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Medicare advantage

Hyunjee Kim, Christina J Charlesworth, K John McConnell, Jennifer B Valentine, David C Grabowski
Dual-eligible beneficiaries or "duals" are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid...
November 1, 2017: Medical Care Research and Review: MCRR
Justin W Timbie, Andy Bogart, Cheryl L Damberg, Marc N Elliott, Ann Haas, Sarah J Gaillot, Elizabeth H Goldstein, Susan M Paddock
OBJECTIVE: To compare performance between Medicare Advantage (MA) and Fee-for-Service (FFS) Medicare during a time of policy changes affecting both programs. DATA SOURCES/STUDY SETTING: Performance data for 16 clinical quality measures and 6 patient experience measures for 9.9 million beneficiaries living in California, New York, and Florida. STUDY DESIGN: We compared MA and FFS performance overall, by plan type, and within service areas associated with contracts between CMS and MA organizations...
December 2017: Health Services Research
Debra Saliba
Patients and families frequently turn to healthcare providers and health researchers for advice about insurance plans and healthcare related purchases. While these questions occur throughout the year, they are more frequent during the annual Medicare Open enrollment period which this year runs from October 15, 2017 to December 7, 2017. During this period, eligible individuals may enroll in or change their Medicare Part D plan and enroll in or change their Medicare Advantage plan (Medicare part C). This article is protected by copyright...
November 9, 2017: Journal of the American Geriatrics Society
Wei Lyu, Fredric D Wolinsky
BACKGROUND: The effect of the onset of difficulties with activities of daily living (ADLs) on the health-related quality of life (HRQoL) of older adults is not well understood. We identified strong longitudinal associations between ADL onset and HRQoL changes for older adults in Medicare Advantage Organizations (MAOs). METHODS: We analyzed 473,282 age-eligible MAO beneficiaries in the 2008-2013 Medicare Health Outcomes Surveys (M-HOS) who reported no ADL difficulties at baseline and completed their two-year follow-ups in 2010-2015...
November 6, 2017: Health and Quality of Life Outcomes
Nella Bieszk, Michael Grabner, Wenhui Wei, John Barron, Ralph Quimbo, Tingjian Yan, Beth Biel, James W Chu
BACKGROUND: In patients with type 2 diabetes (T2D) with poor glycemic control, there is an unmet need for treatment optimization involving the initiation and/or intensification of insulin therapy, which is often delayed because of clinical inertia. Educational initiatives that target patients and physicians might be one way to address this need. OBJECTIVE: To evaluate the effectiveness of educational materials mailed to physicians and their patients in affecting initiation of insulin therapy and other health care outcomes...
November 2017: Journal of Managed Care & Specialty Pharmacy
Elena M Magwene, Ana R Quiñones, Gillian L Marshall, Lena K Makaroun, Stephen Thielke
BACKGROUND: Self-rated health (SRH) shows strong associations with measures of health and well-being. Increasingly, studies have used self-rated mental health (SRMH) as a predictor of various outcomes, independently or together with SRH. Research has not firmly established if and how these two constructs differ. We sought to characterize the relationship between SRH and SRMH, and to determine how this relationship differed across subgroups defined by sociodemographic and health-related characteristics...
September 21, 2017: Journal of Public Health Research
Laura J Anzaldi, Ashwini Davison, Cynthia M Boyd, Bruce Leff, Hadi Kharrazi
BACKGROUND: Geriatric syndromes, including frailty, are common in older adults and associated with adverse outcomes. We compared patients described in clinical notes as "frail" to other older adults with respect to geriatric syndrome burden and healthcare utilization. METHODS: We conducted a retrospective cohort study on 18,341 Medicare Advantage enrollees aged 65+ (members of a large nonprofit medical group in Massachusetts), analyzing up to three years of administrative claims and structured and unstructured electronic health record (EHR) data...
October 25, 2017: BMC Geriatrics
Zoe M Lyon, Yevgeniy Feyman, Garret M Johnson, Austin B Frakt
No abstract text is available yet for this article.
October 24, 2017: BMJ Quality & Safety
Benjamin Chastek, Chieh-I Chen, Clare Proudfoot, Shraddha Shinde, Andreas Kuznik, Wenhui Wei
INTRODUCTION: After a patient with rheumatoid arthritis (RA) fails tumor necrosis factor inhibitor (TNFi) treatment, clinical guidelines support either cycling to another TNFi or switching to a different mechanism of action (MOA), but payers often require TNFi cycling before they reimburse switching MOA. This study examined treatment persistence, cost, and cost per persistent patient among MOA switchers versus TNFi cyclers. METHODS: This study of Commercial and Medicare Advantage claims data from the Optum Research Database included patients with RA and at least one claim for a TNFi (adalimumab, certolizumab pegol, etanercept, golimumab, or infliximab) between January 2012 and September 2015 who changed to another TNFi or a different MOA therapy (abatacept, tocilizumab, or tofacitinib) within 1 year...
October 16, 2017: Advances in Therapy
Gabriel J Escobar, Jennifer M Baker, Benjamin J Turk, David Draper, Vincent Liu, Patricia Kipnis
INTRODUCTION: This article is not a traditional research report. It describes how conducting a specific set of benchmarking analyses led us to broader reflections on hospital benchmarking. We reexamined an issue that has received far less attention from researchers than in the past: How variations in the hospital admission threshold might affect hospital rankings. Considering this threshold made us reconsider what benchmarking is and what future benchmarking studies might be like. Although we recognize that some of our assertions are speculative, they are based on our reading of the literature and previous and ongoing data analyses being conducted in our research unit...
2017: Permanente Journal
Molly Moore Jeffery, W Michael Hooten, Erik P Hess, Ellen R Meara, Joseph S Ross, Henry J Henk, Bjug Borgundvaag, Nilay D Shah, M Fernanda Bellolio
STUDY OBJECTIVE: We explore the emergency department (ED) contribution to prescription opioid use for opioid-naive patients by comparing the guideline concordance of ED prescriptions with those attributed to other settings and the risk of patients' continuing long-term opioid use. METHODS: We used analysis of administrative claims data (OptumLabs Data Warehouse 2009 to 2015) of opioid-naive privately insured and Medicare Advantage (aged and disabled) beneficiaries to compare characteristics of opioid prescriptions attributed to the ED with those attributed to other settings...
September 21, 2017: Annals of Emergency Medicine
Inmaculada Hernandez, Yuting Zhang
PURPOSE: "Me-too" drugs are new pharmaceuticals with the mechanism of action of an existing drug and are considered less innovative than breakthrough drugs. The objective of this study was to evaluate whether the adoption patterns of the breakthrough drug sitagliptin and the "me-too" drug saxagliptin differed; and to assess whether the patterns differed between Medicare stand-alone (PDP) and Medicare-Advantage Part D (MA-PD) plans. METHODS: Pharmacy claims from a 5% random sample of Medicare Part D beneficiaries were used to identify all prescriptions filled for sitagliptin (breakthrough drug) and saxagliptin ("me-too" drug) between October 1, 2006 and December 31, 2011...
June 2017: Journal of Pharmaceutical Innovation
Jesse Sussell, Kata Bognar, Taylor T Schwartz, Jason Shafrin, John J Sheehan, Wade Aubry, Dennis Scanlon
OBJECTIVES: To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. METHODS: The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials...
September 2017: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Junji Yodoi, Yoshiyuki Matsuo, Hai Tian, Hiroshi Masutani, Takashi Inamoto
Human thioredoxin (TRX) is a 12-kDa protein with redox-active dithiol in the active site -Cys-Gly-Pro-Cys-, which is induced by biological stress due to oxidative damage, metabolic dysfunction, chemicals, infection/inflammation, irradiation, or hypoxia/ischemia-reperfusion. Our research has demonstrated that exogenous TRX is effective in a wide variety of inflammatory diseases, including viral pneumonia, acute lung injury, gastric injury, and dermatitis, as well as in the prevention and amelioration of food allergies...
September 29, 2017: Nutrients
Molly M Jeffery, Nilay D Shah, Pinar Karaca-Mandic, Joseph S Ross, Matthew A Rank
BACKGROUND: Utilization trends of omalizumab, a first-in-its-class asthma biologic approved in 2003 for individuals not controlled by inhaled corticosteroids (ICSs), may reveal lessons in patient selection. OBJECTIVE: To describe utilization patterns for omalizumab since its introduction in 2003, with a focus on patient-level characteristics of patients for whom omalizumab was initiated. METHODS: Using a large US database of administrative claims, we identified privately insured and Medicare Advantage beneficiaries with asthma between 2003 and 2015...
September 22, 2017: Journal of Allergy and Clinical Immunology in Practice
Megan S Motosue, M Fernanda Bellolio, Holly K Van Houten, Nilay D Shah, Ronna L Campbell
BACKGROUND: Anaphylaxis is an acute systemic allergic reaction and may be life-threatening. OBJECTIVE: To assess risk factors associated with severe and near-fatal anaphylaxis in a large observational cohort study. METHODS: We analyzed administrative claims data from Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014. Severe anaphylaxis was defined as anaphylaxis resulting in hospital or intensive care unit (ICU) admission, requiring endotracheal intubation, or meeting criteria for near-fatal anaphylaxis...
October 2017: Annals of Allergy, Asthma & Immunology
Sari Hopson, Adrianne Casebeer, Stephen Stemkowski, Dana Drzayich Antol, Zhuliang Tao, Andrew Howe, Jeffrey Patton, Art Small, Anthony Masaquel
BACKGROUND: The increase in hospital acquisition of community oncology clinics in the United States has led to a shift in the site-of-care (SOC) for infusion therapy from the physician office (PO) to the hospital outpatient (HO) setting. OBJECTIVE: To investigate differences by SOC in treatment patterns, quality, and cost among patients with cancer undergoing first-line infusion therapy. RESEARCH DESIGN AND METHODS: This retrospective analysis identified adult patients from Humana medical claims who initiated infusion therapy from 2008 to 2012 for 5 common cancer types in which infusion therapy is likely, including early stage breast cancer; metastatic breast, lung, and colorectal cancers; and non-Hodgkin's lymphoma or chronic lymphocytic leukemia...
September 25, 2017: Journal of Medical Economics
Sarah Thayer, Richard Aguilar, Stephanie Korrer, Wing Chow
PURPOSE: Clinical trial evidence supports greater glycemic control with canagliflozin than with sitagliptin. The objective of this study was to provide real-world evidence comparing outcomes in routine clinical practice among patients initiating each medication. METHODS: With the use of a health care administrative database, patients initiating canagliflozin were compared with patients initiating sitagliptin (first prescription fill as index date). Baseline (6 months before index date) demographic and clinical (eg, comorbidities and diabetes-related complications) characteristics were compared, and propensity score matching was used to control for baseline differences between cohorts...
September 21, 2017: Clinical Therapeutics
Megan S Motosue, M Fernanda Bellolio, Holly K Van Houten, Nilay D Shah, James T Li, Ronna L Campbell
BACKGROUND: Although the incidence of anaphylaxis appears to be increasing, trends in anaphylaxis-related health care utilization are not well understood. OBJECTIVE: To better understand the potential increasing health care burden, we analyzed the changes in anaphylaxis-related health care utilization, including emergency department (ED) discharges, observation stays, inpatient admissions, intensive care unit admissions, and endotracheal intubations. METHODS: We conducted an observational study examining outcomes of anaphylaxis-related ED visits between January 1, 2005, and December 31, 2014...
September 20, 2017: Journal of Allergy and Clinical Immunology in Practice
Elizabeth A Carter, Pamela E Morin, Keith D Lind
BACKGROUND: Overutilization of low-value services (unnecessary or minimally beneficial tests or procedures) has been cited as a large contributor to the high costs of health care in the United States. OBJECTIVES: To analyze trends in utilization of low-value services from 2009 to 2014 among commercial and Medicare Advantage (MA) enrollees 50 and older. RESEARCH DESIGN: A retrospective analysis of deidentified claims obtained from the OptumLab Data Warehouse...
November 2017: Medical Care
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