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Expanding the "safe harbor" in high-deductible health plans: better coverage and lower healthcare costs.
Expanding the "safe harbor" in high-deductible health plans: better coverage and lower healthcare costs. Am J Manag Care. 2017 Dec;23(12):724-725 Authors: Fendrick AM, Soonavala R Abstract Amending regulations to expand the "safe harbor" by allowing predeductible coverage of high-value services and medications for chronic diseases would provide Americans a plan option that better meets their clinical and financial needs. PMID: 29261238 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Fendrick AM, Soonavala R Tags: Am J Manag Care Source Type: research

Chronic disease outcomes from primary care population health program implementation.
Abstract OBJECTIVES: We implemented a health information technology-enabled population health management program for chronic disease management in academic hospital-affiliated primary care practices, then compared quality-of-care outcome measures among practices assigned a central population health coordinator (PHC) and those not assigned a PHC. STUDY DESIGN: Quasi-experimental. METHODS: Central PHCs were nonrandomly assigned to 8 of 18 practices. They met with physicians, managed lists of patients not at goal in chronic disease registries, and performed administrative tasks. In non-PHC practices, existi...
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Ashburner JM, Horn DM, O'Keefe SM, Zai AH, Chang Y, Wagle NW, Atlas SJ Tags: Am J Manag Care Source Type: research

Impact of consumer-directed health plans on low-value healthcare.
CONCLUSIONS: CDHPs in their current form may represent too blunt an instrument to specifically curtail low-value healthcare spending. PMID: 29261240 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Reid RO, Rabideau B, Sood N Tags: Am J Manag Care Source Type: research

Insurance switching and mismatch between the costs and benefits of new technologies.
CONCLUSIONS: As scientific advances generate transformative therapies with substantial structural disconnects between "who pays" and "who benefits," creative approaches may be needed by manufacturers, payers, and others to ensure appropriate access to cost-effective therapies, adequate economic incentives for future development, and sustainable payer economics. Mechanisms may amortize high up-front costs over time, provide for transfers among payers, or a combination. Our research suggests that approaches should be tailored to specific disease and therapy characteristics to be effective. PMID: 2926...
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Cutler D, Ciarametaro M, Long G, Kirson N, Dubois R Tags: Am J Manag Care Source Type: research

ED-based care coordination reduces costs for frequent ED users.
CONCLUSIONS: ED-based care coordination is a promising approach to reduce ED use and hospitalizations among frequent ED users. Our program also demonstrated a decrease in costs per patient. Future efforts to promote population health and control costs may benefit from incorporating similar programs into acute care delivery systems. PMID: 29261242 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Lin MP, Blanchfield BB, Kakoza RM, Vaidya V, Price C, Goldner JS, Higgins M, Lessenich E, Laskowski K, Schuur JD Tags: Am J Manag Care Source Type: research

Evaluation of the Quality Blue Primary Care program on health outcomes.
This study aimed to investigate the role of the Quality Blue Primary Care (QBPC) program on healthcare utilization and overall cost among the beneficiaries of Blue Cross and Blue Shield of Louisiana (BCBSLA). STUDY DESIGN: Retrospective observational cohort study using claims data from adults residing in QBPC-implemented regions continuously enrolled through BCBSLA from June 2012 to December 2014 (N = 89,034). METHODS: Controlling for age, gender, and risk score by propensity score weighting, inpatient, outpatient, and corresponding medical expenditures were each compared between the QBPC group and the control gr...
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Shi Q, Yan TJ, Lee P, Murphree P, Yuan X, Shao H, Bestermann WH, Loupe S, Cantrell D, Carmouche D, Strapp J, Shi L Tags: Am J Manag Care Source Type: research

Impact of statin guidelines on statin utilization and costs in an employer-based primary care clinic.
CONCLUSIONS: Despite differences in ATPIII, ACC/AHA, and USPSTF guidelines, application of any of these statin recommendations would result in optimized statin utilization and fairly neutral effects on cost in this real-world employer-based population. PMID: 29261246 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Gurgle HE, Schauerhamer MB, Rodriguez SA, McAdam-Marx C Tags: Am J Manag Care Source Type: research

Reduction of emergency department use in people with disabilities.
Abstract OBJECTIVES: To examine emergency department (ED) use by individuals with disabilities in safety-net clinics that have adopted the patient-centered medical home (PCMH) model. STUDY DESIGN: This is a retrospective matched cohort study. Prior to matching, we identified 2269 nonelderly Medicaid beneficiaries with disabilities from a Los Angeles Medicaid managed care plan in PCMH clinics and 21,897 in non-PCMH clinics. METHODS: To minimize self-selection bias from clinics and individuals, we created 3 comparison groups through a series of propensity score matching schemes that included matching clini...
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Chu L, Sood N, Tu M, Miller K, Ray L, Sayles JN Tags: Am J Manag Care Source Type: research

Investigating the impact of intervention refusal on hospital readmission.
CONCLUSIONS: Findings suggest that some at-risk patients may not be receptive to services and programs aimed at improving care transitions, resulting in a higher risk for readmission. PMID: 29261248 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Coulourides Kogan A, Koons E, Enguidanos S Tags: Am J Manag Care Source Type: research

Real-world economic value of a 21-gene assay in early-stage breast cancer.
CONCLUSIONS: Universal GEP testing of women 70 years or younger with stage II or grade 2/3 lymph node-negative breast cancers would result in lower outpatient costs, inclusive of the diagnostic test, within the first 6-month episode of care. PMID: 29261249 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Waintraub SE, McNamara D, Graham DMA, Pecora AL, Min J, Wu T, Noh HG, Connors J, Pe Benito R, Choi K, Schultz E, Goldberg SL Tags: Am J Manag Care Source Type: research

Trends in bisphosphonate initiation within an integrated healthcare delivery system.
Abstract In the setting of changing temporal trends in the management of osteoporosis, we examined how select characteristics of new oral bisphosphonate (BP) initiators changed over time among 94,073 women within a large, integrated healthcare organization during the period 2004 to 2012. In the earlier era (2004-2007), approximately half of women younger than 65 years initiating BP therapy (47%-54%) had osteoporosis by bone mineral density (BMD) criteria, but this proportion increased sharply in the later era (2008-2012), with 55% to 81% having osteoporosis. This trend was not evident in older women (≥65 years)...
Source: The American Journal of Managed Care - December 1, 2017 Category: Health Management Authors: Hosein RJ, Lo JC, Ettinger B, Li BH, Niu F, Hui RL, Adams AL Tags: Am J Manag Care Source Type: research

Using the 4 Pillars to increase vaccination among high-risk adults: who benefits?
CONCLUSIONS: An intervention including the 4 Pillars Program was associated with significant increases in vaccination of high-risk adults. However, the overall uptake of recommended vaccines for those with high-risk conditions remained below national goals. PMID: 29182350 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Nowalk MP, Moehling KK, Zhang S, Raviotta JM, Zimmerman RK, Lin CJ Tags: Am J Manag Care Source Type: research

The influence of provider characteristics and market forces on response to financial incentives.
CONCLUSIONS: Responsiveness to financial incentives in cancer care is associated with high market provider density, profit-maximizing billing behavior, and lack of competing financial ownership interests. Identifying physicians and markets responsive to financial incentives may ultimately promote the successful implementation of alternative payment models in cancer care. PMID: 29182351 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: O'Neil B, Tyson M, Graves AJ, Barocas DA, Chang SS, Penson DF, Resnick MJ Tags: Am J Manag Care Source Type: research

Patients' perspectives of care management: a qualitative study.
CONCLUSIONS: Practices can improve patient buy-in for care management through in-person introductions to care managers by their physicians, offering care management to patients who need and are interested in it, broader agreement about terminology and the role of care managers and care plans, and better coordination with care management from insurers and hospitals. PMID: 29182352 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: O'Malley AS, Peikes D, Wilson C, Gaddes R, Peebles V, Day TJ, Jin J Tags: Am J Manag Care Source Type: research

Impact of health reform on young adult prescription medication utilization.
CONCLUSIONS: The dependent coverage provision was associated with an increase in prescription medication expenditures, especially for anti-infectives, among young adults. The amount of expenditures paid by private insurers increased, whereas they decreased for OOP spending. PMID: 29182353 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Pakyz A, Wang H, Cunningham P Tags: Am J Manag Care Source Type: research

Reframing the unaffordability debate: patient responsibility for physician care.
CONCLUSIONS: Average increases in patient obligations for outpatient visits in recent years have been fairly moderate, and multiple sources of survey data suggest that consumers' concerns about overall affordability are decreasing. The high cost of healthcare continues to pose challenges, both at the individual level and for society as a whole. Nevertheless, it is important that potential strategies to improve affordability are informed by trends in patient obligations. PMID: 29182354 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Hempstead K, Gray J, Zink A Tags: Am J Manag Care Source Type: research

Electronic reminder's role in promoting human papillomavirus vaccine use.
CONCLUSIONS: Overall, physicians who report using clinical reminders were more likely to order HPV immunizations. However, the association of clinical reminders with HPV immunizations was not significant in the younger adolescent subpopulation. Further, given that HPV incidence decreases significantly even with small gains in vaccination rates, the increase in HPV immunizations found in the male population aged 11 to 21 years is promising. Therefore, targeting males to receive HPV vaccination immunizations through clinical reminders provides a positively disproportionate return on vaccination rates and disease burden. ...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Bae J, Ford EW, Wu S, Huerta T Tags: Am J Manag Care Source Type: research

Improving antibiotic stewardship: a stepped-wedge cluster randomized trial.
Abstract OBJECTIVES: Antibiotic stewardship is key to optimizing patient outcomes and affordable care. The study objective was to examine the effect of provider education and clinical decision support (CDS) on antibiotic prescribing for acute sinusitis among providers of varying experience. STUDY DESIGN: A stepped-wedge cluster randomized intervention to evaluate antibiotic use for acute sinusitis encounters at 126 Kaiser Permanente Southern California clinics between September 2014 and April 2015. METHODS: The primary outcome was receipt of an antibiotic prescription. Multivariate analysis adjusted for ...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Sharp AL, Hu YR, Shen E, Chen R, Radecki RP, Kanter MH, Gould MK Tags: Am J Manag Care Source Type: research

Changes in cardiovascular care provision after the Affordable Care Act.
CONCLUSIONS: Provision of cardiovascular preventive care increased for some USPSTF-recommended services following enactment of the ACA, with evidence of a sex disparity in aspirin use. Other complementary policy approaches may further enhance uptake of evidence-based clinical preventive services. PMID: 29182357 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Ladapo JA, Chokshi DA Tags: Am J Manag Care Source Type: research

Diabetes care improvement in pharmacist- versus nurse-supported patient-centered medical homes.
CONCLUSIONS: Diabetes care improved during PCMH implementation systemwide, supporting both nurse-led and pharmacist-led SMS models. PMID: 29182358 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Min L, Cigolle CT, Bernstein SJ, Ward K, Moore TL, Ha J, Blaum CS Tags: Am J Manag Care Source Type: research

Validation of a claims-based algorithm to characterize episodes of care.
CONCLUSIONS: Our findings suggest that the MVC claims-based algorithm identifies and classifies claims with high fidelity and outperforms medical records in the identification of postdischarge events. These findings provide important insight to policy makers, payers, and hospital administrators about the value of claims-based data for the implementation of episode-based programs. PMID: 29182359 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Ellimoottil C, Syrjamaki JD, Voit B, Guduguntla V, Miller DC, Dupree JM Tags: Am J Manag Care Source Type: research

Mechanism of action of non-invasive cervical vagus nerve stimulation for the treatment of primary headaches.
Abstract Stimulation of the cervical vagus nerve with implanted vagus nerve stimulation (iVNS) has been used clinically for more than 20 years to treat patients with epilepsy. More recently, a non-invasive cervical vagus nerve stimulation (nVNS), gammaCore, was developed, which has been purported to also stimulate the vagus nerve without the cost and morbidity associated with an iVNS system. gammaCore has been used to acutely treat various types of primary headaches, including migraine and cluster headaches (CH), and for the prevention of episodic, chronic, and menstrual migraines and CH. The gammaCore device was ...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Simon B, Blake J Tags: Am J Manag Care Source Type: research

Review of non-invasive vagus nerve stimulation (gammaCore): efficacy, safety, potential impact on comorbidities, and economic burden for episodic and chronic cluster headache.
Abstract The FDA has cleared gammaCore (non-invasive vagus nerve stimulator [nVNS]) for the treatment of episodic cluster headache (eCH). With the exception of subcutaneous sumatriptan, all other treatments are used off label and have many limitations. The FDA approval process for devices differs from that of drugs. We performed a review of the literature to evaluate new evidence on various aspects of gammaCore treatment and impact. The ACute Treatment of Cluster Headache Studies (ACT1 and ACT2), both double-blind sham-controlled randomized trials, did not meet the primary endpoints of the trials but each demonstr...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Mwamburi M, Liebler EJ, Tenaglia AT Tags: Am J Manag Care Source Type: research

The emerging role of gammaCore ® in the management of cluster headache: expert panel recommendations.
The emerging role of gammaCore® in the management of cluster headache: expert panel recommendations. Am J Manag Care. 2017 Nov;23(17 Suppl):S326-S333 Authors: Silberstein SD, Calhoun AH, Treppendahl C, Dodick DW, Rapoport AM, Mamidi A, Vargas P, Ebert TH, Tepper SJ Abstract A panel of 9 experts, including neurologists, other headache specialists, and medical and pharmacy directors, from 4 health plans (1 integrated delivery network and 3 plans with commercial, Medicare, and Medicaid lines of business), convened to discuss cluster headache (CH). Topics covered included the current treatment landsca...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Silberstein SD, Calhoun AH, Treppendahl C, Dodick DW, Rapoport AM, Mamidi A, Vargas P, Ebert TH, Tepper SJ Tags: Am J Manag Care Source Type: research

Real-world health plan claims analysis of differences in healthcare utilization and total cost in patients suffering from cluster headaches and those without headache-related conditions.
CONCLUSIONS: The results of this analysis show that CH patients utilize healthcare resources at a significantly higher rate and cost the healthcare system significantly more than similar patients without headache-related conditions. There is an unmet need for new treatment modalities in this patient population to improve outcomes and contain cost. PMID: 29144719 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Polson M, Lord TC, Evangelatos TM, Lopes M, Santaniello BL Tags: Am J Manag Care Source Type: research

Cost-effectiveness of gammaCore (non-invasive vagus nerve stimulation) for acute treatment of episodic cluster headache.
Abstract Cluster headache is a debilitating disease characterized by excruciatingly painful attacks that affects 0.15% to 0.4% of the US population. Episodic cluster headache manifests as circadian and circannual seasonal bouts of attacks, each lasting 15 to 180 minutes, with periods of remission. In chronic cluster headache, the attacks occur throughout the year with no periods of remission. While existing treatments are effective for some patients, many patients continue to suffer. There are only 2 FDA-approved medications for episodic cluster headache in the United States, while others, such as high-flow oxygen...
Source: The American Journal of Managed Care - November 1, 2017 Category: Health Management Authors: Mwamburi M, Liebler EJ, Tenaglia AT Tags: Am J Manag Care Source Type: research

Low-value antibiotic prescribing and clinical factors influencing patient satisfaction.
CONCLUSIONS: Patient satisfaction scores are slightly lower when antibiotics are not prescribed for AS, but 75% of those encounters still received favorable satisfaction scores. Factors such as older patient age, more comorbidities, and an established patient-provider relationship had stronger associations with high patient satisfaction. PMID: 29087630 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Sharp AL, Shen E, Kanter MH, Berman LJ, Gould MK Tags: Am J Manag Care Source Type: research

Countywide physician organization learning collaborative and changes in hospitalization rates.
Abstract OBJECTIVES: In 2011, the California Right Care Initiative implemented a countywide physician organization learning collaborative called University of Best Practices (UBP) in San Diego County for major healthcare systems and physician organizations to share best practices in managing cardiovascular and cerebrovascular risk factors. Our objective was to examine whether UBP was associated with fewer hospitalizations for heart attacks and strokes. STUDY DESIGN: A quasi-experimental design was used to compare age-adjusted adult hospitalization rates before UBP initiation (2007-2010) against rates after UB...
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Fulton BD, Ivey SL, Rodriguez HP, Shortell SM Tags: Am J Manag Care Source Type: research

Boosting workplace wellness programs with financial incentives.
Abstract OBJECTIVES: Using a large natural experiment among 39 employers, we examined the effect of adding financial incentives to workplace wellness programs. STUDY DESIGN: The 39 study employers used the same national insurer to administer their wellness programs, allowing us to observe preventive and health-promoting behaviors before and after financial incentives were implemented. Fifteen treatment employers introduced financial incentives into their wellness programs over 3 years, providing variation in the start dates, whereas 24 employers did not introduce financial incentives. These incentives were at...
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Cuellar A, Haviland AM, Richards-Shubik S, LoSasso AT, Atwood A, Wolfendale H, Shah M, Volpp KG Tags: Am J Manag Care Source Type: research

Use of patient-reported outcomes and satisfaction for quality assessments.
CONCLUSIONS: Overall, patients undergoing elective lumbar spine surgery reported being satisfied with outcomes, but the reported responses in PROs were much more variable. As the expectations increase to include PRO measures as valid quality indicators, it is necessary to dedicate time and consideration to understanding the relationships among these measures to support meaningful translations into healthcare policy. PMID: 29087633 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Ehlers AP, Khor S, Cizik AM, Leveque JA, Shonnard NS, Oskouian RJ, Flum DR, Lavallee DC Tags: Am J Manag Care Source Type: research

Trends in hospital-physician integration in medical oncology.
CONCLUSIONS: Hospital-physician integration has been more pronounced in medical oncology than in other high-volume specialties and is increasing at a faster rate. Policy makers should take these findings into consideration, particularly with respect to recent proposals that may continue to fuel these trends. PMID: 29087634 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Clough JD, Dinan MA, Schulman KA Tags: Am J Manag Care Source Type: research

A health plan's investigation of Healthy Days and chronic conditions.
Abstract OBJECTIVES: To investigate whether self-reported unhealthy days are related to 6 chronic conditions and other health indicators by using administrative claims. STUDY DESIGN: Cross-sectional study using Healthy Days survey data linked to administrative claims. METHODS: Survey respondents 65 years or older with Medicare Advantage coverage in November or December 2014 and 12 months continuous presurvey enrollment were identified. Mean physically and mentally unhealthy days were reported by chronic condition subgroups. Mean incremental unhealthy days were calculated for individuals in chronic condit...
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Cordier T, Slabaugh SL, Havens E, Pena J, Haugh G, Gopal V, Renda A, Shah M, Zack M Tags: Am J Manag Care Source Type: research

Is higher patient satisfaction associated with better stroke outcomes?
Abstract OBJECTIVES: To evaluate the association between patient satisfaction and cost, outcomes, and clinical performance of stroke care. STUDY DESIGN: An ecological study was conducted on all participating hospitals of the Hospital Consumer Assessment of Healthcare Providers and Systems patient survey that reported stroke outcomes. METHODS: Patient satisfaction measures were grouped into global, environmental, communication, pain control, staff responsiveness, care transition, and discharge information categories. Linear regression models compared risk-adjusted 30-day mortality, 30-day readmission, inp...
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Xiang X, Xu WY, Foraker RE Tags: Am J Manag Care Source Type: research

Statewide data infrastructure supports population health management: diabetes case study.
CONCLUSIONS: A statewide data infrastructure can be used to identify criteria for outreach and population management of diabetes. The selection criteria are applicable across a statewide population and are associated with a higher relative impact on near-term expenditures than recent A1C test results. Whole-population data aggregation can be used to develop actionable information that is particularly relevant as independent organizations work together under alternative payment model arrangements. PMID: 29087637 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Jones C, Mohlman MK, Jorgenson D, Finison K, McGee K, Kastensmith H Tags: Am J Manag Care Source Type: research

The option value of innovative treatments for non-small cell lung cancer and renal cell carcinoma.
CONCLUSIONS: Option value is important when valuing therapies like nivolumab that extend life in a rapidly evolving area of care. PMID: 29087638 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Thornton Snider J, Batt K, Wu Y, Tebeka MG, Seabury S Tags: Am J Manag Care Source Type: research

Improving care transitions: complex high-utilizing patient experiences guide reform.
CONCLUSIONS: Joint review of clinical characteristics and longitudinal care experiences of high-utilizing, complex patients facilitated movement of historically siloed care management programs from their focus along administrative lines to a longitudinal, patient-centered focus. Decreasing readmission rates among complex patients may require direct linkages with social, mental health, and substance use services outside the healthcare system and improved discharge planning. PMID: 29087639 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Gallagher NA, Fox D, Dawson C, Williams BC Tags: Am J Manag Care Source Type: research

Formulary considerations: the past, present, and future.
PMID: 29087661 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Leber MB Tags: Am J Manag Care Source Type: research

PBMs: their role, the problems, and how practices can work with PBMs.
PMID: 29087662 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Bailey R, Newton R Tags: Am J Manag Care Source Type: research

Positive quality interventions: an innovative platform for oncology practice collaboration.
PMID: 29087663 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Nubla J, Dave N, Reff M Tags: Am J Manag Care Source Type: research

Pharmacy's changing role as care transitions from infused to oral therapies.
PMID: 29087664 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: McCullough S, Newton R Tags: Am J Manag Care Source Type: research

Pharmacy team involvement in navigating the revenue cycle for high-cost medications in patients with cancer.
PMID: 29087665 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Shank BR, Nguyen PAA, Pherson EC Tags: Am J Manag Care Source Type: research

In conversation with a pharmacist: management of CAR T-cell treatment.
PMID: 29087666 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - October 1, 2017 Category: Health Management Authors: Dangi-Garimella S Tags: Am J Manag Care Source Type: research

Provider-owned insurers.
PMID: 29087154 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Howard DH, Trish E Tags: Am J Manag Care Source Type: research

Guideline concordance of new statin prescriptions: who got a statin?
CONCLUSIONS: Veterans are commonly prescribed statins for indications not supported by professional society guidelines. The finding of common use of statins outside established guidelines represents an opportunity to improve the quality and value of the healthcare delivery. PMID: 29087155 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Cascino T, Vali M, Redberg R, Bravata DM, Boscardin J, Eilkhani E, Keyhani S Tags: Am J Manag Care Source Type: research

Racial and ethnic differences in hip fracture outcomes in men.
Abstract OBJECTIVES: To examine temporal trends and racial/ethnic differences in hip fracture incidence and mortality outcome in older men. STUDY DESIGN: Retrospective cohort study. METHODS: We ascertained men 50 years or older with a hip fracture during 2000 to 2010 in a diverse northern California healthcare population. Age, comorbidity index, hip fracture incidence, and all-cause mortality up to 12 months post fracture were examined and compared by race/ethnicity. RESULTS: A total of 6247 men (aged 79.3 ± 9.8 years) experienced a hip fracture during 2000 to 2010: 81.4% were white, 7.5% His...
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Liu LH, Chandra M, Gonzalez JR, Lo JC Tags: Am J Manag Care Source Type: research

In-gap discounts in Medicare Part D and specialty drug use.
CONCLUSIONS: In-gap discounts in Part D decreased patients' financial burden to some extent, but resulted in no change in specialty drug use. As demand for specialty drugs increases, it will be important to ensure patients' access to needed drugs, while simultaneously reducing their financial burden. PMID: 29087157 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Jung J, Xu WY, Cheong C Tags: Am J Manag Care Source Type: research

The effect of narrow network plans on out-of-pocket cost.
CONCLUSIONS: Our findings suggest that individuals who selected narrow network plans in 2014 were able to keep costs low without changing their overall number of outpatient visits. Narrow network plans can reduce costs to beneficiaries without affecting the volume of outpatient visits, if appropriate incentives to visit participating providers are followed. PMID: 29087158 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Gillen EM, Hassmiller Lich K, Trantham LC, Weinberger M, Silberman P, Holmes M Tags: Am J Manag Care Source Type: research

Integrating behavioral health under an ACO global budget: barriers and progress in Oregon.
CONCLUSIONS: Oregon's CCO mandate included a focus on better integrating medical and behavioral healthcare for Medicaid recipients. Despite this intention, challenges exist in the financing of integration, many of which state and federal leaders can address through payment and regulatory reform. PMID: 29087165 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Kroening-Roché J, Hall JD, Cameron DC, Rowland R, Cohen DJ Tags: Am J Manag Care Source Type: research

Evaluation of a packaging approach to improve cholesterol medication adherence.
CONCLUSIONS: In a sample of US veterans, prefilled calendared blister packaging provided an inexpensive method for improving cholesterol medication adherence. PMID: 29087166 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Bosworth HB, Brown JN, Danus S, Sanders LL, McCant F, Zullig LL, Olsen MK Tags: Am J Manag Care Source Type: research

Treatment barriers among younger and older socioeconomically disadvantaged smokers.
Abstract OBJECTIVES: Underutilization of smoking cessation treatments contributes to high rates of smoking in socioeconomically disadvantaged populations. Guided by a conceptual framework, the present study explored how healthcare provider factors, social environment characteristics, and cessation beliefs influence treatment utilization among low-income smokers and whether these associations vary by age. STUDY DESIGN: Analyses were conducted on baseline data from 2406 participants enrolled in a randomized controlled trial that evaluated the effectiveness of a proactive outreach cessation intervention among a ...
Source: The American Journal of Managed Care - September 1, 2017 Category: Health Management Authors: Hammett PJ, Fu SS, Burgess DJ, Nelson D, Clothier B, Saul JE, Nyman JA, Widome R, Joseph AM Tags: Am J Manag Care Source Type: research