Chronic inflammatory demyelinating polyneuropathy: considerations for diagnosis, management, and population health.
This article reviews the epidemiology, diagnosis, treatment options for first- and second-line therapy, treatment guidelines, and monitoring parameters for CIDP. PMID: 30312032 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Ryan M, Ryan SJ Tags: Am J Manag Care Source Type: research

The economic burden and managed care implications of chronic inflammatory demyelinating polyneuropathy.
Abstract Chronic inflammatory demyelinating polyneuropathy (CIDP) is a symmetric demyelinating peripheral neuropathy with either a progressive or relapsing remitting course. CIDP is both debilitating and degenerative, leaving patients with functional impairment due to nerve damage in their extremities. Along with its medical burden, CIDP has a significant economic impact, with disease-related expenses and the often fairly high costs related to the immune therapies used to treat the disease. Costs for patients with this disorder often exceed those of other immune-mediated neuromuscular diseases. For these reasons, ...
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Owens GM Tags: Am J Manag Care Source Type: research

"Precision health" for high-need, high-cost patients.
"Precision health" for high-need, high-cost patients. Am J Manag Care. 2018 Sep;24(9):396-398 Authors: Khullar D, Kaushal R Abstract It is increasingly clear that high-need, high-cost patients are not a homogenous group, but rather a diverse set of patients with varied circumstances and needs. Acting on this insight requires comprehensive data networks we have not traditionally had, and most analyses to date have focused primarily on claims data. We argue that making clinical and financial gains will require data-sharing networks that integrate clinical factors, genomic information, and soci...
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Khullar D, Kaushal R Tags: Am J Manag Care Source Type: research

Food insecurity, healthcare utilization, and high cost: a longitudinal cohort study.
CONCLUSIONS: Food insecurity is associated with higher healthcare use and costs, even accounting for other socioeconomic factors. Whether food insecurity interventions improve healthcare utilization and cost should be tested. PMID: 30222918 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Berkowitz SA, Seligman HK, Meigs JB, Basu S Tags: Am J Manag Care Source Type: research

Language barriers and LDL-C/SBP control among Latinos with diabetes.
CONCLUSIONS: We found no evidence that ethnicity or language barriers in healthcare were associated with poorer lipid or blood pressure control among Latino and white patients with diabetes receiving care in settings with professional interpreters. PMID: 30222919 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Fernandez A, Warton EM, Schillinger D, Moffet HH, Kruger J, Adler N, Karter AJ Tags: Am J Manag Care Source Type: research

Hepatitis C care cascade among persons born 1945-1965: 3 medical centers.
CONCLUSIONS: This analysis showed that although linkage to care was largely successful in the target birth cohort, the largest gap in the HCV care cascade was seen in initiating treatment. Greater emphasis on linking patients to clinical evaluation and treatment is necessary in order to achieve the public health benefits promised by birth-cohort testing. PMID: 30222920 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Brady JE, Vellozzi C, Hariri S, Kruger DL, Nerenz DR, Brown KA, Federman AD, Krauskopf K, Kil N, Massoud OI, Wise JM, Seay TA, Smith BD, Yartel AK, Rein DB Tags: Am J Manag Care Source Type: research

Health literacy, preventive health screening, and medication adherence behaviors of older African Americans at a PCMH.
CONCLUSIONS: HL was positively associated with patient education, some PHS behaviors, and MA. Performance on HL scales may not enable positive identification of PHS behaviors, DC, and MA. Thus, HL may have limited efficacy as a tool to assess PHS behaviors and DC among older AAs. PMID: 30222921 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Aranha ANF, Patel PJ Tags: Am J Manag Care Source Type: research

Early experiences with the Acute Community Care Program in eastern Massachusetts.
CONCLUSIONS: This study using observational data provides preliminary evidence suggesting that ACCP might offer an alternative to EDs for after-hours urgent care. More rigorous evaluation is required to assess ACCP's effectiveness. PMID: 30222922 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Iezzoni LI, Wint AJ, Cluett WS, Ajayi T, Goudreau M, Blanchfield BB, Palmisano J, Tripodis Y Tags: Am J Manag Care Source Type: research

Economic evaluation of patient-centered care among long-term cancer survivors.
CONCLUSIONS: The positive patient perception of PCMH characteristics was associated with reduced healthcare expenditures in adult long-term cancer survivors. PMID: 30222923 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: An J, Lau A Tags: Am J Manag Care Source Type: research

Adjusting Medicare Advantage star ratings for socioeconomic status and disability.
CONCLUSIONS: Increases in star ratings following adjustment of clinical performance for SES and disability using the CAI focused on contracts with higher percentages of DE/LIS beneficiaries. Adjustment for enrollee characteristics may improve the accuracy of quality measurement and remove incentives for providers to avoid caring for more challenging patient populations. PMID: 30222924 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Sorbero ME, Paddock SM, Damberg CL, Haas A, Kommareddi M, Tolpadi A, Mathews M, Elliott MN Tags: Am J Manag Care Source Type: research

Fragmented ambulatory care and subsequent healthcare utilization among Medicare beneficiaries.
Abstract OBJECTIVES: We sought to determine the associations between fragmented ambulatory care and subsequent emergency department (ED) visits and hospital admissions, while considering possible interactions between fragmentation and number of chronic conditions. STUDY DESIGN: We conducted a cohort study over 3 years among 117,977 fee-for-service Medicare beneficiaries who were attributed to primary care physicians in a 7-county region of New York and had 4 or more ambulatory visits in the baseline year. METHODS: We calculated fragmentation scores using a modified Bice-Boxerman Index and, because scores...
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Kern LM, Seirup JK, Rajan M, Jawahar R, Stuard SS Tags: Am J Manag Care Source Type: research

High-touch care leads to better outcomes and lower costs in a senior population.
Abstract OBJECTIVES: There are several models of primary care. A form of high-intensity care is a high-touch model that uses a high frequency of encounters to deliver preventive services. The aim of this study is to compare the healthcare utilization of patients receiving 2 models of primary care, ‚Äč1 with high-touch care and 1 without. STUDY DESIGN: Retrospective cohort study. METHODS: We conducted a retrospective cohort study of 2 models of care used among Medicare Advantage populations. Model 1 is a high-touch care model, and model 2 is a standard care model. Compared with model 2, model 1 has smalle...
Source: The American Journal of Managed Care - September 1, 2018 Category: Health Management Authors: Ghany R, Tamariz L, Chen G, Dawkins E, Ghany A, Forbes E, Tajiri T, Palacio A Tags: Am J Manag Care Source Type: research

Amyotrophic lateral sclerosis: disease state overview.
Abstract Amyotrophic lateral sclerosis (ALS) is a disease that results in the progressive deterioration and loss of function of the motor neurons in the brain and spinal cord, leading to paralysis. ALS affects approximately 16,000 individuals, with a prognosis for survival of 2 to 5 years. There are 2 types of ALS differentiated by genetics: familial and sporadic (idiopathic). Diagnosis is determined by excluding other conditions and utilizing clinical examinations, laboratory tests, and nerve conduction/electromyography studies. Due to the collection of information from the participation of patients with ALS in r...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Hulisz D Tags: Am J Manag Care Source Type: research

Disease-modifying treatment of amyotrophic lateral sclerosis.
Abstract Currently, there is no cure for amyotrophic lateral sclerosis (ALS) and the foundation of ALS management revolves around symptomatic and palliative care. Early diagnosis offers the best prognosis for a longer, quality life while living with the disease. Many medications are used to relieve symptoms but there are only 2 pharmacologic agents indicated for the management of ALS. For 2 decades, riluzole had been the mainstay of disease-modifying therapy, but in 2017, edaravone became the second agent approved in the management of patients with ALS. The mechanism of either agent is not well known. Riluzole is ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Schultz J Tags: Am J Manag Care Source Type: research

ALS managed care considerations.
Abstract As a chronic neurological disorder characterized by the progressive deterioration of neuromuscular function, amyotrophic lateral sclerosis (ALS) renders significant physical, psychological, and emotional tolls on patients, their families, and caregivers. Coupled with and contributing to the severe impact on quality of life are the substantial economic costs, which can be direct and indirect, and personal as well as societal. Understanding the magnitude and specifics of the costs accompanying ALS will provide useful perspectives to pharmacists who treat patients with ALS. PMID: 30207672 [PubMed - in p...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Santaniello B Tags: Am J Manag Care Source Type: research

The burden of cardiovascular disease in patients with diabetes.
Abstract Adults with type 2 diabetes (T2D) have a 2-to-4-fold higher risk for cardiovascular morbidity and mortality than adults without diabetes, according to the American Heart Association (AHA). Furthermore, the AHA deems diabetes to be "1 of the 7 major controllable risk factors for cardiovascular disease (CVD)." Lack of glycemic control may lead to nerve and cardiac conduction impairments and CVD. However, glycemic control is not the only risk factor. Additional risk factors for CVD in T2D include hypertension, dyslipidemia, obesity, lack of physical activity, and smoking. Patients with T2D are also...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Hudspeth B Tags: Am J Manag Care Source Type: research

Antihyperglycemic medications for cardiovascular disease risk reduction.
Abstract In recognition of the substantial prevalence of cardiovascular disease-related comorbidities among patients with diabetes and the potential for some agents to increase this risk, evaluation of cardiovascular outcomes is now a standard component of late-stage clinical trials involving antihyperglycemic agents. While most agents are evaluated in noninferiority trials to establish a lack of cardiovascular-related harm, a few agents have shown significant reductions in cardiovascular-related outcomes, including mortality. PMID: 30160394 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Goldman JD Tags: Am J Manag Care Source Type: research

Economic implications with newer agents to reduce cardiovascular risk in diabetes.
Abstract Cardiovascular disease (CVD) plays a significant role in the morbidity and mortality in type 2 diabetes (T2D). In addition to the negative impact on the health of patients, people with T2D and CVD encounter higher total healthcare costs compared with patients with T2D and without CVD. The FDA guidance of 2008 recommending cardiovascular outcomes trials (CVOTs) for T2D drug candidates prompted pharmaceutical companies to conduct such studies. Some of those drug candidates appear to have beneficial physiologic effects on cardiovascular outcomes. Pharmacoeconomic analysis can correlate observed improvements ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: McAdam-Marx C Tags: Am J Manag Care Source Type: research

Severity of hereditary angioedema, prevalence, and diagnostic considerations.
Abstract Hereditary angioedema (HAE) is a rare disorder, characterized by intermittent attacks of swelling in any part of the body, without the presence of hives. This lifelong disease typically presents in the first 2 decades of life, and is commonly associated with a deficiency in functional C1 esterase inhibitor (C1-INH) activity. C1-INH levels may be decreased or normal, with an accompanied decrease in functionality, depending on the type of HAE present. The frequency and severity of attacks are highly variable among patients with HAE, but can have a significant impact on a patient's quality of life, and may b...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Bernstein JA Tags: Am J Manag Care Source Type: research

Current and emerging therapies to prevent hereditary angioedema attacks.
Abstract Hereditary angioedema (HAE) is a rare genetic disease defined by recurrent attacks of edema, causing a substantial burden for patients, with morbidity, mortality, and reduced quality of life. This burden is increased by delayed diagnosis, inappropriate treatment, and suboptimal follow-up and patient education. Several novel therapeutics have recently been approved or are currently under evaluation for prevention of HAE attacks. PMID: 30132644 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Lumry WR Tags: Am J Manag Care Source Type: research

Economic burden limiting proper healthcare delivery, management, and improvement of patient outcomes.
Abstract Although several new therapies to both treat acute hereditary angioedema (HAE) attacks and provide prophylaxis for patients with recurrent episodes have been introduced in the past several years, HAE remains a disease with a substantial physical, psychosocial, and economic burden to both affected patients and society in general. Not all treatments work for all patients, and research is ongoing to improve HAE diagnosis and selection of therapy for individual patients to optimize outcomes. But the disease has a significant economic impact with high direct and indirect costs, and high charges related to the ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Cardarelli WJ Tags: Am J Manag Care Source Type: research

Unmet clinical needs and economic burden of disease in the treatment landscape of acute myeloid leukemia.
Abstract Acute myeloid leukemia (AML) is the most common form of acute leukemia in adults in the United States, with approximately 19,520 new cases estimated for 2018. Despite advances in the management of hematologic malignancies, the development of novel targeted and immune therapies, and improvements in supportive care, the overall outcome for patients with AML remains poor due to several factors, including increased frequency in the older population, poor response to chemotherapy, high relapse rates, and limited effective therapy options in relapsed patients. In addition, AML presents a substantial clinical an...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Wiese M, Daver N Tags: Am J Manag Care Source Type: research

Current and emerging therapies for patients with acute myeloid leukemia: a focus on MCL-1 and the CDK9 pathway.
Abstract Acute myeloid leukemia (AML) is an aggressive hematologic malignancy that largely impacts the elderly population. Not all AML patients are candidates for the mainstay induction and consolidation treatment options. In addition, despite available therapies, most patients will eventually relapse on, or be refractory to, standard induction therapy, with limited subsequent choices and poor prognosis. Recently, several new and emerging therapies, with a variety of mechanisms of action, have broadened the treatment landscape in newly diagnosed and relapsed/refractory (R/R) AML, providing patients and healthcare ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Lyle L, Daver N Tags: Am J Manag Care Source Type: research

Baseline and postfusion opioid burden for patients with low back pain.
Abstract OBJECTIVES: To evaluate opioid usage patterns for patients with low back pain (LBP) with and without spinal fusion surgery (fusion patients and nonfusion patients, respectively), including long-term prescriptions post fusion. STUDY DESIGN: Claims data of outpatient pharmaceutical prescriptions from privately insured patients. METHODS: The 3-year utilization, cost, and morphine milligram equivalents (MME) of opioid prescriptions were evaluated for patients with LBP with and without lumbar fusion. For fusion patients, opioid prescriptions before and after fusion, as well as prescription use 3, 6, ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Ong KL, Stoner KE, Yun BM, Lau E, Edidin AA Tags: Am J Manag Care Source Type: research

Patient and physician predictors of hyperlipidemia screening and statin prescription.
Abstract OBJECTIVES: Appropriate lipid management has been demonstrated to reduce cardiovascular events, but rates of hyperlipidemia screening and statin therapy are suboptimal. We aimed to evaluate patient and physician predictors of guideline-concordant hyperlipidemia screening and statin prescription. STUDY DESIGN: Retrospective study of patients with primary care provider (PCP) visits from 2014 to 2016 at the University of Pennsylvania Health System. METHODS: Data on patients, screening orders, and prescriptions were obtained from the electronic health record. Multivariate logistic regression models ...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Kannan S, Asch DA, Kurtzman GW, Honeywell S, Day SC, Patel MS Tags: Am J Manag Care Source Type: research

Medicare Advantage enrollees' use of nursing homes: trends and nursing home characteristics.
CONCLUSIONS: MA plans may be selectively contracting with NHs, as evidenced by the larger shares of MA patients who have been placed in facilities with better performance on quality measures. This may reflect MA plans concentrating enrollees in specific facilities and building "networks" of postacute and long-term care providers that provide better and more efficient care. PMID: 30130025 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Jung HY, Li Q, Rahman M, Mor V Tags: Am J Manag Care Source Type: research

Evaluating HCV screening, linkage to care, and treatment across insurers.
CONCLUSIONS: Reducing steps in the HCV SLTC process increases the number of patients who learn their HCV status, receive appropriate care, and initiate treatment. PMID: 30130026 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Mulligan K, Sullivan J, Yoon L, Chou J, Van Nuys K Tags: Am J Manag Care Source Type: research

Reducing coprescriptions of benzodiazepines and opioids in a veteran population.
CONCLUSIONS: Chart review note recommendations were frequently disregarded by providers and are likely insufficient as a primary intervention tool for reducing long-term combination BZD and opioid therapy. PMID: 30130027 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Shayegani R, Pugh MJ, Kazanis W, Wilkening GL Tags: Am J Manag Care Source Type: research

Choosing Wisely clinical decision support adherence and associated inpatient outcomes.
CONCLUSIONS: Consistent improvements in measured outcomes were seen in the treatment group versus the control group. We recommend that provider organizations consider the introduction of real-time CDS to support adherence to evidence-based guidelines, but because we cannot determine the cause of the associations between CDS interventions and improved clinical and financial outcomes, further study is required. PMID: 30130028 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Heekin AM, Kontor J, Sax HC, Keller MS, Wellington A, Weingarten S Tags: Am J Manag Care Source Type: research

Impact of a medical home model on costs and utilization among comorbid HIV-positive Medicaid patients.
CONCLUSIONS: There was increased outpatient service utilization, yet relative cost savings, for HIV-positive Medicaid patients with medical and behavioral health comorbidities who were treated in PCMHs. PMID: 30130029 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Crits-Christoph P, Gallop R, Noll E, Rothbard A, Diehl CK, Connolly Gibbons MB, Gross R, Rhodes KV Tags: Am J Manag Care Source Type: research

Precision medicine and sharing medical data in real time: opportunities and barriers.
Abstract Sharing massive amounts of medical data is critical to precision medicine. The California Department of Public Health recently started to partner with certain hospitals in the state to better understand cancer trends by collecting and securely sending standardized cancer data directly to the California Cancer Registry. This initiative is the first of its kind in the United States. This has afforded the cancer registry the opportunity to perform real-time surveillance on data reported via participating hospitals, and researchers can use advanced methods to analyze these data. Other states are likely to fol...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Yang YT, Chen B Tags: Am J Manag Care Source Type: research

Levers to reduce use of unnecessary services: creating needed headroom to enhance spending on evidence-based care.
Abstract Health system leaders, policy makers, payers, and consumer advocates should use multiple synergistic levers to reduce the use of care that does not provide clinical benefit. PMID: 30130031 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Budros M, Fendrick AM Tags: Am J Manag Care Source Type: research

Optimizing number and timing of appointment reminders: a randomized trial.
Abstract OBJECTIVES: To compare missed appointment rates for patients receiving a single reminder either 3 days prior to a primary care visit, 1 day prior to the visit, or both 3 days and 1 day prior to the visit. STUDY DESIGN: Three-armed randomized controlled trial. METHODS: Text messages or interactive voice response calls were sent to patients with appointments at 25 primary care clinics in an integrated delivery system. A multivariable prediction model was developed to identify patients at high risk of missing appointments, based on prior appointment-keeping history and other variables from electron...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Steiner JF, Shainline MR, Dahlgren JZ, Kroll A, Xu S Tags: Am J Manag Care Source Type: research

Impact of after-hours telemedicine on hospitalizations in a skilled nursing facility.
This study addresses the potential clinical and financial impacts of an after-hours physician coverage service enabled by technology, TripleCare (TC), to prevent avoidable hospitalizations. TC was launched in a 365-bed SNF in Brooklyn, New York, in March 2015. Outcomes were tracked and evaluated for the initial year. Avoided hospitalizations were identified as such by the covering physicians and confirmed by the facility's medical director. Of the 313 patients cared for by the telemedicine-enabled covering physicians during the year of service, 259 (83%) were treated on site, including 91 who avoided hospitalizations as ve...
Source: The American Journal of Managed Care - August 1, 2018 Category: Health Management Authors: Chess D, Whitman JJ, Croll D, Stefanacci R Tags: Am J Manag Care Source Type: research

Costs associated with long-acting insulin analogues in patients with diabetes.
CONCLUSIONS: Despite higher drug costs, the real-world overall medical costs of LAIAs are not significantly different from those of NPH in patients with diabetes. The findings may be helpful for formulary decision making for patients with diabetes in a cost-constrained environment. PMID: 30020738 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Alemayehu B, Speiser J, Bloudek L, Sarnes E Tags: Am J Manag Care Source Type: research

A gray area for reimbursement: medical foods for non-inborn errors of metabolism.
CONCLUSIONS: Most reviewed non-IEM MFs lack evidence to support their safety and efficacy. These non-IEM MFs do not abide by FDA draft guidance, as they do not address a distinct nutritional requirement for a disease and yet often have a National Drug Code or "Rx only" label. Consequently, these products do not meet the statutory definition of an MF. We recommend that CAWCS and other payers not provide insurance coverage for non-IEM MFs until more scientific evidence supports their safety, efficacy, and use for nutritional need of a disease. PMID: 30020739 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Wilson L, Lin TK, Oh A, Cao V Tags: Am J Manag Care Source Type: research

Disease-modifying antirheumatic drug initiation among patients newly diagnosed with rheumatoid arthritis.
CONCLUSIONS: Only slightly more than half of patients initiated RA therapy within 12 months of diagnosis in this commercially insured population. PMID: 30020740 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Bonafede M, Johnson BH, Shah N, Harrison DJ, Tang D, Stolshek BS Tags: Am J Manag Care Source Type: research

Cost per response analysis of strategies for chronic immune thrombocytopenia.
CONCLUSIONS: In adults with chronic ITP, romiplostim represents an efficient way to achieve response, with lower costs per response than eltrombopag; both romiplostim and eltrombopag had lower costs per response than watch and rescue. PMID: 30020741 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Fust K, Parthan A, Li X, Sharma A, Zhang X, Campioni M, Lin J, Wang X, Zur R, Cetin K, Eisen M, Chandler D Tags: Am J Manag Care Source Type: research

5-ASA to sulfasalazine drug switch program in patients with ulcerative colitis.
CONCLUSIONS: A pharmacist-administered drug switch program in patients with UC was significantly more difficult than anticipated, with questionable achievement of cost savings. This experience suggests that future drug switches and studies should focus on patient preferences for drug switching, as this may have implications for switching from brand name to biosimilar drugs. PMID: 30020742 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Goldsmith JR, Waljee AK, George T, Brown A, Choe HM, Noureldin M, Bernstein SJ, Higgins PDR Tags: Am J Manag Care Source Type: research

Direct oral anticoagulant prescription trends, switching patterns, and adherence in Texas Medicaid.
CONCLUSIONS: Texas Medicaid prescription data show a gradual increase in DOAC use with a rapid increase in prescription expenditures. Further exploration of the causes of higher switch rates among DOAC initiators compared with warfarin initiators and nonadherence to DOACs is needed to understand the challenges related to DOAC adoption in practice and to improve patient outcomes. PMID: 30020743 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Wong SL, Marshall LZ, Lawson KA Tags: Am J Manag Care Source Type: research

Two-year adherence and costs for biologic therapy for rheumatoid arthritis.
CONCLUSIONS: Adherence to the first bDMARD was suboptimal even in effectively treated patients, suggesting opportunities to improve adherence in patients with RA initiating biologics. PMID: 30020744 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Stolshek BS, Wade S, Mutebi A, De AP, Wade RL, Yeaw J Tags: Am J Manag Care Source Type: research

Cost of biologic treatment persistence or switching in rheumatoid arthritis.
CONCLUSIONS: Patients with RA who switched biologic therapy incurred higher 1-year total postswitch healthcare costs compared with patients who were persistent on the index biologic. Healthcare costs were lowest for patients who started on etanercept, particularly those who persisted on etanercept. PMID: 30020745 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Gu T, Mutebi A, Stolshek BS, Tan H Tags: Am J Manag Care Source Type: research

Impact of medical and/or pharmacy reimbursement on adult vaccination rates.
Abstract OBJECTIVES:  To evaluate whether adults enrolled in commercial health insurance plans that provide reimbursement for herpes zoster vaccine (HZV) and pneumococcal vaccine (PV) through the medical and pharmacy benefits have higher vaccination rates compared with those whose health plans cover vaccines under the medical benefit alone. STUDY DESIGN:  Retrospective claims analysis using medical and pharmacy claims data from January 1, 2012, through December 31, 2014. Separate but parallel analyses were conducted for HZV and PV. METHODS:  Previously unvaccinated patients were divided in...
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Deshpande G, Visaria J, Singer J, Johnson KD Tags: Am J Manag Care Source Type: research

Modeling the impacts of restrictive formularies on patients with HIV.
CONCLUSIONS:  Less restrictive formulary designs, which allow patients with HIV to initiate potentially safer and more efficacious regimens based on their proclivity to AEs, yield better outcomes and reduce costs. PMID: 30020747 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Baumgardner J, Huber C, Kabiri M, Yoon L, Chou J, Romley J Tags: Am J Manag Care Source Type: research

Treatment patterns among adults with ADHD receiving long-acting therapy.
Abstract OBJECTIVES:  To evaluate the treatment patterns among commercially insured adults in the United States with attention-deficit/hyperactivity disorder (ADHD) who received long-acting (LA) combination therapy (CT) or monotherapy for ADHD. STUDY DESIGN:  Retrospective observational study. METHODS:  Adults with at least 1 ADHD diagnosis and at least 1 LA ADHD medication were identified from the MarketScan claims database (April 1, 2009, to March 31, 2014). The index date was randomly selected among LA medication initiation dates (index treatment). CT was identified if a different ADHD ...
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Zhou Z, Zhou ZY, Kellar SS, Sikirica V, Xie J, Grebla R Tags: Am J Manag Care Source Type: research

Insights on site-of-care cancer research: both quality and cost information are necessary to guide policy.
Abstract The implementation of alternative payment models that successfully capture clinical heterogeneity-without adding unacceptable levels of administrative complexity-may be equally (if not more) important than site-neutral payment policies. PMID: 30020749 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Patel K, Fendrick AM Tags: Am J Manag Care Source Type: research

Value-based health insurance design: how much does socioeconomic status matter?
Abstract Socioeconomic status (SES), an important determinant of individual health status, has not been widely incorporated into employer benefits strategies. Recent research has characterized significant differences in healthcare utilization patterns and cost among workers in different wage categories, raising the possibility that SES does influence individual healthcare utilization behaviors. In particular, SES may have appreciable impact on the effectiveness of benefits tactics, including value-based insurance design (VBID). This paper sets forth a hypothesis that low wage status negatively influences individua...
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Sherman BW, Addy C Tags: Am J Manag Care Source Type: research

The development of diabetes complications in GP-centered healthcare.
CONCLUSIONS: The results of the present study indicate that GP-centered healthcare is associated with a delay in the occurrence of serious diabetes complications and reduces the risk of diabetes complications. This may be because GP-centered care is associated with improved coordination of care. PMID: 30020751 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Karimova K, Uhlmann L, Hammer M, Guethlin C, Gerlach FM, Beyer M Tags: Am J Manag Care Source Type: research

Differences in spending on provider-administered chemotherapy by site of care in Medicare.
CONCLUSIONS: Chemotherapy drug spending per Medicare beneficiary was lower in HOPDs than in physician offices, driven by less frequent use of chemotherapy in HOPDs. As the site of provider-administered chemotherapy shifts from physician offices to HOPDs, continuing assessment of cancer care spending by site of care is necessary. PMID: 30020752 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Kalidindi Y, Jung J, Feldman R Tags: Am J Manag Care Source Type: research

Examining differential performance of 3 medical home recognition programs.
We examined differences in patient outcomes associated with 3 patient-centered medical home (PCMH) recognition programs-National Committee for Quality Assurance (NCQA) Level 3, The Joint Commission (TJC), and Accreditation Association for Ambulatory Health Care (AAAHC)-among Medicare beneficiaries receiving care at federally qualified health centers (FQHCs). STUDY DESIGN: We used data from CMS' FQHC Advanced Primary Care Practice Demonstration, in which participating FQHCs received assistance to achieve NCQA Level 3 PCMH recognition. We assessed the impact of the 3 recognition programs on utilization, quality, and Med...
Source: The American Journal of Managed Care - July 1, 2018 Category: Health Management Authors: Mahmud A, Timbie JW, Malsberger R, Setodji CM, Kress A, Hiatt L, Mendel P, Kahn KL Tags: Am J Manag Care Source Type: research