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https://www.readbyqxmd.com/read/28535106/value-tools-in-managed-care-decision-making-current-hurdles-and-future-opportunities
#1
Jeremy Schafer, Dominic Galante, Jason Shafrin
BACKGROUND: Organizations such as the National Comprehensive Cancer Network, American Society of Clinical Oncology, Institute for Clinical and Economic Review, and Memorial Sloan Kettering have created distinct tools to help different stakeholders assess the value of oncology treatments. However, the oncology value tools were not necessarily created for payers, and it is unclear whether payers are using these tools as part of their drug management process. OBJECTIVE: To understand what value tools payers are using in oncology management and what benefits and shortcomings the tools may have from the payer perspective...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28535103/value-frameworks-for-the-patient-provider-interaction-a-comparison-of-the-asco-value-framework-versus-nccn-evidence-blocks-in-determining-value-in-oncology
#2
Bijal Shah-Manek, Joseph S Galanto, Huong Nguyen, Robert Ignoffo
BACKGROUND: To address the rising concern about oncology drug costs, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) recently developed unique tools to help providers and patients make informed decisions about the value of an anticancer regimen. The ASCO Value Framework (AVF) allows users to generate a net health benefit (NHB) score along with drug acquisition costs for oncology regimens that have been compared in a prospective randomized clinical trial...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28534279/overcoming-resistance-against-managed-care-insights-from-a-bargaining-model
#3
Andree Ehlert, Thomas Wein, Peter Zweifel
Recent healthcare reforms have sought to increase efficiency by introducing managed care (MC) while respecting consumer preferences by admitting choice between MC and conventional care. This article proposes an institutional change designed to let German consumers choose between the two settings through directing payments from the Federal Health Fund to social health insurers (SHIs) or to specialized MC organizations (MCOs). To gauge the chance of success of this reform, a game involving a SHI, a MCO, and a representative insured (RI) is analyzed...
December 2017: Health Economics Review
https://www.readbyqxmd.com/read/28530525/cost-effectiveness-of-nivolumab-ipilimumab-combination-therapy-compared-with-monotherapy-for-first-line-treatment-of-metastatic-melanoma-in-the-united-states
#4
Anna Oh, Dang M Tran, Leann C McDowell, Dor Keyvani, Jay Andrew Barcelon, Oscar Merino, Leslie Wilson
BACKGROUND: The approval of new immunotherapies has dramatically changed the treatment landscape of metastatic melanoma. These survival gains come with trade-offs in side effects and costs, as well as important considerations for third-party payer systems, physicians, and patients. OBJECTIVE: To develop a Markov model to determine the cost-effectiveness of nivolumab, ipilimumab, and nivolumab-ipilimumab combination as firstline therapy in metastatic melanoma, while accounting for differential effectiveness in programmed death-ligand 1 (PD-L1) positive and negative patients...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28530524/is-real-world-evidence-used-in-p-t-monographs-and-therapeutic-class-reviews
#5
Jason T Hurwitz, Mary Brown, Jennifer S Graff, Loretta Peters, Daniel C Malone
BACKGROUND: Payers are faced with making coverage and reimbursement decisions based on the best available evidence. Often these decisions apply to patient populations, provider networks, and care settings not typically studied in clinical trials. Treatment effectiveness evidence is increasingly available from electronic health records, registries, and administrative claims. However, little is known about when and what types of real-world evidence (RWE) studies inform pharmacy and therapeutic (P&T) committee decisions...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28530520/cardiovascular-disease-and-gout-real-world-experience-evaluating-patient-characteristics-treatment-patterns-and-health-care-utilization
#6
Michael H Pillinger, Sripal Bangalore, Alyssa B Klein, Scott Baumgartner, Robert Morlock
BACKGROUND: Gout, hyperuricemia, and cardiovascular disease (CVD) are prevalent conditions in the United States, and while they share common risk factors such as obesity, hypertension, hypercholesterolemia, and type 2 diabetes mellitus, relatively little is known about what patient and disease characteristics may link CVD with hyperuricemia and gout and how the presence of both diseases affects management decisions differently than for patients with gout alone. OBJECTIVE: To identify differences in patient characteristics, patterns of urate-lowering therapy (ULT) use, and gout control in gout patients with and without cardiovascular comorbidity...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28530519/does-a-one-size-fits-all-cost-sharing-approach-incentivize-appropriate-medication-use-a-roundtable-on-the-fairness-and-ethics-associated-with-variable-cost-sharing
#7
Jennifer S Graff, Chuck Shih, Thomas Barker, Gabriela Dieguez, Cheryl Larson, Helen Sherman, Robert W Dubois
BACKGROUND: Tiered formularies, in which patients pay copays or coinsurance out-of-pocket (OOP), are used to manage costs and encourage more efficient health care resource use. Formulary tiers are typically based on the cost of treatment rather than the medical appropriateness for the patient. Cost sharing may have unintended consequences on treatment adherence and health outcomes. Use of higher-cost, higher-tier medications can be due to a variety of factors, including unsuccessful treatment because of lack of efficacy or side effects, patient clinical or genetic characteristics, patient preferences to avoid potential side effects, or patient preferences based on the route of administration...
June 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28511766/medimedia-poll-of-managed-care-readers-telehealth-gets-a-warm-reception
#8
(no author information available yet)
In an online survey conducted in late February and early March, 37% of the 174 respondents rated the likelihood that telehealth will reduce health care costs as high, and 50% favored laws and regulations that would encourage its adoption.
April 2017: Managed Care
https://www.readbyqxmd.com/read/28510522/managed-care-reader-poll-readers-believe-biosimilars-will-be-effective-against-costs
#9
(no author information available yet)
In an online survey of readers conducted in late January and early February, 20% of the 113 respondents indicated that they believed that biosimilars will be highly effective in lowering drug costs, and the reader ratings of their effectiveness skewed toward positive.
March 2017: Managed Care
https://www.readbyqxmd.com/read/28467830/the-environment-as-a-driver-of-immune-and-endocrine-responses-in-dolphins-tursiops-truncatus
#10
Patricia A Fair, Adam M Schaefer, Dorian S Houser, Gregory D Bossart, Tracy A Romano, Cory D Champagne, Jeffrey L Stott, Charles D Rice, Natasha White, John S Reif
Immune and endocrine responses play a critical role in allowing animals to adjust to environmental perturbations. We measured immune and endocrine related markers in multiple samples from individuals from two managed-care care dolphin groups (n = 82 samples from 17 dolphins and single samples collected from two wild dolphin populations: Indian River Lagoon, (IRL) FL (n = 26); and Charleston, (CHS) SC (n = 19). The immune systems of wild dolphins were more upregulated than those of managed-care-dolphins as shown by higher concentrations of IgG and increases in lysozyme, NK cell function, pathogen antibody titers and leukocyte cytokine transcript levels...
2017: PloS One
https://www.readbyqxmd.com/read/28466088/combining-contrast-mining-with-logistic-regression-to-predict-healthcare-utilization-in-a-managed-care-population
#11
Lincoln Sheets, Gregory F Petroski, Yan Zhuang, Michael A Phinney, Bin Ge, Jerry C Parker, Chi-Ren Shyu
BACKGROUND: Because 5% of patients incur 50% of healthcare expenses, population health managers need to be able to focus preventive and longitudinal care on those patients who are at highest risk of increased utilization. Predictive analytics can be used to identify these patients and to better manage their care. Data mining permits the development of models that surpass the size restrictions of traditional statistical methods and take advantage of the rich data available in the electronic health record (EHR), without limiting predictions to specific chronic conditions...
May 3, 2017: Applied Clinical Informatics
https://www.readbyqxmd.com/read/28465766/biologic-disease-modifying-antirheumatic-drugs-in-a-national-privately-insured-population-utilization-expenditures-and-price-trends
#12
Christopher B Atzinger, Jeff J Guo
BACKGROUND: Spending on biologic drugs is a significant driver of drug expenditures for payers in private health plans. Biologic disease-modifying antirheumatic drugs (DMARDs) are some of the most effective and costly treatments in a physician's arsenal. Understanding the total annual expenditure, the average cost per prescription, and the impact of cost-sharing is important for drug benefit managers. OBJECTIVE: To assess drug utilization, expenditures, out-of-pocket (OOP) cost, and price trends of biologic DMARDs in patients with rheumatoid arthritis (RA) in a large managed care organization...
February 2017: American Health & Drug Benefits
https://www.readbyqxmd.com/read/28462238/peritumoral-hyperplasia-in-hepatic-sclerosed-hemangioma
#13
Seitarou Shimada, Kazuto Tajiri, Hayato Baba, Masami Minemura, Koichi Tsuneyama, Masayuki Nakano, Toshiro Sugiyama
Peritumoral hyperplasia (PTH) is a hyperplastic lesion located around hypervascular tumors. Hepatic sclerosed hemangioma is a very rare form of hemangioma with sclerotic changes and is distinct from sclerosing hemangioma. We present a patient with non-alcoholic steatohepatitis-induced cirrhosis who presented with a hypervascular tumor. The tumor showed atypical findings of hemangioma and was treated with surgical resection because hepatic malignancy could not be ruled out. Histopathologic examination revealed the tumor was a sclerosed hemangioma with PTH...
2017: ACG Case Reports Journal
https://www.readbyqxmd.com/read/28461351/passive-enrollment-of-dual-eligible-beneficiaries-into-medicare-and-medicaid-managed-care-has-not-met-expectations
#14
David C Grabowski, Nina R Joyce, Thomas G McGuire, Richard G Frank
The Centers for Medicare and Medicaid Services Financial Alignment Initiative represents the largest effort to date to move beneficiaries who are eligible for both Medicare and Medicaid-known as dual eligibles-into a coordinated care model by the use of passive (automatic) enrollment. Thirteen states are testing integrated payment and delivery demonstration programs in which an estimated 1.3 million dual eligibles are qualified to participate. As of October 2016, passive enrollment had brought over 300,000 dual eligibles into nine capitated programs in eight states...
May 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28460752/-we-ve-learned-to-live-with-it-a-qualitative-study-of-australian-horse-owners-attitudes-perceptions-and-practices-in-response-to-hendra-virus
#15
Anke K Wiethoelter, Kate Sawford, Nicole Schembri, Melanie R Taylor, Navneet K Dhand, Barbara Moloney, Therese Wright, Nina Kung, Hume E Field, Jenny-Ann L M L Toribio
Hendra virus causes sporadic zoonotic disease in Australia following spill over from flying foxes to horses and from horses to people. Prevention and risk mitigation strategies such as vaccination of horses or biosecurity and property management measures are widely publicised, but hinge on initiative and action taken by horse owners as they mediate management, care and treatment of their animals. Hence, underlying beliefs, values and attitudes of horse owners influence their uptake of recommended risk mitigation measures...
May 1, 2017: Preventive Veterinary Medicine
https://www.readbyqxmd.com/read/28448782/amcp-partnership-forum-driving-value-and-outcomes-in-oncology
#16
(no author information available yet)
Innovation in cancer treatment has provided a wealth of recently available therapeutic agents and a healthy drug pipeline that promises to change the way we approach this disease and the lives of those affected in the years to come. However, the majority of these new agents, many of which are targeted to specific genomic features of various tumors, may challenge the health care system's ability to afford cancer care. This innovation drives the need to focus on the value of the treatments provided to patients with cancer and on methods to optimize the efficiency of the dollars we spend, in addition to the clinical value itself...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28448777/effect-of-an-advanced-pharmacy-practice-experience-on-medication-therapy-management-services-in-a-centralized-retail-pharmacy-program
#17
Joseph P Vande Griend, Melissa Rodgers, Wesley Nuffer
BACKGROUND: Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28448772/the-effect-of-a-federal-controlled-substance-act-schedule-change-on-hydrocodone-combination-products-claims-in-a-medicaid-population
#18
Stephanie Tran, Pavel Lavitas, Karen Stevens, Bonnie C Greenwood, Karen Clements, Caroline J Alper, Kimberly Lenz, Mylissa Price, Tasmina Hydery, Jennifer L Arnold, Mito Takeshita, Rachel Bacon, Justin P Peristere, Paul L Jeffrey
BACKGROUND: In 2012, hydrocodone combination products (HCPs) were the most prescribed medications in the United States. Under the Controlled Substance Act of 1970, hydrocodone alone was classified as a Schedule II drug, while HCPs were classified as Schedule III, indicating a lower risk for abuse and misuse. However, according to a Drug Enforcement Agency analysis, the addition of nonopioids has not been shown to diminish abuse potential of hydrocodone. In response to concerns for drug abuse and overdose, the Drug Enforcement Agency rescheduled HCPs to Schedule II in October 2014, with the intent of limiting overprescribing and increasing awareness of their abuse potential...
May 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28437492/clinical-rehabilitation-of-anterior-knee-pain-current-concepts
#19
Laurie A Hiemstra, Sarah Kerslake, Elizabeth A Arendt
Rehabilitation is the hallmark of the nonoperative treatment of anterior knee pain (AKP). Whether a patient has had appropriate rehabilitation can be assessed in the office with a selection of basic and advanced screening tests. Most important, providing specific instructions in your referral to a therapist skilled in treating patients with AKP can ensure that any identified deficits are appropriately addressed. The etiology of AKP is multifactorial. Whatever its "cause," AKP alters neuromuscular function, and correcting these altered body movement patterns will benefit the patient...
March 2017: American Journal of Orthopedics
https://www.readbyqxmd.com/read/28433672/montreal-accord-on-patient-reported-outcomes-use-series-paper-1-introduction
#20
Susan J Bartlett, Sara Ahmed
BACKGROUND: Patient-centered healthcare, where we design and deliver care to address the needs and preferences of patients, represents an important paradigm shift. Patient reported outcomes (PROs) are critical to capture the patient voice, understand how illness and treatments affect people, and establish how well services and treatments address what matters most to patients. OBJECTIVE: Originally developed for use in research, PROs are now used to monitor individuals and populations, manage care, evaluate services and providers, and inform policy...
April 19, 2017: Journal of Clinical Epidemiology
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