Although health plan accountable care models have evolved provider readiness, data, analytics, and the use of performance measurement are important components of plan-provider partnerships.
Since 2005, American Cancer Society has sponsored the Health Insurance Assistance Service, a unique initiative to help cancer patients navigate the private coverage system and to educate policy makers about how coverage works for patients with this serious and chronic condition.
Factors most important for successful implementation of collaborative care for depression differ for patient activation versus achieving remission; both are critical to program success.
Is specialist “gatekeeping” in modern health maintenance organization (HMO) insurance associated with differences in outpatient care? The study finds that HMO gatekeeping may meaningfully reduce specialist utilization.
This study sought to explore if shifting care to nurses in cardiovascular risk management in primary care is a key to more structured chronic care.
Patients often self-refer to the emergency department (ED) for management of an ambulatory care–sensitive condition, and the ED may be the most appropriate care location.
This is a letter clarifying some points in an article published in the February 2016 issue of AJMC by Berger et al on colorectal cancer screening guidelines.
Nearby provider supply did not affect identification of usual sources of primary or dental care among new Medicaid enrollees. Strategies to improve access are needed.
Overview of alternative payment models and how leading national organizations are involved with linking quality improvement initiatives and payment reform.
This study examines the ability of self-insured employers to negotiate hospital prices and the relationship between hospital prices and employer market power in the United States.
We offer recommendations for the development and design of clinical pathways in an effort to establish a set of normative criteria that creates trust and transparency.
Optimal end-stage renal disease (ESRD) starts were associated with lower 12-month morbidity, mortality, and inpatient and outpatient utilization in an integrated healthcare delivery system.
The utilization pattern of anticonvulsants after a change in preferred-formulary coverage resulted in health plan savings of $0.16 per member per month.
Proactive identification of cognitive impairment and compensatory destigmatized patient/familial psychoeducation regarding “forgetfulness” in hospitalized patients with congestive heart failure may reduce readmission rates substantially.
Within the Veterans Affairs system, diabetes performance measures were similar in patients who received chronic opioid therapy and in those who did not.
Clinical and economic outcomes associated with the use of specific potentially inappropriate medications in the elderly were evaluated.
Predictive models for hospital admissions and readmissions in persons aged >65 years have been developed through a combination of comorbidity and previous healthcare use.