The American journal of managed care
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To describe the prevalence and characteristics of preferred skilled nursing facility (SNF) networks established by Medicare accountable care organizations (ACOs). ⋯ Establishing preferred SNF networks is a known strategy among Medicare ACOs to manage postacute care spending and quality. Future research should document these partnerships more in depth and evaluate operational and financial alignment strategies among ACOs, hospitals, and SNFs in managing postacute care.
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To determine whether an intensive value-based care educational program that includes a standardized end-stage renal disease (ESRD) transition pathway would improve the number of optimal starts within Kidney Contracting Entities (KCEs). ⋯ Optimal starts are a key metric of success in value-based care models. We observed a significant increase in optimal starts and in the number of patients starting on PD after implementing a standardized ESRD transition pathway as part of an intensive value-based care educational program.
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To develop a tool for measuring performance of a coordinated care center against the criteria of an integrated practice unit (IPU) and test it against an established care center in the Military Health System (MHS). ⋯ This IPU assessment tool accurately captures both the strengths and weaknesses of a coordinated care facility within the MHS. Iterative refinement of the tool is expected to inform ongoing discussion of the transformation of care in the MHS and the US and to provide a framework by which to measure the care performance of centers wishing to reorganize as IPUs.
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The HIV epidemic remains a critical public health priority in the United States. The Ending the HIV Epidemic (EHE) initiative seeks to reduce HIV diagnoses by 75% by 2025 and by 90% by 2030. Certain demographic groups-including transgender women, cisgender Black women, and Black/African American and Hispanic/Latino men who have sex with men-are disproportionately affected by HIV. ⋯ Population health decision-makers, including managed care organizations and federal and state policy makers, can play a vital role in expanding PrEP coverage and uptake by addressing these barriers and ensuring zero out-of-pocket costs for individuals who need PrEP. Enhancing health care provider education and person-centered HIV prevention strategies (eg, same-day PrEP services, telePrEP programs) also can increase PrEP uptake and adherence and patient satisfaction. A continuous focus on improving PrEP access can substantially contribute to achieving the EHE initiative's goal to end the HIV epidemic.
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Although cardiac rehabilitation (CR) improves cardiovascular outcomes, adherence remains low. Higher patient-incurred out-of-pocket (OOP) spending may be a barrier to CR adherence. We evaluated the association between OOP spending for the first CR session and adherence. ⋯ Among patients with OOP spending, higher spending was associated with lower CR adherence, dose dependently. Reducing OOP costs for CR may improve adherence for beneficiaries with cost sharing.