The American journal of managed care
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Medicare Part D has a drug coverage gap, which imposes risks for discontinuing medications, particularly in mental health disorders where drug costs are high. However, some beneficiaries have generic drug coverage in the gap. ⋯ In Medicare Part D, generic drug coverage was cost saving compared with no coverage in bipolar disorder and schizophrenia while improving health outcomes. Policy makers and insurers might consider generic-only coverage, rather than no gap coverage, to both conserve healthcare resources and improve health.
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Despite evidence that greater US Medicare spending is not associated with better quality of care at a regional level, recent studies suggest that greater hospital spending is associated with lower risk-adjusted mortality. Studies have been limited to older data, specific US states and conditions, and the Medicare population. ⋯ Greater hospital spending is associated with lower risk-adjusted inpatient mortality for major medical conditions in the United States.
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To measure the effect of electronic medical records (EMRs) on a publicly reported composite measure indicating optimal diabetes care (ODC) rates in ambulatory settings. ⋯ There is little evidence that EMR adoption improves diabetes care during the first 2 years postadoption. This is notable as diabetes is a condition for which information technology has the potential to improve care management. The results suggest that policy makers should not expect public sector EMR investments to yield significant short-term improvements in publicly reported measures.
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The Veterans Health Administration (VHA) is changing its primary care delivery by implementing the patient-centered medical home (PCMH). ⋯ Our results suggest that, in addition to technological and fiscal infrastructure, healthcare leaders implementing the PCMH model must take into account interprofessional issues associated with changes in leadership and the adoption of team-based structures.
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New payment methods designed to incentivize more efficient care delivery are accelerating the movement of healthcare providers into organized provider groups. More efficient healthcare delivery requires explicit structuring of care delivery processes around teams of clinicians working toward common patient care goals. Provider organizations accepting new payment methods will need to design and implement compensation systems that provide incentives for team-based care. While lessons from studies performed both outside and inside healthcare provide some guidance on designing and implementing team-based incentives, organized delivery systems face several significant barriers to accomplishing this.