The American journal of managed care
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To quantify temporal changes in colonoscopy indication and assess appropriateness of surveillance use in older adults. ⋯ Guidelines should make clear recommendations about when and how to discontinue postpolypectomy surveillance colonoscopy. Doing so would potentially reduce harms due to complications from low-value procedures and in turn moderate demand and thereby enhance overall procedural access for patients more likely to benefit.
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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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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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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 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.