The American journal of managed care
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If we are to achieve the clinical and economic benefits of primary care and care continuity, the implementation and evaluation of strategies that reward clinicians and patients are warranted.
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Most Medicare beneficiaries obtain supplemental insurance or enroll in Medicare Advantage (MA) to protect against potentially high cost sharing in traditional Medicare (TM). We examined changes in Medicare supplemental insurance coverage in the context of MA growth. ⋯ The rapid rise in MA enrollment from 2005 to 2019 was accompanied by substantial changes in supplemental insurance with TM. Our results emphasize the interconnectedness of different insurance choices made by Medicare beneficiaries.
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Observational Study
Bundled payments lead to quality improvements in hospitals' skilled nursing facility referral networks.
To assess whether hospitals participating in Medicare's Bundled Payments for Care Improvement (BPCI) program for joint replacement changed their referral patterns to favor higher-quality skilled nursing facilities (SNFs). ⋯ BPCI participation was associated with lower volume of SNF referrals and small increases in the quality of SNFs to which patients were discharged, without narrowing hospital-SNF referral networks.
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Chronic kidney disease (CKD) is a widely prevalent disease with heterogeneous disease progression. Prior study findings suggest that early referral to nephrologists can improve health outcomes for patients with CKD. Current practice guidelines recommend nephrology referral when patients are diagnosed with CKD stage 4. We tested whether a subset of patients with CKD stage 3 and common medical comorbidities demonstrates disease progression, cost, and utilization patterns that would merit earlier referral. ⋯ Our findings demonstrate the use of a claims-based algorithm to identify patients with CKD stage 3 who have high costs and are at risk of disease progression, highlighting a potential subset of patients who might benefit from earlier nephrology intervention.
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This analysis examines the implications of new Alzheimer disease drugs in the era of the Inflation Reduction Act (IRA). It focuses on balancing innovation in Alzheimer disease treatment with affordability and access, assessing the impact on Medicare's budget, patient cost, and health care system readiness. ⋯ The study findings underscore the need for a comprehensive approach to ensure fair pricing and equitable access to Alzheimer disease treatments. It suggests the application of frameworks such as the ISPOR Value Flower, focusing on diversity, equity, and comprehensive economic evaluations, to navigate the evolving landscape of Alzheimer disease treatment in the context of the IRA.