The American journal of managed care
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Most Medicaid beneficiaries with hepatitis C virus (HCV) are not treated with direct-acting agents because of budget constraints, but they experience costly complications after becoming Medicare eligible. Maryland's "total coverage" proposal could receive a credit from Medicare to offset Medicaid investments in treatments that could lead to Medicare savings. This study analyzes the cost-effectiveness and budget impact of total coverage for HCV treatments sponsored by state Medicare and Medicaid. ⋯ Medicare-Medicaid partnerships to pay for all HCV treatments today represent good value and a low budget impact. States with trouble covering HCV treatments should consider using this model to plan coverage decisions.
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We compared all-cause mortality in insured patients with cancer who were diagnosed in Kaiser Permanente Southern California (KPSC), the largest integrated health care delivery system in southern California, with that in patients diagnosed in hospitals that serve other private insurance (OPI) plans. ⋯ Among insured patients with cancer in southern California, those diagnosed within KPSC had lower overall mortality compared with the OPI group. Furthermore, this protective effect was greatest for African American/Black patients and Hispanic patients.
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Concerns about high and rising drug prices have prompted a call to manage prescription drugs according to their value. Although not all proposals referred to as "value based" are well suited to advance this mission, health plans must select among them under the influence of competing demands and constraints of their market and nonmarket environments. To understand the implications for health policy, we sought to explore how health plans might select among and implement these approaches for specialty pharmacy (SP) under the incentives and barriers that these conditions create. ⋯ Health plans' preferences for different forms of SP management may not be aligned with policy objectives, particularly those that advance innovation. Policy makers should consider market and nonmarket factors that influence these preferences, including the need to mitigate spending variability and generate evidence to guide coverage decisions.
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To assess in-hospital mortality, length of stay, and costs associated with interhospital fragmentation in 30-day readmissions and to determine whether these associations were more or less pronounced for patients with specific high-prevalence conditions. ⋯ Fragmented readmissions were associated with higher in-hospital mortality and cost. Clinical variation across conditions warrants further investigation to optimize pre- and postdischarge operations and policy.
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After sufficient doses are manufactured and logistical barriers are reduced, convincing an overwhelming majority of people to receive a COVID-19 vaccination may be the next major challenge during this pandemic. A group of experts recently proposed strategies that have compelling rationales and are well grounded in behavioral science. However, their approaches may sometimes be unacceptable, impractical, and/or unsuccessful. ⋯ Many of the proposed strategies have empirical support for achieving desired outcomes in other domains. However, the PANDEMIC framework is untested in regard to increasing the uptake of COVID-19 vaccinations. Therefore, the strategies should be carefully evaluated before they are widely disseminated through public health announcements, email distribution lists, electronic health record messages, and other outlets.