The American journal of managed care
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To evaluate structural capabilities in primary care practices employing nurse practitioners (NPs) and test whether they differ across health professional shortage areas (HPSAs) and non-HPSAs. ⋯ Expanding care coordination may be beneficial for HPSA populations with high rates of morbidity and socioeconomic needs. Future research is needed to understand how the NP workforce may be optimized to meet the growing primary care demands in underserved areas.
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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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To examine how health care utilization and spending vary for low-income employees compared with high-income employees enrolled in an employer-sponsored high-deductible health plan (HDHP). ⋯ Low-salary employees enrolled in HDHPs have higher rates of acute care utilization and spending but lower rates of primary care spending compared with high-salary employees. Results suggest that HDHPs discourage routine physician-patient care among low-salary employees.
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Patient assistance programs (eg, co-pay assistance) may reduce patients' out-of-pocket costs for prescription medicines, providing financial assistance to access medicines for reduced or no cost. A literature review to identify peer-reviewed articles on studies evaluating the impact of co-pay assistance on clinical, patient, and economic outcomes was conducted. ⋯ Limited evidence suggests a potential link between co-pay assistance and clinical outcomes; future research addressing study design challenges in measuring the effects of co-pay assistance is needed.
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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.