American Journal of Managed Care最新文献_第7页

Physiologic insulin resensitization lowers cost in patients with diabetes and kidney disease. 生理性胰岛素再敏感降低糖尿病和肾病患者的成本。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-01-01 DOI: 10.37765/ajmc.2025.89665

Zachary Villaverde, Roy H Hinman, Richard M Grimes

{"title":"Physiologic insulin resensitization lowers cost in patients with diabetes and kidney disease.","authors":"Zachary Villaverde, Roy H Hinman, Richard M Grimes","doi":"10.37765/ajmc.2025.89665","DOIUrl":"10.37765/ajmc.2025.89665","url":null,"abstract":"Objective: To examine the effect of physiologic insulin resensitization (PIR) on the cost of treating patients with diabetes and chronic kidney disease (CKD).Study design: The mean 1-year cost of treating 66 Medicare Advantage patients with diabetes and CKD who were receiving PIR was compared with that of treating 1301 Medicare Advantage patients with diabetes and CKD not receiving PIR. Differences in disease severity were compared using mean risk adjustment factor scores.Methods: Cost comparisons were made for CKD stages 2, 3a, 3b, 4, and 5. The total cost of treating the PIR patients was then compared with the total costs of treating the same number of non-PIR patients to determine cost differences potentially incurred.Results: The mean annual cost of treating PIR patients with stage 2 CKD was $11,251 vs $18,058 for the non-PIR group. For patients with stage 3a CKD, the mean PIR cost was $10,974 vs $18,563 for the non-PIR group. For patients with stage 3b CKD, the mean costs were $19,520 and $18,398, respectively. The mean costs for stages 4/5 CKD were $14,042 vs $22,124, respectively. The costs for an equal number of non-PIR patients at each stage were $345,830 higher than the actual costs of the PIR patients. There were no significant differences in the mean risk adjustment factor scores between the 2 groups.Conclusions: PIR is a possible method of reducing the cost of treating patients with diabetes and CKD. Given the rapidly increasing numbers of patients with diabetes and CKD who are Medicare Advantage beneficiaries, PIR should be considered for use by managed care organizations.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 1","pages":"e11-e14"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029972","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

Provider capacity during Medicaid expansion and a public health emergency. 医疗补助扩张和突发公共卫生事件期间的提供者能力。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89645

Jake Haselswerdt, Kristi Ressel, Emmie Harcourt, Sara Gable, Kathleen Quinn

{"title":"Provider capacity during Medicaid expansion and a public health emergency.","authors":"Jake Haselswerdt, Kristi Ressel, Emmie Harcourt, Sara Gable, Kathleen Quinn","doi":"10.37765/ajmc.2024.89645","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89645","url":null,"abstract":"Objectives: To assess the capacity of Medicaid providers to take on new patients during a time of unprecedented growth in program enrollment due to Medicaid expansion and the COVID-19 public health emergency.Study design: We conducted a survey of Medicaid providers in Missouri in 2023 about their patient load and capacity to accept new patients.Methods: We recruited 141 Missouri Medicaid providers through probability sampling and 109 additional providers through convenience sampling for a total sample size of 250, representing 0.8% of all Medicaid providers in Missouri. Our survey was informed by semistructured interviews with 15 providers conducted earlier in the year. We analyzed results using sample percentages with 95% CIs.Results: As expected, a large majority of respondents reported that their patient load had increased since 2021. Nonetheless, 53% (47%-59%) reported that they personally had the capacity to take on additional patients, and 70% (65%-75%) reported that their larger practice had the capacity to do so. We found no evidence that these responses differed between large metropolitan areas and other areas of the state. Majorities also reported that their practices either had recently hired additional personnel (both staff and providers) or planned to do so, and substantial percentages reported other capacity-expanding changes.Conclusions: Our results suggest that the health care system in Missouri can accommodate even historic growth in Medicaid enrollment and patient loads without compromising access to care as perceived by providers. Further research is needed from the patient side and focused on rural areas.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"e364-e369"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916282","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

Out-of-pocket spending for cardiac rehabilitation and adherence among US adults. 美国成年人心脏康复和依从性的自付费用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89637

Alexandra I Mansour, Ushapoorna Nuliyalu, Michael P Thompson, Steven Keteyian, Devraj Sukul

{"title":"Out-of-pocket spending for cardiac rehabilitation and adherence among US adults.","authors":"Alexandra I Mansour, Ushapoorna Nuliyalu, Michael P Thompson, Steven Keteyian, Devraj Sukul","doi":"10.37765/ajmc.2024.89637","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89637","url":null,"abstract":"Objectives: Although cardiac rehabilitation (CR) improves cardiovascular outcomes, adherence remains low. Higher patient-incurred out-of-pocket (OOP) spending may be a barrier to CR adherence. We evaluated the association between OOP spending for the first CR session and adherence.Study design: Retrospective analysis.Methods: Commercial and Medicare supplemental beneficiaries with a CR-qualifying event between 2016 and 2020 who attended at least 1 CR session within 6 months of discharge were identified in the MarketScan Commercial Database. OOP spending for the first session was categorized as zero or into 1 of 3 increasing tertiles of OOP spending. Poisson regression was used to determine the association between OOP-spending tertile and CR adherence, defined as the number of CR sessions attended within 6 months of discharge.Results: A total of 43,992 beneficiaries attended at least 1 CR session. Of these, 35,883 (81.6%) paid $0, 2702 (6.1%) paid $0.01 to $25.39, 2704 (6.1%) paid $25.40 to $82.41, and 2703 (6.1%) paid at least $82.42 for the first session, constituting the first, second, and third OOP-spending tertiles, respectively. Compared with the zero-OOP cohort, the first-tertile cohort attended 13.5% (95% CI, 1.4%-27.1%; P = .028) more CR sessions and the second- and third-tertile cohorts attended 11.9% (95% CI, -16.4% to -7.1%; P < .001) and 30.9% (95% CI, -40.8% to -19.4%; P < .001) fewer CR sessions on average, respectively. For every additional $10 spent OOP on the first CR session, patients attended 0.41 fewer sessions on average (95% CI, -0.65 to -0.17; P < .001).Conclusion: Among patients with OOP spending, higher spending was associated with lower CR adherence, dose dependently. Reducing OOP costs for CR may improve adherence for beneficiaries with cost sharing.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 12","pages":"651-657"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916277","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

Dallas Nephrology Associates' journey to value-based care. 达拉斯肾病协会的旅程，以价值为基础的护理。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2024-12-01 DOI: 10.37765/ajmc.2024.89656

Belinda Tommey, Paul Skluzacek, Melissa Echols, LeAnn Phelps, Mollyn Shew, Alexander Liang

{"title":"Dallas Nephrology Associates' journey to value-based care.","authors":"Belinda Tommey, Paul Skluzacek, Melissa Echols, LeAnn Phelps, Mollyn Shew, Alexander Liang","doi":"10.37765/ajmc.2024.89656","DOIUrl":"https://doi.org/10.37765/ajmc.2024.89656","url":null,"abstract":"Objectives: In 2016, Dallas Nephrology Associates recognized that the economic, humanistic, and societal burden of end-stage kidney disease was unsustainable and the fee-for-service model of reimbursement did not support a value-based care approach. We decided to be proactive by creating new workflows, education, and disease management so that patients could make well-informed choices, ultimately resulting in better outcomes.Methods: Our shift toward value-based care focused on patient engagement, education, integrated infrastructure, collaboration, and monitoring of metrics associated with improved outcomes. Our practice invested millions of dollars in a population health division, which includes nurse navigators and data analysts focused on managing chronic kidney disease (CKD), delaying progression, and promoting transplantation and home-based dialysis.Results: This retrospective review demonstrates improved outcomes, lower costs, and increased quality of care. Performance metrics have consistently met or exceeded targets. Seventy-three percent of patients now experience an optimal planned start to dialysis. Preemptive transplantation referrals have increased from 7% in 2017 to 61% through June 2023. Referral of patients with stage 4 CKD to educational workshops increased from 38% to 68%, and medical nutrition therapy referrals increased from 23% to 67%. Although reimbursement challenges persist, our commitment to improving care and slowing CKD progression remains steadfast. We emphasize teamwork, robust analytics, and continuous improvement. Future initiatives include encouraging patients receiving in-center hemodialysis to convert to home-based dialysis, addressing behavioral health, and focusing on preventable complications in high-risk patients.Conclusions: By embracing value-based models, we have demonstrated that a patient-centered approach can lead to improved outcomes and value for payers.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"30 Spec. No. 13","pages":"SP999-SP1012"},"PeriodicalIF":2.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822933","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

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