American Journal of Managed Care最新文献

{"title":"Reducing readmissions in the safety net through AI and automation.","authors":"Daniel J Bennett, Jean Feng, Seth Goldman, Avni Kothari, Laura M Gottlieb, Matthew S Durstenfeld, James Marks, Susan Ehrlich, Jonathan Davis, Lucas S Zier","doi":"10.37765/ajmc.2025.89697","DOIUrl":"10.37765/ajmc.2025.89697","url":null,"abstract":"<p><strong>Objectives: </strong>To implement a technology-based, systemwide readmission reduction initiative in a safety-net health system and evaluate clinical, care equity, and financial outcomes.</p><p><strong>Study design: </strong>Retrospective interrupted time series analysis between October 2015 and January 2023.</p><p><strong>Methods: </strong>The readmission reduction initiative standardized inpatient care for patients through a novel, electronic health record-integrated, digitally automated point-of-care decision-support tool. A predictive artificial intelligence algorithm was utilized to identify patients at the highest risk of readmission in both the inpatient and outpatient settings, allowing a population health team to perform proactive outpatient management in medical and social domains to avoid readmission.</p><p><strong>Results: </strong>Readmission rates declined from 27.9% in the preimplementation period to 23.9% in the postimplementation period ( P  < .004) by the end of 2023. A significant gap in readmission rates between Black/African American patients and the general population was eliminated over the course of the evaluation period. Survival analysis demonstrated a reduction in all-cause mortality in the postimplementation period (HR, 0.82; 95% CI, 0.68-0.99; P  = .037). Improvement in readmission rates allowed the health system to retain $7.2 million of at-risk pay-for-performance funding.</p><p><strong>Conclusions: </strong>This technology-based readmission reduction initiative demonstrated efficacy in reducing readmission rates, closing equity gaps, improving survival, and leading to a positive financial impact in a safety-net health system. This approach could be an effective model of technology-based, value-based care for other resource-limited health systems to meet pay-for-performance metrics and retain at-risk funding while improving clinical and equity outcomes.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"142-148"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575956","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":"Improving system-based tobacco cessation in a community health clinic.","authors":"Iqra Ahmad, Janine Bera, Neal D Kohatsu, Julia E Fleuret, Erin L Winter, Jeffrey S Hoch, Desiree R Backman","doi":"10.37765/ajmc.2025.89707","DOIUrl":"10.37765/ajmc.2025.89707","url":null,"abstract":"<p><p>Tobacco use rates remain high in many subpopulations (eg, low-income individuals) who experience several addressable health inequities. Community clinics are ideal sites to address these inequities because of their traditional service populations, commitment to prevention, and links to their communities. We present a case study of one such clinic's strategies to improve system-based tobacco cessation and discuss observed gains in relevant quality improvement metrics.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 3","pages":"SP139-SP144"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626761","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":"Health equity in the era of large language models.","authors":"Aaron A Tierney, Mary E Reed, Richard W Grant, Florence X Doo, Denise D Payán, Vincent X Liu","doi":"10.37765/ajmc.2025.89695","DOIUrl":"10.37765/ajmc.2025.89695","url":null,"abstract":"<p><p>This commentary presents a summary of 8 major regulations and guidelines that have direct implications for the equitable design, implementation, and maintenance of health care-focused large language models (LLMs) deployed in the US. We grouped key equity issues for LLMs into 3 domains: (1) linguistic and cultural bias, (2) accessibility and trust, and (3) oversight and quality control. Solutions shared by these regulations and guidelines are to (1) ensure diverse representation in training data and in teams that develop artificial intelligence (AI) tools, (2) develop techniques to evaluate AI-enabled health care tool performance against real-world data, (3) ensure that AI used in health care is free of discrimination and integrates equity principles, (4) take meaningful steps to ensure access for patients with limited English proficiency, (5) apply AI tools to make workplaces more efficient and reduce administrative burdens, (6) require human oversight of AI tools used in health care delivery, and (7) ensure AI tools are safe, accessible, and beneficial while respecting privacy. There is an opportunity to prevent further embedding of existing disparities and issues in the health care system by enhancing health equity through thoughtfully designed and deployed LLMs.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"112-117"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12085167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576003","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":"Improving pain clinic outcomes with preappointment surveys: data-driven policy change.","authors":"William S Frye, Emily Foard, Jonathan T Rawlins, Kym Householder, Giovanni Cucchiaro","doi":"10.37765/ajmc.2025.89705","DOIUrl":"10.37765/ajmc.2025.89705","url":null,"abstract":"<p><strong>Objectives: </strong>Previous research has demonstrated that having patients complete an optional preappointment survey can increase their likelihood of attending their appointment. However, there is no literature examining how requiring preappointment engagement affects outcomes. The current study aimed to investigate the impact of mandatory preappointment surveys on patient show rates and wait-list times and provide guidance for implementing data-driven policy change.</p><p><strong>Study design: </strong>This study examined show rates and wait-list times during the 1 year before and 1 year following a policy change requiring new patients to complete preappointment surveys before they are scheduled. The χ2 test of homogeneity was used to determine changes between pre- and post-policy change show rates, and an independent t test was used to examine changes in wait-list time.</p><p><strong>Methods: </strong>This study examined the medical records of 275 youth with intake appointments at an interdisciplinary chronic pain management clinic at a large hospital. A retrospective chart review was conducted to determine changes in patient show rates and wait-list times.</p><p><strong>Results: </strong>Findings demonstrated that patient show rates increased from 78.8% to 86.1% after the policy change, and average wait-list time decreased by 55.2% from the year before the policy change.</p><p><strong>Conclusions: </strong>This study's findings provide evidence that requiring patients to complete a preappointment survey before being scheduled significantly improved show rates and decreased wait-list times in a pediatric pain clinic. Providers should balance benefits with potential limitations, such as restricting access to care, when implementing such a policy change. This study also offers practical guidance for implementing data-driven policy change in health care settings.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 3","pages":"SP120-SP126"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626760","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":"The benefits of sustaining high factor VIII levels in people with hemophilia A.","authors":"Russell Gollard","doi":"10.37765/ajmc.2025.89703","DOIUrl":"10.37765/ajmc.2025.89703","url":null,"abstract":"<p><p>Hemophilia A is a bleeding disorder caused by a deficiency in clotting factor VIII (FVIII), leading to recurrent joint bleeds, musculoskeletal damage, and chronic pain. The World Federation of Hemophilia (WFH) recommends prophylactic FVIII replacement therapy to reduce bleeding risk, yet joint deterioration and pain persist. Maintaining high FVIII levels provides clinical benefits but requires awareness of best practices and managed care considerations. This publication examines the clinical and economic impact of hemophilia A, treatment goals, FDA-approved therapies, and managed care factors. People with hemophilia experience lower bone mineral density, increased osteoporosis risk, and significant effects on mental health, mobility, and quality of life. Treatment options-including standard and extended half-life FVIII therapies, non-factor therapies, and gene therapy-vary in sustaining FVIII levels and preventing bleeds. The high cost of care burdens patients and health systems, though prophylaxis reduces emergency visits and hospitalizations. Adherence challenges arise as patients transition to self-infusion, and insurance restrictions often limit access to comprehensive care. The WFH supports individualized, patient-centered management with pharmacokinetic-guided dosing, multidisciplinary care, and shared decision-making. Maximizing FVIII levels, rather than maintaining minimal thresholds, may improve long-term health. A holistic approach-combining early intervention, personalized prophylaxis, and strategies to address treatment barriers-is essential to better outcomes and achieving the WFH goal of zero bleeds.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 2 Suppl","pages":"S15-S22"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606814","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":"Real-world digitally based diabetes management program implementation by a large employer.","authors":"Jean M Abraham, Teresa Ambroz, Megan Chacon, Renée S M Kidney, Helen M Parsons","doi":"10.37765/ajmc.2025.89698","DOIUrl":"10.37765/ajmc.2025.89698","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the implementation of a digitally based diabetes management program by a large, self-insured employer in Minnesota from May 2021 to April 2022.</p><p><strong>Study design: </strong>Descriptive analysis.</p><p><strong>Methods: </strong>We described the development, implementation, and effectiveness of a communications strategy to promote program enrollment in the initial year. Using administrative claims data, we analyzed the demographic and clinical attributes associated with an eligible member's enrollment. Finally, we empirically assessed whether expanding the choice of modalities through which enrollees accessed diabetes self-management education and support (DSMES) increased overall utilization and addressed geographic disparities.</p><p><strong>Results: </strong>Although digital health program applications responded to the timing of the communications campaigns, overall program enrollment in absolute terms was low compared with the size of the eligible population. Among those eligible, female and employee subscribers were more likely to enroll. Overall, DSMES use increased slightly during the initial year, but we did not observe significantly higher rates of use among members in rural areas following the digital health program launch.</p><p><strong>Conclusions: </strong>This study offers new insights to employers and health plans related to supporting digitally based disease management program implementation and enrollee engagement.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"e62-e68"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575955","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":"Facilitators of and barriers to Medicaid investment in electronic consultation services.","authors":"Julie E Kim, Libby Sagara, Alison M DeDent, Delphine S Tuot","doi":"10.37765/ajmc.2025.89696","DOIUrl":"10.37765/ajmc.2025.89696","url":null,"abstract":"<p><strong>Objective: </strong>Electronic consultation, or e-consult, programs have enhanced access to specialty care for primary care providers and their patients, reducing unnecessary in-person visits and maintaining cost-effectiveness. In California, there is great variability in access to e-consult programs for low-income patients who rely on Medicaid managed care plans (MCPs) for covered benefits. This study aimed to understand MCP facilitators of and barriers to e-consult investment in California.</p><p><strong>Study design: </strong>Interviews conducted with California Medicaid MCPs' leaders to learn about the facilitators of and barriers to investment in e-consult programs.</p><p><strong>Methods: </strong>Interviews were analyzed using content analysis with multistage coding. The Exploration, Preparation, Implementation, and Sustainment framework was used to organize facilitator and barrier themes into 4 contexts: outer context (landscape of health care delivery in California), inner context (components within the medical neighborhood), innovation factors (characteristics of e-consult programs), and bridging factors (MCP actions).</p><p><strong>Results: </strong>Twelve themes emerged from 16 interviews. Outer context themes were regulatory policies and financial policies (barriers), limited specialty care (facilitator), and patient perceptions (both). Inner context themes were workforce characteristics (both), clinical leadership (facilitator), and clinical workflows (both). Innovation factor themes were adjunct e-consult vendor services (both) and software integration (facilitator). Bridging factor themes included collaboration with other plans (facilitator), financial risk delegation (barrier), and quality improvement considerations (facilitator).</p><p><strong>Conclusions: </strong>Medicaid regulatory and reimbursement policies posed the most significant barriers to e-consult investment by Medicaid MCPs in California. Recognition of e-consult as a mode of specialty care delivery and reimbursement for clinicians could help future e-consult programs succeed in enhancing access to specialty expertise for low-income patients.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"128-135"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576002","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":"Racial and ethnic disparities in telemental health use among publicly insured children.","authors":"Xin Hu, Ilana Graetz, Jordan Gilleland Marchak, Ann C Mertens, Xu Ji, Janet R Cummings","doi":"10.37765/ajmc.2025.89674","DOIUrl":"10.37765/ajmc.2025.89674","url":null,"abstract":"<p><strong>Objectives: </strong>The COVID-19 pandemic propelled telemental health utilization among children seeking mental health (MH) services. We examined racial and ethnic disparities in telemental health use among publicly insured children before and following COVID-19.</p><p><strong>Methods: </strong>We identified 36,877,141 child-year observations among publicly insured children aged 3 to 17 years with MH-related encounters in a given year from 2016 to 2020. Multivariable linear regressions controlling for individual- and county-level confounders estimated changes in telemental health use before (2016-2019) and following the pandemic (2020) and how these changes differed by individual- and county-level race and ethnicity.</p><p><strong>Results: </strong>The percentage of publicly insured children using telemental health increased from 2.74% pre-COVID-19 to 35.90% in 2020. Among non-Hispanic White children, 3.41% used telemental health care pre-COVID-19, which increased by 36.49 percentage points (PP) in 2020. Non-Hispanic Black children had a lower percentage of telemental health use (2.50%) pre-COVID-19, which increased by 31.20 PP in 2020, resulting in a 5.39 PP smaller increase than non-Hispanic White children (P < .001). Similarly, Hispanic, non-Hispanic Asian, and non-Hispanic Pacific Islander children had 6.19 PP, 15.45 PP, and 12.10 PP smaller increases in telemental health use in 2020 compared with non-Hispanic White children (all P < .001). Moreover, children in counties with the highest (vs lowest) quartiles of non-Hispanic Black and Hispanic populations had lower pre-COVID-19 telemental health use and smaller increases in 2020 (all P < .001).</p><p><strong>Conclusions: </strong>Racial and ethnic disparities in telemental health use widened following COVID-19. Future research should evaluate how telemental health use impacted MH care quality and outcomes among publicly insured children.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"119-126"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575954","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":"Bundled payment impacts uptake of prescribed home health care.","authors":"Jun Li, Lacey Loomer","doi":"10.37765/ajmc.2025.89677","DOIUrl":"10.37765/ajmc.2025.89677","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether the CMS Comprehensive Care for Joint Replacement (CJR) Model, which incentivizes coordinated and efficient care, increased home health care (HHC) uptake among patients referred to HHC after major joint replacement surgery.</p><p><strong>Study design: </strong>Cohort study using a difference-in-differences design comparing hospitals in 75 metropolitan statistical areas randomized into CJR by CMS with non-CJR hospitals in 119 areas as controls.</p><p><strong>Methods: </strong>The primary outcome was the case mix-adjusted, hospital-level HHC uptake rate, which is the rate of patients referred to HHC at hospital discharge receiving an HHC visit within 14 days. Secondary outcomes included HHC uptake rate by race/ethnicity and the quality of HHC agencies used among referrals, which was measured by agency-level improvement in ambulation, unplanned hospitalizations, emergency department visits, time to the first home health visit, and distinct number of agencies.</p><p><strong>Results: </strong>After the launch of CJR, HHC uptake decreased nationally but there was a 3.73-percentage point (4.5%) lower decrease in CJR hospitals; this was driven by White patients (3.54-percentage point differential; P = .026). A marginally statistically significant (P = .054) 5.05-percentage point differential increase for Black patients was observed due to a slight increase in the treatment group and a large decrease in the control group. There was no statistically significant change for Hispanic or Asian American/Pacific Islander populations. No statistically significant increases were observed in the quality of HHC used.</p><p><strong>Conclusions: </strong>CJR mitigated a trend of decreased HHC uptake, but more work is needed to improve uptake for larger portions of the patient population. Our results suggest that addressing care coordination incentives via CJR may mitigate some racial disparities.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 2","pages":"66-73"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469971","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":"Longer appointment duration reduces future missed appointments in safety-net clinics.","authors":"Omolola E Adepoju, Winston Liaw, Charles D Phillips","doi":"10.37765/ajmc.2025.89682","DOIUrl":"10.37765/ajmc.2025.89682","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether longer prior appointment durations are associated with reduced missed appointment rates.</p><p><strong>Study design: </strong>Retrospective cohort study at a large Texas federally qualified health center network.</p><p><strong>Methods: </strong>The dependent variable was missed appointments, and the primary independent variable was prior appointment duration. Other independent variables included sociodemographic (age, sex, race/ethnicity, insurance status), geographic (distance to the clinic, residence in a medically underserved area [MUA]), and clinical (visit history, visit type, visit dates, days between visits) factors. We used mixed-effects logistic regression to examine the relationship between prior appointment duration and missed appointments.</p><p><strong>Results: </strong>The study sample included 28,090 unique patients who had 56,180 appointments. The regression model demonstrated that longer prior appointment duration was associated with a lower likelihood of a missed appointment (OR, 0.90; 95% CI, 0.88-0.92). Being Hispanic or non-Hispanic Black (Hispanic: OR, 1.08; 95% CI, 1.03-1.15; Black: OR, 1.49; 95% CI, 1.38-1.61), lacking insurance (OR, 1.47; 95% CI, 1.38-1.57), and living 40 or more miles from the clinic (OR, 1.21; 95% CI, 1.08-1.36) were associated with higher odds of missing appointments. In contrast, living in an MUA (OR, 0.92; 95% CI, 0.82-0.96), having 3 or more previous visits (3-4 visits: OR, 0.87; 95% CI, 0.82-0.93), having more days between visits (91-180 days between visits: OR, 0.54; 95% CI, 0.50-0.59), and scheduling visits with physicians (OR, 0.90; 95% CI, 0.86-0.95) were associated with lower odds of missing appointments.</p><p><strong>Conclusions: </strong>Duration of past appointments is inversely correlated with future missed appointment rates. Efforts to lengthen appointment times may have important effects on quality and health outcomes.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 2","pages":"e39-e46"},"PeriodicalIF":2.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469987","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}