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Evaluating Proactive Outreach for Prior Authorization Recertifications in Medicaid PatientsImplementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.
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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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Integrating Primary Care and Public Health for Advance Care PlanningThis article proposes a new model, Public-Primary ACP, that leverages coordination between primary care and public health workforces to improve delivery of advance care planning.
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Implementing Team-Based Telemedicine Workflows in Safety-Net Primary CareTelemedicine in safety-net primary care faces particular challenges. Consistent, team-based workflows can support video visit implementation and health care maintenance in telemedicine visits.
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Contingency Management: Promises, Gaps, and Philosophical LimitationsThis editorial reviews the promises, gaps, and philosophical limitations of contingency management for pregnant people who use drugs.
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Contributor: Reflections on World AIDS Day 2023—A Call to Increase Research Funding on HIV and AgingResearch on HIV and aging should be the focus of future research as World AIDS Day brings the chronic illness to the forefront.
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Expanding Access to Clinical Trials Through Community PartnershipsKaren Winkfield, MD, PhD, addresses the importance of meeting patients where they are to expand clinical trial participation and remove barriers to trial access.
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Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification ToolIn this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.
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Opioid Safety Initiative Associated With Decreased Emergency Department Opioid PrescribingA scalable health system–wide emergency physician education and feedback initiative was associated with decreased opioid prescribing, in excess of background temporal decline.
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Receiving NADT for 6 Months Doesn’t Impact Outcomes in Intermediate-Risk Prostate Cancer After EBRTAdding 6 months of neoadjuvant deprivation therapy (NADT) doesn’t seem to add any benefit for patients with intermediate-risk prostate cancer treated with external-beam radiation therapy (EBRT), according to 15-year outcomes presented by Barry Goy, MD, of Kaiser Permanente.
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Association Between Screening for Suspected COVID-19 Cases and Outcomes of Patients Revisiting the Emergency DepartmentPatients who revisit the emergency department shortly after discharge are at high risk for complications and death, exacerbated by COVID-19 screening workload. Detection efforts impact outcomes.
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ACA Network Regulatory Filings Are Inaccurate, Poorly Match Provider DirectoriesA secret shopper survey (N = 8306) in Pennsylvania’s Affordable Care Act (ACA) Marketplace found inconsistencies between carrier regulatory filings and provider directories, frequent inaccuracies in regulatory filings, and challenges in securing timely appointments.
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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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Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional MedicarePatients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.
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Contributor: 3 Key Questions for the Biden Administration and the 117th Congress Coming Out of the COVID-19 CrisisThe incoming Biden administration will be challenged to address flex capacity, the supply chain, and real-time data as we transition from coronavirus disease 2019 (COVID-19) response to durable recovery.
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Medication Adherence Star Ratings Measures, Health Care Resource Utilization, and CostFor patients prescribed diabetes, hypertension, and hyperlipidemia medications, nonadherence to CMS Star Ratings quality measures of medication adherence was associated with increased health care resource utilization and costs.
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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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Responsibility for Treating Tobacco Dependence in Health Clinics Serving Medicaid EnrolleesThis article describes the implementation of Medicaid smoking cessation guidance in a large, urban federally qualified health center to examine how state-level provisions translated into clinic-level policies.
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Cost Savings Associated With Electronic Specialty ConsultationsThis retrospective cohort evaluation found that patients receiving electronic, compared with face-to-face, specialty consultation had significantly lower health care costs for at least 3 months.
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Changing Practice Patterns in CKDClosing out the discussion, an expert in chronic kidney disease (CKD) highlights how care for patients with CKD may change in the future based on data presented at AMCP.
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Treatment Patterns for Patients With Advanced/Metastatic Cancers by Site of CareTreatment patterns and overall survival were similar regardless of site of care between patients receiving anticancer therapy in the hospital outpatient vs physician office setting.
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Service Utilization by High-Need, High-Cost Patients Following Emergency Department VisitsThis article provides insights into patterns of health care use following emergency department visits by high-need, high-cost patients with different types of California Medicaid primary care providers.
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An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health NeedsCare coaching and behavioral health provider referral programs produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat behavioral health conditions.
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Rituximab Reference vs Biosimilar Utilization for Oncology vs Nononcology IndicationsReporting on the real-world utilization of reference rituximab and its biosimilars can help show prescribing habits and reveal cost-saving opportunities.
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Evidence-Based Therapies Targeting the Heterogeneity of IgA NephropathyExplore the evolving treatments for IgA nephropathy, highlighting the shift towards proactive strategies and the role of Nefecon in patient care.
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Value Realization: An Unattained Challenge for Integrated Practice UnitsAs value realization eludes integrated practice units (IPUs), the authors examine 6 key value drivers for IPU teams to competitively drive volumes and hone their multidisciplinary competencies.
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Why ASCO Is a Must-Attend Event for Oncologists WorldwideLeaders in oncology share why the American Society of Clinical Oncology (ASCO) meeting remains a top global gathering for breakthroughs, networking, and lifelong learning.
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Predictive Models for Low Birth Weight: A Comparative Analysis of Algorithmic Fairness–Improving ApproachesThis study compared 6 algorithmic fairness–improving approaches for low-birth-weight predictive models and found that they improved accuracy but decreased sensitivity for Black populations.
