American Journal of Managed Care最新文献_第6页

An integrated practice unit tool for the Military Health System. 军队卫生系统综合实践单元工具。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89648

Thomas DeGraba, Tracey Pérez Koehlmoos, Cathaleen Madsen, Aroon Karra, Michael Dinneen

{"title":"An integrated practice unit tool for the Military Health System.","authors":"Thomas DeGraba, Tracey Pérez Koehlmoos, Cathaleen Madsen, Aroon Karra, Michael Dinneen","doi":"10.37765/ajmc.2024.89648","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89648","url":null,"abstract":"Objectives: To develop a tool for measuring performance of a coordinated care center against the criteria of an integrated practice unit (IPU) and test it against an established care center in the Military Health System (MHS).Study design: Characteristics of 4 patient care coordination models were sorted using the 11 criteria of the IPU.Methods: Subject matter experts evaluated characteristics and criteria for inclusion or exclusion based on the needs of specialty care in the MHS. The consolidated tool was tested using the example of the National Intrepid Center of Excellence (NICoE), which provides coordinated, colocated care for patients with traumatic brain injury, using responses of yes, partial, no, not applicable, or incomplete.Results: The final tool contained 7 IPU criteria subdivided into 18 measures. NICoE was found in 2020 to meet 11 measures fully and 6 partially, with 1 deemed not applicable. In 2023 it met 17 of 18 measures, with the remaining (translation services) available as an enterprise-wide resource. The tool was seen to need improvement in clarification of 3 measures and in 1 criterion that is evaluated differently by patients vs providers.Conclusions: This IPU assessment tool accurately captures both the strengths and weaknesses of a coordinated care facility within the MHS. Iterative refinement of the tool is expected to inform ongoing discussion of the transformation of care in the MHS and the US and to provide a framework by which to measure the care performance of centers wishing to reorganize as IPUs.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 Spec. No. 13","pages":"SP985-SP998"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822931","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

Impact of delayed adoption of novel atrial fibrillation treatments. 延迟采用新型房颤治疗的影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89639

Jaehong Kim, Jeremy Nighohossian, Anastasia G Daifotis, Jinghua He, Jason Shafrin

{"title":"Impact of delayed adoption of novel atrial fibrillation treatments.","authors":"Jaehong Kim, Jeremy Nighohossian, Anastasia G Daifotis, Jinghua He, Jason Shafrin","doi":"10.37765/ajmc.2024.89639","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89639","url":null,"abstract":"Objective: To examine the relationship between adoption of direct oral anticoagulants (DOACs) and health and cost outcomes for patients with nonvalvular atrial fibrillation.Study design: Real-world cohort study.Methods: US adults who newly initiated treatment for nonvalvular atrial fibrillation were identified from claims data. DOAC adoption and stroke rates were assessed at metropolitan statistical area (MSA) and individual levels. The MSA-level cross-sectional analysis examined the relationship between the adoption rate of a DOAC (vs warfarin) and an ischemic stroke. The individual-level instrumental variable analysis examined the impact of treatment choice predicted by regional adoption on stroke within 1 year after treatment initiation. Results were extrapolated to estimate the strokes and costs averted by patients moving from a slow-adopting (10th percentile) MSA to a rapid-adopting (90th percentile) MSA.Results: DOAC uptake rates in MSAs at the 10th and 90th uptake percentile were 53.1% and 78.5%, respectively, in 2014. Overall DOAC uptake increased from 66.3% in 2014 to 91.4% in 2018. Increased DOAC adoption reduced average stroke rates by 1.41 percentage points or 63.2% (P = .002) using the MSA-level descriptive analysis and 1.08 percentage points or 71.2% (P = .002) using the individual-level instrumental variable analysis. Nationally, shifting DOAC rates from those seen in slow-adopting MSAs to those seen in rapid-adopting MSAs could avert up to 32,000 strokes and save up to $1.04 billion annually.Conclusions: More rapid adoption of newly approved nonvalvular atrial fibrillation treatments was associated with reduced stroke rates and high cost savings. Managed care organizations should consider how delays in the uptake of innovative medications impact health and economic outcomes.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"674-680"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916273","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 dangerous intersection of breast cancer and cardiovascular disease: a call for improved prevention.

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89690

Terra Wonsettler

引用次数: 0

Introduction to optimal management of patients with cardio-kidney-metabolic syndrome. 心肾代谢综合征患者的优化管理简介。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89669

Erin D Michos

引用次数: 0

A standardized care pathway increases optimal dialysis starts. 标准化的护理途径增加最佳透析开始。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89642

Roy G Marcus, David M Miller, Brian H Nathanson, Douglas Eckhardt, Steven Henry, Katherine Kwon, Rohit Sharma, Nirav Vakharia

{"title":"A standardized care pathway increases optimal dialysis starts.","authors":"Roy G Marcus, David M Miller, Brian H Nathanson, Douglas Eckhardt, Steven Henry, Katherine Kwon, Rohit Sharma, Nirav Vakharia","doi":"10.37765/ajmc.2024.89642","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89642","url":null,"abstract":"Objective: To determine whether an intensive value-based care educational program that includes a standardized end-stage renal disease (ESRD) transition pathway would improve the number of optimal starts within Kidney Contracting Entities (KCEs).Study design: Retrospective cohort study.Methods: We recorded optimal starts, defined as the initiation of dialysis without a central venous catheter, and the initial modality type (hemodialysis vs peritoneal dialysis [PD]) in adult Medicare patients in a Comprehensive Kidney Care Contracting program. The setting was 4 KCEs within a single physician-led nephrology organization. Data were recorded each quarter (Q) during 2022. During Q1-Q2, patients and clinicians received formal instruction on the benefits of optimal starts. Starting in Q3, we implemented a standardized care pathway for patients at high risk for transition to ESRD. The proportion of optimal starts and the proportion of initial PD from Q1-Q2 vs Q3-Q4 were compared using the χ2 test.Results: A total of 328 study-eligible patients initiated dialysis in 2022, including 166 (50.6%) in Q1-Q2. The proportion of optimal starts increased from 42.8% (71/166) in Q1-Q2 to 58.0% (94/162) in Q3-Q4 (P = .006). The proportion of PD starts increased from 18.7% (31/166) in Q1-Q2 to 28.4% (46/162) in Q3-Q4 (P = .038).Conclusions: Optimal starts are a key metric of success in value-based care models. We observed a significant increase in optimal starts and in the number of patients starting on PD after implementing a standardized ESRD transition pathway as part of an intensive value-based care educational program.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"e345-e351"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916255","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

A team-based approach to type 2 diabetes and cardiovascular care. 以团队为基础的 2 型糖尿病和心血管护理方法。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89672

Ian J Neeland, Sanjay Rajagopalan

{"title":"A team-based approach to type 2 diabetes and cardiovascular care.","authors":"Ian J Neeland, Sanjay Rajagopalan","doi":"10.37765/ajmc.2024.89672","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89672","url":null,"abstract":"The Center for Integrated and Novel Approaches in Vascular-Metabolic Disease (CINEMA) program is an innovative, patient-centered system of care developed by the University Hospitals Harrington Heart and Vascular Institute in Cleveland, Ohio in the US for the management of high-risk patients with type 2 diabetes (T2D) and prediabetes at high risk for cardiovascular-kidney-metabolic (CKM) syndrome and its consequences. At its core, CINEMA is a multidisciplinary team of care experts, working together outside of traditional silos. The patient meets with the entire team up to 4 times each year to address all aspects of cardiovascular (CV) and T2D care. At the first visit, the team formulates a personalized approach that is evidence based and centered on optimal strategies to improve the patient's lifestyle, reduce their risk of CV and kidney disease events, and increase their access and adherence to guideline-directed pharmacologic therapies. A community health worker is utilized to address social determinants of health as needed. The program has a substantial research component, with the intent of developing evidence for novel care paradigms. The multiyear results of the CINEMA program indicate that a multidisciplinary approach to management of high-risk patients is highly effective in reducing CKM syndrome risk factors and increases use of guideline-directed therapies. The aim of this review is to describe the structure, operation, and eligibility criteria for admission to the CINEMA program, provide an overview of how CKM syndrome risks are determined and managed for each patient, and discuss how the integrated approach to care is supported by current recommendations from professional societies and results from other coordinated care/multidisciplinary programs. Lastly, the scalability challenges of a wider rollout of the CINEMA program are considered.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 10 Suppl","pages":"S197-S204"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142869743","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

Diabetes, cardiorenal, and metabolic multispecialty practice recommendations and early intensive management of cardio-renal-metabolic disease. 糖尿病、心肾和代谢多专科实践建议和心肾代谢疾病的早期强化管理。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89671

Yehuda Handelsman

引用次数: 0

Disconnects between provider network directories and patient preferences. 断开供应商网络目录和患者偏好之间的连接。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89638

Wendy Yi Xu, Eli Wei Raver, Thomas Elton, Marisa Davis, Simon F Haeder

{"title":"Disconnects between provider network directories and patient preferences.","authors":"Wendy Yi Xu, Eli Wei Raver, Thomas Elton, Marisa Davis, Simon F Haeder","doi":"10.37765/ajmc.2024.89638","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89638","url":null,"abstract":"Objectives: The question of what providers one has access to under their insurance coverage is crucial for patients in managed care. This study sought to examine information displayed in online provider directories and whether this information matched consumer preferences.Study design: A national survey (N = 4007) paired with an analysis of online provider network directories.Methods: We conducted a quantitative content analysis of online provider directories from March 1 to May 30, 2023. A national survey of American adults was fielded from June 30 to July 2, 2023, to gauge preferences for information displayed in provider directories. Preferences and perceived importance of information elements that should be displayed in provider directories were contrasted with the data elements displayed in directories.Results: We found that provider directories showed wide variations with regard to information displayed and in the amount of navigation required by patients. There were widespread instances of disconnect between patient preferences and data availability. Important data items related to care access and provider quality that were preferred by consumers were not universally presented in directories, such as availability of telemedicine (23% presented), information about office hours (58%), and disability access (59%). Approximately 7% of directories did not indicate whether a provider was accepting new patients, despite the requirement under the No Surprises Act to display such information. Further, certain marginalized populations may find it especially challenging to acquire information about providers.Conclusions: Lack of attention to usability in provider directories may hinder the national goal of ensuring care accessibility for all.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"660-666"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916262","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

Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts. 最近加入医疗保险的老年人群比过去的老年人群使用更多的咨询和心理治疗。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89631

Grace McCormack, Erin L Duffy, Adam Biener

{"title":"Recent cohorts aging into Medicare use more counseling and psychotherapy than past cohorts.","authors":"Grace McCormack, Erin L Duffy, Adam Biener","doi":"10.37765/ajmc.2024.89631","DOIUrl":"10.37765/ajmc.2024.89631","url":null,"abstract":"Objectives: Despite recent policy interest in improving access to mental health care in Medicare, little is known about how demand for care will change among the Medicare population as newer cohorts age into the program. We documented the growing rate of counseling and psychotherapy use in the decade prior to turning age 65 years among subsequent cohorts aging into Medicare. We characterized how this growth varied across demographic groups, income levels, and mental and physical health status.Study design: We present trends using data from the 2002-2017 Medical Expenditure Panel Survey Household Component.Methods: We categorized individuals into 5-year Medicare entry cohorts based on the year they turned age 65 years. Our outcome was an indicator for having a visit for counseling or psychotherapy in a given year. Employing a probit regression, we characterized visit rates across 5-year cohorts, presenting both unadjusted and covariate-adjusted results. We ran stratified regressions by subpopulations.Results: Our sample included 54,666 individuals aged 55 to 64 years, weighted to be nationally representative. The cohort aging into Medicare between 2021 and 2025 was 88% (95% CI, 57%-119%) more likely to have a counseling or psychotherapy visit between the ages of 55 and 64 years compared with the cohort that gained eligibility for Medicare between 2006 and 2010 at the same age. Growth in utilization was pervasive across many subpopulations.Conclusions: Our findings suggest that more recent cohorts aging into Medicare seek significantly more counseling and psychotherapy than prior cohorts. This increased utilization is pervasive across subpopulations, suggesting that plans must prepare to accommodate the needs of new Medicare entrants.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 11","pages":"e337-e340"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640156","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

Management strategies for metabolic dysfunction-associated steatotic liver disease (MASLD). 代谢功能障碍相关性脂肪性肝病 (MASLD) 的管理策略。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-11-01 DOI: 10.37765/ajmc.2024.89635

Naim Alkhouri, Mazen Noureddin

{"title":"Management strategies for metabolic dysfunction-associated steatotic liver disease (MASLD).","authors":"Naim Alkhouri, Mazen Noureddin","doi":"10.37765/ajmc.2024.89635","DOIUrl":"10.37765/ajmc.2024.89635","url":null,"abstract":"Metabolic dysfunction-associated steatotic liver disease (MASLD) is characterized by hepatic steatosis that is confirmed by imaging or histology in the setting of at least 1 metabolic risk factor in the absence of significant alcohol consumption. Nonalcoholic steatohepatitis, or NASH, was recently renamed metabolic dysfunction-associated steatohepatitis (MASH); it represents the progressive form of MASLD. MASH is defined by hepatic steatosis, lobular inflammation, and ballooning degeneration (hepatocellular injury) in a characteristic histologic pattern. Multiple pathophysiologic mechanisms underlie the development of MASLD, and multiple factors (eg, metabolic, hormonal, genetic, nutritional, and epigenetic components) are related to liver injury. MASH has a prevalence in the United States of 1% to 6%, and it is expected to rise in the next decade. Individuals living with MASH frequently suffer from comorbidities such as type 2 diabetes and cardiovascular disease. Several guidelines have been published to support the timely diagnosis of MASH that incorporate noninvasive tests that obviate the need for liver biopsy. Multiple MASH treatment options are in various stages of development. The THR-β agonist resmetirom, approved by FDA in March 2024, offers a liver-directed treatment for those patients living with moderate to severe fibrosis without cirrhosis. Considering the progressive nature of the disease and the availability of a treatment that can be initiated early to halt MASH progression, patients who have risk factors for MASH should urgently be encouraged to visit their health care providers for MASH screening.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 9 Suppl","pages":"S159-S174"},"PeriodicalIF":2.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606574","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