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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The different approaches to setting benchmarks for population-based payment models (empirical, bidding based, and administratively set) have unique advantages and challenges.
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To quantify geographic variation in home health expenditures per Medicare home health beneficiary and investigate factors associated with this variation. ⋯ Home health care exhibits considerable unwarranted variation in per-patient expenditures across counties, signifying inefficiency and waste. Given the expected growth in home health demand, strategies to reduce unwarranted geographic variation are needed.
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The use of biosimilars in oncology and as supportive agents for patients with cancer has introduced an important opportunity to expand access to cost-effective care, but their utilization remains inconsistent and is influenced by a variety of factors. Promoting the uptake of biosimilars across healthcare systems relies on improving perception and education about biosimilars, which involves multiple stakeholders, including pharmacists, providers, and patients. ⋯ Real-world switch studies in oncology biosimilars that have demonstrated bioequivalence provide basis to support efficacy and safety to transition to a biosimilar product. Incorporating oncology biosimilars into treatment pathways will be an important next step in providing value-based care to patients with cancer.
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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.