. METHODS: Adults with T2D on oral antidiabetes drugs initiating basal insulin (n = 18,918) were assessed at baseline (12 months prior to insulin initiation) and follow-up (1 and 2 years)...
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28245653/synchronized-prescription-refills-and-medication-adherence-a-retrospective-claims-analysis
#10
Jalpa A Doshi, Raymond Lim, Pengxiang Li, Peinie P Young, Victor F Lawnicki, Andrea B Troxel, Kevin G Volpp
OBJECTIVES: Medication adherence is often suboptimal, especially among patients on multiple chronic medications. We examined the association between synchronized medication refill schedules-which typically reduce organizational effort and logistical demands-and adherence. STUDY DESIGN: Retrospective study among patients enrolled in Medicare Advantage prescription drug plans. METHODS: We used 2012 pharmacy, medical, and enrollment data linked with consumer meta-data for Medicare patients filling 2 or more maintenance prescriptions for antihypertensives, lipid-lowering agents, antidiabetic agents, antidepressants, and/or antiosteoporotic agents...
February 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28237647/utilization-of-the-national-inpatient-sample-for-abdominal-aortic-aneurysm-research
#11
Anahita Dua, Fadwa Ali, Elizabeth Traudt, Sapan S Desai
Large administrative databases, including the Medicare database by the Centers for Medicare and Medicaid Services, the National Surgical Quality Improvement Project database sponsored by the American College of Surgeons, and the National Inpatient Sample, have been used by major public health agencies for years. More recently, medical researchers have turned to database research to power studies on diseases that are noted to be relatively scarce. This study aimed to review and discuss the utilization of the National Inpatient Sample for abdominal aortic aneurysm research, inclusive of its advantages, disadvantages, and best practices...
February 22, 2017: Surgery
https://www.readbyqxmd.com/read/28230454/adherence-persistence-and-health-care-costs-for-patients-receiving-dipeptidyl-peptidase-4-inhibitors
#12
Karen L Rascati, Karen Worley, Yunus Meah, Damian Everhart
BACKGROUND: The dipeptidyl peptidase-4 (DPP-4) inhibitors are among the newer, yet more established, classes of diabetes medications. OBJECTIVE: To compare adherence, persistence, and health care costs among patients taking DPP-4 inhibitors. METHODS: Claims were extracted from Humana Medicare Advantage Prescription Drug (MAPD) or commercial plans for patients aged > 18 years with ≥ 1 prescription filled for a DPP-4 inhibitor between July 1, 2011, and March 31, 2013...
March 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28229485/osteoporosis-related-health-services-utilization-following-first-hip-fracture-among-a-cohort-of-privately-insured-women-in-the-united-states-2008-2014-an-observational-study
#13
Catherine W Gillespie, Pamela E Morin
Timely identification and treatment of osteoporosis following hip fracture is recommended to mitigate future fracture risk, yet prior work has demonstrated a disconnect between evidence-based recommendations and real-world implementation. We sought to describe contemporary patterns of osteoporosis screening and initiation of pharmacotherapy following hip fracture based on medical and pharmacy claims in the OptumLabs™ Data Warehouse. From a national sample, we identified 8349 women aged 50+ years enrolled in private commercial or Medicare Advantage plans with no prior history of osteoporosis diagnosis, osteoporosis pharmacotherapy, or hip fracture who experienced a hip fracture between 2008 and 2013...
February 23, 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
https://www.readbyqxmd.com/read/28215383/telephone-care-management-of-fall-risk-a-feasibility-study
#14
Elizabeth A Phelan, Maureen Pence, Barbara Williams, Frederick A MacCornack
INTRODUCTION: Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. METHODS: The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients...
March 2017: American Journal of Preventive Medicine
https://www.readbyqxmd.com/read/28205057/comparative-effectiveness-of-adjuvant-chemoradiotherapy-after-gastrectomy-among-older-patients-with-gastric-adenocarcinoma-a-seer-medicare-study
#15
Jennifer M Yeh, Angela C Tramontano, Chin Hur, Deborah Schrag
BACKGROUND: Since the INT-0116 trial reported a survival advantage, postoperative chemoradiotherapy (CRT) has been a care standard for US patients in whom gastric adenocarcinoma has been diagnosed. We sought to estimate the association between treatment and survival among the older US Medicare population. METHODS: This is a retrospective cohort study of Medicare beneficiaries aged 65-79 years with stage IB-III gastric adenocarcinoma diagnosed between 2002 and 2009 in a Surveillance, Epidemiology, and End Results region...
February 15, 2017: Gastric Cancer
https://www.readbyqxmd.com/read/28196579/realisation-of-a-joint-consumer-engagement-strategy-in-the-nepean-blue-mountains-region
#16
Ilse Blignault, Diana Aspinall, Lizz Reay, Kay Hyman
Ensuring consumer engagement at different levels of the health system - direct care, organisational design and governance and policy - has become a strategic priority. This case study explored, through interviews with six purposively selected 'insiders' and document review, how one Medicare Local (now a Primary Health Network, PHN) and Local Health District worked together with consumers, to establish a common consumer engagement structure and mechanisms to support locally responsive, integrated and consumer-centred services...
February 15, 2017: Australian Journal of Primary Health
https://www.readbyqxmd.com/read/28178979/managed-care-and-inpatient-mortality-in-adults-effect-of-primary-payer
#17
Anika L Hines, Susan O Raetzman, Marguerite L Barrett, Ernest Moy, Roxanne M Andrews
BACKGROUND: Because managed care is increasingly prevalent in health care finance and delivery, it is important to ascertain its effects on health care quality relative to that of fee-for-service plans. Some stakeholders are concerned that basing gatekeeping, provider selection, and utilization management on cost may lower quality of care. To date, research on this topic has been inconclusive, largely because of variation in research methods and covariates. Patient age has been the only consistently evaluated outcome predictor...
February 8, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28167722/projected-coding-intensity-in-medicare-advantage-could-increase-medicare-spending-by-200%C3%A2-billion-over-ten-years
#18
Richard Kronick
Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service Medicare beneficiaries, by approximately 1.5 percent per year. The Centers for Medicare and Medicaid Services (CMS) uses patient demographic and diagnostic information to calculate a risk score for each beneficiary, and these risk scores are used to determine payment to MA plans. The increase in relative MA risk scores is largely the result of successful efforts by MA plans to identify additional diagnoses, also known as coding intensity, and not of changes in enrollees' true health...
February 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28157382/electronic-health-record-ehr-organizational-change-explaining-resistance-through-profession-organizational-experience-and-ehr-communication-quality
#19
Ashley K Barrett
The American Recovery and Reinvestment Act passed by the U.S. government in 2009 mandates that all healthcare organizations adopt a certified electronic health record (EHR) system by 2015. Failure to comply will result in Medicare reimbursement penalties, which steadily increase with each year of delinquency. There are several repercussions of this seemingly top-down, rule-bound organizational change-one of which is employee resistance. Given the penalties for violating EHR meaningful use standards are ongoing, resistance to this mandate presents a serious issue for healthcare organizations...
February 3, 2017: Health Communication
https://www.readbyqxmd.com/read/28152957/real-world-treatment-patterns-and-health-care-resource-utilization-hru-among-patients-with-chronic-lymphocytic-leukemia-cll-by-regimen
#20
Lorie Ellis, Stephanie Korrer, Stacey DaCosta Byfield
15 Background: Few studies examine HRU of CLL, the most common hematologic malignancy in adults. This study describes HRU by the most common regimens among CLL patients (pts). METHODS: A retrospective study using a large, national U.S. claims database from 1/2007-10/2013 was conducted. Adult CLL pts (≥2 claims for CLL) with ≥1 claim for systemic anticancer therapy (SACT) were identified; first SACT claim date was the index date. Pts had to have a CLL diagnosis ≤3 months (m) prior to the index date and be continuously enrolled (CE) in the health plan for 24m pre- and ≥6m post-index date...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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