Inflammatory bowel disease readmissions are associated with utilization and comorbidity.
CONCLUSIONS: Nearly 1 in 7 hospitalizations of patients with IBD lead to a 30-day readmission. These IBD-specific readmissions are associated with increased utilization and comorbidity. Patients at risk for readmission need to be targeted to improve outcomes and IBD care quality. PMID: 31622063 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Cohen-Mekelburg S, Rosenblatt R, Wallace B, Shen N, Fortune B, Waljee AK, Saini S, Scherl E, Burakoff R, Unruh M Tags: Am J Manag Care Source Type: research

The long-term social value of granulocyte colony-stimulating factors.
Abstract OBJECTIVES: Febrile neutropenia (FN) is a life-threatening complication of chemotherapy that can lead to hospitalizations, chemotherapy dose reductions or delays, and mortality. Granulocyte colony-stimulating factor (G-CSF) prophylaxis reduces the incidence of FN, enabling patients to undergo and remain on myelosuppressive chemotherapy. We estimate the benefits of continuing current G-CSF use patterns and an alternative that aligns prophylactic G-CSF use with guideline recommendations. STUDY DESIGN: Using The Health Economics Medical Innovation Simulation microsimulation, we estimated lifetime social...
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Sexton Ward A, Kabiri M, Yucel A, Silverstein AR, van Eijndhoven E, Bowers C, Bensink M, Goldman D Tags: Am J Manag Care Source Type: research

Physician clinical knowledge, practice infrastructure, and quality of care.
Abstract OBJECTIVES: To understand if and how one dimension of physician skill, clinical knowledge, moderates the relationship between practice infrastructure and care quality. STUDY DESIGN: We included 1301 physicians who certified in internal medicine between 1991 and 1993 or 2001 and 2003 and took the American Board of Internal Medicine (ABIM)'s Maintenance of Certification (MOC) exam and completed ABIM's diabetes or hypertension registry during their 10-year recertification period between 2011 and 2014. Composite quality scores (overall, process, and intermediate outcome) were based on chart abstractions....
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Vandergrift JL, Gray BM Tags: Am J Manag Care Source Type: research

Variation in US private health plans' coverage of orphan drugs.
Abstract OBJECTIVES: To compare coverage of orphan and nonorphan drugs, to examine variation in orphan drug coverage across the largest US private plans, and to evaluate factors influencing coverage decisions. STUDY DESIGN: Database and regression analyses. METHODS: We analyzed a data set of private health plan coverage decisions for specialty drugs (N = 5000) in 3 ways. First, we compared the frequency with which plans applied restrictions in their decisions for orphan and nonorphan drugs. Second, we examined variation in the frequency with which 17 of the largest 20 private plans applied coverage restr...
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Chambers JD, Panzer AD, Kim DD, Margaretos NM, Neumann PJ Tags: Am J Manag Care Source Type: research

Ease of ordering high- and low-value services in various electronic health records.
CONCLUSIONS: In EHR systems used nationwide, no association existed between the clinical value of a service and the ease of ordering. This disconnect suggests that EHR redesign can significantly improve clinician workflow to facilitate the use of more high-value care and fewer low-value services. PMID: 31622067 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Schwartz E, Ruff A, Kinning M, Fendrick AM Tags: Am J Manag Care Source Type: research

Real-world outcomes among patients with early rapidly progressive rheumatoid arthritis.
Abstract OBJECTIVES: To characterize treatment patterns, healthcare resource utilization (HRU), and disease activity among patients with early rapidly progressive rheumatoid arthritis (eRPRA) in the United States when treated with a first-line biologic disease-modifying antirheumatic drug (bDMARD) tumor necrosis factor-α (TNF) inhibitor or first-line abatacept. STUDY DESIGN: Observational, multicenter, retrospective, longitudinal, medical records-based, cohort study. METHODS: Patients with eRPRA were identified by anti-citrullinated protein antibody positivity, 28-joint Disease Activity Score-C-rea...
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Klink AJ, Curtice TG, Gupta K, Tuell KW, Szymialis AR, Nero D, Feinberg BA Tags: Am J Manag Care Source Type: research

Can accountable care divert the sources of hospitalization?
CONCLUSIONS: CCO led to reductions in hospital admissions, especially preventable admissions, among female Medicaid beneficiaries of reproductive age in Oregon. Findings, if replicated, may imply that the accountable care delivery model implemented in Oregon Medicaid promotes efficient resource utilization. PMID: 31622069 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Yoon J, Oakley LP, Luck J, Harvey SM Tags: Am J Manag Care Source Type: research

Patients' expectations of their anesthesiologists.
CONCLUSIONS: Because satisfaction is a fulfillment of one's expectations, understanding what the patient expects from their anesthesiologist is the initial step to improve satisfaction scores. The onus is on the anesthesiologist to educate the patient about their role, to set realistic expectations of the postoperative course, and to involve the patient in decisions regarding their anesthesia care. PMID: 31622070 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Lin C, Prozesky J, Martin DE, Cherian VT Tags: Am J Manag Care Source Type: research

A deep learning model for pediatric patient risk stratification.
CONCLUSIONS: The deep learning model outperforms the traditional risk models in prospective hospitalization prediction. Thus, deep learning may improve the ability of managed care organizations to perform predictive modeling of financial risk, in addition to improving the accuracy of risk stratification for population health management activities. PMID: 31622071 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Lin ED, Hefner JL, Zeng X, Moosavinasab S, Huber T, Klima J, Liu C, Lin SM Tags: Am J Manag Care Source Type: research

Low screening and follow-up for unhealthy alcohol use among health plan beneficiaries.
CONCLUSIONS: Rates of screening and follow-up for unhealthy alcohol use are low in plan populations. There is room for improvement in documentation and quality of care for alcohol misuse. PMID: 31622072 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2019 Category: Health Management Authors: Liu J, McCree F, Kanovsky D, Santora P, Ahmed K, Bhatt C, Scholle SH Tags: Am J Manag Care Source Type: research

The sociobehavioral phenotype: applying a precision medicine framework to social determinants of health.
Abstract Sociobehavioral phenotypes are actionable risk profiles based on empirically derived social, economic, and behavioral factors that, if applied appropriately, can help healthcare organizations address social determinants of health. PMID: 31518090 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Parikh RB, Jain SH, Navathe AS Tags: Am J Manag Care Source Type: research

VA Geriatric Scholars Program's impact on prescribing potentially inappropriate medications.
CONCLUSIONS: Although the size of the effect was modest, we found that participation in the GSP IGD course reduced prescribing of DPIMs for older veterans. PMID: 31518091 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Burningham Z, Chen W, Sauer BC, Richter Lagha R, Hansen J, Huynh T, Patel S, Leng J, Halwani A, Kramer BJ Tags: Am J Manag Care Source Type: research

Physician-initiated payment reform: a new path toward value.
CONCLUSIONS: We discuss how specialists may help lead in the evolving payment landscape and recommend how these models might be improved. Payers and policy makers could benefit from our findings, which reflect how providers view financial risk in APMs and provide guidance on the types of payment reforms that they may embrace in the journey toward value. PMID: 31518092 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Gondi S, Ferris TG, Patel KK, Song Z Tags: Am J Manag Care Source Type: research

Managed care for long-stay nursing home residents: an evaluation of Institutional Special Needs Plans.
CONCLUSIONS: "At-risk" models, administered through specialized Medicare Advantage plans, that invest in clinical management in the nursing home setting have the potential to allow individuals to receive care on-site and avoid costly inpatient transfers. PMID: 31518093 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: McGarry BE, Grabowski DC Tags: Am J Manag Care Source Type: research

Multi-Payer Advanced Primary Care Practice Demonstration on quality of care.
CONCLUSIONS: Our analyses showed few statistically significant, favorable impacts on quality metrics among Medicare or Medicaid beneficiaries receiving care from MAPCP practices. PMID: 31518094 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Leung M, Beadles C, Romaire M, Gulledge M, MAPCP Evaluation Team Tags: Am J Manag Care Source Type: research

Medicaid managed care: issues for enrollees with serious mental illness.
CONCLUSIONS: Individuals with chronic and complex conditions can be challenging for managed care organizations to support, especially Medicaid enrollees with SMI, who experience high rates of comorbid physical health conditions and complex healthcare needs. To the extent that managed care organizations can help this population navigate their coverage and use more of the available benefits, barriers to care and unmet needs can be reduced or eliminated and outcomes subsequently improved. PMID: 31518095 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Hall JP, LaPierre TA, Kurth NK Tags: Am J Manag Care Source Type: research

Changes in ambulatory utilization after switching from Medicaid fee-for-service to managed care.
Abstract OBJECTIVES: To observe any change in ambulatory care utilization after switching from Medicaid fee-for-service (FFS) to Medicaid managed care (MC). STUDY DESIGN: We conducted a statewide longitudinal study of 21,048 adult Medicaid beneficiaries in New York State who switched from FFS to MC in 2011 or 2012, with 2 sets of controls (n = 21,048 with continuous FFS; n = 21,048 with continuous MC) who were matched on age, gender, dual-eligible status, and number of chronic conditions. METHODS: We measured ambulatory care utilization in the 12 months before and 12 months after the switch date, using r...
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Kern LM, Rajan M, Pincus HA, Casalino LP, Stuard SS Tags: Am J Manag Care Source Type: research

Did Medicare Advantage payment cuts affect beneficiary access and affordability?
CONCLUSIONS: Although MA payment cuts were expected to reduce the attractiveness of the MA program to both plans and enrollees, the program's enrollment grew steadily from 2009 to 2017. Over this period, plans reduced their costs for providing Part A and Part B benefits to their enrollees, thereby preserving room for rebates. Our findings show that plans made such cost reductions without significantly affecting enrollees' access to or affordability of care compared with TM beneficiaries. PMID: 31518097 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Skopec L, Aarons J, Zuckerman S Tags: Am J Manag Care Source Type: research

Medicare Shared Savings Program ACO network comprehensiveness and patient panel stability.
CONCLUSIONS: The comprehensiveness of an MSSP ACO's contracted provider network is associated with stable patient assignment year to year. Patient panel stability may aid in the longitudinal management of some conditions. PMID: 31518098 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Leighton C, Cole E, James AE, Driessen J Tags: Am J Manag Care Source Type: research

Which patients are persistently high-risk for hospitalization?
Abstract OBJECTIVES: Many healthcare systems use prediction models to estimate and manage patient-level probability of hospitalization. Patients identified as high-risk at one point in time may not, however, remain high-risk. We aimed to describe subgroups of patients with distinct longitudinal risk score patterns to inform interventions tailored to patients' needs. STUDY DESIGN: Retrospective national cohort study. METHODS: Using a previously validated prediction algorithm, we identified a cohort of 258,759 patients enrolled in the Veterans Health Administration (VHA) who were in the top 5% of risk for ...
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Chang ET, Piegari R, Wong ES, Rosland AM, Fihn SD, Vijan S, Yoon J Tags: Am J Manag Care Source Type: research

Call center performance affects patient perceptions of access and satisfaction.
CONCLUSIONS: Our results associate decreased telephone waits with improved perceptions of urgent care access even without concomitant decreases in observed appointment waits. These findings may have important implications for regulators as well as for healthcare organizations that must decide resource levels for call centers, including hospitals, federal health insurance exchanges, and insurers. PMID: 31518100 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2019 Category: Health Management Authors: Griffith KN, Li D, Davies ML, Pizer SD, Prentice JC Tags: Am J Manag Care Source Type: research

From the editor-in-chief: within ourselves.
PMID: 31442010 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Alvarnas J Tags: Am J Manag Care Source Type: research

Forward-thinking insurers adopt genomics, Medicare makes perilous, costly leap backward.
PMID: 31442011 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Matloff E, Bonadies D, Farmer M Tags: Am J Manag Care Source Type: research

The impact of germline testing for hereditary cancer postdiagnosis.
PMID: 31442012 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Owens K, Schlager L, Welcsh PL Tags: Am J Manag Care Source Type: research

Genetic oncology testing is complex, but coverage and reimbursement don't have to be.
PMID: 31442013 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: James LP Tags: Am J Manag Care Source Type: research

Genetic testing can reduce suffering and save lives.
PMID: 31442014 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Corduck L Tags: Am J Manag Care Source Type: research

Understanding the role of the OB/GYN in evaluating hereditary cancer risk.
PMID: 31442015 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Levy BS, Caffrey M Tags: Am J Manag Care Source Type: research

COTA collaboration: helping FDA figure out what's possible, what's not in embrace of real-world evidence.
PMID: 31442016 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Norden A, Caffrey M Tags: Am J Manag Care Source Type: research

Current evidence and controversies: advanced practice providers in healthcare.
Abstract The authors compare advanced practice providers' education, training, scope of practice, and quality of care with that of physicians. A framework is essential to promote team-based primary care. PMID: 31419093 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Sarzynski E, Barry H Tags: Am J Manag Care Source Type: research

Late diagnosis of hepatitis C virus infection, 2014-2016: continuing missed intervention opportunities.
Abstract OBJECTIVES: Chronic hepatitis C virus (HCV) infection is typically asymptomatic until severe liver disease occurs and even then can remain undiagnosed for some time; thus, screening and treatment of asymptomatic persons are needed to prevent poor outcomes. In a previous analysis of data from between 2006 and 2011, we found that 17% of newly diagnosed HCV infections in 4 large health systems were among persons with cirrhosis and/or end-stage liver disease, termed "late diagnosis." We sought to determine the proportion with late diagnosis during 2014-2016, after release of CDC baby boomer (1945-19...
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Moorman AC, Xing J, Rupp LB, Gordon SC, Lu M, Spradling PR, Boscarino JA, Schmidt MA, Daida YG, Teshale EH, CHeCS Investigators Tags: Am J Manag Care Source Type: research

The potential impact of CAR T-cell treatment delays on society.
CONCLUSIONS: The social value of CAR T is significantly limited by treatment delays. Efficient payment mechanisms, adequate capital, and payment policy reform are urgently needed to increase patient access and maximize the value of CAR T. PMID: 31419095 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Thornton Snider J, Brauer M, Kee R, Batt K, Karaca-Mandic P, Zhang J, Goldman DP Tags: Am J Manag Care Source Type: research

Passive social health surveillance and inpatient readmissions.
CONCLUSIONS: An MCO created a passive social health surveillance program to more effectively integrate medical and social care. Understanding individual-level social health needs provides the insights needed to develop interventions to prevent hospital readmissions. PMID: 31419096 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Emechebe N, Lyons Taylor P, Amoda O, Pruitt Z Tags: Am J Manag Care Source Type: research

The adoption and spread of hospital care coordination activities under value-based programs.
Abstract OBJECTIVES: To examine the relationship between participation in value-based programs and care coordination activities. STUDY DESIGN: Cross-sectional, observational study of 1648 US hospitals using the American Hospital Association (AHA)'s 2013 Survey of Care Systems. Value-based program participation included participation in either an accountable care organization (ACO) or a bundled payment program. We assessed adoption (whether a hospital was using any of a set of 12 care coordination activities in the AHA survey) and spread (in each hospital adopting care coordination activities, how extensively ...
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Hearld LR, Carroll N, Hall A Tags: Am J Manag Care Source Type: research

Pediatric codeine prescriptions in outpatient and inpatient settings in Korea.
CONCLUSIONS: Codeine was frequently prescribed for pediatric outpatients in Korea, especially in primary care clinics. Efforts to limit codeine use in children are required to prevent the occurrence of codeine-related adverse events. PMID: 31419098 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Kim D, Song I, Yoon D, Shin JY Tags: Am J Manag Care Source Type: research

Access to chiropractic care and the cost of spine conditions among older adults.
Abstract OBJECTIVES: Chiropractic care is a service that operates outside of the conventional medical system and is reimbursed by Medicare. Our objective was to examine the extent to which accessibility of chiropractic care affects spending on medical spine care among Medicare beneficiaries. STUDY DESIGN: Retrospective cohort study that used beneficiary relocation as a quasi-experiment. METHODS: We used a combination of national data on provider location and Medicare claims to perform a quasi-experimental study to examine the effect of chiropractic care accessibility on healthcare spending. We identified...
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Davis MA, Yakusheva O, Liu H, Tootoo J, Titler MG, Bynum JPW Tags: Am J Manag Care Source Type: research

Tools to improve referrals from primary care to specialty care.
CONCLUSIONS: Well-designed referral templates may help improve the clarity and completeness of primary care-specialty care referrals. Existing templates may provide models that can be adapted in collaboration with primary care and broadly applied to improve referrals. Work is needed to improve the impact of service agreements and e-consults on referrals. PMID: 31419100 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Vimalananda VG, Meterko M, Waring ME, Qian S, Solch A, Wormwood JB, Fincke BG Tags: Am J Manag Care Source Type: research

Influence of out-of-network payment standards on insurer-provider bargaining: California's experience.
CONCLUSIONS: California's experience demonstrates that OON payment standards can influence the payer-provider bargaining landscape, affecting network breadth and negotiated rates. PMID: 31419101 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Duffy EL Tags: Am J Manag Care Source Type: research

Cost of dementia in Medicare managed care: a systematic literature review.
CONCLUSIONS: The expected continued growth in Medicare managed care enrollment, coupled with the large and growing impact of ADRD on America's healthcare delivery and finance systems, requires more research on the cost of ADRD within managed care. This research should use more consistent approaches to identify ADRD prevalence and provide more detail regarding which components of care are included in analyses and how the costs of care are captured and measured. PMID: 31419102 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2019 Category: Health Management Authors: Fishman P, Coe NB, White L, Crane PK, Park S, Ingraham B, Larson EB Tags: Am J Manag Care Source Type: research

Review of neovascular age-related macular degeneration treatment options.
This article reviews state-of-the-art management approaches including as-needed and treat-and-extend dosing regimens designed to reduce treatment burden. PMID: 31419088 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Holekamp NM Tags: Am J Manag Care Source Type: research

Managed care opportunities and approaches to supporting appropriate selection of treatment for sight preservation.
Abstract When evaluating the impact of vision-destroying diseases, pharmacologic therapies represent a significant cost to patients, insurance providers, and society. Currently, up to 11 million people in the United States have some form of age-related macular degeneration (AMD), which is one of the leading causes of vision loss in older Americans. Ophthalmologists have administered more than 6 million intravitreal injections of aflibercept, bevacizumab, pegaptanib, and ranibizumab last year. Comprehensive assessment requires managed care administrators and clinicians to understand the direct and indirect costs of...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Cannon E Tags: Am J Manag Care Source Type: research

Improving outcomes and managing costs in idiopathic pulmonary fibrosis.
Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic pulmonary disease that is complicated by diagnostic challenges, multiple comorbidities, and a poor prognosis. Although considered a relatively rare disease, healthcare costs are substantial and disproportionate to the incidence and prevalence of the disease. The comorbidities associated with IPF not only complicate treatment strategies but also increase the burden for patients via higher costs and undesirable health outcomes. Historically, pharmacologic treatment options for IPF have been limited and are often associated with low efficacy. Two drugs approve...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Morrow T Tags: Am J Manag Care Source Type: research

Overview of idiopathic pulmonary fibrosis, evidence-based guidelines, and recent developments in the treatment landscape.
Abstract Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive-fibrosing interstitial lung disease of unknown origin that affects 3 million people worldwide and imparts substantial burdens to patients, their families, and the healthcare system. The IPF disease course is highly variable and presents several diagnostic and management-related challenges. Two therapies, nintedanib and pirfenidone, are FDA approved and are recommended by clinical practice guidelines for the treatment of IPF. Although neither of these treatments is curative, both slow disease progression and impact survival of patients with IPF....
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Glassberg MK Tags: Am J Manag Care Source Type: research

Innovations in topical ocular corticosteroid therapy for the management of postoperative ocular inflammation and pain.
Abstract Topical ophthalmic corticosteroids are of clinical benefit in the management of pain and inflammation after ocular surgery; however, their use can be associated with class-associated adverse events (AEs) and limited bioavailability. Selection of an appropriate topical corticosteroid depends on drug-specific variables such as AE profile, efficacy, potency, dosing, patient-specific administration needs, and formulation properties aimed at minimizing precorneal drug loss, increasing ocular surface drug residence time, and maximizing drug delivery to the anterior tissues. Recently, strategies for improving oc...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Salinger CL, Gaynes BI, Rajpal RK Tags: Am J Manag Care Source Type: research

Hospitalization risk in patients with schizophrenia treated with dose-equivalent antipsychotics.
This study compared the risk of hospitalization among adults with schizophrenia being treated with equivalent dose ranges of lurasidone versus aripiprazole, olanzapine, quetiapine, or risperidone. Administrative claims data for this analysis came from the IBM MarketScan Commercial, Medicare Supplemental, and Multi-State Medicaid databases between January 2011 and June 2017. The study included adults with schizophrenia who initiated treatment with an antipsychotic and were continuously enrolled for 360 days prior to and following the date of the initial antipsychotic prescription. Risk of all-cause and schizophrenia-related...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Ng-Mak D, Messali A, Huang A, Wang L, Loebel A Tags: Am J Manag Care Source Type: research

The economic burden of the opioid epidemic on states: the case of Medicaid.
Abstract The societal burden of opioid use disorder (OUD) is considerable and contributes to increased healthcare costs and overdose deaths. However, the burden is not well understood. The purpose of this analysis is to estimate the state Medicaid programs' costs for treating OUD and how these costs have changed over time. We used data from the Medicaid Analytic eXtract files from 17 states between 1999 and 2013 to examine the healthcare costs associated with OUD. Inpatient, outpatient, and prescription medication costs related to the treatment of OUD were included, as were excess costs for other healthcare servic...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Leslie DL, Ba DM, Agbese E, Xing X, Liu G Tags: Am J Manag Care Source Type: research

Estimated costs to the Pennsylvania criminal justice system resulting from the opioid crisis.
This report focuses on costs related to the criminal justice system (CJS) in Pennsylvania. Costs impacting 3 principal areas of the CJS are examined: opioid-related arrests, court costs, and incarceration. Analysis of the state-level CJS is our main focus; no local-level costs are included. Through this examination, costs of the opioid crisis for the period of 2007 to 2016 were estimated using opioid costs for 2006 as a baseline. Total costs to the Pennsylvania CJS during this period were over $526 million, with most of that accounted for by state corrections. Opioid-related trends in arrests, court proceedings, and incarc...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Zajac G, Nur SA, Kreager DA, Sterner G Tags: Am J Manag Care Source Type: research

Considering the child welfare system burden from opioid misuse: research priorities for estimating public costs.
Abstract The negative impact of opioids on those who misuse them has been widely documented. Despite significant spillover effects in the form of elevated rates of child maltreatment and child welfare system (CWS) involvement for children affected by parental opioid misuse, the public costs of opioid misuse to the CWS remain largely undocumented. This work seeks to understand the value and limitations of public data in estimating the costs of the opioid epidemic on the CWS. National data from federal sources are combined with best estimates of the association between opioid misuse and child services system utiliza...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Crowley DM, Connell CM, Jones D, Donovan MW Tags: Am J Manag Care Source Type: research

The opioid epidemic, neonatal abstinence syndrome, and estimated costs for special education services.
Abstract Children whose mothers used or misused opioids during their pregnancies are at an increased risk of exhibiting cognitive or behavioral impairments in the future, which may result in identifiable disabilities that require special education services in school. The costs associated with these additional educational services, however, have remained unknown. Using data from available empirical work, we calculated a preliminary set of cost estimates of special education and related services for children diagnosed with neonatal abstinence syndrome (NAS). We estimated these costs for a single cohort of children f...
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Morgan PL, Wang Y Tags: Am J Manag Care Source Type: research

Opioid misuse, labor market outcomes, and means-tested public expenditures: a conceptual framework.
This article provides an overview and a conceptual framework for 2 types of labor market-related costs borne by state and federal governments that typically have not been incorporated into existing estimates, which may represent important categories of expenditures. Because detailed estimates of lost tax revenue are available elsewhere, this article focuses largely on whether, and how, to incorporate opioid-related expenses incurred by means-tested government programs into more general estimates of the economic harm created by the opioid epidemic. PMID: 31361430 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Segel JE, Shi Y, Moran JR, Scanlon DP Tags: Am J Manag Care Source Type: research

Preventing the next crisis: six critical questions about the opioid epidemic that need answers.
PMID: 31361431 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2019 Category: Health Management Authors: Scanlon DP, Hollenbeak CS Tags: Am J Manag Care Source Type: research