The American journal of managed care
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Observational Study
Behavior-based diabetes management: impact on care, hospitalizations, and costs.
To (1) examine the impact of the Diabetes Care Rewards (DCR) program on adherence to care standards and (2) evaluate the economic impact of adherence to care standards. ⋯ A behavioral science- and incentive-based diabetes management program was associated with greater rates of adherence to recommended diabetes monitoring care standards, increased routine clinic visits, decreased hospital admissions, and decreased inpatient days. Anticipated increases in pharmaceutical expenditures were offset by overall lower medical expenditures. Results indicate the economic benefits of adherence to evidence-based standards for diabetes care.
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Nearly 93 million American adults have hyperlipidemia, a major risk factor for the development of atherosclerotic cardiovascular disease. Use of HMG-CoA reductase inhibitors (ie, statins) and ezetimibe have decreased hypercholesterolemia's prevalence in the past decade, but poor adherence is common and leads to scenarios where patients do not derive the greatest possible benefit. In addition, statin resistance may play a role when patients' LDL-C levels are not lowered to the expected extent despite good medication adherence. ⋯ In addition, bempedoic acid, lomitapide, and evinacumab are available options that may be instituted in select patients. In development is inclisiran, a small interfering RNA molecule, which antagonizes PCSK9 production. With good adherence and the use of a greater assortment of medications, patients may experience atherogenic lipoprotein lowering, leading to a decrease in cardiovascular disease.
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The coronavirus disease 2019 (COVID-19) pandemic has fundamentally changed how health care systems deliver services and revealed the tenuousness of care delivery based on face-to-face office visits and fee-for-service reimbursement models. Robust population health management, fostered by value-based contract participation, integrates analytics and agile clinical programs and is adaptable to optimize outcomes and reduce risk during population-level crises. ⋯ Telemedicine and integrated behavioral health have ensured critical primary care and specialty access, and mobile health and postacute interventions have shifted site of care and optimized hospital utilization. Beyond the pandemic, population health can lead as a cornerstone of a resilient health system, better prepared to improve public health and mitigate risk in a value-based paradigm.
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To examine differences in health care costs associated with choice of second-line antidiabetes medication (ADM) for commercially insured adults with type 2 diabetes. ⋯ The higher cost of nonsulfonylurea medications was the main driver of relative increases in total costs. Relative decreases in nonpharmacy medical costs among patients receiving newer ADM classes reflect these medications' potential value.
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Uncontrolled hyperlipidemia has been associated with serious cardiovascular events. Statin use may not be optimal either due to low adherence or statin intolerance. Although the definition of statin intolerance remains highly debatable, it can generally be viewed as any adverse reaction that limits its use including but not limited to myopathies and myalgias. ⋯ With the reduction in list price by 60% to $5850 annually, and updated clinical outcome data, both alirocumab and evolocumab were more in line with the willingness-to-pay threshold. Managed care pharmacists can ensure coverage criteria are appropriately developed to give access to individuals who would benefit the most, while decreasing barriers to access. Additionally, pharmacists are well positioned to collaborate with other healthcare providers to increase adherence to traditional LDL-C-lowering agents and streamline prior authorization processing to increase approval rates.