Challenges and similarities in HIV, COVID-19 crises: a Q & A with Anthony Fauci, MD.
Challenges and similarities in HIV, COVID-19 crises: a Q&A with Anthony Fauci, MD. Am J Manag Care. 2020 Jul;26(7):282-283 Authors: Fauci A, Inserro A Abstract To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. The July issue features a conversation with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases. PMID: 32672910 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Fauci A, Inserro A Tags: Am J Manag Care Source Type: research

COVID-19: daily fluctuations, a weekly cycle, and a negative trend.
Abstract Daily fluctuations in new confirmed cases of coronavirus disease 2019 (COVID-19) reveal a weekly cycle, with increasing risk of infection through the workweek, but an overall negative trend. PMID: 32672911 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Cecil WT Tags: Am J Manag Care Source Type: research

Innovative payment to scale up access to medications for opioid use disorder.
Abstract Bundled payments offer promise as a supplement to existing payment models to promote scaling up of opioid use disorder treatment using buprenorphine. PMID: 32672912 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Polsky D, Sen AP, Arsenault S Tags: Am J Manag Care Source Type: research

Having a consistent HIV health care provider and HIV-related clinical outcomes.
This study examined the association of having a consistent HIV health care provider and HIV-related clinical outcomes. STUDY DESIGN: This was a multiyear cross-sectional observational study using secondary data. METHODS: A total of 1584 people living with HIV/AIDS (PLWHA) and receiving HIV health care who participated in the Illinois Medical Monitoring Project from 2009 to 2014 were included. Two logistic regressions were conducted to examine the associations of having a consistent HIV health care provider and 2 clinical HIV outcomes, viral suppression and high CD4 cell count. The inverse probability weighting me...
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Wang Z, Lin HC Tags: Am J Manag Care Source Type: research

Effective care management by Next Generation accountable care organizations.
The objectives of this study were to estimate the utilization and spending impact of a standardized complex care management program implemented at 5 Next Generation accountable care organizations (NGACOs) and to identify reproducible program features that influenced program effectiveness. STUDY DESIGN: In 2016 and 2017, high-risk Medicare beneficiaries aligned to 5 geographically diverse NGACOs were identified using predictive analytics for enrollment in a standardized complex care management program. We estimated the program's impact on all-cause inpatient admissions, emergency department visits, and total medical ex...
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: O'Hara N, Tran OC, Phatakwala S, Cattrell A, Ajami Y Tags: Am J Manag Care Source Type: research

Predictive index for 90-day postoperative outcomes following gynecologic surgery.
CONCLUSIONS: The results of this study suggest that the LACE+ index is suitable as a prediction model for important patient outcomes in a gynecologic surgery population. PMID: 32672915 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Glauser G, Winter E, Caplan IF, Goodrich S, McClintock SD, Srinivas SK, Malhotra NR Tags: Am J Manag Care Source Type: research

Economic outcomes of insurer-led care management for high-cost Medicaid patients.
CONCLUSIONS: Although our study found no association between the CBCM program and subsequent cost or utilization outcomes, understanding why these outcomes were not achieved will inform how future Medicaid programs are designed to achieve better patient outcomes and lower costs. PMID: 32672916 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Harrison JM, Oganisian A, Grande DT, Mitra N, Chhabra M, Chaiyachati KH Tags: Am J Manag Care Source Type: research

The escalation of the opioid epidemic due to COVID-19 and resulting lessons about treatment alternatives.
Abstract Factors worsening the opioid epidemic during the coronavirus disease 2019 (COVID-19) pandemic provide valuable insight for strategy change where we have historically suffered great loss, bodily and financially. PMID: 32672917 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Silva MJ, Kelly Z Tags: Am J Manag Care Source Type: research

Robotic arm-assisted knee surgery: an economic analysis.
Abstract OBJECTIVES: Previous studies on Medicare populations have shown improved outcomes and decreased 90-day episode-of-care costs with robotic arm-assisted total knee arthroplasty (RATKA). The purpose of this study was to evaluate expenditures and utilization following RATKA in the population younger than 65 years. STUDY DESIGN: This is a retrospective longitudinal analysis of a commercial claims data set. METHODS: TKA procedures were identified using the OptumInsight Inc database. The procedures were stratified in 2 groups: the RATKA and manual TKA (MTKA) cohorts. Propensity score matching was ...
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Pierce J, Needham K, Adams C, Coppolecchia A, Lavernia C Tags: Am J Manag Care Source Type: research

A mid-South chronic disease registry and practice-based research network to address disparities.
CONCLUSIONS: Regional registries and PBRNs are powerful tools that can support real-world quality improvement and population health efforts to reduce disparities and improve equity in chronic disease care in medically underserved communities across the United States. PMID: 32672919 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Surbhi S, Brooks IM, Shuvo SA, Zareie P, Tolley EA, Cossman R, Leak C, Davis RL, Stewart AJ, Bailey JE Tags: Am J Manag Care Source Type: research

Patient preferences for provider choice: a discrete choice experiment.
CONCLUSIONS: The results of this study provide new insights to federal and state legislators developing new models or standards on network adequacy and patient decision support tools. PMID: 32672920 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: van den Broek-Altenburg EM, Atherly AJ Tags: Am J Manag Care Source Type: research

The development of a patient-reported functional limitations index.
CONCLUSIONS: The FLI is an easy-to-administer, easy-to-interpret, and valid summary measure of disability that health plans and health care organizations can use for quality-of-care monitoring across a variety of settings to improve care for patients with disabilities. PMID: 32672921 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Mathews M, Agniel D, Elliott MN, Martino SC, Guerino P, Orr N, Ng JH, Beckett MK Tags: Am J Manag Care Source Type: research

The human resource costs of implementing autopend clinical decision support to improve health maintenance.
CONCLUSIONS: The autopend CDS might be similarly costly for other organizations to implement if their managers need to complete comparable activities. However, electronic health record vendors could include autopend as a standard package to reduce development costs and improve the uptake of this promising CDS tool. PMID: 32672922 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2020 Category: Health Management Authors: Panattoni L, Stults CD, Chan AS, Tai-Seale M Tags: Am J Manag Care Source Type: research

Humility and hope: evolution of the HIV pandemic, from ART to today's cancer cures.
PMID: 32639129 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Alvarnas J Tags: Am J Manag Care Source Type: research

References for humility and hope, Alvarnas.
PMID: 32639130 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Alvarnas J Tags: Am J Manag Care Source Type: research

From the editor-in-chief: bigger questions of systems, viruses, and the lives of real people.
PMID: 32639131 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Alvarnas J Tags: Am J Manag Care Source Type: research

Zaia draws on decades of innovation in infectious disease for breakthroughs in gene therapy.
PMID: 32639132 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Zaia JA, Shaw ML Tags: Am J Manag Care Source Type: research

How to optimize cancer therapy when coronavirus hits the fan.
PMID: 32639133 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Barzi A, Sadeghi S Tags: Am J Manag Care Source Type: research

Addressing the gap in precision medicine.
PMID: 32639134 [PubMed - as supplied by publisher] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Fabrizio DA Tags: Am J Manag Care Source Type: research

A path to improve colorectal cancer screening outcomes: faculty roundtable evaluation of cost-effectiveness and utility.
Abstract The American Journal of Managed Care® and Exact Sciences Corporation hosted a roundtable meeting to discuss the impact of colorectal cancer (CRC) screening modalities on improving patient outcomes. The roundtable participants were a diverse panel of experts, including primary care, gastroenterology, and oncology providers; experts in health outcomes research and health policy; and managed care executives with commercial and public payer experience. Participants discussed CRC prevention and treatment strategies, screening modalities and adherence, molecular diagnostics, patient navigation, evaluation o...
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Bone RH, Cross JD, Dwyer AJ, Fox JL, Hyams DM, Hassmiller Lich K, Mackey TA, Miller RM, Fendrick AM Tags: Am J Manag Care Source Type: research

Hopes, worries for US health care in wake of COVID-19: a Q & A with Donald M. Berwick, MD, MPP.
Hopes, worries for US health care in wake of COVID-19: a Q&A with Donald M. Berwick, MD, MPP. Am J Manag Care. 2020 Jun;26(6):238-239 Authors: Berwick DM, Inserro A Abstract To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the June issue, we turned to Donald M. Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of CMS. PMID: 32549058 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Berwick DM, Inserro A Tags: Am J Manag Care Source Type: research

Tests, surgical masks, hospital beds, and ventilators: add big data to the list of tools to fight the coronavirus that are in short supply.
Abstract Big data could help identify potential clues about the immediate (and future) impact of coronavirus disease 2019, but it is in short supply. PMID: 32549059 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Scanlon DP, Stephens MB Tags: Am J Manag Care Source Type: research

What we talk about when we talk about care management.
Abstract To support effective care management programs in the context of value-based care, we propose a framework categorizing care management as disease management, utilization management, and care navigation interventions. PMID: 32549060 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Marcotte LM, Liao JM Tags: Am J Manag Care Source Type: research

Effect of high-deductible insurance on health care use in bipolar disorder.
CONCLUSIONS: After a mandated switch to HDHPs, members with bipolar disorder experienced an 11% decline in visits to nonpsychiatrist mental health providers but unchanged psychiatrist visits, ED visits, and hospitalizations. HDHPs do not appear to have a "blunt instrument" effect on health care use in bipolar disorder; rather, patients might make trade-offs to preserve important care. PMID: 32549061 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Wharam JF, Busch AB, Madden J, Zhang F, Callahan M, LeCates RF, Foxworth P, Soumerai S, Ross-Degnan D, Lu CY Tags: Am J Manag Care Source Type: research

General medical claims for behavioral health patients in Japan.
CONCLUSIONS: The results of this Japanese cohort study show that patients with concurrent BH conditions and chronic medical illnesses have substantially lower total health care costs than numerous studies have demonstrated in US populations. This is perhaps in part due to the integration of medical and BH claims payment and care delivery in Japan, an approach that the US health system may wish to consider testing. PMID: 32549062 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Kishi Y, Kathol RG, Okumura Y Tags: Am J Manag Care Source Type: research

Strategies for implementing best practices in independent physician associations.
CONCLUSIONS: IPA managed care organizations require unique considerations in regard to selected strategies used to manage chronic disease in Medicare populations. These considerations are critical for optimal management of the population, particularly in a risk-based or pay-for-performance environment. PMID: 32549063 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Dunphy JN, Weinberger M, Silberman P Tags: Am J Manag Care Source Type: research

Measures of ED utilization in a national cohort of children.
CONCLUSIONS: The ED utilization measures identify clinically and demographically different groups of patients. Future studies should consider the medical complexity of the population being studied before choosing the most appropriate measure to employ. PMID: 32549064 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Andrews AL, Bettenhausen J, Hoefgen E, Richardson T, Macy ML, Zima BT, Colvin J, Hall M, Shah SS, Neff JM, Auger KA Tags: Am J Manag Care Source Type: research

Health care resource utilization among patients with T2D and cardiovascular-, heart failure-, or renal-related hospitalizations.
CONCLUSIONS: Among patients with T2D, concurrent CV, HF, or renal events present significant disease burden leading to poor quality of life. This information can be used to guide disease management strategies and interventions aimed at reducing comorbidity-related hospitalizations and health care costs, thus providing improved quality of life for these patients. PMID: 32549065 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Annavarapu S, Ghosh S, Li Y, Moretz C, Shetty S, Prewitt T Tags: Am J Manag Care Source Type: research

FASStR: a framework for ensuring high-quality operational metrics in health care.
CONCLUSIONS: The FASStR framework can guide the design, development, and implementation of operational metrics in outpatient health care settings. Further, this framework can assist investigators in the evaluation of the metrics that they are using. Overall, the FASStR framework can result in clearer, more consistent use and evaluation of outpatient performance metrics. PMID: 32549066 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Torabi E, Cayirli T, Froehle CM, Klassen KJ, Magazine M, White DL, Ward MJ Tags: Am J Manag Care Source Type: research

Value-based insurance design in Louisiana: Blue Cross Blue Shield's Zero Dollar Co-pay program.
CONCLUSIONS: The ZDC program provides evidence that value-based insurance designs that incorporate a comprehensive set of medications and focus on populations with chronic disease can reduce spending. PMID: 32549067 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Yuan X, Chaisson J, Cantrell D, Mohundro BL, Carby M, Ford M, Liu M, Ouyang J, Zhang Y, Williams HC, Vicidomina BV, Washington V, Nigam SC Tags: Am J Manag Care Source Type: research

Standardization improves postoperative patient handoff experience for junior clinicians.
CONCLUSIONS: Our workflow-oriented, standardized process for handoff of care from the OR to the ICU can improve perceived communication and psychological safety, especially for junior clinicians. PMID: 32549068 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Prasad A, Cios TJ, Staub-Juergens W, Dziedzina C, Rao S, Singbartl K Tags: Am J Manag Care Source Type: research

Claims identification of patients with severe cancer-related symptoms.
CONCLUSIONS: The claims-based factors associated with the severe symptom cluster can enable identification of patients with mNSCLC who could benefit from clinical outreach programs to enhance the care and support provided to these patients. PMID: 32549069 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: DeClue RW, Antol DD, Casebeer AW, Michael T, Sehman M, Renda A, Ogale S, Stemkowski S, Loy B Tags: Am J Manag Care Source Type: research

Medicare Diabetes Prevention Program: where are the suppliers?
CONCLUSIONS: Findings show inadequate MDPP access, with relatively few suppliers and locations where beneficiaries can receive services. Insufficient reimbursement relative to costs for suppliers may largely account for limited availability. Strategies to facilitate access are urgently needed, which may include partnering with large organizations for greater per capita reach and rural organizations for broader geographic coverage, along with setting fiscally sustainable rates based on refined program implementation and cost analysis. PMID: 32549070 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2020 Category: Health Management Authors: Ritchie ND, Sauder KA, Gritz RM Tags: Am J Manag Care Source Type: research

Wet age-related macular degeneration: treatment advances to reduce the injection burden.
Abstract The burden of age-related macular degeneration (AMD), a leading cause of vision loss in the elderly population, is poised to increase dramatically as the baby boomer generation ages. Fortunately, the prognosis of neovascular AMD has improved dramatically since anti-vascular endothelial growth factor (VEGF) agents reached the market 15 years ago. In large-scale clinical trials, anti-VEGF utilization maintained visual acuity in more than 90% of patients. However, providing anti-VEGF treatment requires the specialized expertise of retina specialists and is labor intensive and costly. Further, results in clin...
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Baumal CR Tags: Am J Manag Care Source Type: research

Managed care opportunities and approaches to select treatment for sight preservation.
Abstract Neovascular (or wet) age-related macular degeneration (AMD) affects more than 10% of people older than 65 years in North America, Europe, Australia, and Asia. It is estimated that about 11 million Americans have some form of AMD, with that number expected to double by 2050. Approximately 20% of patients will advance from a nonneovascular form of the disease to neovascular AMD, which is associated with central visual acuity loss that can result in severe visual impairment and blindness. Improvements in vision preservation and quality of life require regular clinical visits for intravitreal therapy, which, ...
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Wong W Tags: Am J Manag Care Source Type: research

Pandemic to bring painful choices for states, policy makers: a Q & A with Larry Levitt.
Pandemic to bring painful choices for states, policy makers: a Q&A with Larry Levitt. Am J Manag Care. 2020 May;26(5):192-193 Authors: Levitt L, Inserro A Abstract To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the May issue, we turned to Larry Levitt, MPP, executive vice president for health policy for the Kaiser Family Foundation. PMID: 32436674 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Levitt L, Inserro A Tags: Am J Manag Care Source Type: research

Expanding coverage for essential care during COVID-19.
Abstract The coronavirus disease 2019 (COVID-19) pandemic will exacerbate the financial situations of the millions of Americans who struggle to afford their medical care, but policy solutions are available to quickly mitigate this problem. PMID: 32436675 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Fendrick AM, Shrosbree B Tags: Am J Manag Care Source Type: research

The revolving door penalty: is it a matter of time?
Abstract The revolving door of readmissions keeps spinning for patients who report symptoms of shortness of breath. PMID: 32436676 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Goyal RS Tags: Am J Manag Care Source Type: research

The association of health literacy domains with hospitalizations and mortality.
CONCLUSIONS: This study did not show associations of health literacy, numeracy, or graph literacy scores with lower risk of all-cause hospitalization or mortality. Further research is needed with random sampling in a broader spectrum of healthcare settings to better understand what roles health literacy, numeracy, and graph literacy might play in healthcare utilization and clinical outcomes. PMID: 32436677 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Ferri-Guerra J, Mohammed YN, Aparicio-Ugarriza R, Salguero D, Shah A, Baskaran D, Desir M, Ruiz JG Tags: Am J Manag Care Source Type: research

Provider differences in biosimilar uptake in the filgrastim market.
CONCLUSIONS: This study uncovers important associations between provider practice characteristics and biosimilar uptake. Our findings suggest that provider awareness and incentives can be important levers to strengthen US biosimilar market penetration and competition. PMID: 32436678 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Chen AJ, Ribero R, Van Nuys K Tags: Am J Manag Care Source Type: research

Medical home effects on enrollees with mental and physical illness.
Abstract OBJECTIVES: To assess the effect of medical home enrollment on acute care use and healthcare spending among Medicaid beneficiaries with mental and physical illness. STUDY DESIGN: Retrospective cohort analysis of administrative data. METHODS: We used 2007-2010 Medicaid claims and state psychiatric hospital data from a sample of 83,819 individuals diagnosed with schizophrenia or depression and at least 1 comorbid physical condition. We performed fixed-effects regression analysis at the person-month level to examine the effect of medical home enrollment on the probabilities of emergency depart...
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Grove LR, Domino ME, Farley JF, Swietek KE, Beadles C, Ellis AR, Jackson CT, DuBard CA Tags: Am J Manag Care Source Type: research

Accountable care organizations are increasingly led by physician groups rather than hospital systems.
Abstract Because hospitals and health systems sponsored the majority of new accountable care organizations (ACOs) from 2010 to 2015, they influenced priorities and strategies of the policies designed to drive ACO adoption. In recent years, however, the majority of new ACOs have been sponsored by physician groups. This shift means that policies need to be developed with the characteristic strengths and weaknesses of physician-led ACOs in mind. Using data from the Leavitt Partners ACO database, we analyzed the types of providers becoming ACOs over time to look at their numbers and market potential. Because the marke...
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Muhlestein D, Tu T, Colla CH Tags: Am J Manag Care Source Type: research

Six sigma approach to reduce door-to-balloon time for patients with STEMI.
Abstract Specific measures using a Six Sigma approach led to sustained reduction of door-to-balloon times among patients with ST-segment elevation myocardial infarction (STEMI) in a community setting. PMID: 32436681 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Sharma T, Chaudhary R, Garg J, Kondur A, Mohananey D, Chaudhary R Tags: Am J Manag Care Source Type: research

Economic burden of osteoporotic fractures in US managed care enrollees.
CONCLUSIONS: These findings suggest a significant economic burden associated with fractures, including a high total all-cause cost of care. Early identification and treatment of patients at high risk of fractures are of paramount importance to reduce fracture risk and associated healthcare costs. PMID: 32436682 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Williams SA, Chastek B, Sundquist K, Barrera-Sierra S, Leader D, Weiss RJ, Wang Y, Curtis JR Tags: Am J Manag Care Source Type: research

COPD exacerbation costs in the IMPACT study: a within-trial analysis.
Abstract OBJECTIVES: Exacerbations account for the greatest proportion of costs associated with chronic obstructive pulmonary disease (COPD). Here we aimed to evaluate, from the US payer perspective, the costs associated with moderate and severe COPD exacerbation events for patients treated with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) compared with FF/VI or UMEC/VI. STUDY DESIGN: This post hoc, within-trial economic analysis used data derived from the InforMing the PAthway of COPD Treatment (IMPACT) study (NCT02164513). METHODS: Treatment groups within the IMPACT trial received either tr...
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Bogart MR, Hopson SD, Shih HC, Stanford RH, Coutinho AD Tags: Am J Manag Care Source Type: research

Analyzing admission rates for multiple ambulatory care-sensitive conditions.
CONCLUSIONS: In evaluating the rates of ACSC-related admissions, this study demonstrates the contribution of a single, longitudinal benchmark. This study also suggests that hypertension, congestive heart failure, and pneumonia may be areas for future intervention in Clalit. PMID: 32436684 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Leventer-Roberts M, Cohen-Stavi C, Hoshen M, Gofer I, Sherf M, Balicer R Tags: Am J Manag Care Source Type: research

Linked pharmacist-provider new patient visits in primary care.
CONCLUSIONS: The linked visits between the pharmacist and provider allowed for increased provider productivity at 1 of the sites. Based on these results and provider feedback from both sites, this project was viewed as a positive initiative. Scheduling challenges were a barrier to project success at site B. PMID: 32436685 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2020 Category: Health Management Authors: Bateman MT, McCarthy C, Alli K Tags: Am J Manag Care Source Type: research

The need for a Serious Illness Digital Ecosystem (SIDE) to improve outcomes for patients receiving palliative and hospice care.
Abstract Palliative and hospice care services produce immense benefits for patients living with serious illness and for their families. Due to the national shift toward value-based payment models, health systems and payers share a heightened awareness of the need to incorporate palliative and hospice services into their service mix for seriously ill patient populations. During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. This includes development of technologies to promote utilization of palliative and hospice services. However, no co...
Source: The American Journal of Managed Care - April 1, 2020 Category: Health Management Authors: Nicolla J, Bosworth HB, Docherty SL, Pollak KI, Powell J, Sellers N, Reeve BB, Samsa G, Sutton L, Kamal AH Tags: Am J Manag Care Source Type: research

Why palliative care is the answer to the serious illness question in payment reform.
PMID: 32286037 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2020 Category: Health Management Authors: Salinger MR, Boucher NA, LeBlanc TW, Oeffinger KC, Pollak K, Troy JD, Kamal AH Tags: Am J Manag Care Source Type: research

Lack of clarity on Medicare Advantage palliative, other cancer care benefits limits consumer uptake.
PMID: 32286038 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2020 Category: Health Management Authors: Knutson T, Caffrey M Tags: Am J Manag Care Source Type: research