The American journal of managed care
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To determine whether having a usual provider of care (UPC) outside the Veterans Health Administration (VHA) and whether having highly fragmented care (regardless of the providers' health system affiliations) increased the risk of hospitalization among veterans with diabetes. ⋯ Among veterans with diabetes enrolled in both VHA and Medicare, having both a UPC outside the VHA and highly fragmented care was associated with higher odds of hospitalization than either of these ambulatory patterns alone.
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To assess the evolving landscape of low-density lipoprotein cholesterol-lowering therapies (LLTs) and quantify their effect on cardiovascular disease (CVD)-related mortality and morbidity. ⋯ LLTs have yielded significant societal value, and the majority of this value has accrued to patients.
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Proponents of a single-payer or public option health care system often cite the lower administrative expenses in public Medicare compared with those in private Medicare, claiming that this difference represents efficiency. We check the validity of this comparison in terms of accuracy and definitions and suggest expanding its scope to include expanded financial data of the 2 Medicare systems. ⋯ Comparisons of the systems in the United States would benefit from expanding the focus beyond incomparable administrative expenses. For the current period of coronavirus disease 2019, if the trends continue, public Medicare may suffer greater deficits relative to the private Medicare Part C.
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The cost of metastatic triple-negative breast cancer (mTNBC) continues to rise; before the use of immune checkpoint inhibitors in mTNBC, cumulative costs of treatment ranged from $51,070 for patients not treated with chemotherapy, up to $143,150 for patients who received three or more regimens. For those with programmed death ligand 1 (PD-L1)-positive mTNBC, expanding treatments continue to be approved for combination first-line therapy. ⋯ There are several tools that can be used to assess the value of treatment, with significant heterogeneity among frameworks. Innovative programs that have the potential to decrease costs should be considered when evaluating payment models.
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Medicaid managed care organizations are developing comprehensive strategies to reduce the impact of opioid use disorder (OUD) among their members. The goals of this study were to develop and validate a predictive model of OUD and to predict future OUD diagnosis, resulting in proactive, person-centered outreach. ⋯ We built the necessary machine learning infrastructure to identify members with greater than 50% probability of developing OUD. The generated list strategically informs and guides person-centered care and interventions. Through application of these results, we strive to proactively reduce OUD-related structural barriers and prevent OUD from occurring.