The complexities of biosimilars and the regulatory approval process.
In this report, various factors are addressed to improve the knowledge of biosimilars, including clinical, manufacturing, and cost considerations. PMID: 29957908 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Lucio S Tags: Am J Manag Care Source Type: research

Opportunities and challenges in biosimilar uptake in oncology.
Abstract There are now 10 approved biosimilars in the United States, including 3 oncology drugs, and at least 16 others in late-stage development. The introduction of competition into the biologic space launches a new era in the treatment of cancer, possibly increasing access to the extremely costly biologics. The most important and influential stakeholders for biosimilar acceptance and usage are healthcare providers, such as pharmacists and physicians, as well as patients. Gaining their support requires extensive education, postmarketing pharmacovigilance, resolving concerns about immunogenicity, and allowing int...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Dolan C Tags: Am J Manag Care Source Type: research

From the editors: bringing the Joslin Clinical Guidelines to the diabetes care community.
PMID: 29938992 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Ganda OP, Gabbay RA Tags: Am J Manag Care Source Type: research

Joslin Diabetes Center Clinical Oversight Committee.
PMID: 29938993 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Ganda OP, Gabbay RA Tags: Am J Manag Care Source Type: research

CHAPTER 1. Clinical guideline for adults with diabetes.
PMID: 29938994 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Hafida S, Ganda OP, Gabbay RA, Members of the Joslin Clinical Oversight Committee Tags: Am J Manag Care Source Type: research

CHAPTER 2. Clinical nutrition guideline for overweight and obese adults with type 2 diabetes (T2D) or prediabetes, or those at high risk for developing T2D.
PMID: 29938995 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Hamdy O, Ganda OP, Maryniuk M, Gabbay RA, Members of the Joslin Clinical Oversight Committee Tags: Am J Manag Care Source Type: research

CHAPTER 3. Guideline for detection and management of diabetes in pregnancy.
PMID: 29938996 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Brown FM, Anderson-Haynes SE, Blair E, Serdy S, Halprin E, Feldman A, O'Brien KE, Ghiloni S, Suhl E, Rizzotto JA, Ganda OP, Gabbay RA, Members of the Joslin Clinical Oversight Committee Tags: Am J Manag Care Source Type: research

CHAPTER 4. Guideline for the care of the older adult with diabetes.
PMID: 29938997 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Munshi M, Blair E, Ganda OP, Gabbay RA, Members of the Joslin Clinical Oversight Committee Tags: Am J Manag Care Source Type: research

CHAPTER 5. Clinical guideline for pharmacological management of adults with type 2 diabetes.
PMID: 29938998 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Ganda OP, Segal A, Blair E, Beaser R, Gaglia J, Halprin E, Gabbay RA, Members of the Joslin Clinical Oversight Committee Tags: Am J Manag Care Source Type: research

Initial results of a lung cancer screening demonstration project: a local program evaluation.
Abstract OBJECTIVES: To describe participation rates, results, and lessons learned from a lung cancer screening (LCS) demonstration project. STUDY DESIGN: Prospective observational study at 1 of 8 centers participating in a national Veterans Health Administration LCS demonstration project. METHODS: An electronic health record (EHR) algorithm and tobacco pack-year (TPY) information prompt identified patients potentially eligible for LCS. LCS invitation was planned to consist of shared decision-making materials, an invitation letter to call the LCS manager, a reminder letter, and an outreach phone call for...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Fabbrini AE, Lillie SE, Partin MR, Fu SS, Clothier BA, Bangerter AK, Nelson DB, Doro EA, Bell BJ, Rice KL Tags: Am J Manag Care Source Type: research

Prevalence and predictors of hypoglycemia in South Korea.
CONCLUSIONS: Patients with a history of hypoglycemia or receiving combined antidiabetic therapy must be appropriately managed to achieve optimal glycemic control without significant risk of hypoglycemia. PMID: 29939502 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Park SY, Jang EJ, Shin JY, Lee MY, Kim D, Lee EK Tags: Am J Manag Care Source Type: research

Physician practice variation under orthopedic bundled payment.
Abstract OBJECTIVES: To describe the extent of and longitudinal changes in physician practice variation with respect to implant costs, institutional postacute care (PAC) provider utilization, and total episode payments, as well as to evaluate the association between physician volume and quality and these outcomes. STUDY DESIGN: Observational study. METHODS: We combined claims and internal hospital cost data for 34 physicians responsible for 3614 joint replacement episodes under bundled payment at Baptist Health System (BHS). Multilevel multivariable generalized linear models were employed and the intracl...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Liao JM, Emanuel EJ, Whittington GL, Small DS, Troxel AB, Zhu J, Zhong W, Navathe AS Tags: Am J Manag Care Source Type: research

A longitudinal examination of the asthma medication ratio in children.
Abstract OBJECTIVES: The asthma medication ratio (AMR) (number of controller medications / [number of controller medications + number of rescue medications]) can be calculated using claims data. This measure has not previously been studied longitudinally. Our objective is to conduct a longitudinal examination of the AMR in a large national cohort of children with asthma. STUDY DESIGN: Retrospective analysis of pharmacy and medical claims data. METHODS: Using 2013-2014 TruvenHealth MarketScan data, we identified children with asthma. Beginning with the month of first controller claim, we calculated an AMR...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Andrews AL, Brinton D, Simpson KN, Simpson AN Tags: Am J Manag Care Source Type: research

Simply delivered meals: a tale of collaboration.
We report the results of the 2-year intervention in terms of 30-day hospital readmission rates and cost measures (ie, return on investment and cost savings).Of the 622 MMC patients who received SDM during the 24 months, the 30-day readmission rate was 10.3% (compared with the 16.6% 30-day rate of hospital readmission at baseline [ie, before the adoption of CCTP]) for all-cause readmissions. The cost savings for reduced readmissions were $212,160. The return on investment was 387%, or a benefit-cost ratio of $3.87 for every $1.00 spent on meals. Programs such as SDM may reduce the rate of hospital readmission among high-ris...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Martin SL, Connelly N, Parsons C, Blackstone K Tags: Am J Manag Care Source Type: research

Identifying children at risk of asthma exacerbations: beyond HEDIS.
CONCLUSIONS: Population health registries and quality measurement may benefit from using a claims-based definition of pediatric patients at risk of asthma exacerbations that is not as restrictive as the HEDIS persistent asthma criteria. PMID: 29939506 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Hatoun J, Trudell EK, Vernacchio L Tags: Am J Manag Care Source Type: research

Placement of selected new FDA-approved drugs in Medicare Part D formularies, 2009-2013.
Abstract OBJECTIVES: To assess formulary decisions by Part D plans for selected newly approved drugs. STUDY DESIGN: Retrospective cohort study. METHODS: Formulary placement and restrictions were identified for 33 drugs in 8 therapeutic classes (antihyperglycemics, anticoagulants, antiplatelets, disease-modifying agents for multiple sclerosis [MS] and rheumatoid arthritis [RA], chronic obstructive pulmonary disease [COPD] drugs, antiepileptics, and antipsychotics) in 863 Part D plans with continuous CMS contracts between 2009 and 2013. Multivariable models estimated the impact of drug characteristics and ...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Stuart BC, Tom SE, Choi M, Johnson A, Sun K, Qato D, Obi EN, Zacker C, Park Y, Arcona S Tags: Am J Manag Care Source Type: research

Cost sharing for antiepileptic drugs: medication utilization and health plan costs.
Abstract OBJECTIVES: To examine the association between health plan out-of-pocket (OOP) costs for antiepileptic drugs and healthcare utilization (HCU) and overall plan spending among US-based commercial health plan beneficiaries with epilepsy. STUDY DESIGN: Retrospective cohort. METHODS: The Truven MarketScan Commercial Claims database for January 1, 2009, to June 30, 2015, was used. Patients 65 years or younger with epilepsy and at least 12 months of continuous enrollment before index (date meeting first epilepsy diagnostic criteria) were included. Analyses were adjusted for age group, gender, beneficia...
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Joyce NR, Fishman J, Green S, Labiner DM, Wild I, Grabowski DC Tags: Am J Manag Care Source Type: research

Assessing markers from ambulatory laboratory tests for predicting high-risk patients.
CONCLUSIONS: The addition of laboratory risk markers can significantly improve the identification of high-risk patients using models that include age, gender, and a limited number of morbidities; however, models that use comprehensive risk measures may be only marginally improved. PMID: 29939509 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Lemke KW, Gudzune KA, Kharrazi H, Weiner JP Tags: Am J Manag Care Source Type: research

Satisfaction with care after reducing opioids for chronic pain.
CONCLUSIONS: Overall, reducing opioid use for chronic pain is not associated with lower patient satisfaction scores, but encounters with unassigned providers may be associated with slightly lower satisfaction when opioids are reduced. PMID: 29939510 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - June 1, 2018 Category: Health Management Authors: Sharp AL, Shen E, Wu YL, Wong A, Menchine M, Kanter MH, Gould MK Tags: Am J Manag Care Source Type: research

Impact of emergency physician-provided patient education about alternative care venues.
Abstract OBJECTIVES: Interventions that focus on educating patients appear to be the most effective in directing healthcare utilization to more appropriate venues. We sought to evaluate the effects of mailed information and a brief scripted educational phone call from an emergency physician (EP) on subsequent emergency department (ED) utilization by low-risk adults with a recent treat-and-release ED visit. STUDY DESIGN: Patients were randomized into 3 groups for post-ED follow-up: EP phone call with mailed information, mailed information only, and no educational intervention. Each intervention group was compa...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Patel PB, Vinson DR, Gardner MN, Wulf DA, Kipnis P, Liu V, Escobar GJ Tags: Am J Manag Care Source Type: research

Monitoring the hepatitis C care cascade using administrative claims data.
CONCLUSIONS: With validated case-finding algorithms, insurance claims data can be used to describe and monitor portions of the HCV care cascade. Although nearly all enrollees with HCV were engaged in HCV care, only half received treatment, indicating that even commercially insured enrollees may find it challenging to access treatment. PMID: 29851440 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Isenhour C, Hariri S, Vellozzi C Tags: Am J Manag Care Source Type: research

Characteristics and medication use of veterans in Medicare Advantage plans.
CONCLUSIONS: Providers both inside and outside of the VA should consider that substantial information about the medication use of veterans may be unavailable in their healthcare systems' electronic records. PMID: 29851441 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Markossian TW, Suda KJ, Abderhalden L, Huo Z, Smith BM, Stroupe KT Tags: Am J Manag Care Source Type: research

Impact of formulary restrictions on medication intensification in diabetes treatment.
CONCLUSIONS: Part D formulary restrictions on sole-source brand name NIADs had little impact on patterns of treatment intensification for T2D among LIS recipients enrolled in Medicare Part D plans in 2012. PMID: 29851442 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Stuart BC, Slejko JF, Rueda JD, Cooke C, Shen X, Roberto P, Ciarametaro M, Dubois R Tags: Am J Manag Care Source Type: research

Rural hospital transitional care program reduces Medicare spending.
CONCLUSIONS: The estimated $5.4 million in savings from this intervention more than offset the costs of the $1.1 million funding for the award. Although other studies have found that care transitions programs can improve outcomes, this study was unique in the size of the impacts relative to the low-touch intervention and the location in a small rural healthcare system. PMID: 29851443 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Kranker K, Barterian LM, Sarwar R, Peterson GG, Gilman B, Blue L, Stewart KA, Hoag SD, Day TJ, Moreno L Tags: Am J Manag Care Source Type: research

Increasing hepatitis C screening in a large integrated health system: science and policy in concert.
Abstract OBJECTIVES: To evaluate whether the updated 2013 US Preventive Services Task Force (USPSTF) hepatitis C virus (HCV) screening recommendations, related Affordable Care Act provisions, and the impending availability of efficacious therapies were associated with increased screening in an integrated health system. STUDY DESIGN: We analyzed 665,339 records of adult patients visiting Kaiser Permanente Mid-Atlantic States clinics from 2003 to 2014. METHODS: We used Cox proportional hazards to estimate time to HCV screening and confirmation after June 1, 2013, compared with prior. RESULTS: HCV scre...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Rodriguez CV, Rubenstein KB, Linas B, Hu H, Horberg M Tags: Am J Manag Care Source Type: research

Changes in specialty care use and leakage in Medicare accountable care organizations.
Abstract OBJECTIVES: Reducing leakage to outside specialists has been promoted as a key strategy for accountable care organizations (ACOs). We sought to examine changes in specialty care leakage and use associated with the Medicare Shared Savings Program (MSSP). STUDY DESIGN: Analyses of trends in ACOs from 2010 to 2014 and quasi-experimental difference-in-differences analyses comparing changes for ACOs versus local non-ACO providers from before until after the start of ACO contracts, stratified by ACO specialty composition and year of MSSP entry. METHODS: We used Medicare claims for a 20% sample of bene...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Barnett ML, McWilliams JM Tags: Am J Manag Care Source Type: research

Understanding factors associated with readmission disparities among Delta region, Delta state, and other hospitals.
Abstract OBJECTIVES: To understand the factors that potentially account for differences in 30-day readmission ratios for pneumonia, heart failure, and acute myocardial infarction (AMI) among hospitals in the Mississippi Delta region (Delta region), in Delta states excluding the hospitals in the Delta region (Delta state), and in the rest of the nation (other). STUDY DESIGN: A longitudinal study design from 2013 to 2016. METHODS: The dependent variables were 30-day readmission ratios for AMI, heart failure, and pneumonia. The key independent variables were 2 hospital categories (Delta region and Delta sta...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Chen HF, Nevola A, Bird TM, Karim SA, Morris ME, Wan F, Tilford JM Tags: Am J Manag Care Source Type: research

Nevada's Medicaid expansion and admissions for ambulatory care-sensitive conditions.
CONCLUSIONS: This analysis provides evidence that Medicaid expansion may have limited potential to reduce the disparities in rates of hospital admissions for ACSCs. In Nevada, additional efforts might be needed to improve access to outpatient care and reduce preventable admissions. PMID: 29851447 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Mazurenko O, Shen J, Shan G, Greenway J Tags: Am J Manag Care Source Type: research

Introduction of cost display reduces laboratory test utilization.
CONCLUSIONS: The results support cost awareness and cost charge as means of reducing laboratory utilization. However, the outcome varies with the setting. PMID: 29851448 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Ekblom K, Petersson A Tags: Am J Manag Care Source Type: research

Introduction to the opioid epidemic: the economic burden on the healthcare system and impact on quality of life.
Abstract Opioid analgesics are commonly used to treat acute and chronic pain; in 2016 alone, more than 60 million patients had at least 1 prescription for opioid analgesics filled or refilled. Despite the ubiquitous use of these agents, the effectiveness of long-term use of opioids for chronic noncancer pain management is questionable, yet links among long-term use, addiction, and overdose deaths are well established. Because of overprescribing and misuse, an opioid epidemic has developed in the United States. The health and economic burdens of opioid abuse on individuals, their families, and society are substanti...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Hagemeier NE Tags: Am J Manag Care Source Type: research

Current and emerging options to combat the opioid epidemic.
Abstract Today's management of chronic pain presents a challenging clinical dilemma. Although clinicians wish to relieve a patient's suffering, they must do so without undertreating the pain or contributing to the drug abuse problem. Following a steady rise in opioid prescription rates from 2006 to 2012, increased national attention for the obioid abuse epidemic likely contributed to the decline in prescribing rates from 2012 to 2016. Although opioids have helped many patients, they are also associated with adverse events and a growing national crisis of misuse, abuse, and overdose. PMID: 29851450 [PubMed - i...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Kominek C Tags: Am J Manag Care Source Type: research

The role of managed care professionals and pharmacists in combating opioid abuse.
Abstract Substance misuse is a critical and costly public health problem in the United States. Data as of 2016 show 11,517 cases of opioid analgesic misuse, with the majority (6924 cases) related to hydrocodone misuse. Substance misuse impacts our society significantly with high costs related to healthcare, crime, and lost productivity. Opioid analgesic pain relievers are one of the most prescribed classes of medications and are among the most common drugs related to misuse. Increases in emergency department visits of over 200% have been associated with a dramatic surge in written prescriptions for opioid pain rel...
Source: The American Journal of Managed Care - May 1, 2018 Category: Health Management Authors: Moberg K Tags: Am J Manag Care Source Type: research

A retrospective real-world study of dapagliflozin versus other oral antidiabetic drugs added to metformin in patients with type 2 diabetes.
Abstract OBJECTIVES: The efficacy of dapagliflozin as add-on therapy to metformin has been assessed in randomized trials. However, its effectiveness has not been assessed in a US real-world setting. METHODS: Electronic medical record (EMR) data were used to compare clinical outcomes among patients with type 2 diabetes (T2D) treated with dapagliflozin and metformin with or without other oral antidiabetic drugs (D + M ± OAD), versus metformin with at least 1 other OAD (M + OAD). Adult patients with T2D on these regimens from January 01, 2014, to February 28, 2015, were identified in a US EMR database, wi...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Huang H, Bell KF, Gani R, Tugwell CW, Eudicone JM, Krukas-Hampel MR Tags: Am J Manag Care Source Type: research

Eligibility varies among the 4 sodium-glucose cotransporter-2 inhibitor cardiovascular outcomes trials: implications for the general type 2 diabetes US population.
CONCLUSIONS: There were considerable differences in the proportions of US adults with T2D who met the eligibility criteria for these studies.The DECLARE-TIMI 58 trial criteria were the most generalizable to the US T2D population. PMID: 29693360 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Wittbrodt ET, Eudicone JM, Bell KF, Enhoffer DM, Latham K, Green JB Tags: Am J Manag Care Source Type: research

Generalizability of glucagon-like peptide-1 receptor agonist cardiovascular outcome trials enrollment criteria to the US type 2 diabetes population.
CONCLUSIONS: Most adults with T2D in the United States would have qualified for enrollment into at least 1 of the GLP-1 RA CVOTs evaluated. EXSCEL had the most generalizable eligibility criteria of these trials and ELIXA the least. PMID: 29693361 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Wittbrodt ET, Eudicone JM, Bell KF, Enhoffer DM, Latham K, Green JB Tags: Am J Manag Care Source Type: research

Comparison of low-dose liraglutide use versus other GLP-1 receptor agonists in patients without type 2 diabetes.
CONCLUSIONS: In patients without a T2D diagnosis, LD-L use was significantly greater than that with other GLP-1 RAs within 6 months after approval of HD-L; differences persisted until the end of the study. Increased payer scrutiny of appropriate LD-L use is warranted. PMID: 29693362 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Wittbrodt ET, Eudicone JM, Farahbakhshian S, McAdam-Marx C Tags: Am J Manag Care Source Type: research

Edaravone in the treatment of amyotrophic lateral sclerosis: efficacy and access to therapy - a roundtable discussion.
Abstract Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neuromuscular disease affecting approximately 5 out of every 100,000 individuals living in the United States. ALS is associated with 50% mortality within 30 months of initial symptom onset. The rarity of the disease, along with the significant inter- and intra-patient variability in clinical course and a lack of reliable biomarkers, have rendered the development of effective agents to treat ALS a challenge. Because oxidative stress is considered a contributing factor to ALS onset and progression, drugs that eliminate free radicals may protect ...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Brooks BR, Jorgenson JA, Newhouse BJ, Shefner JM, Agnese W Tags: Am J Manag Care Source Type: research

Delivering on the value proposition of precision medicine: the view from healthcare payers.
Abstract A long-held assumption and expectation has been that genomics-based precision medicine will provide clinicians with the tools and therapies they need to consistently deliver the right treatment to the right patient while simultaneously reducing waste and yielding cost savings for health systems. The pace of discovery within the field of precision medicine has been remarkable, yet optimal uptake of new genetic tests and genetically targeted therapies will occur only if payers recognize their value and opt to cover them. Coverage decisions require clear evidence of clinical effectiveness and utility and an ...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Kogan JN, Empey P, Kanter J, Keyser DJ, Shrank WH Tags: Am J Manag Care Source Type: research

Cost sharing and branded antidepressant initiation among patients treated with generics.
Abstract OBJECTIVES: To determine the relationship between consumer cost sharing for branded antidepressants and the initiation of branded therapy among patients with major depressive disorder (MDD) filling a prescription for generic MDD medication. STUDY DESIGN:  Retrospective cross-sectional analyses. METHODS: Patients aged 18 to 64 years with MDD who filled a generic antidepressant were identified in commercial claims data for 2012 to 2014. For each year-specific analysis, an average cost-sharing index for branded antidepressants at the level of the plan was computed. Multivariable models were us...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Buxbaum JD, Chernew ME, Bonafede M, Vlahiotis A, Walter D, Mucha L, Fendrick AM Tags: Am J Manag Care Source Type: research

The well-being of long-term cancer survivors.
Abstract OBJECTIVES: To compare the well-being of long-term cancer survivors with that of US residents of similar age and demographic characteristics, patients recently diagnosed with cancer, and individuals with chronic illness. STUDY DESIGN: Retrospective observational study. METHODS: Using the Health and Retirement Study, a survey of US residents older than 50 years, we defined 4 cohorts: long-term cancer survivors (>4 years post diagnosis), individuals recently diagnosed with cancer (≤4 years post diagnosis), individuals with chronic illness, and US residents older than 50 years ("national...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Sullivan J, Thornton Snider J, van Eijndhoven E, Okoro T, Batt K, DeLeire T Tags: Am J Manag Care Source Type: research

Care coordination for children with special needs in Medicaid: lessons from Medicare.
CONCLUSIONS: States and Medicaid managed care organizations have many options for designing effective care coordination programs for CSHCN. Their choices should account for the diversity of conditions among CSHCN, families' capacity to coordinate care, and social determinants of health. PMID: 29668210 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Stewart KA, Bradley KWV, Zickafoose JS, Hildrich R, Ireys HT, Brown RS Tags: Am J Manag Care Source Type: research

A payer-provider partnership for integrated care of patients receiving dialysis.
CONCLUSIONS: Promising trends were observed among members participating in this payer-provider care partnership with respect to both clinical and economic outcomes. This suggests that collaborations with shared incentives may be a valuable approach for patients with ESRD. PMID: 29668211 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Kindy J, Roer D, Wanovich R, McMurray S Tags: Am J Manag Care Source Type: research

Progress of diabetes severity associated with severe hypoglycemia in Taiwan.
CONCLUSIONS: This study demonstrated that rapid progression of diabetes complications was associated with higher risk of severe hypoglycemia. It is imperative that treating physicians identify patients with acute worsening of diabetes severity and provide proper hypoglycemia education and prevention care. PMID: 29668212 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Kornelius E, Yang YS, Lo SC, Peng CH, Lai YR, Chiou JY, Huang CN Tags: Am J Manag Care Source Type: research

Physician and patient tools to improve chronic kidney disease care.
Abstract OBJECTIVES: To determine if electronic health record (EHR) tools and patient engagement can improve the quality of chronic kidney disease (CKD) care. STUDY DESIGN: Randomized controlled trial. METHODS: We enrolled 153 primary care physicians caring for 3947 high-risk and 3744 low-risk patients with stage III CKD across 13 ambulatory health centers in eastern Massachusetts. Intervention physicians received a set of electronic alerts during office visits recommending risk-appropriate CKD care. Patients of intervention physicians also received tailored educational mailings. For high-risk patie...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Sequist TD, Holliday AM, Orav EJ, Bates DW, Denker BM Tags: Am J Manag Care Source Type: research

Financial burden of healthcare utilization in consumer-directed health plans.
Abstract OBJECTIVES: To evaluate the impact of enrollment in a consumer-directed health plan (CDHP) on out-of-pocket (OOP) spending and on the financial burden associated with healthcare utilization. STUDY DESIGN: Using commercial claims data from 2011 through 2013, we estimated difference-in-differences models that compared changes in outcomes for individuals who switched to CDHPs (CDHP group) with outcome changes for individuals who remained in traditional plans (traditional plan group). METHODS: We estimated the impact of CDHP enrollment on OOP spending at the point of care and on having high financia...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Zhang X, Trish E, Sood N Tags: Am J Manag Care Source Type: research

Limited distribution networks stifle competition in the generic and biosimilar drug industries.
Abstract A limited distribution network (LDN) restricts the distribution channel for a pharmaceutical drug to 1 or a very small number of distributors. This strategy may allow for more effective allocation of drugs in shortage and is purported to help ensure the safe distribution of high-risk drugs to small patient populations. However, in recent years, some drug companies, including Turing Pharmaceuticals, have used LDNs to prevent generic and biosimilar companies from accessing samples of drug products necessary to perform testing required by the FDA for generic and biosimilar drug applications. LDNs also hamper...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Karas L, Shermock KM, Proctor C, Socal M, Anderson GF Tags: Am J Manag Care Source Type: research

Provider and patient burdens of obtaining oral anticancer medications.
We examined barriers to initiation of OAMs in 116 patients with prostate or kidney cancer (149 unique prescriptions). We found that the median time from initial prescription to prior authorization was 3 days and the median time from initial prescription to patient receipt of drug was 12 days. Seventy-three percent of all prescriptions required 2 or more phone calls by clinic staff and 40% required 5 or more calls. Of 107 prescriptions with data available, 54% utilized financial assistance; these required significantly more phone calls (P = .0001) and led to a longer median time to drug obtainment (P = .003) ...
Source: The American Journal of Managed Care - April 1, 2018 Category: Health Management Authors: Geynisman DM, Meeker CR, Doyle JL, Handorf EA, Bilusic M, Plimack ER, Wong YN Tags: Am J Manag Care Source Type: research

Rising out-of-pocket costs threaten an already vulnerable population: an introduction to the PAN Foundation and AJMC collaborative supplement.
Abstract This supplement showcases the winning papers from the PAN Challenge, which aimed to foster conversations about how to rein in out-of-pocket costs to eliminate barriers between patients and their critical medical treatments. PMID: 29620812 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Klein D Tags: Am J Manag Care Source Type: research

Ensuring access to prescription medications in the post-ACA healthcare access landscape: the essential role of FQHCs in the safety net for the underinsured.
CONCLUSIONS: Despite changes in the healthcare access landscape due to the ACA, underinsured populations remain prevalent and the need for financial assistance with medications persists. FQHCs are uniquely situated to provide access to these essential services. Further policy and funding efforts, such as expansion of 340B programs, could assist FQHCs in fulfilling the role of prescription safety-net providers. PMID: 29620813 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Shi L, Wharton MK, Monnette A Tags: Am J Manag Care Source Type: research

Impact of trained oncology financial navigators on patient out-of-pocket spending.
CONCLUSIONS: Providing financial navigation training to staff at hospitals and cancer centers can significantly benefit patients through decreased OOP expenditures and also mitigate financial losses for healthcare institutions. PMID: 29620814 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Yezefski T, Steelquist J, Watabayashi K, Sherman D, Shankaran V Tags: Am J Manag Care Source Type: research