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Contributor: Profit Over People—Medicare Advantage Plans Are Denying Vital NIV Therapy CoverageA longtime respiratory therapist calls for reform of Medicare Advantage in light of denials of coverage for patients who need non-invasive ventilation.
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Ambulatory Care Fragmentation and Hospitalization Among Veterans With DiabetesHaving highly fragmented ambulatory care and a usual provider of care outside the Veterans Health Administration increased the odds of hospitalization among veterans with diabetes.
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Health Outcomes of Dually Eligible Beneficiaries Under Different Medicare Payment ArrangementsWithin the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.
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Entering Peak Norovirus Season as Cases Rise Across the USNationwide norovirus cases have recently increased, followed by an FDA warning for consumers to avoid oysters contaminated in a recent outbreak.
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The Essential Role of Population Health During and Beyond COVID-19The authors detail how population health management enables health systems to promote public health, strengthen health system resiliency, and support financial recovery during and beyond coronavirus disease 2019 (COVID-19).
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Discharge Timing and Associations With Outcomes Following Heart Failure HospitalizationA retrospective multicenter study found that patients with heart failure discharged by noon had higher short- and long-term mortality and increased early readmission rates compared with afternoon discharges.
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Unfulfilled Home Health Referrals Lead to Higher Mortality Among Medicare Advantage MembersMedicare Advantage members referred to home health after acute hospitalization who did not receive home health services had higher mortality at 30, 90, and 180 days.
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Transforming Addiction Care: From Stigma to SupportOn this episode of Managed Care Cast, experts discuss behavioral health services, stigma reduction, and the 4 dimensions of recovery.
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Service Line Care Delivery Model for COVID-19 Patient-Centric CareThe authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.
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Association of Physician Coordination With Interfacility Transfer Acceptance TimelinessThe authors reviewed physician-to-physician conversations during emergency transfer of patients with ST-segment elevation myocardial infarction and found that higher-quality physician coordination was associated with faster time to acceptance.
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Patient-Reported QOL Outcomes of Initial CLL Treatments: ASH 2024Quality-of-life (QOL) outcomes vary widely for patients receiving first-line treatment for chronic lymphocytic leukemia (CLL), according to research presented at the 2024 American Society of Hematology (ASH) meeting.
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Emergency Department Risk Model: Timely Identification of Patients for Outpatient Care CoordinationThe authors created a machine learning–based model to identify patients with major depressive disorder in the primary care setting at high risk of frequent emergency department visits, enabling prioritization for a care coordination program.
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Contributor: What’s Driving Consumers to Switch Away From Health Care PayersHealth care payers need to establish trust and transparency in consumers to ensure consumers remain on their plans.
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Association of Physician Specialty With Psoriatic Arthritis Treatment and CostsIn this retrospective cohort study of patients with newly diagnosed psoriatic arthritis, the authors examine the association of treatment selection and costs with physician specialty.
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Initial Maintenance Therapy Adherence Among Older Adults With Asthma-COPD OverlapOlder adults with coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap, who take fixed-dose combinations of inhaled corticosteroids and long-acting β agonists may be less likely to have persistent low adherence to initial maintenance therapy.
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Care Management Improves Total Cost of Care for Patients With DementiaCompared with usual care, a dementia care management program improved various cost of care and utilization metrics in a Medicare managed care population at 12 months.
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The Price Paradox of Biosimilar-Like Long-Acting InsulinFindings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.
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Impact of Expanded Carrier Screening on Health Care UtilizationThis study shows little evidence of harms or increased health care utilization for people receiving negative (normal) results of expanded carrier screening through genome sequencing.
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Preventive Care: Vaccines MatterA database of information about more than 30,000 patients verified improved morbidity and mortality due to vaccines and preventive health care in prospective trials.
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Contributor: A Fresh Approach to Medication Adherence—Best Practices for Improving Outcomes and Star RatingsBest practices can help MA plans improve their Star Ratings performance while allow for strategies for medication adherence to grow.
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COVID-19 and Clinic Workflow Optimization Using Lean Six SigmaThe authors report an approach of outpatient clinic workflow reorganization utilizing simple, inexpensive measures to improve patient engagement and experience in addition to providing a safe setting for patients for clinic visits in the wake of COVID-19.
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Primary Care Nurse Practitioner Management of Adolescent Behavioral HealthPersonnel costs ($90,514) of a primary care–embedded adolescent behavioral health nurse practitioner over 2 years were 63% of the potential revenue generated ($144,449).
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Impact of Medical Care Coordination Intervention on Patient ActivationThis observational evaluation compared an adult medical care coordination intervention with usual care and found that the intervention was associated with significant improvements in patient activation.
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Predictors of Discharge From the VA Caregiver Support ProgramThe year of application predicts discharge from the Department of Veterans Affairs (VA) caregiver program. Unexpected, disallowed criteria also predict discharge, with significant others facing higher discharge risk than spouses.
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Imposing a Health Insurance Surcharge on the UnvaccinatedImposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications.
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Reducing “Avoidable” ED Visits for Mental Health Could Cut Billions in Costs, Improve Patient OutcomesThe changing landscape of health care during COVID-19 placed focus on increasing accessibility to mental health resources other than the emergency department (ED), with potential savings of over $4 billion in annual costs and improvements in patient outcomes.
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COVID-19 Telehealth Expansion Can Help Solve the Health Care Underutilization ChallengeThe telehealth policy changes enacted for short-term control of the coronavirus disease 2019 (COVID-19) pandemic present an opportunity to address the fundamental gap in health care underutilization.
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Contributor: Medicare Needs to Ensure People With ALS Have Access to Clinically Appropriate Respiratory CareThe pandemic has shown a spotlight on how critically important respiratory care is to Americans who struggle to breathe on their own. Yet, Medicare policy must be updated to ensure that access to lifesaving equipment will never be disrupted.
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Impact of Delayed Adoption of Novel Atrial Fibrillation TreatmentsUsing direct oral anticoagulants as a case study, the authors examined how delayed adoption of novel treatments could impact patient health outcomes and cost.
