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American Journal of Managed Care

Jesús Antonio Álvarez, Rubén Francisco Flores, Jaime Álvarez Grau, Jesús Matarranz
OBJECTIVES: To improve multiple levels of utilization and efficiency in specialized outpatient consults using information technology-based systems, process reengineering, and patient-centeredness. STUDY DESIGN: Prospective research from 2008 to 2014 conducted in a hospital in Madrid, Spain. Quantitative analysis of 1,162,477 consecutive consultation requests and qualitative techniques of 72,368 surveys using a structured questionnaire. METHODS: Key performance indicators were evaluated: operational outcomes (productivity, time gap between requested consultations and performance, staffing accuracy, wait time, and underlying variability), administrative burden (downtime losses; no-show, drop-in, cancelled, and rescheduled visits), perceived quality scores, and income...
February 1, 2019: American Journal of Managed Care
Felix Sebastian Wicke, Anastasiya Glushan, Ingrid Schubert, Ingrid Köster, Robert Lübeck, Marc Hammer, Martin Beyer, Kateryna Karimova
OBJECTIVES: To assess the performance of the adapted Diabetes Complications Severity Index (aDCSI) translated to International Classification of Diseases, Tenth Revision (ICD-10) in predicting hospitalizations, mortality, and healthcare-associated costs. STUDY DESIGN: Retrospective closed cohort study based on secondary data analysis. METHODS: We translated the aDCSI to ICD-10 and calculated aDCSI scores based on health insurance claims data...
February 1, 2019: American Journal of Managed Care
Thomas E Kottke, Jason M Gallagher, Marcia Lowry, Pawan D Patel, Sachin Rauri, Juliana O Tillema, Jeanette Y Ziegenfuss, Nicolaas P Pronk, Susan M Knudson
OBJECTIVES: To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population. STUDY DESIGN: Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners' commercial products and completed a health assessment in 2011, 2012, or 2013...
February 1, 2019: American Journal of Managed Care
Rebecca A Gourevitch, Ateev Mehrotra, Grace Galvin, Avery C Plough, Neel T Shah
OBJECTIVES: Despite public reporting of wide variation in hospital cesarean delivery rates, few women access this information when deciding where to deliver. We hypothesized that making cesarean delivery rate data more easily accessible and understandable would increase the likelihood of women selecting a hospital with a low cesarean delivery rate. STUDY DESIGN: We conducted a randomized controlled trial of 18,293 users of the Ovia Health mobile apps in 2016-2017...
February 1, 2019: American Journal of Managed Care
Cheryl L Damberg, Marissa Silverman, Lane Burgette, Mary E Vaiana, M Susan Ridgely
OBJECTIVES: To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP. STUDY DESIGN: Semistructured qualitative interviews and survey. METHODS: We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives)...
February 1, 2019: American Journal of Managed Care
Anna D Sinaiko, Shehnaz Alidina, Ateev Mehrotra
OBJECTIVES: There is robust evidence that implementation of reference-based pricing (RBP) benefit design decreases spending. This paper investigates employer adoption of RBP as a strategy to improve the value of patients' healthcare choices, as well as facilitators and barriers to the adoption of RBP by employers. STUDY DESIGN: We conducted a qualitative study using 12 in-depth interviews with human resources executives or their representatives at large- or medium-sized self-insured employers...
February 2019: American Journal of Managed Care
Seth A Seabury, J Samantha Dougherty, Jeff Sullivan
OBJECTIVES: To assess the extent to which medication adherence in congestive heart failure (CHF) and diabetes may serve as a measure of physician-level quality. STUDY DESIGN: A retrospective analysis of Medicare data from 2007 to 2009, including parts A (inpatient), B (outpatient), and D (pharmacy). METHODS: For each disease, we assessed the correlation between medication adherence and health outcomes at the physician level. We controlled for selection bias by first regressing patient-level outcomes on a set of covariates including comorbid conditions, demographic attributes, and physician fixed effects...
February 2019: American Journal of Managed Care
Nirosha Mahendraratnam, Corinna Sorenson, Elizabeth Richardson, Gregory W Daniel, Lisabeth Buelt, Kimberly Westrich, Jingyuan Qian, Hilary Campbell, Mark McClellan, Robert W Dubois
OBJECTIVES: To better understand the prevalence of US value-based payment arrangements (VBAs), their characteristics, and the factors that facilitate their success or act as barriers to their implementation. STUDY DESIGN: Surveys were administered to a convenience sample of subject matter experts who were senior representatives from payer organizations and biopharmaceutical manufacturers. These data were supplemented with qualitative interviews in a subsample of survey respondents...
February 2019: American Journal of Managed Care
Haley Bush, James Paik, Pegah Golabi, Leyla de Avila, Carey Escheik, Zobair M Younossi
OBJECTIVES: To assess the association of payer status and mortality in hepatitis C virus (HCV)-infected patients. STUDY DESIGN: For this retrospective observational study, we used the National Health and Nutrition Examination Survey from 2000 to 2010. Adults with complete data on medical questionnaires, HCV RNA, insurance types, and mortality follow-ups were included. METHODS: We used Cox proportional hazards models to evaluate independent associations of insurance type with mortality in HCV-infected individuals...
February 2019: American Journal of Managed Care
Jackson Williams
Cost-benefit analysis for quality measures has emerged as the cornerstone of CMS' Meaningful Measures initiative.
February 2019: American Journal of Managed Care
A Mark Fendrick, Darrell George
When it comes to the political iceberg of drug prices, there is more below the surface. Policies that reduce prices but do not lower consumers' out-of-pocket costs will not address the main challenge facing most Americans.
February 2019: American Journal of Managed Care
Sheldon J Rich
Migraine is a highly prevalent neurological condition with substantial impact on individuals through associated complications, comorbidities, and increased healthcare costs. The burden on society is likewise substantial via increased healthcare costs and greater indirect costs, such as lost productivity. Research about the pathophysiology of migraine has led to the introduction of a new class of drugs, calcitonin gene-related peptide (CGRP) inhibitors. Current drugs in this class are biologics, which are often accompanied by high prices...
January 2019: American Journal of Managed Care
Golden L Peters
Migraine is a leading cause of disability worldwide. Approximately 15% of Americans experience migraines. Most people who have migraines feel that people who do not have them often underestimate their condition. Migraines affect people's quality of life and ability to participate in work, family, and social events. A new class of medication, calcitonin gene-related peptide (CGRP) antagonists, has been approved for migraine prevention in adults. The newly approved CGRP antagonists are erenumab, fremanezumab, and galcanezumab, while eptinezumab looks to 2020 for approval...
January 2019: American Journal of Managed Care
Scott A Soefje
Pancreatic cancer is typically diagnosed in the late stage of the disease, making it the fourth leading cause of cancer-related death in the United States. It is also one of the few cancers with an increasing incidence, particularly in the younger population. By 2030, it is expected to become the second leading cause of cancer-related death. Patients with pancreatic cancer encounter monthly medical costs 15 times higher than those without, with costs highest in the later stages of the disease. Treatments for pancreatic cancer include surgery (available to fewer than 20% of newly diagnosed patients) and, for advanced disease, chemotherapy with gemcitabine with nab-paclitaxel or FOLFIRINOX, which can increase overall survival (OS) by a few months...
January 2019: American Journal of Managed Care
Nelly Adel
Pancreatic cancer remains a disease that is difficult to treat due to a typically late presentation, relatively high resistance to chemotherapy, and lack of effective targeted therapies. The standard of care relies on cytotoxic chemotherapy, primarily FOLFIRINOX and gemcitabine-based regimens. Dose modifications and/or the use of alternative combinations can reduce adverse effects, but these regimens remain highly toxic. As a result, long-term survival is low for patients with advanced or metastatic disease...
January 2019: American Journal of Managed Care
Paul T Norton, Hector P Rodriguez, Stephen M Shortell, Valerie A Lewis
OBJECTIVES: The adoption of advanced health information technology (HIT) capabilities, such as predictive analytic functions and patient access to records, remains variable among healthcare systems across the United States. This study is the first to identify characteristics that may drive this variability among health systems. STUDY DESIGN: Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record (EHR) standardization, and resource allocation practices were associated with use of 5 advanced HIT capabilities...
January 1, 2019: American Journal of Managed Care
Sung J Choi, M Eric Johnson
OBJECTIVES: To estimate the relationship between data breaches and hospital advertising expenditures. STUDY DESIGN: Observational data on hospital expenditures were analyzed using a propensity score-matched regression. The regression was specified as a generalized linear model using a gamma distribution and log link. METHODS: The study sample included Medicare hospitals captured by a survey of traditional media outlets. Hospitals included were nonfederal acute care inpatient hospitals from 2011 to 2014...
January 1, 2019: American Journal of Managed Care
Dori A Cross, Jeffrey S McCullough, Julia Adler-Milstein
OBJECTIVES: To characterize the drivers of the use of electronic health information exchange (HIE) by skilled nursing facilities (SNFs) to access patient hospital data during care transitions. STUDY DESIGN: Explanatory, sequential mixed-methods study. Quantitative data from an audit log captured HIE use by 3 SNFs to retrieve hospitalization information for the 5487 patients discharged to their care between June 2014 and March 2017, along with patient demographic data...
January 1, 2019: American Journal of Managed Care
Sunny C Lin, John M Hollingsworth, Julia Adler-Milstein
OBJECTIVES: To assess whether hospital participation in alternative payment models (APMs) is associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach. STUDY DESIGN: Pooled, cross-sectional analysis of data on US hospitals from 2014 to 2015. METHODS: APM participation came from Leavitt Partners data, Medicare public use files, and the American Hospital Association (AHA) Annual Survey...
January 1, 2019: American Journal of Managed Care
Karen Donelan, Esteban A Barreto, Sarah Sossong, Carie Michael, Juan J Estrada, Adam B Cohen, Janet Wozniak, Lee H Schwamm
OBJECTIVES: The increasing and widespread availability of personal technology offers patients and clinicians the opportunity to utilize real-time virtual communication to enhance access to health services. Understanding the perceived value of different modes of care may help to shape the future use of technology. STUDY DESIGN: Cross-sectional surveys of patients and clinicians participating in telehealth virtual video visits (VVVs) in an academic health system. METHODS: We administered surveys to 426 unique established patients and 74 attending physicians in our hospital to measure perceptions of the comparative experience of VVVs and office visits; 254 patients and 61 physicians completed the surveys...
January 2019: American Journal of Managed Care
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