Published in The American journal of managed care
To examine factors associated with discontinuation of new hepatitis C drugs-second-generation direct-acting antivirals (DAAs)-among Medicare beneficiaries with chronic hepatitis C. A retrospective analysis using 2014-2016 Medicare claims. The study population was patients with chronic hepatitis C in fee-for-service Medicare with Part D who initiate...
Published in The American journal of managed care
OBJECTIVES: Chiropractic care is a service that operates outside of the conventional medical system and is reimbursed by Medicare. Our objective was to examine the extent to which accessibility of chiropractic care affects spending on medical spine care among Medicare beneficiaries. STUDY DESIGN: Retrospective cohort study that used beneficiary rel...
Published in The American journal of managed care
Referrals from primary to specialty care are a critical first step in coordination of specialty care, but shortcomings in the appropriateness, clarity, or completeness of referrals are common. We examined (1) whether 3 tools to coordinate specialty care are associated with better referral characteristics and (2) whether greater perceived helpfulnes...
Published in The American journal of managed care
OBJECTIVES: To estimate heroin overdose trends among insured individuals and characterize patients and healthcare utilization preceding overdose to inform scale-up of effective prevention and treatment. STUDY DESIGN: Retrospective descriptive analysis. METHODS: We analyzed 2010 to 2014 IBM MarketScan Databases and calculated annual heroin overdose ...
Published in The American journal of managed care
OBJECTIVES: To evaluate whether participation in Medicare’s voluntary Bundled Payments for Care Improvement (BPCI) model was associated with changes in discharge referral patterns to skilled nursing facilities (SNFs), specifically number of SNF partners and discharge concentration. STUDY DESIGN: Retrospective observational study using difference-in...
Published in The American journal of managed care
To evaluate how changes in generic drug prices and the incidence of abrupt price increases varied with the number of manufacturers supplying each drug. Analysis of 2005 to 2016 monthly wholesale acquisition costs (WACs) and University of Pittsburgh Medical Center Health Plan counts of pharmacy claims for National Drug Codes (NDCs) for generic drugs...
Published in The American journal of managed care
To assess the association of a clinical decision support (CDS) algorithm for hospital discharge disposition with spending, readmissions, and postdischarge emergency department (ED) use. A retrospective study in a cohort of fee-for-service Medicare patients 65 years or older linked to a database of patients receiving CDS. We evaluated (1) patients w...
Published in The American journal of managed care
The causes of oncology drug price growth remain unclear. Analyzing corresponding trends in revenue can help understand these causes. This study seeks to assess changes over time in prices, patient counts, and drug-level revenues in the US market for oncology therapies and to investigate whether price growth is driven by an increased ability by phar...
Published in The American journal of managed care
To determine the association of health insurance benefit design features with choice of early conservative therapy for patients with new-onset low back pain (LBP). Observational study of 117,448 commercially insured adults 18 years or older presenting with an outpatient diagnosis of new-onset LBP between 2008 and 2013 as recorded in the OptumLabs D...
Published in The American journal of managed care
Optimizing HIV treatment benefits the health of the individual and the community at large. Health department HIV surveillance data matched with Medicaid managed care rosters can be used to target people with HIV infection who have an unsuppressed viral load or are unengaged in care. MetroPlus Health Plan, a Medicaid managed care organization, imple...
