American Journal of Managed Care最新文献_第9页

The role of advanced technologies in improving diabetes outcomes. 先进技术在改善糖尿病预后中的作用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89725

David G Marrero, Christopher G Parkin, Grazia Aleppo, Irl B Hirsch, Janet McGill, Rodolfo J Galindo, Davida F Kruger, Carol J Levy, Anders L Carlson, Guillermo E Umpierrez

{"title":"The role of advanced technologies in improving diabetes outcomes.","authors":"David G Marrero, Christopher G Parkin, Grazia Aleppo, Irl B Hirsch, Janet McGill, Rodolfo J Galindo, Davida F Kruger, Carol J Levy, Anders L Carlson, Guillermo E Umpierrez","doi":"10.37765/ajmc.2025.89725","DOIUrl":"10.37765/ajmc.2025.89725","url":null,"abstract":"Objectives: To discuss the current state of diabetes care in America, the value and utility of innovative diabetes technologies, barriers to access to quality diabetes care and technologies, and how a value-based model of diabetes care can improve outcomes and reduce costs.Study design: Narrative review of the current state of diabetes care in America and use of diabetes technologies such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems.Methods: An internet search of relevant studies and government reports was conducted.Results: Numerous studies have shown that use of CGM and AID improves glycemia, diabetes-related events, and health care resource utilization and lowers overall health care costs. Despite these demonstrated benefits, the majority of individuals with diabetes are not achieving their glycemic goals. Although many of these individuals have limited access to these technologies due to restrictive coverage eligibility criteria, significant disparities exist in technology use within racial/ethnic minority populations and communities of lower socioeconomic status. Transitioning to a value-based approach to diabetes care supports the Quintuple Aim framework.Conclusions: Shifting our current health care delivery paradigm from the traditional volume-based, fee-for-service model to a value-based model that takes a proactive approach could improve patient outcomes and overall quality of life while helping to reduce the long-term costs of diabetes care.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"e102-e112"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12232999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046651","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}

引用次数: 0

Comparing breast cancer treatment outcomes between fee-for-service and Medicare Advantage. 比较按服务收费和医疗保险优惠之间的乳腺癌治疗结果。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89720

Galen Shearn-Nance, Rishi R Sachdev, Long Vu, Weichuan Dong, Alberto J Montero, Siran M Koroukian, Johnie Rose

{"title":"Comparing breast cancer treatment outcomes between fee-for-service and Medicare Advantage.","authors":"Galen Shearn-Nance, Rishi R Sachdev, Long Vu, Weichuan Dong, Alberto J Montero, Siran M Koroukian, Johnie Rose","doi":"10.37765/ajmc.2025.89720","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89720","url":null,"abstract":"Objectives: Medicare Advantage (MA) enrollment has increased over the past 2 decades. We compare receipt of standard treatment, time to treatment initiation (TTI), and overall survival (OS) between fee-for-service (FFS) Medicare and MA for women in Ohio with breast cancer.Study design: Retrospective cohort.Methods: We used Ohio cancer registry data linked with Medicare enrollment files to identify women diagnosed between 2011 and 2016 with local- or regional-stage breast cancer. We evaluated the association between FFS or MA and each outcome, adjusting for age, race, marital status, county type, neighborhood poverty level, stage, hormone receptor status, and dual Medicare-Medicaid enrollment. Standard treatment was mastectomy or breast-conserving surgery plus radiotherapy; chemotherapy for regional disease; and hormone therapy if hormone receptor positive.Results: A total of 12,349 patients met inclusion criteria (6801 FFS; 5548 MA). No difference was found in receipt of standard treatment between FFS and MA patients (adjusted OR [AOR], 0.99; 95% CI, 0.91-1.08) or between Black and White patients (AOR, 1.14; 95% CI, 0.94-1.40); however, Black patients with FFS had lower odds of standard treatment (AOR for interaction, 0.75; 95% CI, 0.57-0.99). We detected no difference in TTI (adjusted HR [AHR], 0.98; 95% CI, 0.94-1.01) or OS (AHR, 1.03; 95% CI, 0.92-1.15) between FFS and MA patients, and we found no significant interaction between MA status and race for OS or TTI.Conclusions: MA enrollment was not independently associated with standard treatment, TTI, or OS after cancer diagnosis. Further work is needed to understand why Black patients with FFS Medicare were less likely to receive standard treatment.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"190-196"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040193","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

Cost-effectiveness of the MiniMed 780G system for type 1 diabetes. MiniMed 780G系统治疗1型糖尿病的成本效益

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89722

Mallika Kommareddi, Kael Wherry

{"title":"Cost-effectiveness of the MiniMed 780G system for type 1 diabetes.","authors":"Mallika Kommareddi, Kael Wherry","doi":"10.37765/ajmc.2025.89722","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89722","url":null,"abstract":"Objectives: Advances in diabetes technology have led to improved glycemic control. However, no study has evaluated the economic impact of advanced hybrid closed-loop (AHCL) technology in the US compared with older and less expensive treatments. We assessed the cost-effectiveness of the MiniMed 780G system (MM780G) with AHCL technology vs multiple daily injections of insulin (MDI) with intermittently scanned continuous glucose monitoring (isCGM) among patients with type 1 diabetes (T1D) in the US.Study design: A 6-month randomized controlled trial compared MM780G against MDI with isCGM among patients with T1D. Outcomes included changes in hemoglobin A 1c and quality of life.Methods: We used the IQVIA Core Diabetes Model to simulate direct costs and quality of life separately over a 4-year horizon and a lifetime horizon. Treatment effects were sourced from the randomized controlled trial, and utilities and disutilities for diabetes-related complications came from the literature. We generated incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves for the base case and 5 one-way sensitivity analyses.Results: At a willingness-to-pay threshold of $100,000, MM780G is cost-effective in the base case, with an ICER of $68,402 per quality-adjusted life-year over a 4-year horizon and $38,842 per quality-adjusted life-year over a lifetime horizon. Sensitivity analyses varying the rates of short-term complications, pricing, and assumptions about treatment-related utilities show cost-effectiveness at a threshold of $100,000 in all but 1 case.Conclusions: MM780G is likely to be cost-effective vs MDI with isCGM in patients with T1D in the US at a willingness-to-pay threshold of $100,000.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"e79-e86"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993482","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

Prior authorizations and the adverse impact on continuity of care. 事先授权和对护理连续性的不利影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89721

Jay S Pickern

引用次数: 0

Care coordination engagement patterns in long-term patients. 长期病人的护理协调参与模式。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89718

Nicolas M Oreskovic, Zachary A Allon, Ann E Erwin

{"title":"Care coordination engagement patterns in long-term patients.","authors":"Nicolas M Oreskovic, Zachary A Allon, Ann E Erwin","doi":"10.37765/ajmc.2025.89718","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89718","url":null,"abstract":"Objective: Health care networks are increasingly turning to programs that provide office-based care coordination to high-cost, high-need patients to control preventable health care costs. Although care coordination programs have been shown to result in shorter-term cost benefits, little is known about patients who remain in such programs beyond 2 years. This study sought to assess the amount of care coordination engagement over time in patients enrolled for more than 2 years in an office-based care coordination program.Study design: Cohort study with 9 years of follow-up data.Methods: The study population was adult patients enrolled for 2 or more years as of November 2023 in an office-based care coordination program at a major academic medical center in Boston, Massachusetts. The association between patient length of enrollment in an outpatient care coordination program and amount of care coordination engagement was assessed using linear regression, with differences between cohorts compared by t test and analysis of variance. Engagement patterns in 5 sequential study cohorts based on date of enrollment were compared.Results: Among all 2258 patients enrolled, care coordination engagement increased linearly over time, with a mean increase of 0.2 care coordination encounters per patient per year. Similar increasing engagement patterns over time were observed across all study cohorts.Conclusions: Length of time enrolled in an office-based care coordination program predicted care coordination engagement, with care coordination services increasing the longer patients remained in the program.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"166-171"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054910","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

Technology, partnerships, data, and culture are keys to bringing precision medicine to community oncology. 技术、伙伴关系、数据和文化是将精准医学引入社区肿瘤学的关键。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89727

Mary Caffrey

引用次数: 0

AI in health care: closing the revenue cycle gap. 医疗保健中的人工智能：缩小收入周期差距。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89717

Erin Weber, Kristine Burnaska, Robert Bowman, Samantha Holvey

引用次数: 0

Impact of hospital-physician integration on Medicare patient mix. 医院-医生整合对医疗保险患者组合的影响。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-04-01 DOI: 10.37765/ajmc.2025.89724

Brady Post, Farbod Alinezhad, Gary J Young

{"title":"Impact of hospital-physician integration on Medicare patient mix.","authors":"Brady Post, Farbod Alinezhad, Gary J Young","doi":"10.37765/ajmc.2025.89724","DOIUrl":"10.37765/ajmc.2025.89724","url":null,"abstract":"Objectives: Hospital employment of physicians, often called hospital-physician vertical integration, has become widespread in health care delivery, but whether hospital employment tilts the case mix of physicians toward higher-complexity patients remains unknown.Study design: Cross-sectional and difference-in-differences analysis of 2014-2019 Medicare Standard Analytic Files.Methods: We compared pre- and postemployment patient panels of primary care physicians who did and did not become hospital employees, analyzing changes in the prevalence of chronic conditions. We measured arthritis, depression, diabetes, hypertension, and ischemic heart disease. We also evaluated whether patients who were dropped from physician panels found alternative sources of primary care.Results: Hospital-employed physicians treated patients of similar or better health; for instance, 54% of integrated physicians' patients had 2 or more chronic conditions compared with 56% among independent physicians (P < .001). After becoming hospital employees, physicians treated approximately 10% fewer Medicare patients (-9.5%; 95% CI, -11.3% to -7.7%). Within physician panels, the prevalence of patients with 2 or more chronic conditions did not significantly change after employment relative to independent physicians (-1.1%; 95% CI, -2.3% to 0.2%). Approximately 37% of patients were dropped from physician panels after employment; these patients were less likely to find alternative primary care compared with those dropped from independent physician panels (P < .001).Conclusions: Hospital employment of physicians resulted in neither a higher number nor a higher proportion of complex patients treated by integrated physicians, at least among traditional Medicare patients.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"e95-e101"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044196","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

Demographic disparities in video visit telemetry: understanding telemedicine utilization. 视频访问遥测的人口差异：了解远程医疗的利用。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-03-01 DOI: 10.37765/ajmc.2025.89699

Daniel Stein, Mark L Moubarek, Jeffrey Fine, Jeffery Wajda, Mark Avdalovic

{"title":"Demographic disparities in video visit telemetry: understanding telemedicine utilization.","authors":"Daniel Stein, Mark L Moubarek, Jeffrey Fine, Jeffery Wajda, Mark Avdalovic","doi":"10.37765/ajmc.2025.89699","DOIUrl":"10.37765/ajmc.2025.89699","url":null,"abstract":"Objectives: To investigate demographic disparities in failed episodes of telemedicine utilization. The primary hypothesis was that certain demographic groups, including older adults and specific racial or ethnic groups, would experience disparate amounts of failed video visits.Study design: A retrospective review was conducted using electronic health record-integrated scheduled telehealth video visit telemetry data gathered for all video visits at a California academic health center from September 1, 2020, to November 30, 2020. For each visit, we collected demographics including age, sex, ethnicity, primary language, and race.Methods: Outcomes were categorized as successful or failed based on review of telemetry data. Successful visits were defined as simultaneous connections and completion of video visit, whereas failed visits were defined as provider-reported failure or lack of simultaneous connections for the telemedicine visit. Binomial generalized logistic regression using a generalized estimating equation approach was used to assess the impact of demographic factors on video visit success. Of 47,065 scheduled telemedicine video visits, telemetry data were available for 30,996; the 16,069 visits excluded from the study were due to no-shows, cancellations, or a nonintegrated solution being utilized.Results: Of 30,996 visits included in the study, 27,273 were successfully completed. Analysis of the 3723 failed visits revealed that older adults and African American/Black patients were more likely to experience failed video visits, with ORs of 2.02 and 1.56, respectively.Conclusions: This study highlights the significant demographic disparities in failed video visit occurrence caused by technical failure as demonstrated by telemetry data. These findings highlight the need for targeted interventions and opportunity for improved outcomes.","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 3","pages":"e69-e73"},"PeriodicalIF":2.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143576001","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 information technology special issue: evolving tech, fundamental methods. 卫生信息技术特刊：技术演进、基本方法。

IF 2.5 4区医学

American Journal of Managed Care Pub Date : 2025-03-01 DOI: 10.37765/ajmc.2025.89694

Courtney R Lyles

引用次数: 0