Insurer costs of COVID-19 by disease severity and duration
CONCLUSIONS: COVID-19 payments for S/C cases were more than 10-fold greater than those of moderate cases and further increased by nearly $95,000 in S/C cases with PCC vs a DOD of fewer than 4 weeks.PMID:38457820 | DOI:10.37765/ajmc.2024.89513 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Chantal E Holy Brandon J Patterson Jill W Ruppenkamp Fayolah Richards Ronita Debnath Antoine C El Khoury Jessica K DeMartino Brahim Bookhart Paul M Coplan Source Type: research

Evaluation of a collaborative model between managed care and affordable housing on acute care costs
CONCLUSIONS: These findings provide needed evidence of the clinical and economic value of forming multisector collaborative models between MCOs and other community providers.PMID:38457821 | DOI:10.37765/ajmc.2024.89514 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Jack Tsai Suja Rajan Chau Truong Vanessa Schick Cecilia Ganduglia Cazaban Source Type: research

Challenges of fracture risk assessment in Asian and Black women
CONCLUSIONS: A large subset of Asian women have discordant BMD and FRAX scores, presenting challenges in osteoporosis management. Furthermore, FN-BMD and especially FRAX scores identified few Black women at high fracture risk warranting treatment. Studies should examine whether fracture risk assessment can be optimized in understudied racial minority populations, particularly when findings are discordant.PMID:38457822 | DOI:10.37765/ajmc.2024.89515 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Joan C Lo Malini Chandra Wei Yang Nailah Thompson Catherine Lee Mohan Ramaswamy Mehreen Khan Amber Wheeler Source Type: research

Increased Medicare payments for homeless patients provide new opportunities for care
Am J Manag Care. 2024 Mar 1;30(3):e63-e64. doi: 10.37765/ajmc.2024.89516.ABSTRACTA final rule has been issued that increases Medicare fee-for-service payment rates for individuals experiencing homelessness. This rule provides new, incentivized opportunities to better screen for and document homelessness among patients in acute inpatient settings. With greater identification of homeless patients, there may be increased needs to develop comprehensive discharge plans that involve coordination with housing providers and social service agencies to prevent the high repeated use of acute care found among many homeless patients.PM...
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Jack Tsai Source Type: research

Inappropriate wrist MRI: did guidelines have an impact?
CONCLUSIONS: MRI as a diagnostic tool for wrist pain is often inappropriate and expensive. Our findings support interventions to increase guideline adherence, such as integrated clinical decision support tools.PMID:38457824 | DOI:10.37765/ajmc.2024.89517 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Trista M Ben ítez Meghan N Cichocki Weijia Jin Anne V Seyferth Lu Wang Kevin C Chung Erika D Sears Source Type: research

At-home hemoglobin A1c testing during COVID-19 improved glycemic control
CONCLUSIONS: This novel, at-home approach to test HbA1c is an effective intervention to increase testing rates and facilitate HbA1c reduction over time in patients with T2D.PMID:38457825 | DOI:10.37765/ajmc.2024.89449 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Lauren C LaMonica Jingwei Ren Nina Jain Eli S Goldberg Kyu B Rhee Paige Wickner Sreekanth K Chaguturu Source Type: research

Improving glycemic control in diabetes through virtual interdisciplinary rounds
CONCLUSIONS: Interdisciplinary rounds can be an effective approach to proactively provide diabetes-focused recommendations. This modality allows for efficient, low-cost, and timely access to an endocrinologist and team to support primary care providers in diabetes management.PMID:38457826 | DOI:10.37765/ajmc.2024.89518 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Abby F Hoffman Cindy Leslie Roberson Pamela Cohen Victoria Lee Jackson John Yeatts Patrick Gregory Samantha Wong Susan E Spratt Source Type: research

The extent and growth of prior authorization in Medicare Advantage
CONCLUSIONS: In 2019, roughly 3 in 4 MA enrollees were in a plan requiring prior authorization. Service-level, area-level, and carrier-level patterns suggest a wide range of approaches to prior authorization requirements.PMID:38457827 | DOI:10.37765/ajmc.2024.89519 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Hannah T Neprash John F Mulcahy Ezra Golberstein Source Type: research

Nurse practitioner low-value care ordering practices: an integrative review
CONCLUSIONS: The full extent to which NPs order LVC services, as well as a comprehensive understanding of the factors influencing their decisions, remains unknown. It is unclear whether NPs order fewer or equal LVC services compared with other health care clinicians. More research on NPs and LVC is indicated.PMID:38457828 | DOI:10.37765/ajmc.2024.89520 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - March 8, 2024 Category: Health Management Authors: Sara B Nugent Roberta P Lavin Barbara I Holmes Damron Source Type: research

Impact of electronic information exchange on repeat imaging during 30-day readmissions among Medicare beneficiaries
CONCLUSIONS: Despite substantial investment, HIEs as currently deployed and used are not associated with decreased odds of repeat imaging in readmissions.PMID:38381541 | DOI:10.37765/ajmc.2024.89493 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: Sara D Turbow Steven D Culler E Camille Vaughan Kimberly J Rask Molly M Perkins Carolyn K Clevenger Mohammed K Ali Source Type: research

Real-world users of triple therapy for asthma in the US
CONCLUSION: In real-world practice, triple therapy is often utilized following other asthma controller medication use. High disease burden, as evidenced by substantial use of rescue medications and continued asthma-related exacerbations, suggests that patients may not have achieved adequate asthma control prior to triple-therapy initiation.PMID:38381542 | DOI:10.37765/ajmc.2024.89494 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: Nadia N Hansel Carl B Abbott Carlyne M Averell Guillaume Germain Fran çois Laliberté Malena Mahendran Mei S Duh Russell A Settipane Source Type: research

Unintended consequences of the Inflation Reduction Act: clinical development toward subsequent indications
CONCLUSIONS: Our analysis of clinical development for new indications reveals aspects of innovation in small molecule drugs that are at risk under the IRA. Specifically, the time lines described in this research demonstrate how the IRA may reduce economic incentives to develop multiple indications, including single-indication launches and investments in postapproval research for additional indications.PMID:38381543 | DOI:10.37765/ajmc.2024.89495 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: Julie Patterson James Motyka John Michael O'Brien Source Type: research

Screening for health literacy, social determinants, and discrimination in health plans
CONCLUSIONS: It is feasible to collect self-reported HL data through a live telephonic format at the time of patient enrollment into a health plan. Health plans can leverage such screenings to better understand patient barriers for health equity-oriented interventions.PMID:38381544 | DOI:10.37765/ajmc.2024.89496 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: J Nwando Olayiwola Candy Maga ña Bereket Kindo Jill Soderquist Faith Obanua Fawwaz Haq Jordyn Newcome Angela Hagan Stephanie Franklin Tamara Smith Juan Troy Joanna Bugbee William H Shrank Source Type: research

The effect of Medicare eligibility on diagnosis of chronic conditions
CONCLUSIONS: Our findings suggest that Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions. Further research is necessary to explore the underlying mechanisms behind this observation.PMID:38381545 | DOI:10.37765/ajmc.2024.89497 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: Sungchul Park Felippe Ottoni Marcondes Source Type: research

Scaling care coordination through digital engagement: stepped-wedge trial assessing readmissions
CONCLUSIONS: Our study expanded resource-limited care coordination by offering low-risk patients a service they were unable to receive previously while having no impact on readmission. PDDE efficiently provided additional touch points between patients and providers.PMID:38381546 | DOI:10.37765/ajmc.2024.89498 (Source: The American Journal of Managed Care)
Source: The American Journal of Managed Care - February 21, 2024 Category: Health Management Authors: Alexandra Polovneff Neemit Shah Abhishek Janardan Erika Smith Ivan Pasillas Natalie Mortensen Jeana M Holt Melek Somai Rodney Sparapani Bradley Crotty Source Type: research