American Journal of Managed Care最新文献_第5页

Searching for the policy-relevant treatment effect in Medicare's ACO evaluations. 医保ACO评价中政策性治疗效果的探讨。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89647

Bryan E Dowd, Roger D Feldman, Woolton Lee, Kathleen Rowan, Shriram Parashuram, Katie White

{"title":"Searching for the policy-relevant treatment effect in Medicare's ACO evaluations.","authors":"Bryan E Dowd, Roger D Feldman, Woolton Lee, Kathleen Rowan, Shriram Parashuram, Katie White","doi":"10.37765/ajmc.2024.89647","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89647","url":null,"abstract":"Objectives: To explain key challenges to evaluating Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) models and ways to address those challenges.Study design: We enumerate the challenges, beginning with the conception of the alternative payment model and extending through the decision to scale up the model should the initial evaluation suggest that the model is successful. The challenges include churn at the provider and ACO levels, beneficiary leakage and spillover, participation in prior payment models, and determinants of shared savings and penalties.Methods: We explain challenges posed in evaluations of voluntary ACO models vs models in which ACOs are randomly assigned to the treatment group. We also note the relationship between the design used in an evaluation and subsequent plans for scaling up successful models.Results: The optimal research design is inextricably tied to the plans for scaling up a successful model. Decisions regarding churn, leakage, spillover, and participating in past payment models can alter the estimated effects of the intervention on participants in the model.Conclusions: If CMMI intends to offer the model to a larger, but similar, group of volunteers, then the estimated treatment effect based on voluntary participants may be the most policy-relevant parameter. However, if the scaled-up population has different characteristics than the evaluation sample, perhaps due to mandatory participation, then the evaluator will need to employ pseudo-randomization appropriate for observational data.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 Spec. No. 13","pages":"SP978-SP984"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822935","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

Characteristics of accountable care organizations' preferred skilled nursing facility networks. 问责护理组织首选熟练护理机构网络的特征。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89640

Louise Secordel, Lauren Hajjar, Jennifer Perloff, Robert E Mechanic

{"title":"Characteristics of accountable care organizations' preferred skilled nursing facility networks.","authors":"Louise Secordel, Lauren Hajjar, Jennifer Perloff, Robert E Mechanic","doi":"10.37765/ajmc.2024.89640","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89640","url":null,"abstract":"Objectives: To describe the prevalence and characteristics of preferred skilled nursing facility (SNF) networks established by Medicare accountable care organizations (ACOs).Study design: Cross-sectional analysis of a 2019 Medicare ACO survey.Methods: We analyzed surveys from 138 Medicare ACOs to assess preferred SNF network prevalence, characteristics, and challenges. Chi-square tests compared ACOs by proportion of ACO Medicare admissions going to preferred SNFs (higher vs lower network use).Results: Results focus on the 77 ACOs that reported having a preferred SNF network (n = 77), with 38% being relatively new (formed in 2018 or 2019). Most ACOs (91%) did not offer financial incentives for preferred SNFs. ACOs reported a range of expectations of preferred SNFs, the most common being cost/quality data sharing (62%), automatic notification of patient admission or discharge (53%), and meeting length-of-stay targets (52%). ACOs also reported some clinical collaboration with preferred SNFs, with the top activity being developing condition-specific care pathways (49%). Commonly reported challenges included poor hospital discharge practices, SNFs' willingness to accept complex patients, and the availability of high-quality SNFs. ACOs with lower use of their preferred SNF network reported more difficulty impacting hospital referral patterns and receiving timely SNF admission notifications.Conclusions: Establishing preferred SNF networks is a known strategy among Medicare ACOs to manage postacute care spending and quality. Future research should document these partnerships more in depth and evaluate operational and financial alignment strategies among ACOs, hospitals, and SNFs in managing postacute care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"684-688"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916260","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

BHAGs for aligning incentives and building a learning system to improve total population health. BHAGs旨在调整激励机制并建立一个学习系统，以改善总体人口健康。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89649

Paul Hughes-Cromwick, Sanne J Magnan

引用次数: 0

Overcoming barriers to HIV prevention: population health considerations on optimizing PrEP access. 克服预防艾滋病毒的障碍：优化PrEP获取的人口健康考虑。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89654

Patrick Sullivan, Diana Brixner, Jerika T Lam, Alice Hsiao

{"title":"Overcoming barriers to HIV prevention: population health considerations on optimizing PrEP access.","authors":"Patrick Sullivan, Diana Brixner, Jerika T Lam, Alice Hsiao","doi":"10.37765/ajmc.2024.89654","DOIUrl":"10.37765/ajmc.2024.89654","url":null,"abstract":"The HIV epidemic remains a critical public health priority in the United States. The Ending the HIV Epidemic (EHE) initiative seeks to reduce HIV diagnoses by 75% by 2025 and by 90% by 2030. Certain demographic groups-including transgender women, cisgender Black women, and Black/African American and Hispanic/Latino men who have sex with men-are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) has proven effective in reducing HIV transmission. Real-world data indicate that the states with higher PrEP coverage have experienced steeper declines in new HIV diagnoses; however, several barriers hinder equitable PrEP access and uptake. Challenges such as stigma, discrimination, lack of education, and insurance barriers contribute to disparities in PrEP uptake and access to care, particularly in underserved communities. Population health decision-makers, including managed care organizations and federal and state policy makers, can play a vital role in expanding PrEP coverage and uptake by addressing these barriers and ensuring zero out-of-pocket costs for individuals who need PrEP. Enhancing health care provider education and person-centered HIV prevention strategies (eg, same-day PrEP services, telePrEP programs) also can increase PrEP uptake and adherence and patient satisfaction. A continuous focus on improving PrEP access can substantially contribute to achieving the EHE initiative's goal to end the HIV epidemic.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11 Suppl","pages":"S207-S215"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803256","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 health care price crisis needs policy solutions. 医疗价格危机需要政策解决方案。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89636

Andréa Caballero, Torie Nugent-Peterson

引用次数: 0

Cost-effectiveness of a multicancer early detection test in the US. 美国多种癌症早期检测测试的成本效益。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89643

Anuraag R Kansal, Ali Tafazzoli, Alissa Shaul, Ameya Chavan, Weicheng Ye, Denise Zou, A Mark Fendrick

{"title":"Cost-effectiveness of a multicancer early detection test in the US.","authors":"Anuraag R Kansal, Ali Tafazzoli, Alissa Shaul, Ameya Chavan, Weicheng Ye, Denise Zou, A Mark Fendrick","doi":"10.37765/ajmc.2024.89643","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89643","url":null,"abstract":"Objectives: Multicancer early detection (MCED) testing could result in earlier cancer diagnosis, thereby improving survival and reducing treatment costs. This study evaluated the cost-effectiveness of MCED testing plus usual care (UC) screening while accounting for the impact of clinical uncertainty and population heterogeneity for an MCED test with broad coverage of solid cancer incidence.Study design: Cost-effectiveness analysis of MCED testing plus UC vs UC alone in an adult population in the US.Methods: A hybrid cohort-level model compared annual MCED testing plus UC with UC alone in detecting cancer among individuals aged 50 to 79 years over a lifetime horizon from a US payer perspective. Sensitivity and scenario analyses were conducted to explore the impact of key clinical uncertainties and population heterogeneity in valuing MCED, including differential survival by cell-free DNA detectability status, cancer progression rate, and how the test is likely to be implemented in clinical practice.Results: Among 100,000 individuals, MCED testing plus UC shifted 7200 cancers to earlier stages at diagnosis compared with UC alone, resulting in an additional 0.14 quality-adjusted life-years (QALYs) and $5241 treatment cost savings per person screened and an incremental cost-effectiveness ratio (ICER) of $66,048/QALY gained at $949 test price. Among analyses of clinical uncertainties, differential survival had the greatest impact on cost-effectiveness. In probabilistic sensitivity analyses, MCED testing plus UC was cost-effective in all analyses with a maximum ICER of $91,092/QALY.Conclusions: Under a range of likely clinical scenarios, MCED testing was estimated to be cost-effective, improving survival and reducing treatment costs.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"e352-e358"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916261","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

Mandatory Medicare bundled payment and the future of hospital reimbursement. 强制性医疗保险捆绑付款和医院报销的未来。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89653

Robert E Mechanic, Jennifer Perloff, Daniel Koppel

引用次数: 0

An overview of cardiovascular-kidney-metabolic syndrome. 心血管-肾脏-代谢综合征概述。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89670

Keith C Ferdinand

{"title":"An overview of cardiovascular-kidney-metabolic syndrome.","authors":"Keith C Ferdinand","doi":"10.37765/ajmc.2024.89670","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89670","url":null,"abstract":"Cardio-kidney-metabolic (CKM) syndrome is a term to describe the interconnection between cardiovascular disease, type 2 diabetes, and chronic kidney disease. The National Health and Nutrition Examination Survey from 1999 to 2020 estimated that 25% of participants had at least 1 CKM condition. It is proposed that CKM syndrome originates in excess and/or dysfunctional adipose tissue, which secretes proinflammatory and prooxidative products leading to damaged tissues in arteries, the heart, and the kidney, and reduction in insulin sensitivity. CKM syndrome is classified into 4 stages based on the presence of risk factors and clinical signs. Risk factors associated with progression of CKM syndrome include chronic inflammatory conditions, family history of diabetes or kidney disease, mental health and sleep disorders, increased levels of elevated high-sensitivity C-reactive protein, and sex-specific risk enhancers. There are substantial racial and ethnic differences, although they are likely due to social determinants of health (SDOH). The American Heart Association suggests that CKM syndrome screening should include both biological factors and SDOH. Interventions in patients with stages 0 to 3 CKM syndrome focus on preventing future cardiovascular events by management of excess adiposity, mainly through diet and exercise in the early stages, then through pharmacological treatment of metabolic syndrome components in later stages. There is a general acceptance that treatment of CKM syndrome should involve a holistic approach to prevention, screening, and management to improve outcomes and reduce long-term morbidity and mortality.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 10 Suppl","pages":"S181-S188"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869744","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

Uptake of rituximab biosimilars in Medicare and Medicaid in 2019-2022. 2019-2022年医疗保险和医疗补助中美罗华生物仿制药的吸收。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89644

Jingjing Qian

{"title":"Uptake of rituximab biosimilars in Medicare and Medicaid in 2019-2022.","authors":"Jingjing Qian","doi":"10.37765/ajmc.2024.89644","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89644","url":null,"abstract":"Objectives: This study evaluated the uptake and costs of 3 biosimilars among Medicare and Medicaid populations for 2019 to 2022: rituximab-abbs (Truxima), rituximab-pvvr (Ruxience), and rituximab-arrx (Riabni).Study design: A retrospective, descriptive study.Methods: Using the annually aggregated, product-level utilization and cost data of biologic and biosimilar rituximab products from CMS drug spending data, total claims and costs (reimbursement and out of pocket) for all rituximab products were identified and extracted from Medicare Part B, Medicare Part D, and Medicaid. Average spending per dosage unit (ASPDU) of individual rituximab products was also extracted, and their annual growth rates in 2022 (vs 2021) were calculated. Descriptive data analyses were performed using Microsoft Excel 2016.Results: Four years after entering the US market, rituximab biosimilar use increased from between 0% and 7% in 2019 to 60%, 41%, and 61% of all rituximab claims paid by Medicare Part B, Medicare Part D, and Medicaid, respectively, in 2022. Corresponding total costs for rituximab biosimilars also reached 45%, 32%, and 47% of all rituximab products. The ASPDU of biologic rituximab increased 2% in Medicare Part B in 2022 (vs 2021) but decreased by 2% in Medicaid. The ASPDU of rituximab biosimilars (rituximab-abbs and rituximab-pvvr) decreased between 15% and 26% in 2022 in Medicare Part B and Medicaid, while their ASPDU slightly increased between 1% and 2% in Medicare Part D.Conclusions: Significant uptake of rituximab biosimilars in Medicare and Medicaid occurred within the first 4 years of marketing in the US.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"e359-e363"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916243","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

Addressing STIs through managed care: opportunities in Medicaid and beyond. 通过管理式医疗解决性传播感染：医疗补助及其他领域的机会。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89641

Naomi Seiler, Katie Horton, Paige Organick-Lee, Mekhi Washington, Taylor Turner, William S Pearson

{"title":"Addressing STIs through managed care: opportunities in Medicaid and beyond.","authors":"Naomi Seiler, Katie Horton, Paige Organick-Lee, Mekhi Washington, Taylor Turner, William S Pearson","doi":"10.37765/ajmc.2024.89641","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89641","url":null,"abstract":"The US is facing a growing epidemic of sexually transmitted infections (STIs), with over 2.5 million cases of chlamydia, gonorrhea, and syphilis reported in 2021 and again in 2022. This public health crisis disproportionately affects youth and racial and ethnic minority communities, exacerbating barriers to accessing sexual health services. Untreated STIs can lead to severe health consequences, including infertility, pelvic inflammatory disease, and increased risk of HIV transmission and acquisition. Managed care organizations (MCOs) within Medicaid play a pivotal role in improving sexual health service delivery and addressing the rise in STIs. This commentary explores opportunities for Medicaid MCOs to enhance STI prevention, screening, and treatment. It was informed by reviews of Medicaid managed care contracts, plan provider manuals, and interviews with Medicaid plan officials and other experts. It presents a set of opportunities to enhance STI prevention, including incentivizing syphilis screening during pregnancy through existing perinatal and maternal health efforts, leveraging extended postpartum coverage for sexual health education, integrating STI services with substance use disorder programs, supporting community-based organizations that serve relevant communities, training community-facing workers in STI care and sexual health, coordinating with local health departments, and providing enrollee access to condoms and home STI tests. Implementing these strategies could reduce STI rates and improve health outcomes, particularly among vulnerable populations. Although this commentary draws on research focused on Medicaid MCOs, a coordinated approach that includes commercial plans and coordination with health departments could ultimately enhance the consistency and quality of STI services and sexual health care across the health care system.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"e341-e344"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916258","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