The American journal of managed care
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To explain key challenges to evaluating Center for Medicare and Medicaid Innovation (CMMI) accountable care organization (ACO) models and ways to address those challenges. ⋯ If CMMI intends to offer the model to a larger, but similar, group of volunteers, then the estimated treatment effect based on voluntary participants may be the most policy-relevant parameter. However, if the scaled-up population has different characteristics than the evaluation sample, perhaps due to mandatory participation, then the evaluator will need to employ pseudo-randomization appropriate for observational data.
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In recent years, evidence has continued to mount showing a strong relationship between diabetes, cardiovascular disease, and chronic kidney disease. This, in turn, has driven a shift to a more integrated and holistic approach in the treatment of patients with cardio-renal-metabolic (CRM) disease. ⋯ The recommendations provide guidance on assessments and treatments, including both lifestyle therapy and pharmacotherapy, for patients across the DCRM spectrum, and are an invaluable tool for clinicians who need to develop treatment plans for complex patients with cardio-renal-metabolic disease. This article reviews the key elements of the DCRM recommendations and summarizes the updates included in the DCRM 2.0.
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Cardio-kidney-metabolic (CKM) syndrome is a term to describe the interconnection between cardiovascular disease, type 2 diabetes, and chronic kidney disease. The National Health and Nutrition Examination Survey from 1999 to 2020 estimated that 25% of participants had at least 1 CKM condition. It is proposed that CKM syndrome originates in excess and/or dysfunctional adipose tissue, which secretes proinflammatory and prooxidative products leading to damaged tissues in arteries, the heart, and the kidney, and reduction in insulin sensitivity. ⋯ The American Heart Association suggests that CKM syndrome screening should include both biological factors and SDOH. Interventions in patients with stages 0 to 3 CKM syndrome focus on preventing future cardiovascular events by management of excess adiposity, mainly through diet and exercise in the early stages, then through pharmacological treatment of metabolic syndrome components in later stages. There is a general acceptance that treatment of CKM syndrome should involve a holistic approach to prevention, screening, and management to improve outcomes and reduce long-term morbidity and mortality.
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In 2016, Dallas Nephrology Associates recognized that the economic, humanistic, and societal burden of end-stage kidney disease was unsustainable and the fee-for-service model of reimbursement did not support a value-based care approach. We decided to be proactive by creating new workflows, education, and disease management so that patients could make well-informed choices, ultimately resulting in better outcomes. ⋯ By embracing value-based models, we have demonstrated that a patient-centered approach can lead to improved outcomes and value for payers.
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To examine the relationship between adoption of direct oral anticoagulants (DOACs) and health and cost outcomes for patients with nonvalvular atrial fibrillation. ⋯ More rapid adoption of newly approved nonvalvular atrial fibrillation treatments was associated with reduced stroke rates and high cost savings. Managed care organizations should consider how delays in the uptake of innovative medications impact health and economic outcomes.