American Journal of Managed Care最新文献_第3页

COPD treatment ratio: a measure for improving COPD population health. 慢性阻塞性肺疾病治疗比率：改善慢性阻塞性肺疾病人群健康的衡量标准。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-09-01 DOI: 10.37765/ajmc.2024.89603

Megha A Parikh, Sabree C Burbage, Meghan H Gabriel, Ben E Shirley, Patrick J Campbell

{"title":"COPD treatment ratio: a measure for improving COPD population health.","authors":"Megha A Parikh, Sabree C Burbage, Meghan H Gabriel, Ben E Shirley, Patrick J Campbell","doi":"10.37765/ajmc.2024.89603","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89603","url":null,"abstract":"Objectives: Despite chronic obstructive pulmonary disease (COPD) being a leading cause of death in the US, there are few COPD measures in current quality programs. The objective of this study was to assess the validity and applicability of the COPD treatment ratio (CTR) as a surrogate marker of COPD exacerbation risk for use in quality measurement. CTR is defined as the ratio of COPD maintenance medications to all COPD medications (maintenance and rescue).Study design: This retrospective cohort study used 2016-2019 administrative claims from Optum Clinformatics Data Mart to evaluate CTR values over a 12-month baseline period, with exacerbations measured the following year. Patients 40 years or older with Medicare Advantage or commercial insurance and with a COPD diagnosis were included.Methods: Logistic regression models were used to examine relationships between CTR values and COPD exacerbations. Prediction model performance was evaluated using C statistics, and receiver operating characteristics were used to determine the optimal cut point for CTR.Results: Of 132,960 patients included in the analysis, 79.5% were Medicare Advantage beneficiaries, and the mean age was 69.6 years. Higher CTR values were significantly associated with reduced risk of any, moderate, and severe exacerbations in the total population and when stratified by insurance type. CTR performed fairly to moderately well in predicting COPD exacerbations. The optimal cut point for COPD exacerbation prediction was 0.7.Conclusions: Study results substantiated CTR as a valid measure of COPD exacerbation risk and support the use of CTR in quality improvement to drive evidence-based care for individuals with COPD.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300104","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

Telehealth insights from an integrated care system. 来自综合医疗系统的远程医疗见解。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-09-01 DOI: 10.37765/ajmc.2024.89609

Rebecca Flournoy, Reema Shah, Elizabeth Moisan, Cecilia Oregón

{"title":"Telehealth insights from an integrated care system.","authors":"Rebecca Flournoy, Reema Shah, Elizabeth Moisan, Cecilia Oregón","doi":"10.37765/ajmc.2024.89609","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89609","url":null,"abstract":"The COVID-19 pandemic accelerated telehealth expansion trends as policy makers instituted flexibilities and coverage changes. Federal telehealth flexibilities expire, however, at the end of 2024. To decide whether to extend those flexibilities, policy makers need information about consumer telehealth preferences, impacts of telehealth on care usage and quality, and telehealth accessibility for the full diversity of patients. Research from one of the nation's largest integrated, value-based health systems provides insights. Findings suggest that telehealth utilization has dropped since the peak of the pandemic but remains higher than prepandemic levels. Telehealth appears to be replacing in-person visits rather than leading to more total visits. Patients generally prefer in-person care but many like having the option to use video- and phone-based telehealth, and both video- and phone-based care appear to be helping patients access primary care. An integrated, value-based care approach may assist a diverse range of patients in accessing telehealth services. Action is still needed, however, to ensure that the full diversity of patients can easily access telehealth offerings. Based on experiences within our health system, we recommend that policy makers maintain public and private payer coverage for video- and phone-based telehealth services; encourage well-designed value-based payment models to simplify and expand telehealth access; improve broadband accessibility and broadband and device affordability so that all patients can access telehealth services; and hold digital health to equivalent high standards for care quality, safety, patient satisfaction, clinical outcomes, and health equity as in-person care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300112","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

Systemic treatments for advanced prostate cancer: relationship between health insurance plan and treatment costs. 晚期前列腺癌的系统治疗：医疗保险计划与治疗费用之间的关系。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-09-01 DOI: 10.37765/ajmc.2024.89606

Deborah R Kaye, Hui-Jie Lee, Alexander Gordee, Daniel J George, Charles D Scales, Peter A Ubel, M Kate Bundorf

{"title":"Systemic treatments for advanced prostate cancer: relationship between health insurance plan and treatment costs.","authors":"Deborah R Kaye, Hui-Jie Lee, Alexander Gordee, Daniel J George, Charles D Scales, Peter A Ubel, M Kate Bundorf","doi":"10.37765/ajmc.2024.89606","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89606","url":null,"abstract":"Objectives: The high costs of cancer care can cause significant harm to patients and society. Prostate cancer, the leading nonskin malignancy in men, is responsible for the second-highest out-of-pocket (OOP) payments among all malignancies. Multiple first-line treatment options exist for metastatic castration-resistant prostate cancer (mCRPC); although their costs vary substantially, comparative effectiveness data are limited. There is little evidence of how gross payments made by insurers and OOP payments made by patients differ by treatment and health plan type and how these payment differences relate to utilization.Study design: Retrospective cohort study.Methods: We used IBM MarketScan databases from 2013-2019 to identify men with prostate cancer who initiated treatment with 1 of 6 drugs approved for first-line treatment of mCRPC. We calculated and compared gross and OOP payments and drug utilization across drug and insurance plan types.Results: We identified 4298 patients who met our inclusion criteria. Insurer payments varied substantially by first-line therapy but were similar across different health plan types, except for docetaxel. OOP payments for a given first-line therapy, in contrast, varied by health plan type. Utilization of first-line therapies varied by plan type in unadjusted analyses, but not after adjusting for patient characteristics.Conclusions: The extent to which patient OOP payments for drugs reflect differences in gross payments made by insurers varies across health insurance plan types. However, even though OOP payments for the same treatment differ across plan types, treatment choice is not significantly different across type of health insurance after controlling for patient characteristics.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300107","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

The feasibility and equity of text messaging to determine patient eligibility for lung cancer screening. 用短信确定患者是否符合肺癌筛查条件的可行性和公平性。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-09-01 DOI: 10.37765/ajmc.2024.89602

Ilona Fridman, Lisa Carter-Bawa, Christine M Neslund-Dudas, Jennifer Elston Lafata

{"title":"The feasibility and equity of text messaging to determine patient eligibility for lung cancer screening.","authors":"Ilona Fridman, Lisa Carter-Bawa, Christine M Neslund-Dudas, Jennifer Elston Lafata","doi":"10.37765/ajmc.2024.89602","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89602","url":null,"abstract":"Objectives: Text messaging could be effective for determining patient eligibility for lung cancer screening (LCS). We explored people's willingness to share their tobacco use history via text message among diverse groups.Study design: Cross-sectional survey.Methods: In 2020, we conducted a cross-sectional survey asking respondents about cellular phone usage, smoking habits, sociodemographic characteristics, and the likelihood of responding to a text message from their health care provider's office about tobacco use. We used χ² and analysis of variance tests for comparisons.Results: Among 745 respondents, 90% used text messaging casually. Overall, 54% never smoked, 33% currently smoked, and 13% previously smoked. Six percent were LCS eligible, and 20% used both cigarettes and e-cigarettes (dual users). Current smokers were significantly younger, less likely to be female, and more likely to use text messaging. LCS-eligible respondents were older and less likely to have a high income. Dual users were younger, less likely to report female gender and live in rural areas, and more likely to have a college education and high income. Most respondents (83%) indicated they were likely to respond to text message inquiries regarding smoking status. Middle-aged respondents (mean age, 37 years) were significantly more willing to report smoking status than younger or older respondents (91% vs 84% and 84%, respectively). Respondents with no college education (83% vs 88%) or with a low income vs a middle or high income (81% vs 86% and 88%, respectively) were significantly less willing to report smoking status via text messages.Conclusions: Text messaging showed promise for evaluating smoking history and for simplifying the process of identifying LCS-eligible individuals. However, achieving equity in identifying eligibility for LCS requires the implementation of multimodal strategies.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142300108","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

It's time to address our nation's health care price crisis. 是时候解决我国的医疗价格危机了。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-09-01 DOI: 10.37765/ajmc.2024.89598

Guy D'Andrea, Torie Nugent-Peterson

引用次数: 0

The accelerated approval program for oncology drugs: celebrating more than 250,000 life-years gained and counting. 肿瘤药物加速审批计划：庆祝超过 25 万个生命年的增长。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-08-01 DOI: 10.37765/ajmc.2024.89590

Julie Patterson, John Michael O'Brien, Jonathan D Campbell

引用次数: 0

Geographic variability of Medicaid acceptance among allergists in the US. 美国过敏症医生接受医疗补助的地域差异。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-08-01 DOI: 10.37765/ajmc.2024.89588

Frances O Ho, Chaoyi Zheng, Mech Frazier, Sai R Nimmagadda, Ruchi S Gupta, Lucy A Bilaver

{"title":"Geographic variability of Medicaid acceptance among allergists in the US.","authors":"Frances O Ho, Chaoyi Zheng, Mech Frazier, Sai R Nimmagadda, Ruchi S Gupta, Lucy A Bilaver","doi":"10.37765/ajmc.2024.89588","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89588","url":null,"abstract":"Objective: To determine the geographic variability of Medicaid acceptance among allergists in the US.Study design: Geospatial analysis predicted Medicaid acceptance across space, and a multivariable regression identified area-level population demographic variables associated with acceptance.Methods: We used the National Plan & Provider Enumeration System database to identify allergists. Medicaid acceptance was determined from lists or search engines from state Medicaid offices and calls to provider offices. Spatial analysis was performed using the empirical Bayesian kriging tool. Multivariate logistic regression was used to identify county-level characteristics associated with provider Medicaid acceptance.Results: Of 5694 allergists, 55.5% accepted Medicaid. Acceptance in each state ranged from 13% to 90%. Washington, Arizona, and the Northeast had lowest predicted proportion of both Medicaid acceptance and Medicaid acceptance per 10,000 enrollees. Overall, county-level characteristics were not associated with the likelihood of accepting Medicaid in multivariate analyses. Only the percentage of individuals living in poverty was associated with a higher likelihood of providers accepting Medicaid (OR, 1.245; 95% CI, 1.156-1.340; P < .001).Conclusions: A barrier to accessing allergy-related health care is finding a provider who accepts a patient's insurance, which is largely variable by state. Lack of access to allergy care likely affects health outcomes for children with prevalent atopic conditions such as food allergy.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989463","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

Cross-validation of insurer and hospital price transparency data. 保险公司和医院价格透明度数据的交叉验证。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-08-01 DOI: 10.37765/ajmc.2024.89594

Morgan A Henderson, Morgane C Mouslim

引用次数: 0

Hospitals' strategies to reduce costs and improve quality: survey of hospital leaders. 医院降低成本和提高质量的策略：对医院领导的调查。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-08-01 DOI: 10.37765/ajmc.2024.89593

Gmerice Hammond, Tierney Lanter, Fengxian Wang, R J Waken, Jie Zheng, Arnold M Epstein, E John Orav, Karen E Joynt Maddox

{"title":"Hospitals' strategies to reduce costs and improve quality: survey of hospital leaders.","authors":"Gmerice Hammond, Tierney Lanter, Fengxian Wang, R J Waken, Jie Zheng, Arnold M Epstein, E John Orav, Karen E Joynt Maddox","doi":"10.37765/ajmc.2024.89593","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89593","url":null,"abstract":"Objectives: Hospitals in the US operate under various value-based payment programs, but little is known regarding the strategies they use in this context to improve quality and reduce costs, overall or in voluntary programs including Bundled Payments for Care Improvement Advanced (BPCI-A).Study design: A survey was administered to hospital leaders at 588 randomly selected acute care hospitals, with oversampling of BPCI-A participants, from November 2020 to June 2021. Twenty strategies and 20 barriers were queried in 4 domains: inpatient, postacute, outpatient, and community resources for vulnerable patients.Methods: Summary statistics were tabulated, and responses were adjusted for sampling strategy and nonresponse.Results: There were 203 respondents (35%), of which 159 (78%) were BPCI-A participants and 44 (22%) were nonparticipants. On average, respondents reported implementing 89% of queried strategies in the inpatient domain, such as care pathways or predictive analytics; 65% of postacute strategies, such as forming partnerships with skilled nursing facilities; 84% of outpatient strategies, such as scheduling close follow-up to prevent emergency department visits/hospitalizations; and 82% of strategies aimed at high-risk populations, such as building connections with community resources. There were no differences between BPCI-A and non-BPCI-A hospitals in 19 of 20 care redesign strategies queried. However, 78.3% of BPCI-A-participating hospitals reported programs aimed at reducing utilization of skilled nursing and inpatient rehabilitation facilities compared with 37.6% of non-BPCI-A hospitals (P < .0001).Conclusions: Hospitals pursue a broad range of efforts to improve quality. BPCI-A hospitals have attempted to reduce use of postacute care, but otherwise the strategies they pursue are similar to other hospitals.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989464","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

Adherence patterns 1 year after initiation of SGLT2 inhibitors: results of a national cohort study. 开始使用 SGLT2 抑制剂 1 年后的依从性模式：一项全国队列研究的结果。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-08-01 DOI: 10.37765/ajmc.2024.89591

Hsiao-Ching Huang, Daniel R Touchette, Mina Tadrous, Glen T Schumock, Saria Awadalla, Todd A Lee

{"title":"Adherence patterns 1 year after initiation of SGLT2 inhibitors: results of a national cohort study.","authors":"Hsiao-Ching Huang, Daniel R Touchette, Mina Tadrous, Glen T Schumock, Saria Awadalla, Todd A Lee","doi":"10.37765/ajmc.2024.89591","DOIUrl":"10.37765/ajmc.2024.89591","url":null,"abstract":"Objectives: Adherence to medications is important for the management of chronic diseases. Although the proportion of days covered (PDC) is a common metric for measuring adherence, it may be insufficient to distinguish relevant differences in medication-taking behavior. Group-based trajectory models (GBTMs) have been used to better represent adherence over time. This study aims to examine adherence patterns 1 year after initiation among users of sodium-glucose cotransporter 2 (SGLT2) inhibitors using GBTMs and evaluate the ability of baseline characteristics to predict adherence trajectory.Study design: SGLT2 inhibitor new-user cohort study from 2014 to 2018.Methods: We calculated 12-month PDC and categorized patients with PDC of 80% or greater as adherent. We performed multivariable logistic regression on adherence status controlling for baseline covariates. GBTMs were fit to identify adherence patterns 12 months following SGLT2 inhibitor initiation. Five multinomial logistic regression models including different subsets of predictors were used to predict adherence trajectory group assignment.Results: In a cohort of 228,363 SGLT2 inhibitor users, the mean PDC was 57%, with 36% of the cohort being adherent. Overall, women and patients with anxiety or depression were less likely to be adherent. Six patterns of SGLT2 inhibitor adherence were identified with GBTMs: 1 fill (PDC = 0.08), early discontinuation (PDC = 0.22), consistently low adherence (PDC = 0.35), moderate adherence (PDC = 0.48), high adherence (PDC = 0.79), and near-perfect adherence (PDC = 0.95). All prediction models showed poor predictive accuracy (0.35).Conclusions: We found wide variation in adherence patterns among SGLT2 inhibitor users in a national cohort. Predictors from a health care claims database were unable to accurately predict adherence trajectory.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989459","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