American Journal of Managed Care最新文献_第10页

A team-based approach to type 2 diabetes and cardiovascular care. 以团队为基础的 2 型糖尿病和心血管护理方法。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89672

Ian J Neeland, Sanjay Rajagopalan

{"title":"A team-based approach to type 2 diabetes and cardiovascular care.","authors":"Ian J Neeland, Sanjay Rajagopalan","doi":"10.37765/ajmc.2024.89672","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89672","url":null,"abstract":"The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program is an innovative, patient-centered system of care developed by the University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio in the US for the management of high-risk patients with type 2 diabetes (T2D) and prediabetes at high risk for cardiovascular-kidney-metabolic (CKM) syndrome and its consequences. At its core, CINEMA is a multidisciplinary team of care experts, working together outside of traditional silos. The patient meets with the entire team up to 4 times each year to address all aspects of cardiovascular (CV) and T2D care. At the first visit, the team formulates a personalized approach that is evidence based and centered on optimal strategies to improve the patient's lifestyle, reduce their risk of CV and kidney disease events, and increase their access and adherence to guideline-directed pharmacologic therapies. A community health worker is utilized to address social determinants of health as needed. The program has a substantial research component, with the intent of developing evidence for novel care paradigms. The multiyear results of the CINEMA program indicate that a multidisciplinary approach to management of high-risk patients is highly effective in reducing CKM syndrome risk factors and increases use of guideline-directed therapies. The aim of this review is to describe the structure, operation, and eligibility criteria for admission to the CINEMA program, provide an overview of how CKM syndrome risks are determined and managed for each patient, and discuss how the integrated approach to care is supported by current recommendations from professional societies and results from other coordinated care/multidisciplinary programs. Lastly, the scalability challenges of a wider rollout of the CINEMA program are considered.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 10 Suppl","pages":"S197-S204"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869743","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

Diabetes, cardiorenal, and metabolic multispecialty practice recommendations and early intensive management of cardio-renal-metabolic disease. 糖尿病、心肾和代谢多专科实践建议和心肾代谢疾病的早期强化管理。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89671

Yehuda Handelsman

引用次数: 0

Disconnects between provider network directories and patient preferences. 断开供应商网络目录和患者偏好之间的连接。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89638

Wendy Yi Xu, Eli Wei Raver, Thomas Elton, Marisa Davis, Simon F Haeder

{"title":"Disconnects between provider network directories and patient preferences.","authors":"Wendy Yi Xu, Eli Wei Raver, Thomas Elton, Marisa Davis, Simon F Haeder","doi":"10.37765/ajmc.2024.89638","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89638","url":null,"abstract":"Objectives: The question of what providers one has access to under their insurance coverage is crucial for patients in managed care. This study sought to examine information displayed in online provider directories and whether this information matched consumer preferences.Study design: A national survey (N = 4007) paired with an analysis of online provider network directories.Methods: We conducted a quantitative content analysis of online provider directories from March 1 to May 30, 2023. A national survey of American adults was fielded from June 30 to July 2, 2023, to gauge preferences for information displayed in provider directories. Preferences and perceived importance of information elements that should be displayed in provider directories were contrasted with the data elements displayed in directories.Results: We found that provider directories showed wide variations with regard to information displayed and in the amount of navigation required by patients. There were widespread instances of disconnect between patient preferences and data availability. Important data items related to care access and provider quality that were preferred by consumers were not universally presented in directories, such as availability of telemedicine (23% presented), information about office hours (58%), and disability access (59%). Approximately 7% of directories did not indicate whether a provider was accepting new patients, despite the requirement under the No Surprises Act to display such information. Further, certain marginalized populations may find it especially challenging to acquire information about providers.Conclusions: Lack of attention to usability in provider directories may hinder the national goal of ensuring care accessibility for all.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"660-666"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916262","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

Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts. 最近加入医疗保险的老年人群比过去的老年人群使用更多的咨询和心理治疗。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89631

Grace McCormack, Erin L Duffy, Adam Biener

{"title":"Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts.","authors":"Grace McCormack, Erin L Duffy, Adam Biener","doi":"10.37765/ajmc.2024.89631","DOIUrl":"10.37765/ajmc.2024.89631","url":null,"abstract":"Objectives: Despite recent policy interest in improving access to mental health care in Medicare, little is known about how demand for care will change among the Medicare population as newer cohorts age into the program. We documented the growing rate of counseling and psychotherapy use in the decade prior to turning age 65 years among subsequent cohorts aging into Medicare. We characterized how this growth varied across demographic groups, income levels, and mental and physical health status.Study design: We present trends using data from the 2002-2017 Medical Expenditure Panel Survey Household Component.Methods: We categorized individuals into 5-year Medicare entry cohorts based on the year they turned age 65 years. Our outcome was an indicator for having a visit for counseling or psychotherapy in a given year. Employing a probit regression, we characterized visit rates across 5-year cohorts, presenting both unadjusted and covariate-adjusted results. We ran stratified regressions by subpopulations.Results: Our sample included 54,666 individuals aged 55 to 64 years, weighted to be nationally representative. The cohort aging into Medicare between 2021 and 2025 was 88% (95% CI, 57%-119%) more likely to have a counseling or psychotherapy visit between the ages of 55 and 64 years compared with the cohort that gained eligibility for Medicare between 2006 and 2010 at the same age. Growth in utilization was pervasive across many subpopulations.Conclusions: Our findings suggest that more recent cohorts aging into Medicare seek significantly more counseling and psychotherapy than prior cohorts. This increased utilization is pervasive across subpopulations, suggesting that plans must prepare to accommodate the needs of new Medicare entrants.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11","pages":"e337-e340"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640156","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

Management strategies for metabolic dysfunction-associated steatotic liver disease (MASLD). 代谢功能障碍相关性脂肪性肝病 (MASLD) 的管理策略。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89635

Naim Alkhouri, Mazen Noureddin

{"title":"Management strategies for metabolic dysfunction-associated steatotic liver disease (MASLD).","authors":"Naim Alkhouri, Mazen Noureddin","doi":"10.37765/ajmc.2024.89635","DOIUrl":"10.37765/ajmc.2024.89635","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by hepatic steatosis that is confirmed by imaging or histology in the setting of at least 1 metabolic risk factor in the absence of significant alcohol consumption. Nonalcoholic steatohepatitis, or NASH, was recently renamed metabolic dysfunction-associated steatohepatitis (MASH); it represents the progressive form of MASLD. MASH is defined by hepatic steatosis, lobular inflammation, and ballooning degeneration (hepatocellular injury) in a characteristic histologic pattern. Multiple pathophysiologic mechanisms underlie the development of MASLD, and multiple factors (eg, metabolic, hormonal, genetic, nutritional, and epigenetic components) are related to liver injury. MASH has a prevalence in the United States of 1% to 6%, and it is expected to rise in the next decade. Individuals living with MASH frequently suffer from comorbidities such as type 2 diabetes and cardiovascular disease. Several guidelines have been published to support the timely diagnosis of MASH that incorporate noninvasive tests that obviate the need for liver biopsy. Multiple MASH treatment options are in various stages of development. The THR-β agonist resmetirom, approved by FDA in March 2024, offers a liver-directed treatment for those patients living with moderate to severe fibrosis without cirrhosis. Considering the progressive nature of the disease and the availability of a treatment that can be initiated early to halt MASH progression, patients who have risk factors for MASH should urgently be encouraged to visit their health care providers for MASH screening.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 9 Suppl","pages":"S159-S174"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606574","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

Privately negotiated facility fees at ambulatory surgery centers and hospitals. 在门诊手术中心和医院私下协商设施费用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89624

Daphne T Hao, Vinay K Rathi, Joseph S Ross, Rosh K V Sethi, Roy Xiao

引用次数: 0

Prescription rebate guarantees: employer insights. 处方回扣保障：雇主的见解。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89585

Rochelle Henderson, Julie Patterson, John Michael O'Brien

{"title":"Prescription rebate guarantees: employer insights.","authors":"Rochelle Henderson, Julie Patterson, John Michael O'Brien","doi":"10.37765/ajmc.2024.89585","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89585","url":null,"abstract":"Objectives: To describe (1) rebate arrangements for specialty drugs, (2) the use and influence of benefits brokers and consultants, and (3) the importance of rebate-related factors when selecting a pharmacy benefits manager (PBM) among a sample of employers with self-funded pharmacy benefits.Study design: A national survey of employer drug benefit decision makers (N = 110) for organizations with self-insured pharmacy benefits.Methods: We summarized respondents' current rebate agreements for specialty drugs and their perspectives on the importance of rebates and rebate guarantees overall as well as by type of rebate agreement and by the person or entity identified as most influential in rebate strategy.Results: Nearly two-thirds of employers reported having rebate agreements with a rebate guarantee for specialty drugs (n = 69; 62.7%). The person or entity most influential to rebate strategy decisions was often a benefits consultant (37.3%), a human resources/benefits leader (29.1%), or a benefits broker (21.8%). Employers with rebate guarantees ascribed a higher level of importance to guarantees when selecting a PBM (median [IQR], 9 [7-10]) than employers receiving rebates without a guarantee (7 [6-8]) and those who do not receive rebates (7.5 [4-9]) (P = .001).Conclusions: These findings shed light on the importance of rebate guarantees and the role of employer benefits consultants and brokers in PBM selection. As the public discourse on PBMs and drug rebates continues, it is important to recognize the role employer benefits consultants may play in perpetuating employer reliance on guaranteed rebate arrangements.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11","pages":"574-580"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640214","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

Pervasiveness and clinical staff perceptions of HPV vaccination feedback. HPV 疫苗接种反馈的普遍性和临床工作人员的看法。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89629

Jodi A Lewis, Kathryn Brignole, Tara L Queen, Justin G Trogdon

{"title":"Pervasiveness and clinical staff perceptions of HPV vaccination feedback.","authors":"Jodi A Lewis, Kathryn Brignole, Tara L Queen, Justin G Trogdon","doi":"10.37765/ajmc.2024.89629","DOIUrl":"10.37765/ajmc.2024.89629","url":null,"abstract":"Objectives: This study describes the use of data-based feedback, such as human papillomavirus (HPV) vaccination rates, to advance HPV vaccination uptake in pediatric and family medicine clinics.Study design: A survey of primary care clinical staff in the US who provided HPV vaccination to children aged 9 to 12 years (N = 2527; response rate, 57%).Methods: The primary outcome was a mutually exclusive categorical variable that described the type of quality metrics for which providers received feedback in the past year: HPV vaccine, other pediatric vaccinations, other quality metrics, or none. Secondary outcomes were provider perceptions of HPV vaccine feedback helpfulness and their comfort with colleagues seeing their HPV vaccination rates. Logistic models adjusted for clinical staff and clinic characteristics.Results: Only 36.2% (n = 916) of respondents received HPV feedback. Feedback on HPV vaccination rates was more likely in nonrural clinics (OR, 2.03; 95% CI, 1.38-2.99), clinics in systems of 5 or more (OR, 1.81; 95% CI, 1.38-2.36), and in clinics serving 50 or more children per week (OR, 3.08; 95% CI, 2.03-4.66). Hispanic, Latino, or Spanish (OR, 1.54; 95% CI, 1.00-2.36) and Black or African American clinical staff (OR, 2.12; 95% CI, 1.44-3.12) were more likely than White clinical staff to find HPV vaccine feedback helpful. Relative to pediatricians, family medicine clinical staff were less comfortable with colleagues seeing their HPV vaccination rates (OR, 0.70; 95% CI, 0.57-0.87).Conclusions: Clinical staff seldom receive feedback about HPV vaccination in primary care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11","pages":"e320-e328"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11852389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640213","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

Utilization management and physician burnout. 使用管理与医生职业倦怠。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89626

Arwen Struthers, Mary Ann Chapman, P David Charles, Amanda Conschafter, Josie Cooper, Gavin Clingham

{"title":"Utilization management and physician burnout.","authors":"Arwen Struthers, Mary Ann Chapman, P David Charles, Amanda Conschafter, Josie Cooper, Gavin Clingham","doi":"10.37765/ajmc.2024.89626","DOIUrl":"10.37765/ajmc.2024.89626","url":null,"abstract":"Objective: This study was designed to assess physician experiences with utilization management and burnout and investigate whether they are linked.Study design: We conducted an electronic survey with items related to demographics, profession, utilization management, burnout, and potential policy solutions.Methods: The survey was sent to 7222 physicians working in outpatient settings who were recruited from a large, opt-in database. Outcome measures were responses to categorical and Likert-style survey items related to demographics, utilization management, burnout, and potential policy solutions.Results: Of 7222 requests sent, 501 physicians completed the survey and were included in the final data set (77% men; mean [SD] age, 57 [9.8] years; mean [SD] years in practice, 24 [8.9]). Of these, 200 were general practitioners and 301 were nonhospital specialists. Physicians indicated that utilization management procedures for prior authorization (81%), step therapy (79%), and nonmedical switching (69%) were major or significant barriers to their clinical and patient care. More than half (52%) reported spending 6 to 21 or more hours per week on paperwork related to health insurance utilization management, 67% had experienced burnout at some point in their careers, and 64% indicated that utilization management had been a contributing factor to feelings of burnout, with an additional 8% citing it as the main factor. Physicians favored streamlining prior authorization practice (77%), requiring step therapy to be based on science (73%), and ensuring that peer-to-peer reviews are done by qualified medical experts (67%).Conclusion: These findings indicate that utilization management has a detrimental impact on physicians and patient care and contributes to physician burnout.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11","pages":"561-566"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640160","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

As myeloma trials tackle frontline treatment, where are the Black patients? 当骨髓瘤试验触及一线治疗时，黑人患者在哪里？

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89691

Ryan Flinn, Mary Caffrey

引用次数: 0