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Am J Manag Care 2019 Apr;25(5 Spec No.):SP140

Am J Manag Care 2019 Apr;25(5 Spec No.):SP176-SP177

Am J Manag Care 2019 Apr;25(5 Spec No.):SP173-SP175

Am J Manag Care 2019 Apr 1;25(4):e126-e134. Epub 2019 Apr 1.

Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, 2020 Gravier St, Room 213, New Orleans, LA 70112. Email:

Objectives: Continuity of care (COC) is a core element of primary care, which has been associated with improved health outcomes. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are potentially preventable if these conditions are managed well in the primary care setting. The aim of this article is to conduct a systematic review of literature on the association between COC and hospitalizations for ACSCs. Read More

Am J Manag Care 2019 Apr 1;25(4):e119-e125. Epub 2019 Apr 1.

UTHealth School of Public Health, 1200 Pressler, E923, Houston, TX 77030. Email:

Objectives: The Partners in Dementia Care (PDC) intervention has shown improved psychosocial outcomes while reducing overall inpatient and emergency department (ED) utilization among veterans with cognitive impairment and behavioral symptoms. However, veterans who use the Veterans Health Administration (VHA) also seek care from non-VHA sources, potentially reducing the effectiveness of care coordination. We evaluated whether PDC affected VHA and non-VHA inpatient and ED use by veterans with dementia. Read More

Am J Manag Care 2019 Apr 1;25(4):e111-e118. Epub 2019 Apr 1.

VA Loma Linda Healthcare System, Research Service (151), 11201 Benton St, Loma Linda, CA 92357. Email:

Objectives: Recruiting professional staff is an important business reason for hospitals allowing health trainees to engage in supervised patient care. Whereas prior studies have focused on educational institutions, this study focuses on teaching hospitals and whether trainees' clinical experiences affect their willingness to work (ie, recruitability) for the type of healthcare center where they trained.

Study Design: A pre-post, observational study based on Learners' Perceptions Survey data in which respondents served as their own controls. Read More

Am J Manag Care 2019 Apr 1;25(4):e104-e110. Epub 2019 Apr 1.

Daniel J. Crespin, PhD, Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455. Email:

Objectives: Some large employers and healthcare analysts have advocated for retail competition that relies on providers competing on performance metrics to improve care quality. Using publicly available performance measures, we determined whether health systems increased the quality of diabetes care provided by their clinics based on performance relative to competitors.

Study Design: Our analysis examined publicly reported performance measures of diabetes care from 2006 to 2013 for clinics in Minnesota health systems. Read More

Am J Manag Care 2019 Apr 1;25(4):e98-e103. Epub 2019 Apr 1.

University of Georgia, 250 W Green St, Athens, GA 30602. Email:

Objectives: To examine the association between potential inappropriate prescribing practices of opioids and deaths among opioid users in the Georgia Medicaid population.

Study Design: A retrospective analysis of individual pharmacy claims data from Georgia Medicaid from 2009 through 2014.

Methods: The sample was restricted to patients without cancer aged 18 to 64 years with an opioid prescription and included 3,562,227 observations representing 401,488 individuals. Read More

Am J Manag Care 2019 Apr;25(4):201-204

University of Arizona College of Pharmacy, 650 E Van Buren St, Office 3373, Phoenix, AZ 85004. Email:

Objectives: To determine if symptoms changed after changing chronic obstructive pulmonary disease (COPD) triple-therapy inhalers to a less expensive regimen.

Study Design: Retrospective observational case-series analysis.

Methods: A quality improvement program was instituted to reduce drug costs associated with COPD inhalers between fall 2016 and spring 2017. Read More

Am J Manag Care 2019 Apr;25(4):192-198

Section of General Internal Medicine (152G), VA Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130. Email:

Objectives: Deprescribing could reduce the risk of harm from inappropriate medications. We characterized patients' acceptance of deprescribing recommendations from pharmacists, primary care providers (PCPs), and specialists relative to the original prescriber's professional background.

Study Design: Secondary analysis of national Patient Perceptions of Discontinuation survey responses from Veterans Affairs (VA) primary care patients with 5 or more prescriptions. Read More

Am J Manag Care 2019 Apr;25(4):182-188

HealthPartners, 8170 33rd Ave S, MS 21110X, Minneapolis, MN 55425. Email:

Objectives: To identify opportunities to improve the health and well-being of members of HealthPartners, a health plan based in Minnesota.

Study Design: Cross-sectional analysis of insurance claims, death records, and survey data.

Methods: We calculated a current health score from insurance claims and death records for all 754,584 members 18 years and older who met inclusion and exclusion criteria for the period January 1, 2015, to December 31, 2015, and/or January 1, 2016, to December 31, 2016. Read More

Am J Manag Care 2019 Apr;25(4):174-180

Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Ste 1600, Seattle, WA 98101. Email:

Objectives: Fecal immunochemical tests (FITs) can efficiently screen for colorectal cancer (CRC), but little is known on the timing to their completion. We investigate the time to return of a FIT following an order and describe patient characteristics associated with FIT return.

Study Design: Retrospective cohort study. Read More

Am J Manag Care 2019 Apr;25(4):171-172

AstraZeneca, 1800 Concord Pike, Wilmington, DE 19803. Email:

The authors of the manuscript "Generalizability of Glucagon-Like Peptide-1 Receptor Agonist Cardiovascular Outcome Trials Enrollment Criteria to the US Type 2 Diabetes Population" respond to a letter to the editor. Read More

Am J Manag Care 2019 Apr;25(4):170-171

HealthMetrics Outcomes Research, 27576 River Reach Dr, Bonita Springs, FL 34134. Email:

Previous research overstated the generalizability of the Exenatide Study of Cardiovascular Event Lowering trial results by omitting the restriction on the percentage of patients without a prior cardiovascular event. Read More

Am J Manag Care 2019 Mar;25(4 Spec No.):SP115

Am J Manag Care 2019 Mar;25(4 Spec No.):SP123-SP126

Am J Manag Care 2019 Mar;25(4 Spec No.):SP116-SP119

Am J Manag Care 2019 Mar;25(4 Spec No.):SP120-SP122

Am J Manag Care 2019 Mar;25(3):140

Correction to the Trends From the Field article, "Risk Stratification for Return Emergency Department Visits Among High-Risk Patients," published in the August 2017 issue of The American Journal of Managed Care. Read More

Am J Manag Care 2019 Mar;25(3):135-139

University of Pennsylvania, 423 Guardian Dr, 1313 Blockley Hall, Philadelphia, PA 19104. Email:

Objectives: Adequate access to primary and dental care is essential for population health, and some state Medicaid programs have expanded insurance coverage for both. However, there are few data on new Medicaid enrollees' ability to access services. We examined the relationship between provider supply and enrollees' identification of usual sources of care. Read More

Am J Manag Care 2019 Mar;25(3):129-134

Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY 14642. Email:

Objectives: It is unclear whether the Medicaid expansion under the Affordable Care Act had an effect on coverage in states with relatively generous pre-expansion Medicaid eligibility levels. We examined the effect of the Medicaid expansions on Medicaid coverage in 4 generous states: New York, Vermont, Massachusetts, and Delaware.

Study Design: We used the American Community Survey (2011-2016) to estimate effects on coverage among nonelderly adults with incomes up to 138% of the federal poverty level. Read More

Am J Manag Care 2019 Mar;25(3):120-127

Division of General Medicine, Department of Internal Medicine, University of Michigan, North Campus Research Complex, Bldg 16, Room 419W, 2800 Plymouth Rd, Ann Arbor, MI 48109-2800. Email:

Objectives: Michigan expanded Medicaid under the Affordable Care Act (ACA) through a federal waiver that permitted state-mandated features, including an emphasis on primary care. We investigated the factors associated with Michigan primary care providers (PCPs)' decision to accept new Medicaid patients under Medicaid expansion.

Study Design: Statewide survey of PCPs informed by semistructured interviews. Read More

Am J Manag Care 2019 Mar;25(3):114-118

Department of Pediatrics, The Ohio State University College of Medicine, 700 Children's Drive, RM FB3322, Columbus, OH 43205. Email:

Objectives: To describe the extent and implications of "churn" between different Medicaid eligibility classifications in a pediatric population: (1) aged, blind, and disabled (ABD) Medicaid eligibility, determined by disability status and family income; and (2) Healthy Start Medicaid eligibility, determined by family income alone.

Study Design: As a result of a 2013 policy change, children with ABD eligibility transitioned from fee-for-service to capitated care. We used Ohio Medicaid claims data from July 2013 through June 2015 to explore the relationships among instability in eligibility category, demographics, and utilization. Read More

Am J Manag Care 2019 Mar;25(3):107-112

Weill Cornell Medicine, 420 E 70th St, Box 331, New York, NY 10021. Email:

Objectives: Results of previous studies of Medicare beneficiaries have shown that more fragmented ambulatory care is associated with more emergency department (ED) visits and hospital admissions. Whether this observation is generalizable to Medicaid beneficiaries is unknown.

Study Design: We conducted a 3-year retrospective cohort study in the 7-county Hudson Valley region of New York. Read More

Am J Manag Care 2019 Mar 1;25(3):e88-e97. Epub 2019 Mar 1.

axialHealthcare, Inc, Cummins Station, 209 S 10th Ave S #332, Nashville, TN 37203. Email:

Objectives: This study sought to formulate a consolidation of guidelines representing best practices related to office-based opioid treatment (OBOT) of opioid use disorder (OUD) using buprenorphine. It also demonstrates how a set of evidence-based guidelines may be linked with claims data to leverage analytic techniques that drive cost-effective, positive health outcomes.

Study Design: Literature review of US and international guidelines for OBOT using buprenorphine for OUD. Read More

Am J Manag Care 2019 Mar 1;25(3):e83-e87. Epub 2019 Mar 1.

RAND Corporation, 1200 S Hayes St, Arlington, VA 22202. Email:

Objectives: Community health centers (CHCs) historically have reported challenges obtaining specialty care for their patients, but recent policy changes, including Medicaid eligibility expansions under the Affordable Care Act, may have improved access to specialty care. The objective of this study was to assess current levels of difficulty accessing specialty care for CHC patients, by insurance type, and to identify specific barriers and strategies that CHCs are using to overcome these barriers.

Study Design: Cross-sectional survey, administered during summer 2017, of medical directors at CHCs in 9 states and the District of Columbia, all of which expanded Medicaid. Read More

Am J Manag Care 2019 Mar 1;25(3):e76-e82. Epub 2019 Mar 1.

Aledade Inc, 4550 Montgomery Ave, Ste 950, Bethesda, MD 20814. Email:

Objectives: Although use of the Medicare Annual Wellness Visit (AWV) is increasing nationally, it remains unclear whether it can help contain healthcare costs and improve quality. In the context of 2 primary care physician-led accountable care organizations (ACOs), we tested the hypothesis that AWVs can improve healthcare costs and clinical quality.

Study Design: A retrospective cohort study using propensity score matching and quasi-experimental difference-in-differences regression models comparing the differential changes in cost, emergency department (ED) visits, and hospitalizations for those who received an AWV versus those who did not from before until after the AWV. Read More

Am J Manag Care 2019 Mar 1;25(3):e71-e75. Epub 2019 Mar 1.

University of Connecticut Health Disparities Institute, 241 Main St, 5th Floor, Hartford, CT 06106. Email:

Objectives: To measure Connecticut's Affordable Care Act qualified health plan enrollees' health insurance literacy (HIL) by race, ethnicity, and language preference.

Study Design: Statewide landline and cell phone telephonic survey.

Methods: Geographically balanced cohort that oversampled black and Hispanic enrollees. Read More

Am J Manag Care 2019 Mar 1;25(3):e66-e70. Epub 2019 Mar 1.

Division of Quality and Informatics, Florida Cancer Specialists & Research Institute, 6420 W Newberry Rd, Ste 100, Gainesville, FL 32605. Email:

Objectives: The site of cancer care delivery has been shown to be associated with the total cost of care. The magnitude of this effect in patients receiving expensive immuno-oncology (I-O) therapies has not been evaluated. We evaluated cost differentials between community-based and hospital-based outpatient clinics among patients receiving I-O therapies. Read More

Am J Manag Care 2019 Mar 1;25(3):e58-e65. Epub 2019 Mar 1.

Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, 200 Springs Rd, Bedford, MA 01730. Email:

Objectives: Use of nonbenzodiazepine sedative hypnotics, especially zolpidem, has grown substantially, raising concerns about safety. Here, we evaluated prescribing patterns of zolpidem in the Veterans Health Administration.

Study Design: A cross-sectional study of veterans receiving zolpidem in the outpatient setting from October 1, 2011, to September 30, 2016. Read More

Am J Manag Care 2019 Feb;25(2 Spec No.):SP61-SP73

Am J Manag Care 2019 Feb;25(2 Spec No.):SP43-SP44

Am J Manag Care 2019 02 1;25(2):e50-e57. Epub 2019 Feb 1.

Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla 1, 28222 Majadahonda, Madrid, Spain. Email:

Objectives: To improve multiple levels of utilization and efficiency in specialized outpatient consults using information technology-based systems, process reengineering, and patient-centeredness.

Study Design: Prospective research from 2008 to 2014 conducted in a hospital in Madrid, Spain. Quantitative analysis of 1,162,477 consecutive consultation requests and qualitative techniques of 72,368 surveys using a structured questionnaire. Read More

Am J Manag Care 2019 02 1;25(2):e45-e49. Epub 2019 Feb 1.

Institute of General Practice, Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. Email:

Objectives: To assess the performance of the adapted Diabetes Complications Severity Index (aDCSI) translated to International Classification of Diseases, Tenth Revision (ICD-10) in predicting hospitalizations, mortality, and healthcare-associated costs.

Study Design: Retrospective closed cohort study based on secondary data analysis.

Methods: We translated the aDCSI to ICD-10 and calculated aDCSI scores based on health insurance claims data. Read More

Am J Manag Care 2019 02 1;25(2):e39-e44. Epub 2019 Feb 1.

HealthPartners, 8170 33rd Ave S, MS 21110X, Minneapolis, MN 55425. Email:

Objectives: To validate a method that estimates disease burden as disability-adjusted life-years (DALYs) from insurance claims and death records for the purpose of identifying the conditions that place the greatest burden of disease on an insured population.

Study Design: Comparison of the DALYs generated from death records and insurance claims with functional status and health status reported by individuals who were insured with one of HealthPartners' commercial products and completed a health assessment in 2011, 2012, or 2013.

Methods: We calculated values of Spearman's ρ, the rank-order coefficient of correlation, for the correlation of DALYs with self-reported function and self-reported health. Read More

Am J Manag Care 2019 02 1;25(2):e33-e38. Epub 2019 Feb 1.

Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115. Email:

Objectives: Despite public reporting of wide variation in hospital cesarean delivery rates, few women access this information when deciding where to deliver. We hypothesized that making cesarean delivery rate data more easily accessible and understandable would increase the likelihood of women selecting a hospital with a low cesarean delivery rate.

Study Design: We conducted a randomized controlled trial of 18,293 users of the Ovia Health mobile apps in 2016-2017. Read More

Am J Manag Care 2019 02 1;25(2):e26-e32. Epub 2019 Feb 1.

RAND Corporation, 1776 Main St, Santa Monica, CA 90407. Email:

Objectives: To understand physician organization (PO) responses to financial incentives for quality and total cost of care among POs that were exposed to a statewide multipayer value-based payment (VBP) program, and to identify challenges that POs face in advancing the goals of VBP.

Study Design: Semistructured qualitative interviews and survey.

Methods: We drew a stratified random sample of 40 multispecialty California POs (25% of the POs that were eligible for incentives). Read More

Am J Manag Care 2019 02;25(2):85-88

Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Room 409, Boston, MA 02115. Email:

Objectives: There is robust evidence that implementation of reference-based pricing (RBP) benefit design decreases spending. This paper investigates employer adoption of RBP as a strategy to improve the value of patients' healthcare choices, as well as facilitators and barriers to the adoption of RBP by employers.

Study Design: We conducted a qualitative study using 12 in-depth interviews with human resources executives or their representatives at large- or medium-sized self-insured employers. Read More

Am J Manag Care 2019 02;25(2):78-83

USC Schaeffer Center, VPD Suite 414, Los Angeles, CA 90087. Email:

Objectives: To assess the extent to which medication adherence in congestive heart failure (CHF) and diabetes may serve as a measure of physician-level quality.

Study Design: A retrospective analysis of Medicare data from 2007 to 2009, including parts A (inpatient), B (outpatient), and D (pharmacy).

Methods: For each disease, we assessed the correlation between medication adherence and health outcomes at the physician level. Read More

Am J Manag Care 2019 02;25(2):70-76

Duke-Margolis Center for Health Policy, 1201 Pennsylvania Ave, Ste 500, Washington, DC 20004. Email:

Objectives: To better understand the prevalence of US value-based payment arrangements (VBAs), their characteristics, and the factors that facilitate their success or act as barriers to their implementation.

Study Design: Surveys were administered to a convenience sample of subject matter experts who were senior representatives from payer organizations and biopharmaceutical manufacturers. These data were supplemented with qualitative interviews in a subsample of survey respondents. Read More

Am J Manag Care 2019 02;25(2):61-67

Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3300 Gallows Rd, Falls Church, VA 22042. Email:

Objectives: To assess the association of payer status and mortality in hepatitis C virus (HCV)-infected patients.

Study Design: For this retrospective observational study, we used the National Health and Nutrition Examination Survey from 2000 to 2010. Adults with complete data on medical questionnaires, HCV RNA, insurance types, and mortality follow-ups were included. Read More

Am J Manag Care 2019 02;25(2):59-60

Dialysis Patient Citizens, 1012 14th St NW, Ste 1475, Washington, DC 20005. Email:

Cost-benefit analysis for quality measures has emerged as the cornerstone of CMS' Meaningful Measures initiative. Read More

Am J Manag Care 2019 02;25(2):57-58

University of Michigan, 2800 Plymouth Rd, Bldg 16, Fl 4, 016-400S-25, Ann Arbor, MI 48109-2800. Email:

When it comes to the political iceberg of drug prices, there is more below the surface. Policies that reduce prices but do not lower consumers' out-of-pocket costs will not address the main challenge facing most Americans. Read More

Am J Manag Care 2019 Jan;25(2 Suppl):S35-S39

President, SJR Associates, LLC; and Adjunct Clinical Assistant Professor, University of Michigan, Ann Arbor, MI. Email:

Migraine is a highly prevalent neurological condition with substantial impact on individuals through associated complications, comorbidities, and increased healthcare costs. The burden on society is likewise substantial via increased healthcare costs and greater indirect costs, such as lost productivity. Research about the pathophysiology of migraine has led to the introduction of a new class of drugs, calcitonin gene-related peptide (CGRP) inhibitors. Read More

Am J Manag Care 2019 Jan;25(2 Suppl):S23-S34

Associate Professor, Pharmacy Practice Department-Ambulatory Care Division, St. Louis College of Pharmacy, St. Louis, MO. Email:

Migraine is a leading cause of disability worldwide. Approximately 15% of Americans experience migraines. Most people who have migraines feel that people who do not have them often underestimate their condition. Read More

Am J Manag Care 2019 Jan;25(1 Suppl):S11-S16

Director, Pharmacy Cancer Center, Department of Pharmacy, Mayo Clinic, Rochester, MN. Email:

Pancreatic cancer is typically diagnosed in the late stage of the disease, making it the fourth leading cause of cancer-related death in the United States. It is also one of the few cancers with an increasing incidence, particularly in the younger population. By 2030, it is expected to become the second leading cause of cancer-related death. Read More

Am J Manag Care 2019 Jan;25(1 Suppl):S3-S10

Chair, Pharmacy Practice, Associate Professor, Oncology, Touro College of Pharmacy, New York, NY. Email:

Pancreatic cancer remains a disease that is difficult to treat due to a typically late presentation, relatively high resistance to chemotherapy, and lack of effective targeted therapies. The standard of care relies on cytotoxic chemotherapy, primarily FOLFIRINOX and gemcitabine-based regimens. Dose modifications and/or the use of alternative combinations can reduce adverse effects, but these regimens remain highly toxic. Read More

Am J Manag Care 2019 Jan 1;25(1):e21-e25. Epub 2019 Jan 1.

School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA 94704. Email:

Objectives: The adoption of advanced health information technology (HIT) capabilities, such as predictive analytic functions and patient access to records, remains variable among healthcare systems across the United States. This study is the first to identify characteristics that may drive this variability among health systems.

Study Design: Responses from the 2017/2018 National Survey of Healthcare Organizations and Systems were used to assess the extent to which healthcare system organizational structure, electronic health record (EHR) standardization, and resource allocation practices were associated with use of 5 advanced HIT capabilities. Read More

Am J Manag Care 2019 Jan 1;25(1):e14-e20. Epub 2019 Jan 1.

Department of Health Management and Informatics, University of Central Florida, 4364 Scorpius St, Orlando, FL 32816. Email:

Objectives: To estimate the relationship between data breaches and hospital advertising expenditures.

Study Design: Observational data on hospital expenditures were analyzed using a propensity score-matched regression. The regression was specified as a generalized linear model using a gamma distribution and log link. Read More

Am J Manag Care 2019 Jan 1;25(1):e7-e13. Epub 2019 Jan 1.

Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455. Email:

Objectives: To characterize the drivers of the use of electronic health information exchange (HIE) by skilled nursing facilities (SNFs) to access patient hospital data during care transitions.

Study Design: Explanatory, sequential mixed-methods study. Quantitative data from an audit log captured HIE use by 3 SNFs to retrieve hospitalization information for the 5487 patients discharged to their care between June 2014 and March 2017, along with patient demographic data. Read More