The American journal of managed care最新文献

{"title":"Health care fragmentation and blood pressure control among adults taking antihypertensive medication.","authors":"Calvin Colvin, M. Safford, P. Muntner, Lisandro D. Colantonio, L. Kern","doi":"10.37765/ajmc.2022.88837","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88837","url":null,"abstract":"OBJECTIVES\u0000To determine the association of fragmented ambulatory health care with uncontrolled blood pressure (BP) and apparent treatment-resistant hypertension (aTRH) among older adults taking antihypertensive medication, overall and by race and gender.\u0000\u0000\u0000STUDY DESIGN\u0000Cross-sectional study using data from 2868 REasons for Geographic And Racial Differences in Stroke (REGARDS) study participants 66 years and older who completed a study examination in 2013-2016, had Medicare fee-for-service coverage, and were taking antihypertensive medication.\u0000\u0000\u0000METHODS\u0000We used logistic regression to analyze the association of fragmented health care with uncontrolled BP and aTRH. Fragmented health care was operationalized as a reversed Bice-Boxerman Index score in the 75th percentile or higher, calculated using the number of ambulatory providers and health care visits in the year preceding the study examination. Uncontrolled BP was defined by systolic BP of at least 140 mm Hg or diastolic BP of at least 90 mm Hg. aTRH was defined by taking 3 or more classes of antihypertensive medication with uncontrolled BP or 4 or more classes with controlled BP.\u0000\u0000\u0000RESULTS\u0000The overall adjusted odds ratios (95% CIs) for uncontrolled BP, aTRH with controlled BP, and aTRH with uncontrolled BP associated with fragmented health care were 1.10 (0.89-1.37), 1.08 (0.80-1.47), and 1.32 (0.96-1.81), respectively. Fragmented health care was not associated with uncontrolled BP or aTRH among White participants, women, or men. Among Black participants, the odds ratio (95% CI) associated with fragmented health care was 1.21 (0.81-1.82) for uncontrolled BP, 1.22 (0.72-2.07) for aTRH with controlled BP, and 1.82 (1.07-3.11) for aTRH with uncontrolled BP.\u0000\u0000\u0000CONCLUSIONS\u0000Fragmented health care may increase the likelihood of aTRH with uncontrolled BP among older Black adults taking antihypertensive medication.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"128 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123190929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA safety warnings and trends in testosterone marketing to physicians.","authors":"A. Togun, A. Sankar, P. Karaca-Mandic","doi":"10.37765/ajmc.2022.88841","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88841","url":null,"abstract":"In response to study findings showing the risk of cardiovascular adverse events associated with testosterone therapy, the FDA issued safety warnings in 2014 and modified testosterone labeling in March 2015 to indicate the increased risk of stroke and heart attack. It is unknown whether there were changes in testosterone marketing practices by pharmaceutical companies following the FDA label warning. Both primary care physicians (PCPs) and non-PCPs prescribe testosterone and are targeted by pharmaceutical marketing representatives to encourage testosterone prescribing. Likewise, pharmaceutical marketing occurs in both urban and rural areas. Our study is the first to examine testosterone marketing practices around the period of the testosterone label warning by physician specialty and rural vs urban primary care service area. In this study, we found that testosterone marketing efforts such as marketing spending per encounter, quarterly marketing spending per physician, and quarterly number of encounters per physician increased among non-PCPs and urban physicians for 4 quarters following an FDA boxed warning in 2015 on testosterone prescriptions. After the black box warning, off-label testosterone advertisements stopped. This reduction in advertising could have made it more attractive for pharmaceutical companies to increase their marketing spending targeting non-PCPs and physicians in urban areas. Understanding responses of pharmaceutical companies to FDA guidelines is important and can help inform future guideline initiatives.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123795311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managed care opportunities and approaches to select treatment for sight preservation.","authors":"Yuqian Liu","doi":"10.37765/ajmc.2022.88854","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88854","url":null,"abstract":"Anti-vascular endothelial growth factor therapies have become the mainstay of treatment for both diabetic macular edema and neovascular age-related macular degeneration. This treatment is imperative for vision preservation including visual acuity. However, treatment burdens include high costs, frequent injections, continued visual loss, and loss of ability to perform day-to-day functions. Although clinical trial data have provided insights to treatment options and protocols, real-world patient experiences and adherence to therapies do not often mimic clinical trials as patients cannot fully adhere to their treatment schedule, leading to poor disease outcomes. Payers may consider various strategies such as step therapies, fee schedule management, and driving utilization through specialty pharmacies to contain costs. However, it is important to recognize not all patients will respond to a one-size-fits-all approach to treatment, warranting a more personalized approach.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130120771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Celiac disease.","authors":"D. Leffler, S. Saha, R. Farrell","doi":"10.1093/acprof:oso/9780199398911.003.0054","DOIUrl":"https://doi.org/10.1093/acprof:oso/9780199398911.003.0054","url":null,"abstract":"Timely diagnosis and treatment of celiac disease is important not only to improve the immediate quality of life of the patient but also to decrease the long-term risks of untreated celiac disease. A large Finnish study showed that the 5-year survival among patients who strictly adhered to a gluten-free diet was similar to that of the general population. Growth and development in infants and children proceed normally with continued gluten avoidance, and in adults many of the disease complications including osteopenia are avoided. However, peripheral neuropathy, ataxia, and severe osteopenia, particularly in the setting of secondary hyperparathyroidism, usually persist. Enteropathyassociated T-cell lymphoma is widely recognized as a complication of celiac disease, and gluten restriction has been shown to significantly decrease the risk of this malignancy to the level of the general population. Whether gluten restriction is beneficial or should be recommended for patients with asymptomatic disease remains controversial. However, the available evidence suggests that this treatment is always indicated in patients showing celiac enteropathy, at least to prevent the possible long-term complications of this condition. Despite a dearth of evidence presently to support population-wide screening for celiac disease, patients at high-risk for celiac disease should be screened based on symptoms, family history, and associated conditions, as morbidity from subclinical disease in young patients has been demonstrated.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"25 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120994853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world usage of bevacizumab-bvzr biosimilar in US oncology practice.","authors":"Jingyan Yang, J. Kelton, J. Thompson, J. Alvir, M. Maculaitis, A. Shelbaya","doi":"10.37765/ajmc.2022.88831","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88831","url":null,"abstract":"OBJECTIVES\u0000Bevacizumab is commonly used to treat solid tumors. However, little is known about the manner and the extent to which bevacizumab biosimilars are utilized in real-world oncology practice in the United States. The objective of this study was to describe patient and provider characteristics and treatment patterns associated with the recently introduced bevacizumab-bvzr biosimilar.\u0000\u0000\u0000STUDY DESIGN\u0000Retrospective cohort study.\u0000\u0000\u0000METHODS\u0000A retrospective analysis of medical and pharmacy claims between January 24, 2019, and July 31, 2020, was performed. Adult patients with at least 1 claim indicating usage of bevacizumab-bvzr were included. Patients who could not be assigned to an applicable diagnosis group were excluded. Index treatment date was defined as the date of the first claim for bevacizumab-bvzr. Descriptive analysis was conducted for all study variables.\u0000\u0000\u0000RESULTS\u0000A total of 206 patients were included; patients most often were 65 years or older (49.5%), were female (62.6%), and resided in the West (45.1%). The most common indications observed for bevacizumab-bvzr were metastatic colorectal cancer (mCRC; 51.0%), cancer of the female genital organs (CFGO; 27.2%), glioblastoma (11.2%), and non-small cell lung cancer (8.7%). Overall, 72.4% and 48.2% of patients with mCRC and CFGO, respectively, had switched to bevacizumab-bvzr from the reference drug or another bevacizumab biosimilar. Bevacizumab-bvzr was used in chemotherapy combination regimens for patients with mCRC and CFGO.\u0000\u0000\u0000CONCLUSIONS\u0000Utilization was observed in extrapolated indications. Findings suggest that both switching between reference product and bevacizumab biosimilars and using bevacizumab-bvzr as part of chemotherapy combination regimens have been adopted in US oncology practice.","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128926002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of an out-of-pocket maximum in Medicare Part D.","authors":"Sonal Parasrampuria,&nbsp;Gerard F Anderson","doi":"10.37765/ajmc.2022.88828","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88828","url":null,"abstract":"<p><strong>Objectives: </strong>Three different out-of-pocket (OOP) maximums in Medicare Part D have been proposed: $2000 by the House of Representatives, $3100 by the Senate Finance Committee, and the beginning of catastrophic coverage by the Medicare Payment Advisory Commission. However, little is known about how beneficiaries would be affected.</p><p><strong>Study design: </strong>We estimated multivariate linear regression models to determine which beneficiary characteristics were associated with the greatest savings under each proposed OOP maximum and simulated a potential behavioral response by beneficiaries.</p><p><strong>Methods: </strong>Using Part D 2017 claims data for beneficiaries in stand-alone prescription drug plans (PDPs) and Medicare Advantage prescription drug (MA-PD) plans, we estimated the number of beneficiaries affected, their demographic characteristics, and their drug utilization patterns. We then simulated a potential behavioral response by beneficiaries.</p><p><strong>Results: </strong>Under the $2000 OOP proposed threshold, only 7% of PDP and 4% of MA-PD plan beneficiaries would have spending high enough to reach the OOP maximum. Annual mean (SD) savings would be $1301 ($1849) for PDP beneficiaries and $1363 ($1888) for MA-PD plan beneficiaries, concentrated among beneficiaries taking specialty drugs. As the threshold increases, fewer beneficiaries would accrue savings, but savings would increase. For the highest proposed OOP maximum, mean (SD) savings would be $2720 ($3465) and $2473 ($2805) for PDP and MA-PD plan beneficiaries, respectively. In our simulations, we estimated that the number of beneficiaries affected by an OOP maximum could increase by 2% to 11%, depending on the magnitude of response, but changes in savings would be minimal.</p><p><strong>Conclusions: </strong>As currently drafted, proposed OOP maximums would reduce OOP spending for a small population of Part D beneficiaries, with savings concentrated among beneficiaries with the very highest costs who are taking specialty medications.</p>","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":" ","pages":"e55-e62"},"PeriodicalIF":3.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39779920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailoring complex care to patients' needs: myths, realities, and best next steps.","authors":"Brent C Williams,&nbsp;A Mark Fendrick","doi":"10.37765/ajmc.2022.88750","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88750","url":null,"abstract":"<p><p>The authors of this editorial highlight some of the myths surrounding complex care management, identify areas where research could be most informative, and recommend best next steps in developing effective and efficient complex care management programs.</p>","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":" ","pages":"47-50"},"PeriodicalIF":3.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39903561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intersection of complexity and high utilization among health center patients aged 18 to 64 years.","authors":"Nadereh Pourat,&nbsp;Xiao Chen,&nbsp;Yusuke Tsugawa,&nbsp;Connie Lu,&nbsp;Weihao Zhou,&nbsp;Hank Hoang,&nbsp;Brionna Hair,&nbsp;Joshua Bolton,&nbsp;Alex Sripipatana","doi":"10.37765/ajmc.2022.88751","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88751","url":null,"abstract":"<p><strong>Objectives: </strong>Existing literature indicates that multimorbidity, mental health (MH) conditions, substance use disorders (SUDs), and social determinants of health are hallmarks of high-need, high-cost patients. Health Resources and Services Administration-funded health centers (HCs) provide care to nearly 30 million patients, but data on their patients' complexity and utilization patterns are limited. We identified subgroups of HC patients based on latent concepts of complexity and utilization.</p><p><strong>Study design: </strong>We used cross-sectional national data from the 2014 Health Center Patient Survey and latent class analyses to identify distinct and homogenous groups of complex high-utilizing patients aged 18 to 64 years.</p><p><strong>Methods: </strong>We included indicators of chronic conditions (CCs), MH, SUD risk, and health behavior to measure complexity. We used number of outpatient and emergency department visits in the past year to measure utilization.</p><p><strong>Results: </strong>HC patients were separated in 9 distinct groups based on 3 complexity latent classes (MH, multiple CCs, and low risk) and 3 utilization classes (low, high, and superutilizers). Conditions associated with each subgroup differed. The highest prevalence of bipolar disorder (45%) and high SUD risk (6%) was observed among MH superutilizers, whereas the highest prevalence of cardiovascular disease (48%) and obesity (96%) was seen among CC superutilizers. Most MH superutilizer patients concurrently had MH conditions and obesity and were smokers, but most CC superutilizer patients concurrently had hypertension, obesity, and cardiovascular disease.</p><p><strong>Conclusions: </strong>Our examination of complexity and utilization indicated distinct HC patient populations. Managing the care of each group may require different targeted intervention approaches such as multidisciplinary care teams that include MH providers or specialists.</p>","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":" ","pages":"66-72"},"PeriodicalIF":3.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39765492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world HIV diagnostic testing patterns in the United States.","authors":"Chakkarin Burudpakdee,&nbsp;Aimee M Near,&nbsp;Jenny Tse,&nbsp;Jillian Faccone,&nbsp;Pedro L Rodriguez,&nbsp;James K Karichu,&nbsp;Mindy M Cheng","doi":"10.37765/ajmc.2022.88826","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88826","url":null,"abstract":"<p><strong>Objectives: </strong>To understand real-world implementation of the updated CDC HIV diagnostic testing algorithm.</p><p><strong>Study design: </strong>Retrospective database analysis.</p><p><strong>Methods: </strong>Using data from Quest Diagnostics, we identified patients with at least 1 HIV-1/HIV-2 antibody differentiation test (BioRad Geenius HIV 1/2 Supplemental Assay [Geenius]) between January 1 and December 31, 2017. Study measures included Health Insurance Portability and Accountability Act-compliant patient demographics, test results, test frequency, and sequence relative to the CDC HIV diagnostic algorithm, including HIV-1 RNA Qualitative Assay (Aptima) or HIV-2 nucleic acid test (NAT).</p><p><strong>Results: </strong>A total of 26,319 patients were identified (mean [SD] age, 40.7 [14.3] years; 66.4% male), with 28,954 Geenius tests, 7234 Aptima tests, and 298 HIV-2 NATs. In 26.4% of test sequences, the Geenius results were indeterminate or negative and required subsequent confirmatory NATs. A total of 8.5% of patients had more than 1 Geenius test in 2017, and 11.2% of the time, results of the first and second tests differed. A total of 74.2% of test sequences matched the CDC-recommended algorithm.</p><p><strong>Conclusions: </strong>Our study findings suggest that the CDC HIV diagnostic algorithm is complex and may pose suboptimal testing efficiency. Opportunities to improve diagnostic efficiency by reducing indeterminate results and repeat tests are warranted.</p>","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":" ","pages":"e42-e48"},"PeriodicalIF":3.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39765496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote monitoring saves costs in outpatient negative pressure wound therapy.","authors":"Leah P Griffin,&nbsp;Mikaela M Sifuentes","doi":"10.37765/ajmc.2022.88738","DOIUrl":"https://doi.org/10.37765/ajmc.2022.88738","url":null,"abstract":"<p><strong>Objectives: </strong>In the outpatient setting, combining remote therapy monitoring (RTM) with negative pressure wound therapy (NPWT) can support improved adherence to prescribed therapy. A recent study reported that patients receiving NPWT with RTM required fewer therapy days than patients receiving NPWT alone, possibly reducing costs of care. Our objective was to determine whether RTM reduced 90-day costs in patients undergoing NPWT.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of patients receiving NPWT with or without RTM in the postacute setting.</p><p><strong>Methods: </strong>Patients beginning NPWT between March 2018 and May 2019 were included. Payer claims data were collected and analyzed with t test for continuous variables and χ2 test for categorical variables. Multiple regressions were performed to control for confounding variables.</p><p><strong>Results: </strong>Of the 1105 patients included the study, 675 (61%) received RTM and 430 (39%) did not. RTM patients were significantly older (P < .0001), had more ulcers (P = .0004), and had higher Charlson Comorbidity Index (CCI) scores (P < .0001). The unadjusted mean 90-day wound-related cost was not significantly higher for non-RTM patients than for RTM patients (P = .0799). After controlling for differences in age, payer type, CCI score, and wound type, there was a significant reduction in 90-day wound-related costs in the RTM group compared with the non-RTM group ($11,119 vs $14,752; P = .0131). The RTM group had higher NPWT costs ($3757 vs $3289; P = .0035) but lower wound-related non-NPWT costs ($7361 vs $11,462; P = .0045).</p><p><strong>Conclusions: </strong>This study demonstrated the value of RTM in supporting NPWT adherence and decreasing the costs of wound care in these patients.</p>","PeriodicalId":267832,"journal":{"name":"The American journal of managed care","volume":" ","pages":"53-58"},"PeriodicalIF":3.2,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39765490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}