The American journal of managed care
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To develop and test a methodology for optimally setting automatic auditing thresholds to minimize administrative costs without encouraging overall budget growth in a state Medicaid program. ⋯ Using machine learning and optimization methods, it is possible to design recommended budget thresholds that could lead to significant reductions in administrative burden without encouraging overall cost growth.
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More robust attribution methods are necessary to understand physician-level variation in quality of care across risk-adjusted inpatient measures. We address a gap in the literature involving attribution of physicians to inpatient stays using administrative claims data, in which rule-based methods often inadequately attribute physicians. ⋯ We provide a robust method to attribute physicians to patients, which is a necessary tool to understand physician-level variation in quality of care within the inpatient acute care setting. The proposed method provides consistency across facilities and eliminates unattributed patients resulting from unsatisfied business rules.
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Medical engineers continue to develop and enhance continuous glucose monitoring (CGM) devices and other devices to improve care for persons with diabetes. In a remarkably short period of time, these devices have become refined. ⋯ Clinicians' knowledge and understanding of how to interpret the Ambulatory Glucose Profile (AGP) report can improve patient outcomes. In addition, organizations that recognize areas of workflow that may be impacted can implement processes that improve use of the standard AGP report.
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The prevalence of diabetes is growing in the United States at an alarming rate. Early and intensive diagnosis and management of diabetes can reduce the economic burden and improve the societal burden of long-term diabetes-related complications. Healthcare providers practicing in the primary care setting are on the front line of screening, diagnosis, and managing a large majority of persons with diabetes. ⋯ Patients who utilize CGM are able to reduce their risk of hospitalizations, minimize work absenteeism, lower their A1C, lower their risk of hypoglycemia, as well as long-term microvascular and macrovascular complications. The American Diabetes Association updated its evidence-based Standards of Medical Care in Diabetes in 2022 around the use of CGM, as has the American Association of Clinical Endocrinology. Because these devices can have a positive effect on the management of persons with diabetes, managed care and healthcare providers should allow technological integration for their patients.
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COVID-19 hospitalizations among unvaccinated individuals cost billions of dollars. More employers are considering imposing a premium surcharge on employees participating in the company's health plan who are not vaccinated against COVID-19. These employers see this approach as similar to health premium surcharges for tobacco use, justifying the higher premiums on the basis that unvaccinated individuals could cause the plan to experience higher hospitalization and related costs. ⋯ Employers should weigh their vaccination goals against these interests and consider whether a legally compliant surcharge would further their goals. Employers should carefully consider the prevailing culture among their employees and assess whether the policy would be effective and noncoercive. Premium surcharges may be effective for some but not all employers.