The American journal of managed care
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Prior authorization (PA) aims to promote the safe and effective use of medications and to control costs. However, PA-related administrative tasks can contribute to burden on health care providers. This study examines how such tasks affect treatment decisions. ⋯ Respondents report that they may alter clinical decisions to avoid PA requirements and related burdens, even in cases in which use of the PA medication was clinically appropriate. Processes that reduce the administrative burden of PA through improved communication and transparency as well as standardized documentation may help ensure that PA more seamlessly achieves its goals of safe and effective use of medications.
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Johns Hopkins Medicine underwent a significant evolution with a new Office of Population Health (OPH), inclusive of a hybrid clinical and administrative structure, to optimally align expertise with care delivery functions. Initial priorities included identification of high-risk patients to receive care management, integrated behavioral health, and wraparound supports to address social determinants of health. ⋯ The plan prioritized (1) generation of a data and analytics road map, (2) advanced population management clinical services for priority populations, (3) improved performance on value-based care programming, and (4) enhanced health system coordination. With a new OPH, Johns Hopkins Medicine is better positioned to execute on value-based initiatives in support of its patients.
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To characterize patient-reported health and assess the psychometric performance of health-related quality of life (HRQOL) in high-cost, high-need (HCHN) populations. ⋯ Patient-reported health outcomes remain poor in HCHN populations, even after health care utilization recedes. HRQOL is a promising outcome measure for HCHN-focused payment and delivery interventions.
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Postacute care (PAC) heavily relies on effective connection between acute and postacute providers. However, little is known about whether and to what extent providers' patient-sharing relationships influence patient outcomes. This study aimed to examine whether patients with stroke who were discharged to PAC hospitals with which the originating hospital had a strong patient-sharing relationship have a lower rate of rehospitalization and lower mortality risk. ⋯ A greater number of shared patients and a more concentrated referral linkage between acute and PAC providers may reduce potential adverse outcomes in PAC patients. Instead of attaining more partners, PAC policies should encourage providers to strengthen their patient-sharing relationship with their existing PAC partners.
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Observational Study
Social determinants of health and high-cost utilization among commercially insured population.
To assess the impact of adding neighborhood social determinants of health (SDOH) data to demographic and clinical characteristics for predicting high-cost utilizers and to examine variations across age groups. ⋯ Policy makers and industry stakeholders should be aware of the mechanisms behind the relationship between neighborhood social conditions and health outcomes and how the relationship differs across age groups.