American Journal of Managed Care最新文献_第2页

Impact of medical care coordination intervention on patient activation. 医疗护理协调干预对患者激活的影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89747

Samuel T Savitz, Michelle A Lampman, Shealeigh A Inselman, Vicki L Hunt, Angela B Mattson, Robert J Stroebel, Pamela J McCabe, Stephanie G Witwer, Bijan J Borah

{"title":"Impact of medical care coordination intervention on patient activation.","authors":"Samuel T Savitz, Michelle A Lampman, Shealeigh A Inselman, Vicki L Hunt, Angela B Mattson, Robert J Stroebel, Pamela J McCabe, Stephanie G Witwer, Bijan J Borah","doi":"10.37765/ajmc.2025.89747","DOIUrl":"10.37765/ajmc.2025.89747","url":null,"abstract":"Objective: To evaluate the impact of an adult medical care coordination (AMCC) intervention on patient activation.Study design: This observational evaluation compared AMCC with usual care (UC). Eligible patients were adults discharged home who had 2 or more chronic conditions and a high risk of readmission. AMCC involved registered nurse care coordinators providing self-management support to patients via 1 home visit and regular phone calls. The outcome was the 10-item Patient Activation Measure (PAM), a validated patient-reported outcome tool with 4 levels ranging from 1 (lower activation) to 4 (higher activation). Measurement occurred at baseline and 30, 90, and 180 days.Methods: We evaluated patient activation as an ordinal outcome using an ordered logistic regression model, a dichotomous outcome using a linear probability model, and a continuous outcome using ordinary least squares.Results: We identified 915 (432 AMCC, 483 UC) patients who completed both the baseline and at least 1 follow-up PAM. For the ordinal analysis, AMCC was associated with a significant increase in the percentage with a PAM of level 3 at 30, 90, and 180 days and a decrease in the percentage with a PAM of level 1 or 2 at 180 days. For the dichotomous analysis, AMCC was associated with a significant increase in the percentage of patients with a PAM of level 3 or 4 at 180 days (15.2 percentage points; 95% CI, 5.6-24.7).Conclusions: AMCC significantly increased patient activation, particularly at the final measurement. These findings highlight the potential value of AMCC as a self-management intervention, enhancing patients' confidence to manage their health.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"279-285"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477749","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

Utilization and costs among oncologists participating in a private insurance shared savings model. 参与私人保险共享储蓄模式的肿瘤学家的使用和成本。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89750

Brigham Walker, Lalan Wilfong, Nicholas Robert, Alexander Siebert, J Russell Hoverman

{"title":"Utilization and costs among oncologists participating in a private insurance shared savings model.","authors":"Brigham Walker, Lalan Wilfong, Nicholas Robert, Alexander Siebert, J Russell Hoverman","doi":"10.37765/ajmc.2025.89750","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89750","url":null,"abstract":"Objectives: Participation in the Oncology Care Model has influenced care utilization and costs relative to nonparticipating practices. Less is known, however, about how care is potentially altered by participation in similar private payer-based models. Here, we take advantage of a natural experiment in which 2 large practices from among a network of oncology practices participated in a shared savings program (SSP) with a private insurer.Study design: Quasi-experimental (difference-in-differences) statistical analysis of oncology claims data.Methods: We used monthly provider-level claims data from September 2014 through August 2017 for patients with breast, colon, and lung cancer from The US Oncology Network. Key outcome measures were monthly mean office visits, total costs, and buy-and-bill drug costs among patients with breast, colon, and lung cancer. We then compared the utilization and cost patterns, preintervention and post participation, among patients on this insurance at participating practices vs those of patients at nonparticipating practices.Results: Monthly per-patient total costs in colon cancer and lung cancer were lower through the first year of participation in the program by $1391 (95% CI, -$2218 to -$563; P < .01) and $1050 (95% CI, -$1878 to -$222; P = .02), respectively. These savings increased for colon cancer but disappeared for lung cancer in the second year. The program appeared to have no significant impact on any costs for participants with breast cancer in either of the years we examined.Conclusions: Our results suggest that private payer-based SSP models can be associated with reduced costs for colon cancer care. There is weaker evidence of effects in lung cancer and no evidence in breast cancer. Such heterogeneous effects can inform future model development.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"e141-e146"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477667","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

Potential health literacy resources for health plans: a narrative review. 卫生计划潜在的卫生素养资源：叙述性回顾。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89759

Saira Nawaz, Candy Magaña, Kathryn A Hasenstab, M Ella Lewie, Andy Rollins, Shireen Haq, Kyle J Moon, Anne Trinh, Faith Obanua, J Nwando Olayiwola

{"title":"Potential health literacy resources for health plans: a narrative review.","authors":"Saira Nawaz, Candy Magaña, Kathryn A Hasenstab, M Ella Lewie, Andy Rollins, Shireen Haq, Kyle J Moon, Anne Trinh, Faith Obanua, J Nwando Olayiwola","doi":"10.37765/ajmc.2025.89759","DOIUrl":"10.37765/ajmc.2025.89759","url":null,"abstract":"Objectives: Financial toxicity (FT) represents the impact of health care expenses on patients' financial well-being and access to care. Although existing literature has mostly looked at FT in the context of cancer and other medical conditions, we sought to identify risk factors for FT on a population-wide level.Study design: This was a cross-sectional study of the 2022 National Health Interview Survey (NHIS).Methods: Eight financial hardship questions were selected from the 2022 NHIS to represent FT. The unweighted sum of financial hardship questions to which a person responded \"yes\" was calculated as the FT score (FinTox), and risk factors for FinTox were analyzed using a negative binomial model.Results: There were 27,246 adults with a mean age of 52.96 years included for analysis, among whom 17.1% (n = 4659) responded \"yes\" to at least 1 FT question, of whom most had a FinTox of 1 or 2 (n = 3112; 66.8%). Increasing age (β = -0.616; P = .020), higher education (β = -1.08; P = .023), and higher income (β = -0.149; P < .001) were associated with lower FinTox, whereas involuntary unemployment (β = 0.920; P = .001), transient loss of health insurance (β = 1.075; P = .044), and high-deductible health plans (β = 0.519; P = .013) were associated with higher FinTox.Conclusions: Understanding risk factors for FT at a population level can help identify patients at risk for catastrophic financial effects or inadequate access to care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 6","pages":"SP351-SP363"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486843","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

Affordable Care Act enrollment in Texas after rating area adjustments. 在评级地区调整后，平价医疗法案在德克萨斯州的入学率。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89751

Elena Andreyeva, Daniel Marthey, Simon F Haeder, Benjamin Ukert

{"title":"Affordable Care Act enrollment in Texas after rating area adjustments.","authors":"Elena Andreyeva, Daniel Marthey, Simon F Haeder, Benjamin Ukert","doi":"10.37765/ajmc.2025.89751","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89751","url":null,"abstract":"Objective: To evaluate the association between Texas Affordable Care Act rating area change and health plan enrollment, plan selection, and premiums from 2022 to 2024 for urban and rural counties.Study design: Texas integrated a rating area consisting of all 177 rural counties into nearby metropolitan rating areas in 2023. We analyzed this policy using enrollment data from the Marketplace Open Enrollment County-Level Public Use Files from 2022-2024.Methods: We calculated the growth in enrollment across rural and urban counties and estimated linear regression models to understand whether enrollment grew faster in rural counties than in urban counties after the policy change.Results: Total marketplace plan enrollment increased by 80% (95% CI, 70%-90%) in urban counties and 76% (95% CI, 68%-84%) in rural counties. Urban and rural counties experienced the largest growth among enrollees aged 35 to 44 years (urban: 107%; 95% CI, 94%-119%; rural: 103%; 95% CI, 95%-112%) and enrollees with incomes between 100% and 150% of the federal poverty level (urban: 124%; 95% CI, 106%-142%; rural: 116%; 95% CI, 106%-127%). The share of counties reporting gold plan enrollment increased in urban and rural counties from 70% to 95% and 51% to 93%, respectively. Rating area changes were not associated with differential enrollment changes across rural and urban counties.Conclusions: We found similar growth rates in enrollment for rural and urban counties. Marketplace enrollees were more likely to choose a gold plan, suggesting that they shifted away from less-expensive bronze plans.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"e147-e152"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477744","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

Managed care reflections: a Q&A with Melinda B. Buntin, PhD. 管理式护理反思：与Melinda B. Buntin博士的问答。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89744

Melinda B Buntin, Christina Mattina

引用次数: 0

Should payers incentivize pharmacies to blister-package chronic medications? 付款人是否应该鼓励药店对慢性药物进行吸塑包装？

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89745

Eric P Borrelli, Peter Saad, Nathan E Barnes, Idal Beer, Julia D Lucaci

{"title":"Should payers incentivize pharmacies to blister-package chronic medications?","authors":"Eric P Borrelli, Peter Saad, Nathan E Barnes, Idal Beer, Julia D Lucaci","doi":"10.37765/ajmc.2025.89745","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89745","url":null,"abstract":"Medication nonadherence is prevalent among patients taking acute and/or chronic medications. It has been associated with poorer health outcomes, increased mortality, and higher costs for payers and the health care system. Numerous factors contribute to medication nonadherence, with forgetfulness being the primary reason. Payers have a vested interest in improving patient adherence to medications to mitigate overall health care costs by enhancing disease management, and they typically offer programs and initiatives aimed at improving medication adherence. One intervention that has had success in improving medication adherence and patient outcomes across a variety of disease states is putting patients' medications in blister packs. Although there is decades' worth of evidence demonstrating the success of blister packaging, utilization outside of the long-term care setting in the US is limited, likely due to the fragmentation of the health care system. Even though putting medications in blister packs has the potential to improve outcomes, pharmacies are the institutions that would have to implement this initiative while not seeing the financial savings from the reduced health care costs. Although it may improve their patients' outcomes, they would not be capturing the cost savings required to implement a potential new workflow and/or offset additive costs. Therefore, payers should consider incentivizing pharmacies to put medications in blister packs. Because payers would realize cost savings from the reduction in health care costs, they could reinvest some of that money toward blister packaging at their pharmacies and/or provide preferred contracting and network status for independent pharmacies that blister-package medications to help improve their population's health.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"261-264"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477752","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

Breast cancer and the use of predictive genomics. 乳腺癌和预测性基因组学的应用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89763

Sadie Dobrozsi

引用次数: 0

Unmet health care and health-related social needs of laundromat users. 洗衣店使用者未得到满足的保健和与健康有关的社会需要。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-05-01 DOI: 10.37765/ajmc.2025.89733

Lindsey Jeanne Leininger, Courtney Bragg, Allister Chang, Andrea Palm

{"title":"Unmet health care and health-related social needs of laundromat users.","authors":"Lindsey Jeanne Leininger, Courtney Bragg, Allister Chang, Andrea Palm","doi":"10.37765/ajmc.2025.89733","DOIUrl":"10.37765/ajmc.2025.89733","url":null,"abstract":"Objectives: To estimate the prevalence of unmet health care and health-related social needs (HRSNs) among laundromat users and examine differences by health insurance coverage.Study design: Cross-sectional observational study.Methods: We collected a survey from participants in a pilot intervention conducted in 14 Pennsylvania laundromats between September and December 2023. The measures included health insurance coverage, unmet health care needs, and unmet HRSNs. Descriptive analyses and linear probability regression models with laundromat fixed effects were used to estimate the overall prevalence of unmet needs and explore subgroup differences.Results: Among the 1995 sample members, approximately half (52.9%) had Medicaid coverage, 21.7% had private coverage, 14.5% were uninsured, 5.4% had Medicare, and 5.5% were dually enrolled in Medicare and Medicaid. The prevalence of having any unmet HRSN was higher than having any unmet health care need (54.3% vs 12.3%). Across unmet need measures, Medicaid sample members had 1.5 to 5 times higher levels relative to the privately insured. Differences by insurance coverage remained in fixed-effects analyses that limited comparisons to laundromat users at the same location.Conclusions: Laundromat-based outreach is likely most promising for Medicaid-serving stakeholders because Medicaid enrollees are disproportionately represented among laundromat users and have disproportionately high levels of unmet needs.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"233-239"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095777","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

Longitudinal, relationship-based case management: a prospective cohort trial. 纵向、基于关系的病例管理：一项前瞻性队列试验。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-05-01 DOI: 10.37765/ajmc.2025.89731

Patrick Runnels, Ryan Muskin, Mark Votruba, Peter J Pronovost, Afua Ansah, James Penman

{"title":"Longitudinal, relationship-based case management: a prospective cohort trial.","authors":"Patrick Runnels, Ryan Muskin, Mark Votruba, Peter J Pronovost, Afua Ansah, James Penman","doi":"10.37765/ajmc.2025.89731","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89731","url":null,"abstract":"Objectives: This study addresses the challenge of improving outcomes for the 5% of individuals with complex chronic diseases who utilize 50% of health care resources. Previous interventions targeting this population have shown limited impact, often due to transactional and time-limited approaches. This study proposes a longitudinal, relationship-based case management framework as an alternative solution.Study design: A nonrandomized, prospective cohort study was conducted among Medicaid enrollees with complex medical and social needs.Methods: The intervention involved case managers building strong interpersonal relationships over a minimum of 1 year, addressing barriers to care and facilitating solutions. Primary outcomes were total health care expenditures and patient-rated quality of life.Results: The intervention group exhibited a significant reduction in total health care costs over 1 year ($8568 per patient), with greater savings observed for patients with higher preintervention costs. Additionally, an estimated annual savings net of program costs of $248,121 was observed. Patient-rated quality of life showed substantial improvement, evident at both 6 months and 1 year post enrollment.Conclusions: This study demonstrates the effectiveness of a longitudinal, relationship-based case management approach in improving outcomes for individuals with complex medical, social, and behavioral needs. Unlike transactional interventions, this approach emphasizes partnership and customization, yielding substantial cost reductions and enhanced quality of life. Although limitations exist, including nonrandomization and staff diversity, this study provides a foundation for future research and scalability of similar interventions.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"216-221"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095759","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

Using data exchange to improve quality reporting, target outreach, and reduce cost. 使用数据交换来改进质量报告、目标扩展和降低成本。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-05-01 DOI: 10.37765/ajmc.2025.89738

Barbara Rubino, Chelsea Hart-Connor, Todd A May

{"title":"Using data exchange to improve quality reporting, target outreach, and reduce cost.","authors":"Barbara Rubino, Chelsea Hart-Connor, Todd A May","doi":"10.37765/ajmc.2025.89738","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89738","url":null,"abstract":"The burden of collecting data and reporting on quality measures is a strain on both providers and payers, exacerbated by the multitude of required metrics and disparate data systems. Covered California, the California health benefits exchange that supports more than 1.9 million Californians receiving insurance through the Affordable Care Act, and insurance carrier Health Net, serving approximately 138,000 members on the exchange, implemented a novel approach to data exchange using Covered California's all-payer claims database (APCD). This initiative used historical cancer screening data for Health Net enrollees who had been insured under different Covered California plans in the prior 5 years and analyzed the impact of historical data sharing on screening rates, cost, and efficiency. Historical data exchange led to improved accuracy of quality measure reporting by up to 14% in breast cancer screening quality scores. Additionally, through reduced administrative costs and the elimination of duplicative testing, Health Net saw more than $640,000 in estimated potential cost savings. The success of the pilot between Covered California and Health Net has led to an expansion across all carriers, highlighting the potential of APCDs to facilitate more targeted quality improvement strategies and improve efficiency in health care. This initiative underscores the importance of innovative data exchange strategies to advance health care quality, efficiency, and equity.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"e138-e140"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095778","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