The American journal of managed care
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To evaluate the impact of the Community-Based Care Management (CBCM) program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization (MCO). CBCM was a Medicaid insurer-led care coordination and disease management program staffed by nurse care managers paired with community health workers. ⋯ Although our study found no association between the CBCM program and subsequent cost or utilization outcomes, understanding why these outcomes were not achieved will inform how future Medicaid programs are designed to achieve better patient outcomes and lower costs.
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Observational Study
The development of a patient-reported functional limitations index.
To develop an easy-to-interpret, patient-reported Functional Limitations Index (FLI) that can be used to assess and monitor the full spectrum of functioning in a community-dwelling population. ⋯ The FLI is an easy-to-administer, easy-to-interpret, and valid summary measure of disability that health plans and health care organizations can use for quality-of-care monitoring across a variety of settings to improve care for patients with disabilities.
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The objectives of this study were to estimate the utilization and spending impact of a standardized complex care management program implemented at 5 Next Generation accountable care organizations (NGACOs) and to identify reproducible program features that influenced program effectiveness. ⋯ Centrally staffed complex care management programs can reduce costs and improve outcomes for high-risk Medicare beneficiaries. Integrating predictive risk stratification, evidence-based intervention design, and performance monitoring can ensure consistent outcomes.
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Seeking consistent HIV health care is essential for achieving expected clinical outcomes, as antiretroviral therapy prevents HIV from reproduction and decreases opportunistic infections. However, whether having a consistent HIV health care provider is associated with desirable clinical outcomes remained unclear. This study examined the association of having a consistent HIV health care provider and HIV-related clinical outcomes. ⋯ Having a consistent HIV health care provider was associated with a higher likelihood of achieving desirable HIV clinical outcomes among PLWHA. To optimize these outcomes, policy and educational interventions are needed for PLWHA to have consistent HIV health care providers and to establish long-term, consistent physician-patient relationships.
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There is an ongoing policy discussion regarding an adequate breadth of provider networks. Health plans with "restricted networks" of providers have proved surprisingly popular on the Affordable Care Act health insurance exchanges because of a substantial gap in premiums between plans with open networks and closed networks. The objective of this paper is to assess which other attributes of the provider network matter to patients when choosing health insurance. ⋯ The results of this study provide new insights to federal and state legislators developing new models or standards on network adequacy and patient decision support tools.