Most-Read AJMC Studies and Commentaries of 2015

During 2015, the most popular papers published by The American Journal of Managed Care (AJMC) included studies on predicting adherence, engaging members and providers in chronic care management programs, care fragmentation among chronically ill patients, and using behavioral health interventions to improve outcomes and reduce costs.

Here are the most-read papers published in AJMC in 2015.

10. Limited Effects of Care Management for High Utilizers on Total Healthcare Costs

There has been a sharp contrast between the results of randomized and nonrandomized trials of care management to lower healthcare costs. In randomized trials, estimates of total cost savings are consistently low or none. According to the author, organizations implementing care management programs should expect low or no total cost savings, as literature and promotional materials based on nonrandomized studies dramatically overestimate total cost savings for high-utilizing patients.

9. Predicting Adherence Trajectory Using Initial Patterns of Medication Filling

An evaluation of initial medication dispensings found that initial filling behaviora strongly predicted future adherence. The authors classified patients into 6 adherence trajectories based on patterns of statin filling over the year following the initiation of the therapy. Four months of initial adherence had strong prediction for all patients, especially for the best and worst trajectories.

Being able to predict a patient’s adherence trajectory could help better target interventions to the patients who would benefit the most, the authors concluded.

8. Results From a National Survey on Chronic Care Management by Health Plans

Chronic care management programs are a standard part of the overall approach health plans are using to manage the health of their members. A systematic examination of chronic care management programs found that while interventions improve care and reduce cost, plans are having difficulty engaging members and providers. To combat this issue, plans are integrating their chronic care management programs into the provider workflow, working with providers on care redesign, and leveraging patient support technology.

7. Care Fragmentation, Quality, and Costs Among Chronically Ill Patients

Using claims data and identifying patterns of care, researchers were able to determine that chronically ill patients who see a primary care provider offering highly fragmented care were more likely to experience lapses in care quality and incur greater healthcare costs.

The authors found that providers in the highest quartile of fragmentation were more likely to have a departure from clinical best practice and have higher rates of preventable hospitalizations. In addition, high fragmentation for these patients was associated with $4542 higher healthcare spending.

6. Acupuncture and Chiropractic Care: Utilization and Electronic Medical Record Capture

A majority of patients with chronic musculoskeletal pain (CMP) at a health maintenance organization have used acupuncture, chiropractic care, or both, according to the findings from this July 2015 study. The researchers found despite the fact that 32% of survey respondents reported using acupuncture, 47% reported chiropractic use, and 21% reported using both, the electronic medical record data did not capture this information. As such, the authors determined that despite substantial usage, many patients were not reporting such care to their clinicians.

5. Private Sector Risk-Sharing Agreements in the United States: Trends, Barriers, and Prospects

Risk-sharing agreements between drug manufacturers and payers have seen greater use outside the United States, and this study sought to determine whether the use of these agreements might assist the evolution of the US healthcare system.

The authors reviewed risk-sharing agreements, interviewed stakeholders, and conducted a survey to understand experiences and expectations of these agreements. They determined that most manufacturers and payers see the potential in using risk-sharing agreements, but despite considerable interest, the number of new agreements remains small.

4. Employers Should Disband Employee Weight Control Programs

The authors of this paper argued that as no study has demonstrated that wellness programs focusing on weight control have had any positive effects, employers should disband them. According to the authors, no evidence has shown weight control programs have generated savings or reduced inpatient admissions associated with obesity. On the contrary, these programs impact employee morale and can even harm employee health.

3. A Multidisciplinary Intervention for Reducing Readmissions Among Older Adults in a Patient-Centered Medical Home

A community-based multidisciplinary transitional care program significantly reduced readmission rates and increased the time to readmission, according to this study published in the February 2015 issue.

The multidisciplinary practice model, consisting of medical providers, clinical pharmacists, and social workers, also avoided potential costs.

2. Changing Physician Behavior: What Works?

A systematic review of reviews evaluating the effectiveness of different methods of implementing clinical research and guidelines found that active forms of continuing medical education and multifaceted interventions were the most effective way to implement guidelines into general practice. However, the researchers recommended further research to evaluate the effectiveness of these methods in a surgical setting.

1. Leveraging Remote Behavioral Health Interventions to Improve Medical Outcomes and Reduce Costs

The most read AJMC article of the year analyzed whether the use of remotely delivered behavioral health intervention could improve health, reduce hospital admissions, and lower the cost of care for individuals with a recent cardiovascular event.

The program was an 8-week behavioral health intervention and the researchers found that patients who participated in the program had significantly fewer all-cause hospital admissions and overall savings in the cost of care.