The American journal of managed care
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Donald M. Berwick, MD, MPP, the former CMS administrator who is president emeritus and senior fellow at the Institute for Healthcare Improvement, discusses cost variation in cancer care found through the digital classification system the COTA Nodal Address.
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In this issue of Evidence-Based Oncology™ we see a foreshadowing of what the future of cancer care innovation could look like and how we may learn to move forward, safely, at an ever-accelerating pace.
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The cost burden of patients with SMA is considerable, and is estimated to be approximately $4 million to $5 million over 10 years in patients with early-onset SMA. This cost is 54.2 times greater than an otherwise healthy population. The utilization of medication, resources, and cost differs between different types of SMA and is more intensive in infantile-onset SMA type 1. ⋯ With the approval of novel pharmacotherapy options for SMA, timely treatment initiation may help to decrease healthcare burden and costs associated with early-onset SMA. Current options are effective in improving mobility, but maximum benefit has yet to be seen as this population is still growing. Due to the cost of treatment, managed care pharmacists should consider appropriate utilization management and innovative outcomes-based payment models to decrease risk while maximizing outcomes.
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To understand changes in primary care (PC) utilization in Medicaid and the Children's Health Insurance Program (CHIP) 3 years after the Affordable Care Act (ACA). ⋯ The first 6 months of ACA implementation in New Jersey were marked by a surge in Medicaid/CHIP enrollment that extended beyond the ACA target population, greater enrollment retention, and apparent bottlenecks in PC delivery. After the initial surge, new enrollees used PC at rates at least as high as in the pre-ACA period, whereas established enrollees used PC at a declining rate throughout the post-ACA period. PC delivery for new enrollees may have limited the availability of services for some established enrollees.
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Observational Study
Mortality risk stratification can predict readmissions but not length of stay.
To determine whether the mortality risk stratification (MORIS) strata can predict outcomes including mortality, readmission, and discharge disposition for specific diagnoses. ⋯ Stewardship of resources is necessary to obtain high value in care. A long LOS, discharge to skilled nursing facilities, and unplanned readmissions contribute to a significant utilization of resources. The MORIS strata are useful in predicting disease-specific mortality and readmission, but they are not useful in predicting LOS or discharge disposition.