The American journal of managed care
-
Reducing hospital admissions in patients with multiple complex chronic conditions is both a quality indicator and cost-effective to health care systems. This study assesses and compares utilization rates and cost of encounters between patients referred and seen in an outpatient critical care transition clinic (Healthy Transitions Clinic [HTC]) and those referred and not seen. ⋯ In patients with complex chronic medical conditions with recent hospital admissions, the HTC model appears to reduce both admissions and encounter costs. Further community/regional studies are needed to better define this observation on a longitudinal basis.
-
Whether and how the COVID-19 pandemic affected utilization of routine medical care in areas with low infection risk, such as Taiwan, has not been widely addressed. We aimed to evaluate the impact of the COVID-19 pandemic on access to medical care. ⋯ The COVID-19 pandemic prevented some individuals from keeping regular medical appointments even in an area with a low infection risk. Our findings imply that more research is required to mitigate the effects of delayed medical care for patients who infrequently utilized medical care during and after the long-lasting pandemic period.
-
To compare Medicare Advantage (MA) and traditional Medicare (TM) performance on quality, health, and cost outcomes in peer-reviewed literature published since 2010. ⋯ More than half of recent analyses comparing MA and TM find that MA delivers significantly better quality of care, better health outcomes, and lower costs compared with TM.
-
To understand responses of primary care clinics to inclusion in a tiered total cost of care insurance benefit design. ⋯ Managers of primary care clinics respond to a tiered benefit design that holds them accountable for total cost of care. They respond by offering price discounts and expressing interest in reducing costly referrals and unnecessary use of services.
-
To examine how primary care practices use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and its patient-centered medical home (PCMH) items during their PCMH transition. ⋯ CAHPS surveys were considered actionable for PCMH transformation and used in standardizing and coordinating care. The CAHPS PCMH items were considered integral to the continuous QI needed for moving beyond formal PCMH recognition and maximizing transformation. This supports the National Committee for Quality Assurance's recommendation to administer the CAHPS or CAHPS PCMH survey for PCMH transformation.