The American journal of managed care
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The United States has an increasing number of patients with heart failure (HF) who experience significant disease burden as well as contribute to high economic healthcare costs and usage of healthcare resources. HF costs are currently estimated at $30.7 billion. If no improvements are made to current treatment outcomes, it is expected to grow to $69.8 billion by the year 2030. ⋯ These mixed program outcomes show the importance of evaluating HF-related transitional care program components for future directions. Newly approved treatments for HF with preserved ejection fraction may improve clinical outcomes for these patients. Pharmacists and physicians can help improve access to HF medications by assisting patients on how to navigate manufacturer assistance programs, submitting complete and well-supported prior authorization forms when needed, and encouraging the use of pharmacy price matching and price checkers.
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Accelerated approval drugs account for less than 1% of Medicaid spending, but states seek CMS approval to avoid coverage of these drugs and cut costs.
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Individuals with multiple chronic conditions (MCCs) represent a growing proportion of the adult population in the United States, particularly among lower-income individuals and people of color. Despite ongoing efforts to characterize this population and develop approaches for effective management, individuals with MCCs continue to contribute substantially to health care expenditures. Based on a review of recent literature, several identified barriers limit the effectiveness of care for patients with MCCs. ⋯ The COVID-19 pandemic has shed further light on inequities contributing to suboptimal MCC patient management. Awareness of the prevalence and demographic attributes of patients with MCCs and the identified barriers to care may help improve patient engagement and treatment outcomes for this high-cost population. This paper provides recommendations for enhancing MCC patient care outcomes in the current and post-COVID-19 health care delivery settings.
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Observational Study
Association between hospital-insurer contract structure and hospital performance.
To describe the association between the form of hospitals' contracts-either markup from a benchmark or a discount from a list price-and performance: price, charge, cost, and length of stay. ⋯ Limited research exists on the relationship between contract structure and hospital performance. Our results suggest that hospital performance is related to contract structure, possibly due to factors such as differences in bargaining strategies or ex post incentives.
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Psoriasis is a complex immune disorder associated with substantial metabolic and psychological comorbidities, posing challenges to treatment. Interleukin (IL)-23 inhibitors, the newest class of biologics for the treatment of moderate to severe psoriasis, are more selective mechanistically than previous biologic classes and may have utility in management of patients with comorbidities, particularly those with metabolic syndrome (MetS). Moreover, recent long-term data suggest that IL-23 inhibitors offer unique advantages in both safety and efficacy. As the relationship between psoriasis and MetS continues to be elucidated, the availability of agents that are safe and effective in patients with and without comorbidities represents an important step in the spectrum of treatment.