The American journal of managed care
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Deaths from prescription opioids have reached epidemic levels in the United States, yet little is known about how insurers' coverage policies may affect rates of fatal and nonfatal overdose among individuals filling an opioid prescription. ⋯ Opioid utilization management among these beneficiaries was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose. Further work exploring the impact of utilization management and insurer policies is needed.
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Procalcitonin (PCT) testing is FDA approved to guide antibiotic therapy in patients with lower respiratory tract infection (LRTI). However, its utilization and impact on real-world antibiotic prescribing behavior are unknown. We investigated the rate of PCT testing to evaluate an association between initial PCT level and antibiotic prescription patterns for patients with suspected LRTI within a large integrated health system. ⋯ Within a real-world environment of patients hospitalized with LRTI, PCT testing was low and the PCT levels did not appear to influence antibiotic prescribing behavior. Our findings suggest that clinicians continue to prioritize clinical judgment over initial PCT levels when prescribing antibiotics for suspected LRTIs.
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To assess in a Medicare Advantage population (1) whether discharge to home health, compared with discharge to home, following an inpatient stay subject to CMS postacute care transfer (PACT) regulations, is associated with better outcomes or lower expenditures and (2) whether the impact differs among subpopulations. ⋯ The PACT policy may be promoting greater value by reducing readmissions while lowering total expenditures for patients who do not require intensive postacute care. Findings were in contrast to those of previous studies, in which discharge to home health has been associated with higher rates of readmission. Earlier studies did not control for unmeasurable confounders, involved narrowly defined populations, and used older data.
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In the outpatient setting, combining remote therapy monitoring (RTM) with negative pressure wound therapy (NPWT) can support improved adherence to prescribed therapy. A recent study reported that patients receiving NPWT with RTM required fewer therapy days than patients receiving NPWT alone, possibly reducing costs of care. Our objective was to determine whether RTM reduced 90-day costs in patients undergoing NPWT. ⋯ This study demonstrated the value of RTM in supporting NPWT adherence and decreasing the costs of wound care in these patients.
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The current study investigated mental health utilization review (UR) clinical service authorization requests, denials, and reasons for denial in a statewide Medicaid managed care organization (MMCO) program. ⋯ Low UR denial rates warrant further examination of the relationship between UR and both quality of care and patient outcomes in mental health care. With the substantial resources spent on UR, findings could point to areas of potential reforms to the system that may minimize these costs and improve care for patients with mental illness.