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Am J Manag Care 2020 Jun;26(6 Suppl):S123-S143

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

The American Journal of Managed Care® and Exact Sciences Corporation hosted a roundtable meeting to discuss the impact of colorectal cancer (CRC) screening modalities on improving patient outcomes. The roundtable participants were a diverse panel of experts, including primary care, gastroenterology, and oncology providers; experts in health outcomes research and health policy; and managed care executives with commercial and public payer experience. Participants discussed CRC prevention and treatment strategies, screening modalities and adherence, molecular diagnostics, patient navigation, evaluation of large data sets, managed care, outcomes research, quality improvement, and reimbursement policies. Read More

Am J Manag Care 2020 Jun;26(5 Spec No.):SP146-SP147

Am J Manag Care 2020 Jun;26(5 Spec No.):SP167

Am J Manag Care 2020 Jun;26(5 Spec No.):SP164-SP166

Am J Manag Care 2020 Jun;26(5 Spec No.):SP136

Am J Manag Care 2020 Jun;26(5 Spec No.):eSP1

Am J Manag Care 2020 Jun;26(5 Spec No.):SP162-SP163

Am J Manag Care 2020 Jun 1;26(6):e198-e201. Epub 2020 Jun 1.

Denver Health and Hospital Authority, 777 Bannock St, MC 6017, Denver, CO 80204. Email:

Objectives: The Medicare Diabetes Prevention Program (MDPP) launched in April 2018, offering an unprecedented opportunity to reach the estimated 48.3% of older adults with prediabetes. Success of the innovative policy is likely to depend on adequate supplier availability. Read More

Am J Manag Care 2020 Jun 1;26(6):e191-e197. Epub 2020 Jun 1.

Humana Inc, 515 W Market St, 7th Floor, Louisville, KY 40202. Email:

Objectives: The goal of this study was to establish a claims-based mechanism for identifying patients with metastatic non-small cell lung cancer (mNSCLC) and high levels of patient-reported cancer-related symptoms who could benefit from engagement with health care programs.

Study Design:  A cross-sectional survey of patients with mNSCLC was conducted from July 2017 to May 2018. Surveys were mailed to patients who were within 3 months of cancer treatment and enrolled in a Medicare Advantage health plan. Read More

Am J Manag Care 2020 Jun 1;26(6):e184-e190. Epub 2020 Jun 1.

Department of Anesthesiology and Perioperative Medicine, Penn State Health, 500 University Dr, Hershey, PA 17033. Email:

Objectives: Effective communication among health care providers is critically important for patient safety. Handoff of patient care from the operating room (OR) to the intensive care unit (ICU) is particularly prone to errors. The process is more complicated in an academic environment in which junior clinicians are being trained. Read More

Am J Manag Care 2020 Jun 1;26(6):e179-e183. Epub 2020 Jun 1.

Blue Cross Blue Shield of Louisiana, 5525 Reitz Ave, Baton Rouge, LA 70809. Email:

Objectives: To determine whether a program that eliminated pharmacy co-pays, the Blue Cross Blue Shield of Louisiana (BCBSLA) Zero Dollar Co-pay (ZDC) program, decreased health care spending. Previous studies have found that value-based insurance designs like the ZDC program have little or no impact on total health care spending. ZDC included an expansive set of medications related to 4 chronic diseases rather than a limited set of medications for 1 or 2 chronic diseases. Read More

Am J Manag Care 2020 Jun 1;26(6):e172-e178. Epub 2020 Jun 1.

Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave S, 703 Oxford House, Nashville, TN 37232. Email:

Objectives: Poorly defined measurement impairs interinstitutional comparison, interpretation of results, and process improvement in health care operations. We sought to develop a unifying framework that could be used by administrators, practitioners, and investigators to help define and document operational performance measures that are comparable and reproducible.

Study Design: Retrospective analysis. Read More

Am J Manag Care 2020 Jun 1;26(6):e166-e171. Epub 2020 Jun 1.

Humana Healthcare Research Inc, 515 Market St, Louisville, KY 40202. Email:

Objectives: In patients with type 2 diabetes (T2D), comorbidity-related hospitalizations can have significant impact on longitudinal care. This study aimed to estimate incremental all-cause health care resource utilization (HCRU) and costs between patients with T2D who experienced cardiovascular (CV)-, heart failure (HF)-, or renal-related hospitalizations vs those who did not.

Study Design: This was a retrospective cohort study using data from a large national health plan. Read More

Am J Manag Care 2020 Jun;26(6):267-272

Department of Pediatrics, Medical University of South Carolina, 135 Rutledge Ave, MSC 561, Charleston, SC 29425. Email:

Objectives: Emergency department (ED) utilization is often used as an indicator of poor chronic disease control and/or poor quality of care. We sought to determine if 2 ED utilization measures identify clinically or demographically different populations of children.

Study Design: Retrospective cohort study utilizing IBM Health/Truven MarketScan Medicaid data. Read More

Am J Manag Care 2020 Jun;26(6):262-266

Regal Medical Group, 8510 Balboa Blvd, Ste 150, Northridge, CA 91325. Email:

Objectives: Scholars have highlighted the importance of preventing hospital admissions and readmissions for individuals with costly chronic conditions. Providing effective care management strategies can help reduce inpatient admissions, thereby reducing rising health care costs. However, implementing effective care management strategies may be more difficult for independent physician associations (IPAs) that contract with multiple organizations that have competing interests and agendas. Read More

Am J Manag Care 2020 Jun;26(6):256-261

Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugi-Cho, Nakahara-ku Kawasaki City, Japan. Email:

Objectives: To evaluate the magnitude of general medical claims expenditures (ie, medical service use) for individuals who use and do not use behavioral health (BH) services in the Japanese free-access medical insurance system to determine if BH patients use substantially more health services, as has consistently been reported in the United States.

Study Design: Retrospective comparison of Japanese occupation-based total health services use for enrollees with and without comorbid BH conditions.

Methods: The study used a health insurance claims database for more than 3 million enrollees in Japan. Read More

Am J Manag Care 2020 Jun;26(6):248-255

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, 401 Park St, Ste 401, Boston, MA 02215. Email:

Objectives: To determine the impact of high-deductible health plans (HDHPs) on health care use among individuals with bipolar disorder.

Study Design: Interrupted time series with propensity score-matched control group design, using a national health insurer's claims data set with medical, pharmacy, and enrollment data.

Methods: The intervention group was composed of 2862 members with bipolar disorder who were enrolled for 1 year in a low-deductible (≤$500) plan and then 1 year in an HDHP (≥$1000) after an employer-mandated switch. Read More

Am J Manag Care 2020 Jun;26(6):245-247

Department of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA 98105. Email:

To support effective care management programs in the context of value-based care, we propose a framework categorizing care management as disease management, utilization management, and care navigation interventions. Read More

Am J Manag Care 2020 Jun;26(6):241-244

Department of Health Policy & Administration and Center for Health Care Policy Research, The Pennsylvania State University, 504 Ford Bldg, University Park, PA 16802-6500. Email:

Big data could help identify potential clues about the immediate (and future) impact of coronavirus disease 2019, but it is in short supply. Read More

Am J Manag Care 2020 06;26(6):238-239

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the June issue, we turned to Donald M. Berwick, MD, MPP, president emeritus and senior fellow at the Institute for Healthcare Improvement and former administrator of CMS. Read More

Am J Manag Care 2020 May;26(5 Suppl):S112-S117

W-Squared Group, Longboat Key, FL. Email:

Neovascular (or wet) age-related macular degeneration (AMD) affects more than 10% of people older than 65 years in North America, Europe, Australia, and Asia. It is estimated that about 11 million Americans have some form of AMD, with that number expected to double by 2050. Approximately 20% of patients will advance from a nonneovascular form of the disease to neovascular AMD, which is associated with central visual acuity loss that can result in severe visual impairment and blindness. Read More

Am J Manag Care 2020 May;26(5 Suppl):S103-S111

Tufts University School of Medicine and New England Eye Center, Boston, MA. Email:

The burden of age-related macular degeneration (AMD), a leading cause of vision loss in the elderly population, is poised to increase dramatically as the baby boomer generation ages. Fortunately, the prognosis of neovascular AMD has improved dramatically since anti-vascular endothelial growth factor (VEGF) agents reached the market 15 years ago. In large-scale clinical trials, anti-VEGF utilization maintained visual acuity in more than 90% of patients. Read More

Am J Manag Care 2020 05 1;26(5):e162-e165. Epub 2020 May 1.

Henry J. Austin Health Center, 112 Ewing St, Trenton, NJ 08609. Email:

Objectives: To implement a project of linked pharmacist-provider new patient visits and then evaluate the impact on the productivity of the provider and pharmacist.

Study Design: A clinical pharmacist was integrated into the workflow at 2 sites (sites A and B) of Henry J. Austin Health Center, a federally qualified health center, so that new patients were scheduled to see the pharmacist in a 15-minute encounter immediately before a 15-minute encounter with the primary care provider. Read More

Am J Manag Care 2020 05 1;26(5):e155-e161. Epub 2020 May 1.

Clalit Research Institute, Arlozoroff 101, Tel Aviv, Israel 6209804. Email:

Objectives: This study assessed rates of ambulatory care-sensitive condition (ACSC) admissions within a healthcare system to identify areas for intervention.

Study Design: This was a multiyear cross-sectional study using the data warehouse of Clalit Health Services (Clalit), the largest payer/provider healthcare system in Israel, with complete clinical records for more than 4 million members. All admissions from 2009 to 2014 were included in the study. Read More

Am J Manag Care 2020 05 1;26(5):e150-e154. Epub 2020 May 1.

US Value Evidence and Outcomes, GlaxoSmithKline plc, 5 Moore Dr, Research Triangle Park, Durham, NC. Email:

Objectives: Exacerbations account for the greatest proportion of costs associated with chronic obstructive pulmonary disease (COPD). Here we aimed to evaluate, from the US payer perspective, the costs associated with moderate and severe COPD exacerbation events for patients treated with fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) compared with FF/VI or UMEC/VI.

Study Design: This post hoc, within-trial economic analysis used data derived from the InforMing the PAthway of COPD Treatment (IMPACT) study (NCT02164513). Read More

Am J Manag Care 2020 05 1;26(5):e142-e149. Epub 2020 May 1.

Radius Health, Inc, 550 E Swedesford Rd, Ste 370, Wayne, PA 19087. Email:

Objectives: To examine healthcare resource utilization (HRU) and costs in a population of managed care enrollees who experienced an osteoporotic fracture.

Study Design: Retrospective cohort study using the Optum Research Database (January 2007 to May 2017).

Methods: All-cause and osteoporosis-related HRU and costs were analyzed in patients 50 years and older with a qualifying index fracture and continuous enrollment with medical and pharmacy benefits for 12 months preindex (baseline period). Read More

Am J Manag Care 2020 05 1;26(5):e140-e141. Epub 2020 May 1.

Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Email:

Specific measures using a Six Sigma approach led to sustained reduction of door-to-balloon times among patients with ST-segment elevation myocardial infarction (STEMI) in a community setting. Read More

Am J Manag Care 2020 05;26(5):225-228

Leavitt Partners, 299 S Main St, Ste 2300, Salt Lake City, UT 84111. Email:

Because hospitals and health systems sponsored the majority of new accountable care organizations (ACOs) from 2010 to 2015, they influenced priorities and strategies of the policies designed to drive ACO adoption. In recent years, however, the majority of new ACOs have been sponsored by physician groups. This shift means that policies need to be developed with the characteristic strengths and weaknesses of physician-led ACOs in mind. Read More

Am J Manag Care 2020 05;26(5):218-223

Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC 27599-7411. Email:

Objectives: To assess the effect of medical home enrollment on acute care use and healthcare spending among Medicaid beneficiaries with mental and physical illness.

Study Design: Retrospective cohort analysis of administrative data.

Methods: We used 2007-2010 Medicaid claims and state psychiatric hospital data from a sample of 83,819 individuals diagnosed with schizophrenia or depression and at least 1 comorbid physical condition. Read More

Am J Manag Care 2020 05;26(5):208-213

Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Los Angeles, CA 90089-3333. Email:

Objectives: To identify differences in biosimilar uptake across providers and to examine the association between provider biosimilar uptake and observable practice-level characteristics.

Study Design: A retrospective analysis of 100% of a commercial medical claims database from June 2015 to June 2018.

Methods: We focused on providers of biologic (Neupogen) and biosimilar (Zarxio) filgrastim. Read More

Am J Manag Care 2020 05;26(5):200-206

Geriatric Research, Education and Clinical Center, Bruce W. Carter Miami VA Medical Center, 1201 NW 16th St, Miami, FL 33125. Email:

Objectives: To determine whether health literacy, numeracy, and graph literacy are associated with all-cause hospitalizations or mortality in community-dwelling veterans.

Study Design: Retrospective cohort study.

Methods: A total of 470 community-dwelling veterans underwent evaluations of health literacy, numeracy, and graph literacy with validated instruments in 2012 and were followed until 2018. Read More

Am J Manag Care 2020 05;26(5):197-198

St. Vincent Hospital, 123 Summer St, Ste 521, Worcester, MA 01608. Email:

The revolving door of readmissions keeps spinning for patients who report symptoms of shortness of breath. Read More

Am J Manag Care 2020 05;26(5):195-196

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

The coronavirus disease 2019 (COVID-19) pandemic will exacerbate the financial situations of the millions of Americans who struggle to afford their medical care, but policy solutions are available to quickly mitigate this problem. Read More

Am J Manag Care 2020 05;26(5):192-193

To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. For the May issue, we turned to Larry Levitt, MPP, executive vice president for health policy for the Kaiser Family Foundation. Read More

Am J Manag Care 2020 Apr;26(4 Spec No.):SP106-SP108

Am J Manag Care 2020 Apr;26(4 Spec No.):SP101

Am J Manag Care 2020 Apr;26(4 Spec No.):SP130-SP131

Am J Manag Care 2020 Apr;26(4 Spec No.):SP127-SP128

Am J Manag Care 2020 Apr;26(4 Spec No.):SP124-SP126

Palliative and hospice care services produce immense benefits for patients living with serious illness and for their families. Due to the national shift toward value-based payment models, health systems and payers share a heightened awareness of the need to incorporate palliative and hospice services into their service mix for seriously ill patient populations. During the last decade, a tremendous amount of capital has been invested to better integrate information technology into healthcare. Read More

Am J Manag Care 2020 Mar;26(4 Suppl):S91-S96

Clinical Analytics, WellDyne, Lakeland, FL; University of Florida College of Pharmacy, Gainesville, FL. Email:

Insomnia is a common sleep disorder in adults that can have many negative health impacts. The aggregate total of direct and indirect insomnia healthcare costs has been estimated to be as high as $100 billion US dollars per year. In addition to the societal cost burden, insomnia also negatively affects patients' quality of life (QOL), including social and occupational functioning or productivity as well as impaired cognition or mood. Read More

Am J Manag Care 2020 Mar;26(4 Suppl):S85-S90

Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, the State University of New Jersey, Piscataway, NJ; Department of Pharmacy, Penn Medicine Princeton House Behavioral Health, Princeton, NJ. Email:

Up to 10% of the US adult population will experience chronic insomnia, with women and elderly individuals at particularly high risk. Cognitive behavioral therapy is the core treatment for insomnia. When cognitive behavioral therapy is not enough, medications can help patients overcome the barriers and learned behaviors that prevent a good night's sleep. Read More

Am J Manag Care 2020 Mar;26(4 Suppl):S76-S84

University of Southern California School of Pharmacy and Keck School of Medicine, Los Angeles, CA. Email:

Insomnia, whether short-term or chronic, is a common condition. It has a negative impact on vulnerable patient groups, including active military personnel and veterans, patients with coexisting psychiatric and medical disorders, those in life transitions such as menopause, and elderly persons. Although cognitive behavioral therapy for insomnia (CBTI) is first-line treatment for insomnia, its high cost and a lack of trained providers has prevented widespread uptake. Read More

Am J Manag Care 2020 Mar;26(3 Suppl):S62-S68

SelectHealth, Murray, UT. Email:

Schizophrenia is a complicated chronic disease affecting approximately 3.5 million people in the United States, and its annual healthcare costs exceed $155 billion. People living with schizophrenia often experience a reduced quality of life (QOL) and are more likely to be homeless, unemployed, or living in poverty compared with the general population. Read More

Am J Manag Care 2020 Mar;26(3 Suppl):S55-S61

Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, Piscataway, NJ; Monmouth Medical Center, Long Branch, NJ. Email:

Schizophrenia is a chronic neuropsychiatric disorder that has a significant impact on the functioning and quality of life of individuals affected by the disease. It affects 0.6% to 1. Read More

Am J Manag Care 2020 Mar;26(3 Suppl):S48-S54

Titus Family Department of Clinical Pharmacy, University of Southern California, Los Angeles, CA. Email:

Schizophrenia is a chronic mental health disorder hallmarked by a variety of symptoms impacting mental state, emotions, and behaviors, including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, and cognitive impairment. Schizophrenia leaves patients with the inability to function appropriately in their daily lives, including at work, in relationships, and even with self-care. The exact cause of this disorder has yet to be elucidated; however, multiple factors, including genetic susceptibility and environmental influences, have been implicated in its development. Read More

Am J Manag Care 2020 Mar;26(2 Suppl):S32-S40

Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL. Email:

The approval of the humanized monoclonal antibody trastuzumab in 1998 changed the trajectory of treatment and subsequent outcomes for patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and is now the standard of care in the neoadjuvant, adjuvant, and metastatic settings. However, as with most biologic drugs, trastuzumab comes with a relatively high price tag compared with traditional cytotoxic chemotherapy and contributes to healthcare budgets. Three engineered products related to trastuzumab-2 antibody-drug conjugates, ado-trastuzumab emtansine and fam-trastuzumab deruxtecan-nxki, as well as the subcutaneous trastuzumab/hyaluronidase-have since been approved and have expanded the treatment options for this patient population. Read More

Am J Manag Care 2020 Mar;26(2 Suppl):S23-S31

Prime Therapeutics, Eagan, MN. Email:

Oncology biologics are one of the fastest-growing segments of pharmaceutical development, bringing more options to patients, including those with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. The advent of multiple oncology biosimilars is affecting this patient population, as 5 trastuzumab biosimilars had been FDA approved as of the end of 2019; only 2, however, have been commercially marketed. Trastuzumab serves as the foundation for treatment for patients with HER2-positive breast cancer. Read More

Am J Manag Care 2020 04 1;26(4):e135-e139. Epub 2020 Apr 1.

Premier Applied Sciences, Premier Inc, 13034 Ballantyne Corporate Pl, Charlotte, NC 28277. Email:

Objectives: To explore healthcare professionals' perceptions of challenges to chronic pain management.

Study Design: Qualitative interview study.

Methods: Semistructured telephone interviews with healthcare professionals involved in chronic pain management and thematic analysis of transcriptions. Read More

Am J Manag Care 2020 04 1;26(4):e127-e134. Epub 2020 Apr 1.

Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Bldg, Palo Alto, CA 94301. Email:

Objectives: To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient's acute problem, versus the max-packers, who typically address additional conditions also.

Study Design: Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. Read More

Am J Manag Care 2020 04 1;26(4):e121-e126. Epub 2020 Apr 1.

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

Objectives: The outcomes of liver transplantation may vary according to socioeconomic factors such as insurance coverage. The aim of this study was to assess the association between the type of insurance payer and outcomes of liver transplant candidates and recipients in the United States.

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