Population Health Management最新文献_第6页

The Academic Payvider Model: Care and Coverage. 学术付费者模式：护理与保险。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-03-06 DOI: 10.1089/pop.2023.0300

Erika D Harness, Zachary N Goldberg, Yash B Shah, Akshay S Krishnan, Varun Jayanti, David B Nash

{"title":"The Academic Payvider Model: Care and Coverage.","authors":"Erika D Harness, Zachary N Goldberg, Yash B Shah, Akshay S Krishnan, Varun Jayanti, David B Nash","doi":"10.1089/pop.2023.0300","DOIUrl":"10.1089/pop.2023.0300","url":null,"abstract":"The US health care system has significant room for growth to achieve the Quintuple Aim. Reforming the relationship between payers and providers is pivotal to enhancing value-based care (VBC). The Payvider model, a joint approach to care and coverage rooted in vertical integration, is a potential solution. The authors aimed to investigate academic medical institutions adopting this model, termed Academic Payviders. All Association of American Medical Colleges (AAMC)-member allopathic medical schools were evaluated to identify programs meeting the inclusion criteria of offering both medical care and insurance coverage to patients via partnership with a payer or ownership of, or by, a payer. Twenty-five Academic Payvider systems were identified from 171 total AAMC-member programs. Most programs were founded after 2009 (n = 20), utilized a provider-dominant structural model (n = 17), and offered health plans to patients via Medicare Advantage (n = 23). Passage of the Affordable Care Act, recent trends in health care consolidation, and increased political and financial prioritization of social determinants of health (SDOH) may help to explain the rise of this care and coverage model. The Academic Payvider movement could advance academic medicine toward greater acceptance of VBC via innovations in medical education, resource stewardship in residency, and the establishment of innovative leadership positions at the administrative level.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"160-167"},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Use of a Blood Biomarker Test Improves Economic Utility in the Evaluation of Older Patients Presenting with Cognitive Impairment. 在评估出现认知障碍的老年患者时，使用血液生物标记物检测可提高经济效益。

IF 1.8 4区医学

Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-03-28 DOI: 10.1089/pop.2023.0309

William J Canestaro, Randall J Bateman, David M Holtzman, Mark Monane, Joel B Braunstein

{"title":"Use of a Blood Biomarker Test Improves Economic Utility in the Evaluation of Older Patients Presenting with Cognitive Impairment.","authors":"William J Canestaro, Randall J Bateman, David M Holtzman, Mark Monane, Joel B Braunstein","doi":"10.1089/pop.2023.0309","DOIUrl":"10.1089/pop.2023.0309","url":null,"abstract":"More than 16 million Americans living with cognitive impairment warrant a diagnostic evaluation to determine the cause of this disorder. The recent availability of disease-modifying therapies for Alzheimer's disease (AD) is expected to significantly drive demand for such diagnostic testing. Accurate, accessible, and affordable methods are needed. Blood biomarkers (BBMs) offer advantages over usual care amyloid positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarkers in these regards. This study used a budget impact model to assess the economic utility of the PrecivityAD® blood test, a clinically validated BBM test for the evaluation of brain amyloid, a pathological hallmark of AD. The model compared 2 scenarios: (1) baseline testing involving usual care practice, and (2) early use of a BBM test before usual care CSF and PET biomarker use. At a modest 40% adoption rate, the BBM test scenario had comparable sensitivity and specificity to the usual care scenario and showed net savings in the diagnostic work-up of $3.57 million or $0.30 per member per month in a 1 million member population, translating to over $1B when extrapolated to the US population as a whole and representing a 11.4% cost reduction. Savings were driven by reductions in the frequency and need for CSF and PET testing. Additionally, BBM testing was associated with a cost savings of $643 per AD case identified. Use of the PrecivityAD blood test in the clinical care pathway may prevent unnecessary testing, provide cost savings, and reduce the burden on both patients and health plans.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"174-184"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Certified Community Behavioral Health Clinic Demonstration Impact on Health Care Utilization Among Non-Medicaid Patients with Severe Mental Illnesses. 认证社区行为健康诊所示范项目对非医疗补助严重精神疾病患者使用医疗服务的影响。

IF 1.8 4区医学

Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-08-12 DOI: 10.1089/pop.2024.0103

Daniel Maeng, Patrick Walsh, George Nasra, Hochang B Lee

{"title":"Certified Community Behavioral Health Clinic Demonstration Impact on Health Care Utilization Among Non-Medicaid Patients with Severe Mental Illnesses.","authors":"Daniel Maeng, Patrick Walsh, George Nasra, Hochang B Lee","doi":"10.1089/pop.2024.0103","DOIUrl":"10.1089/pop.2024.0103","url":null,"abstract":"In 2017, the Certified Community Behavioral Health Clinic (CCBHC) demonstration was implemented in New York State to redesign care delivery and financing for behavioral health services. Although CCBHC primarily targeted Medicaid patients, it was hypothesized that the clinic-level benefits of CCBHC were expected to impact even non-Medicaid patients treated in CCBHCs. To test this hypothesis, this study conducted a health insurance claims data analysis of non-Medicaid (ie, commercial and Medicare) patients with severe mental illnesses, comparing a cohort of CCBHC-treated patients with a propensity score-matched comparison cohort of patients treated by non-CCBHC clinics on rates of mental health service utilization, hospitalization, and emergency department (ED) visits. The data suggested CCBHC was associated with more than 10% increase in outpatient mental health service utilization by the patients' second year of CCBHC exposure, accompanied by similarly significant reductions in the rates of all-cause ED visits and non-psychiatric hospitalization. These findings suggest that for behavioral health clinics that serve a sufficiently large population of Medicaid, the impact of innovative clinical redesign attributable to CCBHC is likely to extend to all patients treated by them.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"345-352"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141917349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Employer Strategies for Health Care Price Transparency. 医疗保健价格透明化的雇主策略。

IF 1.8 4区医学

Population Health Management Pub Date : 2024-06-01 Epub Date: 2024-07-31 DOI: 10.1089/pop.2024.0085

Ronald J Ozminkowski

{"title":"Employer Strategies for Health Care Price Transparency.","authors":"Ronald J Ozminkowski","doi":"10.1089/pop.2024.0085","DOIUrl":"10.1089/pop.2024.0085","url":null,"abstract":"This paper describes hospital, insurance, and pharmaceutical price transparency policies and applications in the United States and in selected countries around the world. Many of these policies apply to self-insured employers. So far, the experience in the United States and elsewhere is clear that federal and state price transparency regulations have had little impact on whether employees or dependents search for low-cost or high-quality providers or on the cost and quality of their health care. This is because of weak regulatory oversight, conflicting federal and state reporting requirements, and few economic incentives for providers and insurance companies to supply easily readable or analyzable price information. However, price transparency requirements are here to stay. This paper therefore offers several recommendations to maximize the utility of price transparency tools provided for employees and other insureds, by their employers, providers, commercial insurance carriers, or technology firms. From a policy perspective, coupling reporting requirements with clearer technological guidance and much stronger regulatory oversight would increase the utility of price transparency efforts. For individual employers, the impact of price transparency efforts may increase by coupling price transparency tools with health plan network and design strategies, behavioral economic nudges, and programs designed to improve health, well-being, and quality of care. Many program vendor partners, consultants, and actuarial, technology, and research firms can help make these efforts useful.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"320-326"},"PeriodicalIF":1.8,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Call for an American Social Care System: Social Services Reimbursement to Address Fragmented Care. 呼吁建立美国社会护理体系：通过社会服务补偿来解决护理分散的问题。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-01-17 DOI: 10.1089/pop.2023.0251

Anish Patnaik, Haaris Mateen, David S Buck

引用次数: 0

Health Care Bricolage: A Method to Reduce High-Cost Medical Spend. 医疗保健双轨制：减少高成本医疗支出的方法。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-03-12 DOI: 10.1089/pop.2024.0008

Steven E Goldberg, Maren S Fragala

引用次数: 0

Evaluation of the Impact of Discharge Clinic Follow-Up Interventions on 30-Day Readmission Rates. 出院门诊随访干预对 30 天再入院率影响的评估。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-03-14 DOI: 10.1089/pop.2023.0273

Jessica Sass, Debra Hampton, Jean Edward, Roberto Cardarelli

引用次数: 0

Sickle Cell Disease in an Older Adult Population: A Retrospective Review of Health Care Resource Utilization. 老年镰状细胞病：医疗资源利用情况回顾。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-02-23 DOI: 10.1089/pop.2023.0268

Jessica L Ryan, Jeremiah S Rastegar, Jessica M Dobbins, Deborah N Peikes, Anna Theodorou, Brian Garcia, Bryan Loy, Ebony Bell, J Nwando Olayiwola

{"title":"Sickle Cell Disease in an Older Adult Population: A Retrospective Review of Health Care Resource Utilization.","authors":"Jessica L Ryan, Jeremiah S Rastegar, Jessica M Dobbins, Deborah N Peikes, Anna Theodorou, Brian Garcia, Bryan Loy, Ebony Bell, J Nwando Olayiwola","doi":"10.1089/pop.2023.0268","DOIUrl":"10.1089/pop.2023.0268","url":null,"abstract":"Sickle cell disease (SCD) has a history of health inequity, as patients with SCD are primarily Black and often marginalized from the health care system. Although recent health care and treatment advancements have prolonged life expectancy, it may be insufficient to support the complex needs of the growing population of older adults with SCD. This retrospective study used a cohort (N = 812) of Medicare Advantage beneficiaries 45 years and older (ages: 45-54, 55-64, 65-74, 75-89) with SCD to identify associations of SCD-related complications and comorbidities with emergency department (ED) visits, potentially avoidable ED visits, all-cause hospitalization, and potentially avoidable hospitalizations, 2018-2020. The 75-89 age group had lower odds of an ED visit (OR 0.56; 95% CI 0.32-1.00), 65-74 age group had lower odds of an ED visit (OR 0.49; 95% CI 0.31-0.78) and hospitalization (OR 0.50; 95% CI 0.31-0.79), compared with the 45-54 age group. Acute chest syndrome was associated with increased odds of an ED visit (OR 2.02; 95% CI 1.10-3.71), avoidable ED visit (OR 1.87; 95% CI 1.14-3.06), and hospitalization (OR 3.61; 95% CI 2.06-6.31). Pain was associated with increased odds of an ED visit (OR 2.64; 95% CI 1.85-3.76), an avoidable ED visit (OR 3.08; 95% CI 1.90-4.98), hospitalization (OR 1.51; 95% CI 1.02-2.24), and avoidable hospitalization (OR 6.42; 95% CI 1.74-23.74). Older adults with SCD have been living with SCD for decades, often while managing pain crises and complications associated increased incidence of an ED visit and hospitalization. The characteristics and needs of this population must continue to be examined to increase preventative care and reduce costly emergent health care resource utilization.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"120-127"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139940592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Elective Joint Replacement Among Medicaid Beneficiaries: Utilization and Postoperative Adverse Events by Racial and Ethnic Groups. 医疗补助受益人中的择期关节置换术：按种族和族裔群体分列的使用情况和术后不良事件。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-03-06 DOI: 10.1089/pop.2023.0310

Hyunjee Kim, Kyle D Hart, Angela Senders, Kathryn Schabel, Said A Ibrahim

{"title":"Elective Joint Replacement Among Medicaid Beneficiaries: Utilization and Postoperative Adverse Events by Racial and Ethnic Groups.","authors":"Hyunjee Kim, Kyle D Hart, Angela Senders, Kathryn Schabel, Said A Ibrahim","doi":"10.1089/pop.2023.0310","DOIUrl":"10.1089/pop.2023.0310","url":null,"abstract":"Hip and knee replacement have been marked by racial and ethnic disparities in both utilization and postoperative adverse events among Medicare beneficiaries, but limited knowledge exists regarding racial and ethnic differences in joint replacement care among Medicaid beneficiaries. To close this gap, this study used Medicaid claims in 2018 and described racial and ethnic differences in the utilization and postoperative adverse events of elective joint replacements among Medicaid beneficiaries. Among the 2,260,272 Medicaid beneficiaries, 5987 had an elective joint replacement in 2018. Asian (0.05%, 95% confidence interval [CI]: 0.03%-0.07%) and Hispanic beneficiaries (0.12%, 95% CI: 0.07%-0.18%) received joint replacements less frequently than American Indian and Alaska Native (0.41%, 95% CI: 0.27%-0.55%), Black (0.33%, 95% CI: 0.19%-0.48%), and White (0.37%, 95% CI: 0.25%-0.50%) beneficiaries. Black patients demonstrated the highest probability of 90-day emergency department visits (34.8%, 95% CI: 32.7%-37.0%) among all racial and ethnic groups and a higher probability of 90-day readmission (8.0%, 95% CI: 6.9%-9.0%) than Asian (3.4%, 95% CI: 0.7%-6.0%) and Hispanic patients (4.4%, 95% CI: 3.4%-5.3%). These findings indicate evident disparities in postoperative adverse events across racial and ethnic groups, with Black patients demonstrating the highest probability of 90-day emergency department visits. This study represents an initial exploration of the racial and ethnic differences in joint replacement care among Medicaid beneficiaries and lay the groundwork for further investigation into contributing factors of the observed disparities.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"128-136"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing "Meaningful Use" of Health Information Technology in Pennsylvania: Electronic Prescription Rates of Metropolitan and Rural Counties. 宾夕法尼亚州医疗信息技术 "有意义使用 "的比较：大都市县和农村县的电子处方率。

IF 2.5 4区医学

Population Health Management Pub Date : 2024-04-01 Epub Date: 2024-02-27 DOI: 10.1089/pop.2023.0258

Heath Saffer, Amy Cunningham

{"title":"Comparing \"Meaningful Use\" of Health Information Technology in Pennsylvania: Electronic Prescription Rates of Metropolitan and Rural Counties.","authors":"Heath Saffer, Amy Cunningham","doi":"10.1089/pop.2023.0258","DOIUrl":"10.1089/pop.2023.0258","url":null,"abstract":"The Health Information Technology for Economic and Clinical Health Act incentivized the adoption of electronic health records (EHRs). Health systems looked to leverage technology to assist in serving populations in health professional shortage areas. Qualitative research points to EHR usability as a source of health inequities in rural settings, making the challenges of EHR usage a subject of interest. Pennsylvania offers a model for investigating rural health infrastructure with it having the third largest rural population in the United States. This study analyzed the adoption of Electronic Prescribing in the 67 Pennsylvania (PA) counties. Physician adoption and usage data for PA and the United States were compared using a t-test to establish a basis for comparison. PA counties were categorized using the United States Department of Agriculture (USDA)'s Rural-Urban Commuting Areas (RUCAs) system. Surescript use percentages were plotted against the RUCA scores of each PA county to create a polynomial regression model. PA office-based physicians, on average, utilize e-prescription tools at the same rate as the national average with 59% of practices utilizing Surescripts as of 2013. There was no significant correlation between Surescript usage and the rural/urban classification of counties in Pennsylvania (R-squared value of 0.06). Pennsylvania was able to adopt health information technology (HIT) infrastructure at the same rate as the national average. Rural and metropolitan definitions do not correlate to meaningful use of HIT, thus usability of HIT cannot be tied to health outcomes. Future studies looking at specific forms of HIT and their ability to decrease the burden of administrative work for clinicians.","PeriodicalId":20396,"journal":{"name":"Population Health Management","volume":" ","pages":"114-119"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0