The American journal of managed care
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Providers who do not contract with insurance plans are considered out-of-network (OON) providers. There were 2 objectives in this study: (1) to examine the variations of OON cost sharing, both at the state level and by care settings, and (2) to investigate the pattern of OON care use and cost sharing associated with OON care over time. ⋯ Cost-sharing payments for OON care represent a growing financial burden for some enrollees. Consumers should be held harmless from higher cost sharing for OON care when it occurs without their knowledge or consent. Further, health plan network adequacy may also merit closer scrutiny. Leveraging provider participation in narrow networks must be balanced with broader consumer protections.
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Health systems will improve postacute outcomes when CMS begins sharing its performance data on nursing facility chains.
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Concomitant excessive alcohol consumption and benzodiazepine use is associated with adverse health outcomes. We examined associations of unhealthy alcohol use and other patient characteristics with benzodiazepine use. ⋯ Benzodiazepine use in primary care was associated with older age, female sex, white race/ethnicity, lower socioeconomic status, and unhealthy alcohol use. These findings may be applied to develop policies and interventions to promote judicious benzodiazepine use.
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Banner Health, a large delivery system in Maricopa County, Arizona, entered into both Medicare and commercial insurance contracts that varied the amount of financial risk that Banner assumed. Rates of utilization and spending under these various contracts were investigated. ⋯ The results are consistent with CMS' efforts to shift reimbursement away from pure fee-for-service reimbursement.
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To better understand patients' levels of health literacy regarding what constitutes no-cost preventive visits versus possibly costly office visits and their ease of obtaining information about coverage and costs from providers and health insurance companies. ⋯ Many Americans have limited health literacy regarding what constitutes a preventive care visit. Support must continue to educate the population about preventive care visits and improve the ease of obtaining information from health insurance companies about preventive coverage.