The American journal of managed care
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A lack of therapeutically targetable molecular alterations and its aggressive nature make triple-negative breast cancer (TNBC) a challenging disease. Chemotherapy is standard of care for most patients with metastatic disease, but median overall survival is less than 18 months. Unravelling the molecular underpinnings of TNBC revealed it to be a potentially highly immunogenic subtype within a more broadly immunologically inert cancer type, suggesting that it may respond to immunotherapy. ⋯ Two FDA-approved companion diagnostic PD-L1 assays are available to identify patients eligible for immunotherapy treatment, but other biomarkers of response are also being examined. Ongoing clinical trials are also evaluating a range of targeted therapies as combination partners, which may have immunomodulatory effects in addition to their main mechanism of action, complementing the activity of ICIs. This article will evaluate the current and emerging clinical trends in the use of ICIs as part of combination regimens in the treatment of patients with metastatic TNBC.
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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.
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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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Low-value services are a major problem in the US health care system. We believe that the coronavirus disease 2019 pandemic's unprecedented impact on the health system, and society writ large, offers an opportunity to reshape the conversation and incentives around low-value services. ⋯ We examine how financial and nonfinancial incentives, uncertainty in clinical decision-making, and insufficient partnering with patients and families contribute to the delivery of low-value care. We then explore potential solutions, including making it easier for clinicians to forgo low-value services and providing them with actionable information to make those decisions, expanding payer efforts to develop "value report cards," developing measures that map the adverse health and economic effects of low-value services, and training clinicians and health care leaders to engage in conversations with patients about the personal medical, financial, and psychological harms of low-value services.
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Observational Study
Small but nimble: measures taken to face the COVID-19 pandemic in small French military hospitals.
To describe a complete panel of actions of the Service de Santé des Armées (SSA) (ie, French Military Health Service) that together contributed to prevent French health system saturation during the coronavirus disease 2019 (COVID-19) pandemic. ⋯ Key facets of this achievement were interunit collaboration, esprit de corps, and health workers' adaptability. Small hospitals can provide a coherent answer to the COVID-19 pandemic, as long as they organize and prioritize the patients' care.