The American journal of managed care
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The Affordable Care Act eliminated patient cost sharing for evidence-based preventive care, yet the impact of this policy on colonoscopy and mammography rates is unclear. We examined the elimination of cost sharing among small business beneficiaries of Humana, a large national insurer. ⋯ The results suggest that the implementation of the policy is not having its intended effects, as cost sharing rates for colonoscopy and mammography did not change substantially, and utilization of colonoscopy and mammography changed little, following this new policy approach.
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To examine the relationship among use of an on-site employer-provided primary care medical home, and health services use and health plan costs for inpatient and outpatient services and pharmaceuticals. ⋯ Employees and their dependents who were "casual users" of the HCC had the highest claims costs and use of outside healthcare services. Additional research is needed to assess the extent to which employees' utilization of services at on-site primary care medical homes affects employee health outcomes, resulting in potential effects on company healthcare plan expenditures, worker productivity, and return on investment.
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Medicare Part D is a prescription drug program that provides seniors and disabled individuals enrolled in Medicare with outpatient drug coverage benefits. Part D has been shown to increase access to medicines and improve medication adherence; however, the effect of Part D on health outcomes has not yet been extensively studied. ⋯ Reductions in mortality have occurred because of fewer deaths associated with medication-sensitive conditions such as diabetes, congestive heart failure, stroke, and myocardial infarction. Improved access to medication through Medicare Part D helps patients improve blood pressure, cholesterol, and blood glucose levels, which in turn can prevent or delay the onset of disease and the incidence of adverse health events, thus reducing mortality.
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Methods for efficient medication reconciliation are increasingly important in primary care. Aggregated pharmacy data within the native electronic health record (EHR) may create a new opportunity for efficient and systematic medication reconciliation in practice. Our objective was to identify the prevalence and predictors of medication discrepancies between pharmacy claims data and the medication list in a primary care EHR. ⋯ Our study revealed a high rate of discrepancies between pharmacy claims data and the provider medication list. Aggregated pharmacy claims data available through the EHR may be an important tool to facilitate medication reconciliation in primary care.
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The purpose of this study was to determine the value of life-years saved due to colorectal cancer (CRC) screening with colonoscopy for the population aged 50 to 64 years. The cost perspective is that of a private (commercial) insurer, while the value perspective includes survival past age 65 years, when most of the US population is insured by Medicare. We focused on colonoscopy because it is not only diagnostic but also therapeutic; because positive results on other screening tests generally are followed up with colonoscopy; and to build on previous study results that colonoscopy is ultimately more cost-effective than other screening, even considering its expense. ⋯ Our results suggest that commercial insurers and employers should promote CRC screening as a high-value service. Promoting such screening through high-quality, low-cost providers would be an exemplar of efficient system innovation.