The American journal of managed care
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The 2021 American Rescue Plan Act (ARPA) increased the availability and magnitude of premium tax credits (PTCs) for consumers purchasing individual marketplace plans in 2021-2022. Millions currently purchase PTC-ineligible plans off of the marketplace. We estimate the proportion of off-marketplace enrollees who would be eligible for the expanded PTCs under ARPA, calculate PTC amounts for eligible enrollees, and examine factors influencing plan choice that could inform outreach efforts. ⋯ These findings suggest the need for targeted outreach to encourage off-marketplace enrollees to switch to marketplace plans.
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To assess the impact of preappointment surveys and reminder phone calls on show rate and time spent in new patient appointments at a multidisciplinary pediatric chronic pain clinic. ⋯ With new patients, preappointment surveys can improve clinic show rate and decrease time spent in initial appointments. Clinics may consider policies targeting completion of preappointment surveys to assist with show rate, but they must consider their patients' barriers to completing surveys so access to care is not limited.
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CMS' coverage with evidence development (CED) policy allows Medicare beneficiaries to access promising therapies and services while additional data are collected. CED program characteristics are mostly unreported, and qualities associated with retirement of CED data collection requirements are unknown. We aimed to review and systematically describe CED program history and components and report programmatic elements correlated with retirement of CED data collection requirements, while identifying areas for policy improvement. ⋯ Changes in the CED program through improving program predictability and transparency with regard to outstanding questions, roles of relevant stakeholders, and requirements for reporting and reevaluation would strengthen the program's effectiveness. Ultimately, these improvements would provide incentives for stakeholder participation in data collection to achieve the goal of increasing access to beneficial therapies and improving clinical outcomes.
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Opioid prescriptions in the perioperative setting are a known risk factor for long-term opioid use and misuse. Recent initiatives in the United States to address the issue have focused on judicious prescribing patterns and quality measurement to minimize opioid dispensing. However, policy gaps have limited the effectiveness of current interventions. ⋯ Additionally, formalized clinician education regarding specific nonopioid pain management alternatives may increase utilization, as will incorporation into perioperative OSPM clinical pathways. It is also important for patients to have access to the option for multimodal OSPM in the perioperative setting without financial disincentives, which may arise in surgery-specific bundled payment models. Finally, expansion of research activities regarding clinical and cost-efficacy outcomes may help to advance use of these options, laying the groundwork for development of a broader set of quality measures reflecting utilization and outcomes of multimodal OSPM in the perioperative setting.
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Cancer remains the second leading cause of death in the United States despite decades of treatment advances. While death rates have fallen for breast, cervical, and colorectal cancers, all of which have population-based screening options, rates remain high for the majority of malignancies, with most diagnosed in the later stages. In addition, adherence to screening recommendations in the United States is low, with high rates of false-positive results. ⋯ However, the impact on cancer-related deaths remains unclear. Other unanswered questions include cost-effectiveness, the impact of false-positive results on patients and costs, the overdiagnosis of more indolent cancers, uptake among patients and clinicians, and the need for protocols covering their use. Research and development of blood-based MCED tests continue.