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Am J Manag Care 2022 Jun;28(4 Spec No.):SP208-SP209

Am J Manag Care 2022 Jun;28(4 Spec No.):SP160

Am J Manag Care 2022 Apr;28(3 Spec No.):SP102-SP103

Am J Manag Care 2022 Jun 1;28(6):e232-e238. Epub 2022 Jun 1.

General Internal Medicine, University of Pittsburgh, 230 McKee Pl, Ste 600, Pittsburgh, PA 15213. Email:

Objectives: To complete a scoping review of US health insurers' use of health-related quality of life (HRQOL) patient-reported outcome measures (PROMs).

Study Design: Literature review.

Methods: A literature search was constructed for articles that contained an insurer-related term and an HRQOL-related term between 1999 and 2019 using the MEDLINE, Embase, Web of Science, Cochrane Database of Systematic Reviews, EconLit, and Business Source Complete databases. Read More

Am J Manag Care 2022 Jun 1;28(6):e228-e231. Epub 2022 Jun 1.

UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224. Email:

Objectives: Health systems must adapt to an increased consumer-centric environment to remain relevant in an ever-growing competitive health care landscape in which convenience is a key driver of patient satisfaction and loyalty. To adapt to this new environment, health systems must redesign processes to transform the delivery of ambulatory care and provide near real-time access to specialty care.

Study Design: A pediatric academic medical center in western Pennsylvania used a process-improvement approach to enhance timely access to specialty care and deliver a consumer-centric patient experience. Read More

Am J Manag Care 2022 Jun 1;28(6):e221-e227. Epub 2022 Jun 1.

College of Nursing, University of Colorado Anschutz Medical Campus, ED 2 North, Room 4317, 13120 E 19th Ave, Aurora, CO 80045. Email:

Objectives: Patient and Caregiver Support for Serious Illness (PACSSI), a per-member per-month (PMPM) alternative reimbursement structure for palliative care (PC) services, has been described as overly generous by HHS. We developed a modified version, PACSSI-Flexible (PACSSI-F), by modeling reimbursement for PC based on the changes in patient functional status. We estimated reimbursement for the first year that an organization might implement the PACSSI-F for PC services. Read More

Am J Manag Care 2022 Jun 1;28(6):e212-e220. Epub 2022 Jun 1.

IBM Watson Health, 75 Binney St, Cambridge, MA 02142. Email:

Objectives: To quantify the clinical and economic burden of patients with severe asthma with low blood eosinophil counts (BECs) untreated with biologics.

Study Design: Retrospective cohort study in IBM MarketScan claims database.

Methods: Patients 12 years and older with severe asthma with BEC data were selected between January 1, 2013, and June 30, 2018 (date of the most recent BEC was used as the index date). Read More

Am J Manag Care 2022 Jun 1;28(6):e203-e211. Epub 2022 Jun 1.

The Permanente Medical Group, 39400 Paseo Padre Pkwy, Fremont, CA 94538. Email:

Objectives: The opioid abuse epidemic has focused attention on efforts to decrease opioid prescribing. Although education and feedback interventions are potential levers to affect opioid prescribing, their incremental contribution against a background of declining opioid prescriptions is unclear.

Study Design: We retrospectively evaluated opioid prescribing frequencies after an emergency physician-specific education and feedback initiative in an integrated health care system. Read More

Am J Manag Care 2022 Jun 1;28(6):e198-e202. Epub 2022 Jun 1.

Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106. Email:

Central to the Porter-Lee value agenda, integrated practice unit (IPU) pilots have multiplied over time, striving to fundamentally reorganize the delivery of care via multidisciplinary teams while improving outcome measurement and driving competitive volumes. As these pilots emerge to form bridges of coordinated care, critics continue to question the value proposition of these IPUs: Do they achieve the Quadruple Aim of modern health care by improving cost of care, health outcomes, patient experience, and provider experience? Noting that value realization has eluded IPU pilots globally over the past 15 years, the authors examine 6 critical challenges and propose recommendations to consistently deploy effective IPUs, leading to a win-win proposition for all key stakeholders. Read More

Am J Manag Care 2022 06;28(6):288-292

Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239. Email:

Objectives: To describe the types and breadth of network adequacy standards used by state Medicaid programs with managed care arrangements.

Study Design: Document analysis of Medicaid provider network reports, managed care plan contracts, access monitoring review plans, Medicaid services manuals, quality strategy reviews, and state statutes and regulations.

Methods: We analyzed 52 primary documents from 2017 to 2020, representing 39 of the 40 states (including the District of Columbia) with Medicaid managed care. Read More

Am J Manag Care 2022 Jun;28(6):282-286

University of Florida College of Pharmacy, 1225 Center Dr, PO Box 100486, Gainesville, FL 32610. Email:

Objectives: Optimizing patient outcomes is a goal for medication therapy management (MTM) programs, with patient satisfaction representing a valuable measure to provide information about pharmacist-delivered services and the overall effectiveness of the program. The objective of this study was to assess patient satisfaction after engaging in a telephonic comprehensive medication review (CMR) with a pharmacist in a Medicaid population.

Study Design: This was a retrospective cohort study. Read More

Am J Manag Care 2022 Jun;28(6):273-280

COVIA Health Solutions, 115 Meadow View Ln, Lansdale, PA 19446. Email:

Objectives: To evaluate the impact of the star rating bonus payment policy on annual influenza vaccination rates before and after the policy was adopted for Medicare Advantage (MA) plans in 2012.

Study Design: Observational study using data from the Medicare Current Beneficiary Survey from 2007 to 2015 to test whether the bonus payment policy led to higher flu vaccination rates in MA prescription drug (MAPD) plans vs fee-for-service prescription drug plans (PDPs), which were ineligible for bonus payments.

Methods: Mean preperiod (2007-2011) and postperiod (2012-2015) influenza vaccination rates were compared for enrollees in both types of plans using descriptive and multivariate difference-in-difference (DID) equations. Read More

Am J Manag Care 2022 06;28(6):262-268

University of Pennsylvania, 1310 Blockley Hall, 421 Guardian Dr, Philadelphia, PA 19104. Email:

Objectives: Strategies to maintain hospital capacity during the COVID-19 pandemic included reducing hospital length of stay (LOS) for infected patients. We sought to evaluate the association between LOS and enrollment in the COVID Accelerated Care Pathway, which consisted of a hospital observation protocol and postdischarge automated text message-based monitoring.

Study Design: Retrospective matched cohort study of patients hospitalized from December 14, 2020, to January 31, 2021. Read More

Am J Manag Care 2022 Jun;28(6):254-260

Pulmonary Medicine Service, Texas Children's Hospital, 6701 Fannin St, Suite 1040.00, Houston, TX 77030. Email:

Objectives: Identification of patients with asthma at increased risk for hospitalization and emergency department (ED) visits presents opportunity for intervention.

Study Design: Retrospective analysis of computerized health plan claims data.

Methods: Texas Children's Health Plan, a large Medicaid managed care program, developed an asthma risk scoring algorithm using the clinically relevant parameters of hospitalization for asthma, ED visits for asthma, short-acting β agonist medication dispensing, inhaled corticosteroid medication dispensing, number of prescribing providers, loss to follow-up, and oral corticosteroid dispensing. Read More

Am J Manag Care 2022 Jun;28(6):251-252

Precision Pharmacotherapy Research and Development Institute, Tabula Rasa HealthCare, 13485 Veterans Way, Ste 410, Orlando, FL 32827. Email:

The authors provide feedback on generalizations made regarding interventions for high-risk populations in previous research. Read More

Am J Manag Care 2022 05 1;28(5):e189-e197. Epub 2022 May 1.

105 S Hill Rd, Colonia, NJ 07067. Email:

Objectives: Patient assistance programs (eg, co-pay assistance) may reduce patients' out-of-pocket costs for prescription medicines, providing financial assistance to access medicines for reduced or no cost. A literature review to identify peer-reviewed articles on studies evaluating the impact of co-pay assistance on clinical, patient, and economic outcomes was conducted.

Study Design: A literature review was conducted by searching Embase and MEDLINE. Read More

Am J Manag Care 2022 05 1;28(5):e185-e188. Epub 2022 May 1.

Brandeis University, 415 South St, MS035, Waltham, MA 02454. Email:

Objectives: To describe the use of home-based services in accountable care organizations (ACOs).

Study Design: Cross-sectional analysis of 2019 ACO survey.

Methods: We analyzed surveys completed by 151 ACOs describing the characteristics of home-based care programs serving high-need, high-cost patients. Read More

Am J Manag Care 2022 05 1;28(5):e178-e184. Epub 2022 May 1.

Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, 402 E 67th St, New York, NY 10065. Email:

Objectives: To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services.

Study Design: Observational study design using Health Care Cost Institute claims representing 3 large national commercial insurers.

Methods: The main outcome was count of 19 potential low-value services in 2014. Read More

Am J Manag Care 2022 05 1;28(5):e170-e177. Epub 2022 May 1.

Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843. Email:

Objectives: To examine how health care utilization and spending vary for low-income employees compared with high-income employees enrolled in an employer-sponsored high-deductible health plan (HDHP).

Study Design: We use commercial medical claims data and administrative human resource data from a large employer between 2014 and 2018. We link the administrative data, which include details on salary and other benefit choices, to each employee in each year with medical claims. Read More

Am J Manag Care 2022 05 1;28(5):e163-e169. Epub 2022 May 1.

University of Washington, 1959 NE Pacific St, 375-B, Seattle, WA 98195-7630. Email:

Objectives: Real-world patterns of surveillance testing in colorectal cancer (CRC) and the effects on health and cost outcomes are largely unknown. Our objectives were to (1) assess trends in carcinoembryonic antigen (CEA) testing, CT scans, and colonoscopy utilization and (2) examine the value of CEA testing intensity by characterizing receipt of curative treatment for recurrence and measuring direct medical costs.

Study Design: Prospective cohort study. Read More

Am J Manag Care 2022 05 1;28(5):e157-e162. Epub 2022 May 1.

Department of General Internal Medicine, Bern University Hospital, Freiburgstrasse, 3010 Bern, Switzerland. Email:

Objectives: To change blood pressure treatment, clinicians can modify medication count or dose. However, existing studies have measured count modification, which may miss clinically important dose change in the absence of count change. This research demonstrates how dose modification captures more information about management than medication count alone. Read More

Am J Manag Care 2022 05;28(5):232-236

VA Center for the Study of Health Care Innovation, Implementation, and Policy, 11301 Wilshire Blvd, Bldg 206, 2nd Floor, Los Angeles, CA 90073. Email:

Objectives: Poor coordination across care transitions for patients with chronic ambulatory care-sensitive conditions (ACSCs) leads to adverse clinical outcomes. Veterans are at high risk for post-emergency department (ED) adverse outcomes, but the care needs of patients leaving the ED after "treat-and-release" visits are poorly characterized. To inform intervention development and implementation, we assessed for medication changes and follow-up care needs among patients with treat-and-release Veterans Affairs (VA) ED visits for chronic ACSCs. Read More

Am J Manag Care 2022 05;28(5):229-231

Veterans Affairs Center for Clinical Management Research, 2215 Fuller Rd, 111D, Ann Arbor, MI 48105. Email:

Objectives: To quantify temporal changes in colonoscopy indication and assess appropriateness of surveillance use in older adults.

Study Design: Retrospective longitudinal study of national Veterans Health Administration (VHA) data of all patients who underwent outpatient colonoscopy in 2005-2014.

Methods: After validating an electronic algorithm for classifying colonoscopy indication in VHA, we examined trends in colonoscopy indication over time and across patient characteristics. Read More

Am J Manag Care 2022 05;28(5):223-228

Stanford University, 434 Galvez Mall, Stanford, CA 94305. Email:

Objectives: The relationship between provider age and quality of care is theoretically indeterminate. Older providers are more experienced, which could lead to a positive relationship between age and quality, but providers' practice patterns could become outdated as technology and scientific knowledge change, which could lead to a negative relationship between age and quality. However, little work has investigated the provider age/quality relationship, and no work has investigated the relationship between provider age and opioid prescribing behavior. Read More

Am J Manag Care 2022 05;28(5):212-217

Columbia University School of Nursing, 560 W 168th St, New York, NY 10032. Email:

Objectives: To evaluate structural capabilities in primary care practices employing nurse practitioners (NPs) and test whether they differ across health professional shortage areas (HPSAs) and non-HPSAs.

Study Design: Secondary analysis of cross-sectional survey data and health care workforce data from 2018-2019.

Methods: We computed bivariate analyses and multivariable adjusted regression models to evaluate differences in NP characteristics and practice characteristics and to determine the odds of having particular structural capabilities in HPSA practices compared with non-HPSA practice. Read More

Am J Manag Care 2022 05;28(5):207-211

University of Maryland Baltimore, 220 Arch St, 12th Fl, Baltimore, MD 21201. Email:

Objectives: In an era of heightened opioid prescribing scrutiny, ensuring safe and adequate pain management is challenging. Understanding opioid use in patients with cancer can facilitate effective pain management regimens while minimizing safety concerns. This study characterized patterns of and factors associated with opioid use following a new cancer diagnosis. Read More

Am J Manag Care 2022 05;28(5):201-206

Massachusetts General Hospital, 15 Parkman St, Wang Ambulatory Care Center 634, Boston, MA 02114. Email:

Objectives: Our study examines the impact of an emergency department (ED) patient navigation program for patients in a Medicaid accountable care organization across 3 hospitals in a large health system. Our program engages community health workers to (1) promote primary care engagement, (2) facilitate care coordination, and (3) identify and address patients' health-related social needs.

Study Design: Our study was a retrospective analysis of health care utilization and costs in the 30 days following the index ED visit, comparing individuals receiving ED navigation and matched controls. Read More

Am J Manag Care 2022 04;28(3 Spec No.):SP142-SP143

Am J Manag Care 2022 04;28(3 Spec No.):SP97

Am J Manag Care 2022 04 1;28(4):e153-e156. Epub 2022 Apr 1.

Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington St #63, Boston, MA 02111. Email:

Objectives: To examine US commercial health plans' adoption of 2018 FDA-approved drugs.

Study Design: Database analysis.

Methods: We identified novel drugs that the FDA approved in 2018 and categorized them as follows: cancer treatment, orphan drug, included in an expedited review program, and biosimilar. Read More