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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

A descriptive study of patients receiving foundational financial assistance through local specialty pharmacies.
CONCLUSIONS: The facilitation of treatment by GDF and Walgreens LSPs may be the key to many patients receiving their treatment and maintaining medication persistence. GDF co-pay assistance helped cover most out-of-pocket costs associated with medications and aided with travel expenses for patients, especially in the area of oncology. For many patients, this meant reducing the significant financial barriers to accessing care and facilitating the necessary treatment for their chronic or life-altering disease. Without this assistance, many patients would simply not have been able to meet the expected medication persistence an...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Zhu J, Odebralski R, Boghani S, Walley C, Koen F, Conley C, Kirkham HS Tags: Am J Manag Care Source Type: research

Introduction to basal insulin therapy: clinical management of diabetes.
Abstract Diabetes is a series of metabolic conditions associated with many serious comorbidities, such as heart disease and stroke, peripheral arterial disease and lower-extremity amputations, retinopathy, nephropathy, and peripheral neuropathy. The American Diabetes Association, the American Association of Clinical Endocrinologists, and the International Diabetes Federation recommend that individuals with diabetes be as near to normoglycemic as possible. There are many glycemic management barriers among patients, such as cost, patient perceptions, and clinical inertia. Advancements in the treatment of diabetes wi...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Gonzalvo JD Tags: Am J Manag Care Source Type: research

Evaluating the managed care implications of longer-acting basal insulin analog therapies.
This article spotlights the outcomes of the phase 3 clinical trials for these newer formulations, as well as more recent meta-analyses and real-world studies. It also highlights the implications for managed care plans as they move to add these insulins to their formularies. PMID: 29620817 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Logan T, Daisy B Tags: Am J Manag Care Source Type: research

Incorporating value into physician payment and patient cost sharing.
Abstract The United States is simultaneously moving toward value-based payments for populations and precision medicine for individuals. During this evolution, innovations in payment and delivery that enhance tailoring of treatments to individuals while improving the value of care are needed. We propose one such innovation that would allow physician payment and patient cost sharing to better reflect the value of care by allowing the appropriateness of a service for a given patient in a given clinical situation to play a more meaningful role in the design of such incentives. We introduce the idea of a payment modifi...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Song Z, Navathe AS, Emanuel EJ, Volpp KG Tags: Am J Manag Care Source Type: research

False-positive mammography and its association with health service use.
CONCLUSIONS: Providers should discuss the implications of mammography findings at the time of screening to help mitigate potential detrimental effects and promote appropriate engagement in health services. PMID: 29553275 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Gunn CM, Bokhour B, Battaglia TA, Silliman RA, Hanchate A Tags: Am J Manag Care Source Type: research

Development and implementation of an academic cancer therapy stewardship program.
CONCLUSIONS: Our cancer therapy stewardship program yielded many useful insights into how our physicians face challenging clinical situations. It also helped to improve overall clinical quality and patient care by emphasizing the importance of value-based care and evidence-based medicine. Expanding this program will likely lead to many interesting experiments aimed at improving medical education and research, patient safety outcomes, and clinical quality. PMID: 29553276 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Steinberg AS, Parikh AB, Kim S, Peralta-Hernandez D, Aggour T, Isola L Tags: Am J Manag Care Source Type: research

Overuse and insurance plan type in a privately insured population.
CONCLUSIONS: Neither HDHPs nor HMO plans, with their closed networks and referral requirements, consistently reduced overuse, although HMO plans were never associated with higher rates of overuse. As policy makers seek levers for reducing low-value healthcare utilization, health insurance plan features may prove a valuable target, although the effect may be complicated by other factors. PMID: 29553277 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Rosenthal MB, Colla CH, Morden NE, Sequist TD, Mainor AJ, Li Z, Nguyen KH Tags: Am J Manag Care Source Type: research

Patients discharged from the emergency department after referral for hospitalist admission.
We report patient demographics and primary diagnoses. Main outcome measures included return to the ED, hospitalization, or mortality, all within 30 days. RESULTS: There were 710 discharges from the ED for 670 patients referred for hospitalist admission; 21.7% returned to the ED, 12.3% were hospitalized, and 0.4% died within 30 days. Chest pain was the most common diagnosis (38.2%); 18.1% of these patients returned to the ED within 30 days. Patients with the following 3 diagnoses returned to the ED most frequently: sickle cell disease (82.4%), alcohol-related diagnoses (43.5%), and abdominal pain (35.7%). In multivaria...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Caulfield CA, Stephens J, Sharalaya Z, Laux JP, Moore C, Jonas DE, Liles EA Tags: Am J Manag Care Source Type: research

Trends in opioid and nonsteroidal anti-inflammatory use and adverse events.
CONCLUSIONS: Opioid use declined following implementation of the OSI, whereas NSAID use remained constant. Rates of AEs were higher among opioid users, which provides additional rationale for efforts to use NSAIDs for pain management when appropriate. PMID: 29553279 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Fassio V, Aspinall SL, Zhao X, Miller DR, Singh JA, Good CB, Cunningham FE Tags: Am J Manag Care Source Type: research

Ambulatory care-sensitive emergency visits among patients with medical home access.
CONCLUSIONS: Patients with ACSCs often presented to the ED without contacting their medical home. Frequently, the ED is the most appropriate location given symptoms at presentation. PMID: 29553280 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Hafez D, McMahon LF, Balogh L, Brinley FJ, Crump J, Ealovega M, Fan A, Kwok Y, Krieger K, O'Connor T, Ostafin E, Reichert H, Meddings J Tags: Am J Manag Care Source Type: research

Assessing medical home mechanisms: certification, asthma education, and outcomes.
CONCLUSIONS: HCHs were associated with better asthma care and outcomes. Asthma education with AAPs also was associated with better outcomes despite being a minority of HCHs' total effect. These findings suggest that HCHs improve outcomes partially via increased care management activity, but also via other mechanisms (eg, electronic health records, registries). PMID: 29553281 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Shippee ND, Finch M, Wholey DR Tags: Am J Manag Care Source Type: research

Patient-reported denials, appeals, and complaints: associations with overall plan ratings.
Abstract OBJECTIVES: To assess whether Medicare patients' reports of denied care, appeals/complaints, and satisfactory resolution were associated with ratings of their health plan or care. STUDY DESIGN: Retrospective analysis of 2010 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data. METHODS: Multivariate linear regression of data from 154,766 respondents (61.1% response rate) tested the association of beneficiary ratings of plan and care with beneficiary reports of denied care, appeals, complaints, and complaint resolution, adjusting for beneficiary demograph...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Quigley DD, Haviland AM, Dembosky JW, Klein DJ, Elliott MN Tags: Am J Manag Care Source Type: research

Improving quality of care in oncology through healthcare payment reform.
CONCLUSIONS: The effective pairing of quality initiatives with healthcare reimbursement structures will likely be key to the long-term success of such APMs. PMID: 29553283 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Wen L, Divers C, Lingohr-Smith M, Lin J, Ramsey S Tags: Am J Manag Care Source Type: research

Considerations for the cost-effective management of hepatic encephalopathy.
Abstract Hepatic encephalopathy (HE) is a neuropsychiatric complication commonly associated with liver disease, namely cirrhosis. The inability of the liver to metabolize ammonia results in a buildup of ammonia, which can cross the blood-brain barrier and cause significant neurocognitive impairment. Up to 80% of patients with cirrhosis will experience HE and a large proportion of these patients are at high risk of recurrent HE. There are several factors to consider when developing a cost-effective approach to managing HE, such as patient compliance, the adverse event (AE) profile of drug therapy, efficacy of drug ...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Flamm SL Tags: Am J Manag Care Source Type: research

Influenza in older patients: a call to action and recent updates for vaccinations.
Abstract Influenza affects millions of people in the United States each year. Older patients are particularly at risk for infection, hospitalization, and death due to influenza-related complications, such as pneumonia. One of the best ways to avoid becoming ill is to have the annual influenza vaccination. Unfortunately, immunization rates are poor in the older adult population, at about 65% each year. Vaccine effectiveness in this population is reduced because of lower seroconversion rates that arise from poorer immunologic response to vaccination. Several new influenza vaccines that have been introduced to the ma...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Wilhelm M Tags: Am J Manag Care Source Type: research

Managed care considerations and economic implications of vaccination practices.
Abstract Influenza is an acute viral respiratory disease caused by the influenza A and B viruses. The epidemiologic characteristics of influenza are in constant flux as the viruses mutate frequently, and the subsequent spread of illness depends on the affected population's susceptibility to the new antigens. These viral mutations necessitate frequent updates to the annual seasonal influenza vaccine. Those most at risk for serious complications of influenza are young children and elderly persons. Although influenza vaccination rates are highest among adults 65 years or older, vaccine effectiveness in this age group...
Source: The American Journal of Managed Care - March 1, 2018 Category: Health Management Authors: Nowalk MP Tags: Am J Manag Care Source Type: research

Leveraging benefit design for better diabetes self-management and A1C control.
Abstract OBJECTIVES: To evaluate the relationship between cost sharing for blood glucose testing strips and glycemic control rates. STUDY DESIGN: A retrospective observational study using medical and pharmacy claims data integrated with laboratory glycated hemoglobin (A1C) values for patients using insulin and testing strips. A new user study design was utilized to identify individuals from 14 commercial US health plans who filled testing strips with assumed intention to monitor blood glucose. METHODS: Patients were divided into low (
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Agiro A, Xie Y, Bowman K, DeVries A Tags: Am J Manag Care Source Type: research

Claims-based risk model for first severe COPD exacerbation.
CONCLUSIONS: This claims-based risk model can predict the likelihood of first severe COPD exacerbation. The CTR could also potentially be used to target populations at greatest risk for severe exacerbations. This could be relevant for providers and payers in approaches to prevent severe exacerbations and reduce costs. PMID: 29461849 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Stanford RH, Nag A, Mapel DW, Lee TA, Rosiello R, Schatz M, Vekeman F, Gauthier-Loiselle M, Merrigan JFP, Duh MS Tags: Am J Manag Care Source Type: research

Development of a tailored survey to evaluate a patient-centered initiative.
CONCLUSIONS: We developed reliable instruments to evaluate the essential elements of a patient-centered care initiative at an academic medical center, which minimized patient burden and maximized the response rate. PMID: 29461850 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Winget M, Haji-Sheikhi F, Asch SM Tags: Am J Manag Care Source Type: research

Impact of telephonic comprehensive medication reviews on patient outcomes.
CONCLUSIONS: Although study results have shown telephonic CMRs to be an effective way to enhance patient care and reduce healthcare expenditures, the components of telephonic MTM programs that make them most effective and the population on which they have the greatest impact are unknown. Moving forward, further evaluation of these programs is necessary to determine which specific factors, such as access to patient electronic health records, patient follow-up frequency, and the use of collaborative practice agreements, are most vital to improving patient outcomes. PMID: 29461851 [PubMed - in process] (Source: The Ameri...
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: DeZeeuw EA, Coleman AM, Nahata MC Tags: Am J Manag Care Source Type: research

Variation in markups on outpatient oncology services in the United States.
CONCLUSIONS: High markups exist for oncology services, and further legislation is needed to protect patients from highly variable pricing and to address disparities in access to high-quality cancer care. PMID: 29461852 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Park A, Xu T, Poku M, Taylor J, Makary MA Tags: Am J Manag Care Source Type: research

Community navigators reduce hospital utilization in super-utilizers.
CONCLUSIONS: Community navigators can reduce subsequent hospital utilization in super-utilizers. Expansions of this model should examine the model's effectiveness in other populations and outcomes. PMID: 29461853 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Thompson MP, Podila PSB, Clay C, Sharp J, Bailey-DeLeeuw S, Berkley AJ, Baker BG, Waters TM Tags: Am J Manag Care Source Type: research

Data breach locations, types, and associated characteristics among US hospitals.
CONCLUSIONS: Hospitals should conduct routine audits to allow them to see their vulnerabilities before a breach occurs. Additionally, information security systems should be implemented concurrently with health information technologies. Improving access control and prioritizing patient privacy will be important steps in minimizing future breaches. PMID: 29461854 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Gabriel MH, Noblin A, Rutherford A, Walden A, Cortelyou-Ward K Tags: Am J Manag Care Source Type: research

ACA Marketplace premiums and competition among hospitals and physician practices.
CONCLUSIONS: Premiums for FFM plans were higher in markets with greater concentrations of hospitals and physicians but fewer insurers. Higher premiums make health insurance less affordable for people purchasing unsubsidized coverage and raise the cost of Marketplace premium tax credits to the government. PMID: 29461855 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Polyakova M, Bundorf MK, Kessler DP, Baker LC Tags: Am J Manag Care Source Type: research

Cost-effectiveness of collaborative care for depression and PTSD in military personnel.
CONCLUSIONS: Despite its higher costs, CACT appears to be a cost-effective strategy relative to OUC for managing PTSD and depression in the MHS. PMID: 29461856 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Lavelle TA, Kommareddi M, Jaycox LH, Belsher B, Freed MC, Engel CC Tags: Am J Manag Care Source Type: research

Pricing of monoclonal antibody therapies: higher if used for cancer?
The objective of this study was to compare the prices of monoclonal antibodies (mAbs) approved in the last 20 years by the FDA across disease states. STUDY DESIGN: We identified all indications approved by the FDA for mAbs from 1997 to 2016 and calculated the annual price of 1-year treatment for each mAb-indication combination as the product of the US average wholesale price per milligram and the recommended dose. METHODS: We compared the annual price of treatment with each mAb across disease states using generalized linear models with gamma distribution and log link, controlling for route of administration, chem...
Source: The American Journal of Managed Care - February 1, 2018 Category: Health Management Authors: Hernandez I, Bott SW, Patel AS, Wolf CG, Hospodar AR, Sampathkumar S, Shrank WH Tags: Am J Manag Care Source Type: research

Evidence-based management of irritable bowel syndrome with diarrhea.
Abstract Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms ...
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Pimentel M Tags: Am J Manag Care Source Type: research

Evidence-based management of irritable bowel syndrome with diarrhea.
Abstract Irritable bowel syndrome (IBS), a complex disorder of the gastrointestinal tract, is characterized by abdominal pain associated with defecation or changes in stool form or frequency. IBS is associated with substantial burden, including direct medical costs and indirect costs. Direct costs associated with IBS in the United States have been estimated to exceed $1 billion. However, indirect costs, such as negative effect on quality of life (QOL) and work productivity, are difficult to quantify. There are 3 main subtypes: IBS with prominent diarrhea (IBS-D), IBS with constipation, and IBS with mixed symptoms ...
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Pimentel M Tags: Am J Manag Care Source Type: research

Bridging the digital divide: mobile access to personal health records among patients with diabetes.
We examined PHR use through a computer-based Web browser or mobile device. STUDY DESIGN: Cross-sectional historical cohort analysis. METHODS: Among adult patients in the diabetes registry of an integrated healthcare delivery system, we studied the devices used to access their PHR during 2016. RESULTS: Among 267,208 patients with diabetes, 68.1% used the PHR in 2016; 60.6% of all log-ins were via computer and 39.4% were via mobile device. Overall, 63.9% used it from both a computer and mobile device, 29.6% used only a computer, and 6.5% used only a mobile device. After adjustment, patients who were black, His...
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Graetz I, Huang J, Brand RJ, Hsu J, Yamin CK, Reed ME Tags: Am J Manag Care Source Type: research

Electronic health record "super-users" and "under-users" in ambulatory care practices.
CONCLUSIONS: To achieve the broader benefits of the EHR and health IT, health systems and policy makers need to identify and address barriers to full use of health IT functionalities. PMID: 29350506 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Rumball-Smith J, Shekelle P, Damberg CL Tags: Am J Manag Care Source Type: research

Hospital participation in Meaningful Use and racial disparities in readmissions.
CONCLUSIONS: Hospital participation in MU reduced disparities in 30-day readmissions for African American Medicare beneficiaries. PMID: 29350507 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Unruh MA, Jung HY, Kaushal R, Vest JR Tags: Am J Manag Care Source Type: research

The health information technology special issue: has IT become a mandatory part of health and healthcare?
Abstract The 7th annual Health Information Technology (IT) issue provides a window into how health IT tools are working well, how they may not be working as intended, and what we can do to continue making progress toward optimal use of technology to accomplish our shared goals: better health, better care experience, and lower per capita cost. PMID: 29350508 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Reider J Tags: Am J Manag Care Source Type: research

Measuring overuse with electronic health records data.
CONCLUSIONS: The use of EHR data, both extracted and manually abstracted, provides an opportunity to more accurately and reliably identify overuse of low-value healthcare services. PMID: 29350509 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Isaac T, Rosenthal MB, Colla CH, Morden NE, Mainor AJ, Li Z, Nguyen KH, Kinsella EA, Sequist TD Tags: Am J Manag Care Source Type: research

Electronic sharing of diagnostic information and patient outcomes.
This study uses Hospital Compare (HC) and American Hospital Association (AHA) Annual Information Technology Survey data to estimate the association between sharing EHR data and patient outcomes. STUDY DESIGN: Descriptive and multivariate linear regression analyses. METHODS: This study links 2 years of HC data on 30-day patient mortality and readmissions for heart failure (HF) and pneumonia with 2 years of AHA data. The sample was restricted to hospitals included in both years in both sets of data. We estimated the associations between sharing EHR diagnostic data and patient outcomes with a multivariate linear reg...
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Deyo D, Khaliq A, Mitchell D, Hughes DR Tags: Am J Manag Care Source Type: research

A cost-effectiveness analysis of cardiology eConsults for Medicaid patients.
CONCLUSIONS: These findings suggest that eConsults are associated with total cost savings to payers due principally to reductions in the cost of cardiac outpatient procedures. PMID: 29350511 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Anderson D, Villagra V, Coman EN, Zlateva I, Hutchinson A, Villagra J, Olayiwola JN Tags: Am J Manag Care Source Type: research

Electronic health record problem lists: accurate enough for risk adjustment?
CONCLUSIONS: Inaccuracies in EHR problem list-based comorbidity data can lead to incorrect determinations of case mix. Such data should be validated prior to application to risk adjustment. PMID: 29350512 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Daskivich TJ, Abedi G, Kaplan SH, Skarecky D, Ahlering T, Spiegel B, Litwin MS, Greenfield S Tags: Am J Manag Care Source Type: research

Racial/ethnic variation in devices used to access patient portals.
CONCLUSIONS: Although racial/ethnic minority enrollees were less likely to access the online patient portal overall, a greater proportion of black and Hispanic users accessed the patient portal with mobile devices than did non-Hispanic white users. The rapid spread of mobile devices among racial/ethnic minorities may help reduce variation in online patient portal use. Mobile device use may represent an opportunity for healthcare organizations to further engage black and Hispanic enrollees in online patient portal use. PMID: 29350513 [PubMed - in process] (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - January 1, 2018 Category: Health Management Authors: Chang E, Blondon K, Lyles CR, Jordan L, Ralston JD Tags: Am J Manag Care Source Type: research