The American journal of managed care
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To assess the effectiveness of a proactive provider intervention in prompting prior authorization (PA) submissions or provider response prior to PA expiration for medically complex Medicaid patients. ⋯ Proactive outreach resulted in a greater percentage of PA submissions and a significantly reduced time to PA submission. These findings provide important information for payers in guiding clinical programs to enhance continuity of care among at-risk populations.
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Therapeutic/clinical inertia is thought to be responsible for up to 80% of cardiovascular events. This study was conducted as a comprehensive scoping and bibliometric analysis of peer-reviewed scholarly documents reporting on factors associated with therapeutic/clinical inertia in caring for patients with hypertension. Additionally, this study identified the factors associated with therapeutic/clinical inertia in hypertension. ⋯ This scoping and bibliometric study provides insights into the width and depth of scholarly peer-reviewed documents on factors associated with therapeutic/clinical inertia in caring for patients with hypertension. Findings of this study could be helpful in shaping future directions of research into therapeutic/clinical inertia in hypertension.
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This letter describes the experience of long-stay patients and provides a perspective of the need for more studies on outliers' impact on health care.
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HealthPartners developed a checklist, the School Environment Index (SEI), that it uses to help elementary schools identify opportunities to improve student nutrition and increase physical activity. The objective in this pilot study was to assess whether the SEI, as administered, can be used to measure the progress of these programs. ⋯ The SEI shows adequate internal consistency and sensitivity to change in this pilot evaluation. It is also feasible and useful to identify opportunities to improve practices and policies related to student nutrition and physical activity in partnership with the participating elementary schools. However, it lacks reliability as used. Increasing the number of respondents per school might moderate the impact of individual respondents and thereby increase reliability.
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In April 2018, CMS began reimbursing both clinical and community settings for providing the CDC-recognized Diabetes Prevention Program (DPP) to eligible Medicare beneficiaries. To better understand the process of offering the program to Medicare beneficiaries, we interviewed relevant stakeholders in a large, integrated health care delivery system. ⋯ Although the reimbursement of DPP for Medicare beneficiaries was a landmark decision, the current structure and requirements make it difficult for health systems and community-based providers to implement and promote this benefit. This study highlights the challenges that even integrated health systems are facing to implement MDPP, as well as potential strategies to overcome these barriers and expand the reach of the program. Medicare should seek ways to increase the financial incentives and decrease the barriers associated with implementing MDPP.