The American journal of managed care
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Our study examines the impact of an emergency department (ED) patient navigation program for patients in a Medicaid accountable care organization across 3 hospitals in a large health system. Our program engages community health workers to (1) promote primary care engagement, (2) facilitate care coordination, and (3) identify and address patients' health-related social needs. ⋯ Our program demonstrates that high-intensity, short-term patient navigation in the ED can help reduce ED visits in those with low baseline ED utilization and facilitate stronger connections with primary care.
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Observational Study
Physician prices and low-value services: evidence from general internal medicine.
To assess the cross-sectional relationship between prices paid to physicians by commercial insurers and the provision of low-value services. ⋯ Commercially insured patients of high-priced physicians received fewer low-value services, although spending on low-value services was higher. More research is needed to understand why high-priced providers deliver fewer low-value services and whether physician prices are correlated with other measures of quality.
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To change blood pressure treatment, clinicians can modify medication count or dose. However, existing studies have measured count modification, which may miss clinically important dose change in the absence of count change. This research demonstrates how dose modification captures more information about management than medication count alone. ⋯ Measuring change in antihypertensive treatment using medication count frequently missed an isolated dose change in treatment modification and less often misclassified regimen modifications where there was no modification in total dose. In future research, measuring dose modification using our new algorithm would capture change in hypertension treatment intensity more precisely than current methods.
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To describe the use of home-based services in accountable care organizations (ACOs). ⋯ ACOs deliver a diverse array of home-visit services including primary care, acute medical care, palliative care, care transitions, and interventions to address social determinants of health. Many services provided are not billable, and therefore ACO leaders are hesitant to fund expansions without strong evidence of ROI. Expanding Medicare ACO home-visit waivers to all risk-bearing ACOs and covering integrated telehealth services would improve the financial viability of these programs.
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In an era of heightened opioid prescribing scrutiny, ensuring safe and adequate pain management is challenging. Understanding opioid use in patients with cancer can facilitate effective pain management regimens while minimizing safety concerns. This study characterized patterns of and factors associated with opioid use following a new cancer diagnosis. ⋯ Fewer than half of patients received opioids in the 2 years following cancer onset. Among users, we found a relatively small proportion of potentially problematic opioid use. Further research is warranted to assess the adequacy of cancer pain treatment and determinants of high-risk opioid use.