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

Factors associated with unplanned admissions among patients with chronic conditions. 慢性病患者意外入院的相关因素。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89755

Michael Gottlieb, Natalia Golovashkina, Brian D Stein, Paul Casey, Garth Walker, Doug Thompson

{"title":"Factors associated with unplanned admissions among patients with chronic conditions.","authors":"Michael Gottlieb, Natalia Golovashkina, Brian D Stein, Paul Casey, Garth Walker, Doug Thompson","doi":"10.37765/ajmc.2025.89755","DOIUrl":"10.37765/ajmc.2025.89755","url":null,"abstract":"Objectives: Value-based care models, such as the Medicare Shared Savings Program, have placed increasing emphasis on unplanned admissions among patients with multiple chronic conditions (UAMCCs) as a quality metric. However, there are limited data on which factors are associated with the highest risk of UAMCCs. This study sought to determine which factors were associated with increased risk of UAMCCs.Study design: Retrospective study conducted among all adult patients with 2 or more chronic conditions defined by CMS presenting to 2 hospitals within a major Midwest health care system from November 1, 2022, to October 31, 2023.Methods: Demographics, chronic conditions, primary care physician (PCP) visit utilization, and annual wellness visit (AWV) utilization were analyzed using multivariable logistic regression to identify associations with UAMCCs.Results: Among 18,448 patients (55.8% women) included in the study, 3842 (20.8%) had at least 1 UAMCC. Patients with UAMCCs were more likely to have Medicare or Medicaid insurance; be widowed; speak Spanish; have a higher Charlson Comorbidity Index score; and have Alzheimer disease, atrial fibrillation, heart failure, chronic kidney disease, depression, chronic obstructive pulmonary disease, and/or stroke. When examining PCP visit measures, AWVs and having 1 or more PCP visits were associated with fewer UAMCCs.Conclusions: Higher Charlson Comorbidity Index scores, several health conditions, and Spanish language were associated with increased UAMCCs. AWVs and having 1 or more PCP visits were associated with fewer UAMCCs.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 6","pages":"SP312-SP321"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486841","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

Risk factors for financial toxicity in health care. 卫生保健中财务毒性的风险因素。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89757

Randall A Bloch, Louis L Nguyen

{"title":"Risk factors for financial toxicity in health care.","authors":"Randall A Bloch, Louis L Nguyen","doi":"10.37765/ajmc.2025.89757","DOIUrl":"10.37765/ajmc.2025.89757","url":null,"abstract":"Objectives: Financial toxicity (FT) represents the impact of health care expenses on patients' financial well-being and access to care. Although existing literature has mostly looked at FT in the context of cancer and other medical conditions, we sought to identify risk factors for FT on a population-wide level.Study design: This was a cross-sectional study of the 2022 National Health Interview Survey (NHIS).Methods: Eight financial hardship questions were selected from the 2022 NHIS to represent FT. The unweighted sum of financial hardship questions to which a person responded \"yes\" was calculated as the FT score (FinTox), and risk factors for FinTox were analyzed using a negative binomial model.Results: There were 27,246 adults with a mean age of 52.96 years included for analysis, among whom 17.1% (n = 4659) responded \"yes\" to at least 1 FT question, of whom most had a FinTox of 1 or 2 (n = 3112; 66.8%). Increasing age (β = -0.616; P = .020), higher education (β = -1.08; P = .023), and higher income (β = -0.149; P < .001) were associated with lower FinTox, whereas involuntary unemployment (β = 0.920; P = .001), transient loss of health insurance (β = 1.075; P = .044), and high-deductible health plans (β = 0.519; P = .013) were associated with higher FinTox.Conclusions: Understanding risk factors for FT at a population level can help identify patients at risk for catastrophic financial effects or inadequate access to care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 6","pages":"SP337-SP350"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486844","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

Use of voluntary alignment in the Next Generation ACO model. 在下一代ACO模型中使用自愿对齐。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89739

Tyler Boese, Bryan E Dowd, Roger D Feldman, Kathleen Rowan, Woolton Lee, Devi Chelluri, Susan Cahn, Shriram Parashuram

{"title":"Use of voluntary alignment in the Next Generation ACO model.","authors":"Tyler Boese, Bryan E Dowd, Roger D Feldman, Kathleen Rowan, Woolton Lee, Devi Chelluri, Susan Cahn, Shriram Parashuram","doi":"10.37765/ajmc.2025.89739","DOIUrl":"10.37765/ajmc.2025.89739","url":null,"abstract":"Objectives: To describe adoption and use of voluntary alignment throughout the Next Generation Accountable Care Organization (NGACO) model from 2016 through 2021. Voluntary alignment allows Medicare beneficiaries to self-attribute to a particular medical provider or organization by signing a form or making a selection in the MyMedicare.gov portal.Study design: We performed mixed-methods analyses of cross-sectional survey, enrollment, and claims data and coding transcripts of interviews with NGACO leadership.Methods: We statistically compared characteristics of NGACOs and beneficiaries that engaged in voluntary alignment compared to claims alignment. Additionally, we grouped qualitative interview responses into 2 overarching themes that emerged around NGACO leaders' perceptions, use, and experiences with voluntary alignment.Results: Few NGACOs engaged in widespread use of voluntary alignment. NGACOs that adopted voluntary alignment were similar to those that did not in most respects, although beneficiaries aligned through voluntary alignment were sicker and more expensive than those aligned through claims only. Many NGACO leaders reported they were content with claims-based alignment and did not think implementing initiatives to increase voluntary alignment would be worthwhile.Conclusions: The analysis suggests possible lessons for using voluntary alignment in future ACO models. NGACO leaders perceived that the use of voluntary alignment was limited by a high implementation effort, a need for patient education, and tight administrative time frames. Perceived benefits of voluntary alignment included attribution flexibility and creating opportunities for beneficiary engagement. Some leaders suggested allowing year-round voluntary alignment sign-up to better integrate voluntary alignment into their regular office workflows.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"e153-e158"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477666","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 medical care coordination intervention on patient activation. 医疗护理协调干预对患者激活的影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89747

Samuel T Savitz, Michelle A Lampman, Shealeigh A Inselman, Vicki L Hunt, Angela B Mattson, Robert J Stroebel, Pamela J McCabe, Stephanie G Witwer, Bijan J Borah

{"title":"Impact of medical care coordination intervention on patient activation.","authors":"Samuel T Savitz, Michelle A Lampman, Shealeigh A Inselman, Vicki L Hunt, Angela B Mattson, Robert J Stroebel, Pamela J McCabe, Stephanie G Witwer, Bijan J Borah","doi":"10.37765/ajmc.2025.89747","DOIUrl":"10.37765/ajmc.2025.89747","url":null,"abstract":"Objective: To evaluate the impact of an adult medical care coordination (AMCC) intervention on patient activation.Study design: This observational evaluation compared AMCC with usual care (UC). Eligible patients were adults discharged home who had 2 or more chronic conditions and a high risk of readmission. AMCC involved registered nurse care coordinators providing self-management support to patients via 1 home visit and regular phone calls. The outcome was the 10-item Patient Activation Measure (PAM), a validated patient-reported outcome tool with 4 levels ranging from 1 (lower activation) to 4 (higher activation). Measurement occurred at baseline and 30, 90, and 180 days.Methods: We evaluated patient activation as an ordinal outcome using an ordered logistic regression model, a dichotomous outcome using a linear probability model, and a continuous outcome using ordinary least squares.Results: We identified 915 (432 AMCC, 483 UC) patients who completed both the baseline and at least 1 follow-up PAM. For the ordinal analysis, AMCC was associated with a significant increase in the percentage with a PAM of level 3 at 30, 90, and 180 days and a decrease in the percentage with a PAM of level 1 or 2 at 180 days. For the dichotomous analysis, AMCC was associated with a significant increase in the percentage of patients with a PAM of level 3 or 4 at 180 days (15.2 percentage points; 95% CI, 5.6-24.7).Conclusions: AMCC significantly increased patient activation, particularly at the final measurement. These findings highlight the potential value of AMCC as a self-management intervention, enhancing patients' confidence to manage their health.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"279-285"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477749","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

Utilization and costs among oncologists participating in a private insurance shared savings model. 参与私人保险共享储蓄模式的肿瘤学家的使用和成本。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89750

Brigham Walker, Lalan Wilfong, Nicholas Robert, Alexander Siebert, J Russell Hoverman

{"title":"Utilization and costs among oncologists participating in a private insurance shared savings model.","authors":"Brigham Walker, Lalan Wilfong, Nicholas Robert, Alexander Siebert, J Russell Hoverman","doi":"10.37765/ajmc.2025.89750","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89750","url":null,"abstract":"Objectives: Participation in the Oncology Care Model has influenced care utilization and costs relative to nonparticipating practices. Less is known, however, about how care is potentially altered by participation in similar private payer-based models. Here, we take advantage of a natural experiment in which 2 large practices from among a network of oncology practices participated in a shared savings program (SSP) with a private insurer.Study design: Quasi-experimental (difference-in-differences) statistical analysis of oncology claims data.Methods: We used monthly provider-level claims data from September 2014 through August 2017 for patients with breast, colon, and lung cancer from The US Oncology Network. Key outcome measures were monthly mean office visits, total costs, and buy-and-bill drug costs among patients with breast, colon, and lung cancer. We then compared the utilization and cost patterns, preintervention and post participation, among patients on this insurance at participating practices vs those of patients at nonparticipating practices.Results: Monthly per-patient total costs in colon cancer and lung cancer were lower through the first year of participation in the program by $1391 (95% CI, -$2218 to -$563; P < .01) and $1050 (95% CI, -$1878 to -$222; P = .02), respectively. These savings increased for colon cancer but disappeared for lung cancer in the second year. The program appeared to have no significant impact on any costs for participants with breast cancer in either of the years we examined.Conclusions: Our results suggest that private payer-based SSP models can be associated with reduced costs for colon cancer care. There is weaker evidence of effects in lung cancer and no evidence in breast cancer. Such heterogeneous effects can inform future model development.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"e141-e146"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477667","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

Affordable Care Act enrollment in Texas after rating area adjustments. 在评级地区调整后，平价医疗法案在德克萨斯州的入学率。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89751

Elena Andreyeva, Daniel Marthey, Simon F Haeder, Benjamin Ukert

{"title":"Affordable Care Act enrollment in Texas after rating area adjustments.","authors":"Elena Andreyeva, Daniel Marthey, Simon F Haeder, Benjamin Ukert","doi":"10.37765/ajmc.2025.89751","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89751","url":null,"abstract":"Objective: To evaluate the association between Texas Affordable Care Act rating area change and health plan enrollment, plan selection, and premiums from 2022 to 2024 for urban and rural counties.Study design: Texas integrated a rating area consisting of all 177 rural counties into nearby metropolitan rating areas in 2023. We analyzed this policy using enrollment data from the Marketplace Open Enrollment County-Level Public Use Files from 2022-2024.Methods: We calculated the growth in enrollment across rural and urban counties and estimated linear regression models to understand whether enrollment grew faster in rural counties than in urban counties after the policy change.Results: Total marketplace plan enrollment increased by 80% (95% CI, 70%-90%) in urban counties and 76% (95% CI, 68%-84%) in rural counties. Urban and rural counties experienced the largest growth among enrollees aged 35 to 44 years (urban: 107%; 95% CI, 94%-119%; rural: 103%; 95% CI, 95%-112%) and enrollees with incomes between 100% and 150% of the federal poverty level (urban: 124%; 95% CI, 106%-142%; rural: 116%; 95% CI, 106%-127%). The share of counties reporting gold plan enrollment increased in urban and rural counties from 70% to 95% and 51% to 93%, respectively. Rating area changes were not associated with differential enrollment changes across rural and urban counties.Conclusions: We found similar growth rates in enrollment for rural and urban counties. Marketplace enrollees were more likely to choose a gold plan, suggesting that they shifted away from less-expensive bronze plans.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"e147-e152"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477744","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

Managed care reflections: a Q&A with Melinda B. Buntin, PhD. 管理式护理反思：与Melinda B. Buntin博士的问答。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89744

Melinda B Buntin, Christina Mattina

引用次数: 0

Potential health literacy resources for health plans: a narrative review. 卫生计划潜在的卫生素养资源：叙述性回顾。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89759

Saira Nawaz, Candy Magaña, Kathryn A Hasenstab, M Ella Lewie, Andy Rollins, Shireen Haq, Kyle J Moon, Anne Trinh, Faith Obanua, J Nwando Olayiwola

{"title":"Potential health literacy resources for health plans: a narrative review.","authors":"Saira Nawaz, Candy Magaña, Kathryn A Hasenstab, M Ella Lewie, Andy Rollins, Shireen Haq, Kyle J Moon, Anne Trinh, Faith Obanua, J Nwando Olayiwola","doi":"10.37765/ajmc.2025.89759","DOIUrl":"10.37765/ajmc.2025.89759","url":null,"abstract":"Objectives: Financial toxicity (FT) represents the impact of health care expenses on patients' financial well-being and access to care. Although existing literature has mostly looked at FT in the context of cancer and other medical conditions, we sought to identify risk factors for FT on a population-wide level.Study design: This was a cross-sectional study of the 2022 National Health Interview Survey (NHIS).Methods: Eight financial hardship questions were selected from the 2022 NHIS to represent FT. The unweighted sum of financial hardship questions to which a person responded \"yes\" was calculated as the FT score (FinTox), and risk factors for FinTox were analyzed using a negative binomial model.Results: There were 27,246 adults with a mean age of 52.96 years included for analysis, among whom 17.1% (n = 4659) responded \"yes\" to at least 1 FT question, of whom most had a FinTox of 1 or 2 (n = 3112; 66.8%). Increasing age (β = -0.616; P = .020), higher education (β = -1.08; P = .023), and higher income (β = -0.149; P < .001) were associated with lower FinTox, whereas involuntary unemployment (β = 0.920; P = .001), transient loss of health insurance (β = 1.075; P = .044), and high-deductible health plans (β = 0.519; P = .013) were associated with higher FinTox.Conclusions: Understanding risk factors for FT at a population level can help identify patients at risk for catastrophic financial effects or inadequate access to care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 Spec. No. 6","pages":"SP351-SP363"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486843","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

Should payers incentivize pharmacies to blister-package chronic medications? 付款人是否应该鼓励药店对慢性药物进行吸塑包装？

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89745

Eric P Borrelli, Peter Saad, Nathan E Barnes, Idal Beer, Julia D Lucaci

{"title":"Should payers incentivize pharmacies to blister-package chronic medications?","authors":"Eric P Borrelli, Peter Saad, Nathan E Barnes, Idal Beer, Julia D Lucaci","doi":"10.37765/ajmc.2025.89745","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89745","url":null,"abstract":"Medication nonadherence is prevalent among patients taking acute and/or chronic medications. It has been associated with poorer health outcomes, increased mortality, and higher costs for payers and the health care system. Numerous factors contribute to medication nonadherence, with forgetfulness being the primary reason. Payers have a vested interest in improving patient adherence to medications to mitigate overall health care costs by enhancing disease management, and they typically offer programs and initiatives aimed at improving medication adherence. One intervention that has had success in improving medication adherence and patient outcomes across a variety of disease states is putting patients' medications in blister packs. Although there is decades' worth of evidence demonstrating the success of blister packaging, utilization outside of the long-term care setting in the US is limited, likely due to the fragmentation of the health care system. Even though putting medications in blister packs has the potential to improve outcomes, pharmacies are the institutions that would have to implement this initiative while not seeing the financial savings from the reduced health care costs. Although it may improve their patients' outcomes, they would not be capturing the cost savings required to implement a potential new workflow and/or offset additive costs. Therefore, payers should consider incentivizing pharmacies to put medications in blister packs. Because payers would realize cost savings from the reduction in health care costs, they could reinvest some of that money toward blister packaging at their pharmacies and/or provide preferred contracting and network status for independent pharmacies that blister-package medications to help improve their population's health.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 6","pages":"261-264"},"PeriodicalIF":2.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477752","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

Breast cancer and the use of predictive genomics. 乳腺癌和预测性基因组学的应用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-06-01 DOI: 10.37765/ajmc.2025.89763

Sadie Dobrozsi

引用次数: 0