The American journal of managed care
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To complete a scoping review of US health insurers' use of health-related quality of life (HRQOL) patient-reported outcome measures (PROMs). ⋯ This review found a wide variety of articles across insurance providers, health conditions, and uses of PROMs. There is a noted paucity of data in pediatric populations and little information about the use of data collected within health care settings that is transmitted to health insurers.
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Identification of patients with asthma at increased risk for hospitalization and emergency department (ED) visits presents opportunity for intervention. ⋯ Texas Children's Health Plan asthma risk score stratifies risk of asthma hospitalization and ED visits for Medicaid-insured children. The risk score performs better for children aged 3 to less than 18 years than for those aged 1 to less than 3 years.
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Central to the Porter-Lee value agenda, integrated practice unit (IPU) pilots have multiplied over time, striving to fundamentally reorganize the delivery of care via multidisciplinary teams while improving outcome measurement and driving competitive volumes. As these pilots emerge to form bridges of coordinated care, critics continue to question the value proposition of these IPUs: Do they achieve the Quadruple Aim of modern health care by improving cost of care, health outcomes, patient experience, and provider experience? Noting that value realization has eluded IPU pilots globally over the past 15 years, the authors examine 6 critical challenges and propose recommendations to consistently deploy effective IPUs, leading to a win-win proposition for all key stakeholders.
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The authors provide feedback on generalizations made regarding interventions for high-risk populations in previous research.
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Patient and Caregiver Support for Serious Illness (PACSSI), a per-member per-month (PMPM) alternative reimbursement structure for palliative care (PC) services, has been described as overly generous by HHS. We developed a modified version, PACSSI-Flexible (PACSSI-F), by modeling reimbursement for PC based on the changes in patient functional status. We estimated reimbursement for the first year that an organization might implement the PACSSI-F for PC services. ⋯ Modeling of the PACSSI-F using secondary data provides a novel example of economic forecasting for alternative reimbursement structures in PC. Alternative reimbursement payment policies are necessary to expand PC for the seriously ill population.