American Journal of Managed Care最新文献

{"title":"Utilization of low- and high-value health care by individuals with and without cognitive impairment.","authors":"Douglas Barthold, Shangqing Jiang, Anirban Basu, Elizabeth A Phelan, Stephen Thielke, Soo Borson, A Mark Fendrick","doi":"10.37765/ajmc.2024.89580","DOIUrl":"10.37765/ajmc.2024.89580","url":null,"abstract":"<p><strong>Objectives: </strong>Cognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia.</p><p><strong>Study design: </strong>Retrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018).</p><p><strong>Methods: </strong>We examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition.</p><p><strong>Results: </strong>Receipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P = .047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P = .029], statins [32-percentage-point reduction; P = .045], and antiresorptive therapy [61-percentage-point reduction; P = .019]).</p><p><strong>Conclusions: </strong>LV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11429857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602117","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}

{"title":"Quantifying the insurance value for rare diseases: Duchenne muscular dystrophy.","authors":"Jason Shafrin, Suhail Thahir, Alexa C Klimchak, Ivana Audhya, Lauren E Sedita, John A Romley","doi":"10.37765/ajmc.2024.89584","DOIUrl":"10.37765/ajmc.2024.89584","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the magnitude of an ISPOR novel value element, insurance value, as applied to new treatments for a rare, severe disease with pediatric onset: Duchenne muscular dystrophy (DMD).</p><p><strong>Study design: </strong>Prospective survey of individuals planning to have children in the future.</p><p><strong>Methods: </strong>A survey was administered to US adults (aged ≥ 21 years) planning to have a child in the future to elicit willingness to pay (WTP) for insurance coverage for a new hypothetical DMD treatment that improved mortality and morbidity relative to the current standard of care. To identify an indifference point between status quo insurance and insurance with additional cost that would cover the treatment if respondents had a child with DMD, a multiple random staircase design was used. Insurance value-the value individuals receive from a reduction in future health risks-was calculated as the difference between respondent's WTP and what a risk-neutral individual would pay. The risk-neutral value was the product of the (1) probability of having a child with DMD (decision weighted), (2) quality-adjusted life-years (QALYs) gained from the new treatment, and (3) WTP per QALY.</p><p><strong>Results: </strong>Among 207 respondents, 80.2% (n = 166) were aged 25 to 44 years, and 59.9% (n = 124) were women. WTP for insurance coverage of the hypothetical treatment was $973 annually, whereas the decision-weighted risk-neutral value was $452 per year. Thus, insurance value constituted 53.5% ($520) of value for new DMD treatments.</p><p><strong>Conclusions: </strong>Individuals planning to have children in the future are willing to pay more for insurance coverage of novel DMD treatments than is assumed under risk-neutral, QALY-based frameworks.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602113","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}

{"title":"Unfulfilled home health referrals lead to higher mortality among Medicare Advantage members.","authors":"Elan Gada, Paul Pangburn, Chris Sahr, Chad P Schaben, Richard Young","doi":"10.37765/ajmc.2024.89579","DOIUrl":"10.37765/ajmc.2024.89579","url":null,"abstract":"<p><strong>Objectives: </strong>Medicare Advantage (MA) members referred to home health after inpatient hospitalization may or may not receive these services for a variety of member- and health care system-related reasons. Our objective was to compare outcomes among MA members referred to home health following hospitalization who receive home health services vs those who do not.</p><p><strong>Study design: </strong>Retrospective quasi-experimental study.</p><p><strong>Methods: </strong>Following acute hospitalization, members with discharge orders to receive home health services between January 2021 and October 2022 were identified in a medical claims database consisting of MA beneficiaries. Members who received services within 30 days of discharge were balanced using inverse propensity score weighting on member- and admission-related covariates with a comparator group of members who did not receive services. Primary outcomes included mortality and readmissions in the ensuing 30, 90, and 180 days. Secondary outcomes included emergency department visits, primary care visits, and per-member per-month costs.</p><p><strong>Results: </strong>The home health-treated group consisted of 2115 discharges, and the untreated group consisted of 761 discharges. The treated group experienced lower mortality at 30 days (2% vs 3%, respectively; OR, 0.58; 95% CI, 0.36-0.92), 90 days (8% vs 10%; OR, 0.77; 95% CI, 0.60-0.98), and 180 days (11% vs 14%; OR, 0.81; 95% CI, 0.65-0.99). The treated group also experienced higher readmissions at 30 days (13% vs 10%; OR, 1.26; 95% CI, 1.01-1.60), 90 days (24% vs 16%; OR, 1.69; 95% CI, 1.39-2.05), and 180 days (33% vs 24%; OR, 1.52; 95% CI, 1.29-1.79).</p><p><strong>Conclusion: </strong>MA members referred to home health after acute hospitalization who did not receive home health services had higher mortality.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602116","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}

{"title":"Patient satisfaction with letter-based communication of LCS pulmonary nodule results.","authors":"Daoyue Wang, Rui Shi, Lili Hu, Ran Chen, Jun Sun, Wei Huang, Hongyang Zhou, Feng Rong","doi":"10.37765/ajmc.2024.89581","DOIUrl":"10.37765/ajmc.2024.89581","url":null,"abstract":"<p><strong>Objective: </strong>To analyze patient satisfaction with letter-based communication of lung cancer screening (LCS) pulmonary nodule results.</p><p><strong>Study design: </strong>Prospective randomized controlled trial of LCS between May and December 2019.</p><p><strong>Methods: </strong>All participants came from a prospective randomized controlled study on pulmonary nodule results in LCS with low-dose CT (LDCT) to analyze patient satisfaction, perception of information received via letters, preferred methods of receiving results, and dissatisfaction-related characteristics.</p><p><strong>Results: </strong>A total of 153 patients were detected to have pulmonary nodules among 600 recruited participants in the lung cancer high-risk group screened using LDCT. Most of the patients were satisfied with receiving pulmonary nodule results via letters (78.4%; n = 120) and agreed that the letters contained an appropriate amount of information (83.7%; n = 128). Univariate logistic regression analysis revealed that satisfaction was related to age (OR, 0.905; 95% CI, 0.832-0.985), education level (OR, 0.367; 95% CI, 0.041-3.250), no family history of cancer (OR, 0.100; 95% CI, 0.011-0.914), and the number of nodules (OR, 6.028; 95% CI, 1.641-22.141). Of the patients who reported dissatisfaction with letter-based communication (7.2%; n = 11), the most common reasons cited were that they contained insufficient patient education materials and that it was difficult to comprehend the medical terminology. The majority of participants (61.4%; n = 94) reported that they would prefer the letter-based communication. No correlation was identified between satisfaction and gender, smoking status, alcohol consumption, risk factors, nodule size, or nodule location.</p><p><strong>Conclusions: </strong>Patients were generally satisfied with receiving their LCS pulmonary nodule results via letters, reporting that the letters included adequate information about their diagnosis and follow-up steps. This may provide a basis for feasible result communication via letters for cancer screening programs in underdeveloped regions in China.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602112","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}

{"title":"Factors associated with primary care physician turnover in the VA.","authors":"Leah M Marcotte, Charles Maynard, Ashok Reddy, Seppo T Rinne, Ryan Sterling, Peter J Kaboli, Edwin S Wong","doi":"10.37765/ajmc.2024.89527","DOIUrl":"10.37765/ajmc.2024.89527","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the association between primary care team workload satisfaction and primary care physician (PCP) turnover and examine potential mediation of workplace climate factors using survey and administrative data.</p><p><strong>Study design: </strong>Longitudinal observational study using data from 2008 to 2016.</p><p><strong>Methods: </strong>The outcome variable was PCP turnover. The main explanatory variable was satisfaction with amount of workload. We included 7 additional workplace climate measures (eg, satisfaction with direct supervision) as mediators. We included characteristics of PCPs (eg, PCP years of experience, gender), salary, and clinic factors (eg, urban vs rural geography, community vs hospital based) as covariates.</p><p><strong>Results: </strong>US Department of Veterans Affairs (VA) PCPs working at 787 VA primary care clinics nationally were recruited for this study. Over the 9-year study period, 8362 unique PCPs were employed in the VA. The unadjusted mean quarterly turnover rate was 1.83%, and the mean (SD) workload satisfaction score was 3.58 ( 0.24) on a 5-point Likert scale over the study period. In adjusted analysis, a 1-point increase in workload satisfaction was associated with a decrease of 0.73 (95% CI, 0.36-1.10) percentage points in the probability of turnover in a calendar quarter. In the mediation analysis, we found that workload satisfaction impacted turnover through only 1 of the 7 workplace climate measures: satisfaction with direction by senior managers.</p><p><strong>Conclusions: </strong>Our study findings highlight the key role that achieving primary care workload satisfaction can play in reducing PCP turnover. Identification of direction by senior managers as an underlying mechanism is an important finding for strategic planning to mitigate PCP turnover.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602110","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}

{"title":"Reducing low-value care is a feasible approach to enhancing access and affordability of high-value care for older Americans.","authors":"Michelle S Rockwell, A Mark Fendrick","doi":"10.37765/ajmc.2024.89577","DOIUrl":"10.37765/ajmc.2024.89577","url":null,"abstract":"<p><p>The authors advocate for a strategy that reallocates the substantial workforce effort and financial resources currently devoted to low-value care to enhance access and affordability of high-value services.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602114","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}

{"title":"Budget impact analysis of biosimilar natalizumab in the US.","authors":"Edward Li, Adrian Goh, Soni Gupta, Marion Schauf, Anna Chen, Daniel M Hartung","doi":"10.37765/ajmc.2024.89558","DOIUrl":"10.37765/ajmc.2024.89558","url":null,"abstract":"<p><strong>Objectives: </strong>Biosimilars provide an opportunity for a more sustainable and cost-effective treatment for multiple sclerosis (MS). This study evaluated the potential financial impact of implementing a formulary change from reference to biosimilar natalizumab (NTZ) from the US commercial payer perspective.</p><p><strong>Study design: </strong>The budget impact of transitioning to biosimilar NTZ for the treatment of relapsing-remitting MS (RRMS) was estimated over a 3-year time horizon based on real-world dosing. Additional scenario analyses were conducted by varying the price differential of biosimilar NTZ.</p><p><strong>Methods: </strong>The target population was estimated from a 1-million-member hypothetical commercial health plan. Model inputs were drug acquisition costs and treatment-related and patient coinsurance costs. Budget impact and cost savings per member per year were calculated by assuming a biosimilar uptake of 10% in year 1 to 20% in year 3.</p><p><strong>Results: </strong>Over 3 years, 255 patients were estimated to be treated with high-efficacy disease-modifying therapies for RRMS. The inclusion of biosimilar NTZ onto a formulary would result in cumulative cost savings to payers of $452,611 over 3 years, with mean savings per treated member per year of $1179, $1769, and $2359 in years 1, 2, and 3, respectively. One-way sensitivity analyses indicated that budget impact results were most sensitive to drug acquisition costs of both reference and biosimilar NTZ.</p><p><strong>Conclusion: </strong>Adoption of biosimilar NTZ can yield considerable cost savings to US health plans that could result in increased treatment access for patients with RRMS.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602086","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}

{"title":"Financial crossroads of care: physicians' struggle and patient outcomes.","authors":"Sammer Marzouk, Lucy Tu, Fatima Cody Stanford","doi":"10.37765/ajmc.2024.89578","DOIUrl":"10.37765/ajmc.2024.89578","url":null,"abstract":"<p><p>In 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11392557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602111","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}

{"title":"Clinician characteristics associated with fluoride varnish applications during well-child visits.","authors":"Kun Li, Annie Yu-An Chen, Kimberley H Geissler, Andrew W Dick, Ashley M Kranz","doi":"10.37765/ajmc.2024.89582","DOIUrl":"10.37765/ajmc.2024.89582","url":null,"abstract":"<p><strong>Objectives: </strong>To identify factors associated with clinicians' likelihood and intensity of applying fluoride varnish (FV) overall and for visits paid by Medicaid and private insurers.</p><p><strong>Study design: </strong>Observational study using claims data.</p><p><strong>Methods: </strong>Using the Massachusetts All-Payer Claims Database (2016-2018), we conducted a repeated cross-sectional study of 2911 clinicians (7277 clinician-year observations) providing well-child visits to children aged 1 to 5 years. Zero-inflated negative binomial models estimated the probability of a clinician applying FV and the number of visits with FV applications, overall and separately for visits paid by Medicaid and private insurers.</p><p><strong>Results: </strong>A total of 30.9% of clinician-years applied FV at least once, and overall, an average of 8.4% of a clinician's well-child visits included FV annually. Controlling for all covariates, having a higher percentage of patients insured by Medicaid was associated with applying FV (OR, 1.35; 95% CI, 1.23-1.45) and a higher expected number of applications (OR, 1.05; 95% CI, 1.02-1.09). Additionally, having a higher percentage of patients aged 1 to 5 years was associated with applying FV (OR, 1.20; 95% CI, 1.01-1.43), but not the number of applications. Similar associations were observed among visits paid by private insurers.</p><p><strong>Conclusions: </strong>Despite clinical recommendations and mandated insurance reimbursements, the likelihood and intensity of FV applications was low for most pediatric primary care clinicians. Clinician behavior was associated with patient-panel characteristics, suggesting the need for interventions that account for these differences.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11476784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141602087","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}

{"title":"Smarter continuity in an era of expanding challenges in primary care.","authors":"Nicole M Benson, A Mark Fendrick","doi":"10.37765/ajmc.2024.89508","DOIUrl":"10.37765/ajmc.2024.89508","url":null,"abstract":"<p><p>If we are to achieve the clinical and economic benefits of primary care and care continuity, the implementation and evaluation of strategies that reward clinicians and patients are warranted.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443684","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}