Now showing items 1-20 of 449

    • The Expanding Use of Continuous Glucose Monitoring in Type 2 Diabetes

      Dabbagh, Zakery; McKee, M Diane; Pirraglia, Paul A; Clements, Karen M; Liu, Feifan; Amante, Daniel J; Shukla, Prateek; Gerber, Ben S (2022-06-09)
      Over the last two decades, continuous glucose monitoring (CGM) has become a common self-monitoring strategy in type 1 diabetes (T1D). CGM, in which a minimally invasive, sensor-based device automatically measures and reports one's glucose levels up to every 5 min, improves hemoglobin A1c (HbA1c), reduces the frequency of dysglycemia, improves quality of life, and is cost-effective for people living with T1D compared to self-monitoring blood glucose (SMBG). CGM studies in type 2 diabetes (T2D) have been limited to date, especially those involving participants not requiring intensive insulin therapy.
    • Do Patient Outcomes Vary by Patient Age Following Primary Total Hip Arthroplasty?

      Ayers, David C; Yousef, Mohamed; Zheng, Hua; Yang, Wenyun; Franklin, Patricia D (2022-05-31)
      Background: Multiple authors have sought to determine what patient characteristics influence outcome after total hip arthroplasty (THA). Age has shown no effect on outcome in some evaluations, while others have reported higher functional improvement in younger patients. The aim of this study was to determine if outcome after THA varies based on patient age. Methods: A prospective, multicenter cohort of 7,934 unilateral primary THA patients from the FORCE-TJR comparative effectiveness consortium was evaluated. Demographic data, comorbid conditions, and Patient-Reported Outcome Measures, including (HOOS), HOOS-12, HOOS JR, and SF-36 (PCS) and (MCS), were collected preop and at 1-year postop. Descriptive statistics were generated, stratified by age (<55 years [younger adult], 55-64 years [older adult], 65-74 years [early elder], and ≥75 years [late elder]), and differences in pain, function, and quality of life among the 4 age groups were evaluated. A multivariate regression model with 95% confidence interval (CI) was used to assess the role of patient age as a predictive factor for HOOS pain and function scores reported 1 year after primary THA. Results: Prior to surgery, younger patients (<55 years) reported worse pain, function, and quality of life than the other 3 patient groups. At 1 year after THA, younger patients (<55 years) reported slightly worse pain and quality of life but better function scores than the 3 older patients' groups. Younger patients (<55 years) achieved higher baseline to 1-year pain, and function score changes when compared to the older patients' groups. The quality of life score changes was not different among the 4 age groups. The differences in 1-year postop scores (ranging from 2.74 to 8.46) and the magnitude of score changes from baseline to 1 year (ranging from 1.9 to 5.85), although statistically significant (P < .001), did not reach the minimal clinically important difference (MCID). The multivariate regression analysis shows that age is a significant predictor for pain at 1 year but not for function. Although HOOS pain score is predicted to be higher by 4.38 points (less pain) 1 year after THA in older patients (≥75), when compared to younger patients (<55 years), again the difference is well below the MCID and is clinically insignificant. Conclusion: Although there are statistically significant differences in pain relief, functional improvement, and quality of life between younger and older patients among different patients' age groups, there is no clinically significant difference. THA provides an improvement in quality of life by decreasing pain and increasing function in all 4 age groups, with large improvements in Patient-Reported Outcome Measures scores (>2 standard deviations) without clinically significant age-related differences in THA outcome at 1 year.
    • Uptake of hepatitis C virus treatment in a multi-state Medicaid population, 2013-2017

      Clements, Karen M; Kunte, Parag S; Clark, Melissa A; Gurewich, Deborah; Greenwood, Bonnie C; Sefton, Laura; Pratt, Carter; Person, Sharina D; Wessolossky, Miryea A (2022-05-04)
      Objective: To examine trends in the direct acting antiviral (DAA) uptake in a multi-state Medicaid population with hepatitis C virus (HCV) prior to and after ledipasvir/sofosbuvir (LDV/SOF) approval and changes in prior authorization (PA) requirements. Data sources: Analyses utilized enrollment, medical, and pharmacy claims in four states, December 2013-December 2017. Study design: An interrupted time series examined trends in uptake (1+ claim for a DAA) before and after two events: LDV/SOV approval (October 2014) and lifting of PA requirements for 40% of members (July 2016). Analyses were also performed in subgroups defined by the number and dates of change in PA requirements in members' Medicaid plans. Data collection/extraction methods: Members aged 18-64 years with an ICD code for HCV were included in the sample from diagnosis date until treatment initiation or Medicaid disenrollment. Principal findings: The annual sample size ranged from 38,302 to 45,005 with approximately 30% ages 18-34 years and 40% female. In December 2013, 0.08% was treated, rising to 0.74% in December 2017 (p < 0.001). Uptake increased from 0.34%/month in October 2014 to 0.70%/month after LDV/SOF approval, (p < 0.001), and increased relative to the pre-LDV/SOV trend through June 2016 (p = 0.04). Uptake increased to 1.18%/month after PA change, (p < 0.001) and remained flat through 2017 (p = 0.64). Cumulatively, 20.1% were treated by December 2017. In plans with few/no requirements through 2017, uptake increased to 1.19%/month after LDV/SOF approval (p < 0.001) and remained flat through 2017 (p = 0.11), with 22.2% cumulatively treated. Among plans that lifted PA requirements from three to zero in mid-2016, uptake did not increase after LDV/SOF approval (p = 0.36) but did increase to 1.41%/month (p < 0.001) after PA change, with 18.1% cumulatively treated. Conclusions: HCV Treatment increased through 2017. LDV/SOF approval and lifting PA requirements led to an increase in uptake followed by flat monthly utilization. Cumulative uptake was higher in plans with few/no PA requirements relative to those with three requirements through mid-2016.
    • Improving Performance with Flowcharts

      Aboagye, Ruth (2020-08-26)
      Blog post to AEA365, a blog sponsored by the American Evaluation Association (AEA) dedicated to highlighting Hot Tips, Cool Tricks, Rad Resources, and Lessons Learned for evaluators. The American Evaluation Association is an international professional association of evaluators devoted to the application and exploration of program evaluation, personnel evaluation, technology, and many other forms of evaluation. Evaluation involves assessing the strengths and weaknesses of programs, policies, personnel, products, and organizations to improve their effectiveness.
    • Opioid Overdoses Among High-Risk Medicaid Members: Healthcare Cost, Service Utilization, and Risk Factor Analysis

      Savageau, Judith A.; Brindisi, Melissa; Miller, Faye; Sefton, Laura A.; Stoler, Adam; Harvey, Margaret; Bernson, Dana (2020-07-28)
      Research Objective: Identify risk factors associated with opioid overdoses among three high-risk populations of Medicaid members related to cost and service utilization. Study Design: Repeated cross-sectional study using five years of Massachusetts Medicaid (MassHealth) claims and state agency data. Population Studied: MassHealth members aged 11-64 years considered to be high-risk (homeless, unstably housed, and/or criminal justice-involved) and in need of support services, especially those with extensive behavioral health (BH) needs. These three populations were identified as being particularly vulnerable to non-fatal and/or fatal opioid overdoses. Principal Findings: MassHealth members who were both justice-involved and unstably housed were at much higher risk of an opioid overdose than the MassHealth population overall, especially those with a substance use disorder (SUD) or a serious mental illness (SMI). Experiencing both homelessness and justice involvement substantially compounded members’ non-fatal overdose risk, regardless of BH diagnosis. Co-occurring SUD/SMI was a key driver of high overdose prevalence, particularly among the justice-involved. Compared to MassHealth members in general, those with justice involvement and unstable housing had costs that were 50-65% higher; members who experienced homelessness had triple the costs. Healthcare service use both before and after an overdose was relatively low, including the timeframe between multiple non-fatal overdoses. In multivariate analyses, all three high-risk factors (i.e., populations) were significantly related to an increased opioid overdose risk after controlling for additional risk factors (BH diagnoses, chronic medical conditions, and demographic characteristics). Males and whites were more likely to have an opioid overdose; those with diabetes or hypertension were less likely. These results were similar when assessing various opioid overdose outcomes (non-fatal and/or fatal). Conclusions: These findings helped inform MassHealth’s understanding of its members’ experiences regarding medical and BH services, especially among high-risk populations with an opioid overdose. The identification of risk factors most predictive of a subsequent overdose may help address the needs of these high-risk groups. For most of the populations studied, prevalence of co-occurring BH diagnoses was much higher than MassHealth members in general and appeared to impact opioid overdose rates. Most members received services for 1-2 months in both the pre- and post-overdose periods; service use was relatively low in the year following a non-fatal overdose, suggesting retention was also low. Multivariate analyses consistently showed that gender and race were significantly associated with increased overdose risk. Implications for Policy or Practice: Understanding opioid overdose risk factors and identifying service utilization gaps and missed opportunities are important. As payment reforms evolve under the umbrella of accountable care organizations, BH community partnership models are key for collaborating with healthcare and social service providers, and community resources for care management, care coordination, and referrals to support services. Our study initially developed an in-depth descriptive analysis of individuals with SUD, SMI, or both identified as being at high risk for an opioid overdose. Understanding service trajectory and outcomes through additional analyses was critical for planning and prioritizing appropriate services. As payors are actively making decisions about effective systems of care, they are particularly interested in understanding the need for community-based and residential services, particularly for those with housing instability and/or criminal justice involvement.
    • Impact of Sequential Opioid Dose Reduction Interventions in a State Medicaid Program Between 2002 and 2017

      Garcia, Maria M.; Lenz, Kimberly J.; Greenwood, Bonnie C.; Angelini, Michael C.; Thompson, Tyson; Clements, Karen M.; Mauro, Rose; Jeffrey, Paul L. (2019-08-01)
      Policies that address opioid dose limits may help to decrease high-risk opioid prescribing. We evaluated 3 sequential and progressive decreases in high-dose (HD) opioid limits implemented by Massachusetts Medicaid over 15 years. The study population included members ages 18 to 64 years with > /=1 claim for a schedule II opioid between January 2002 and March 2017. The 3 interventions consisted of prior authorization requirements for prescriptions exceeding the morphine equivalent dose (MED) HD dose limits: > 360 mg (intervention 1a and 1b), > 240 mg (intervention 2), and > 120 mg (intervention 3). A segmented regression evaluated the change in natural log of the average daily MED (AD_MED). The natural log of the AD_MED decreased during the 6 quarters after intervention 1a (P < .001), immediately after intervention 1b (P=.0002), and continued to decrease over the following 8 quarters (P=.023). The natural log of the AD_MED decreased immediately after intervention 2 (P=.002) and again after intervention 3 (P < .001). The percentage of users exceeding the HD limits of 360 mg, 240 mg, and 120 mg MED decreased by 87.3%, 79.8%, and 75.2% from baseline, respectively. The natural log of the AD_MED decreased among members after implementation of 3 sequential and progressive HD prior authorization limits, as did the percentage of members exceeding each of the HD limits. PERSPECTIVE: This study demonstrates the longitudinal impact of a prior authorization policy-based HD limit in a Medicaid population. This study contributes to options for policymakers and other Medicaid programs as a potential strategy to assist in addressing the opioid epidemic.
    • The Effective Medicaid Pharmacy Program: A White Paper for Medicaid Directors and State Agency Personnel

      Greenwood, Bonnie C.; Nicolella, Elena (2019-06-28)
      In June 2019, NESCSO and Commonwealth Medicine jointly released a white paper titled The Effective Medicaid Pharmacy Program. Through information compiled from stakeholder interviews and an environmental scan, this brief paper reviews components of an effective Medicaid pharmacy program and provides practical information for Medicaid programs and state leadership. An effective Medicaid pharmacy program provides members with access to medically necessary medications that are cost-effective, aligned with best clinical practice, and provided in a transparent environment. It is important consider a program’s administrative structure, pharmacy benefit delivery system, and influence of external factors in the achievement of these goals.
    • Best Practices for Member Outreach and Engagement: How Effective ACOs Build Understanding and Respect

      Carpenter, Jessica; Gordon, Jocelyn (2019-06-24)
      Targeted strategies and sustained efforts at member outreach and engagement are helping Accountable Care Organizations (ACOs) and their Community Partners (CPs) achieve their shared goals for delivering patient-centered care. The most successful organizations focus on activities designed to create a stronger connection with their members, building trust and a better understanding of individuals’ characteristics and care needs. Positive results of these efforts include successful person-centered care planning, improved compliance with care plans and prescriptions, and implementation of recommended lifestyle changes — changes that help support independent living, reduce medical costs and complications, and drive improvements in member satisfaction.
    • University of Massachusetts Medical School Report to Minnesota Department of Human Services Health and Incarceration Project

      London, Katharine; Tourish, Jeremy (2019-06-01)
      On behalf of the Minnesota Department of Health Services, Health Law & Policy experts from our Public and Private Health Solutions group completed a literature review of successful efforts to improve the health of previously incarcerated individuals. In addition, our experts conducted five focus groups to obtain recommendations from experienced professionals who work directly with previously incarcerated individuals regarding interventions likely to improve the health of this unique population. This study came about at the direction of Minnesota Legislature. They were interested in developing a methodology for paying higher rates to health care providers who provide services to high cost and high complexity groups such as individuals who were previously incarcerated. The goal is to ensure that populations experiencing the greatest health disparities would achieve the same health and quality outcomes as other populations in Minnesota. Accompanying the report is a list of recommendations for future policy considerations that be viewed here.
    • Infants Exposed To Homelessness: Health, Health Care Use, And Health Spending From Birth To Age Six

      Clark, Robin E.; Weinreb, Linda; Flahive, Julie M.; Seifert, Robert W. (2019-05-01)
      Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.
    • Will ending certain drug rebates lower list prices and patient out-of-pocket costs?

      Taylor, Mckenzie; Tran, Stephanie (2019-04-10)
      Earlier this year, the Department of Health and Human Services (HHS) proposed changes to the current pricing and contracting system for federal health care programs, Medicare Part D and Medicaid.This proposal aligns with the Trump Administration’s blueprint for lowering drug prices which we have written about previously.
    • The expanding role of pharmacists: A positive shift for health care

      Chiara, Ashley (2019-03-26)
      When reflecting upon the impactful members of a patient’s healthcare team, much consideration is given to the patient’s nurses, primary care physician and specialists. However, with nearly nine in 10 Americans living within five miles of a community pharmacy, and four in five receiving prescription benefits through a pharmacy benefit manager (PBM), the role of the pharmacist in orchestrating a patient’s care on the front lines is often overlooked.
    • Payment reform for kids

      Seifert, Robert W. (2019-02-05)
      Comprehensive care for children – including greater attention to behavioral health, socio-emotional development, and strong family relationships – may hold the key to lifelong health and well-being. With this premise, a group in Connecticut has just published recommendations for improving pediatric primary care through payment reform.
    • Transforming Pediatrics to Support Population Health

      Seifert, Robert W.; Deignan, Hilary (2019-02-05)
      This report for The Connecticut Health Foundation & the Child Health and Development Institute of Connecticut, Inc., compiled by our Health Law & Policy experts, explores how payment reform could support improvements in child health services. Our experts point specifically toward pediatric primary care as a place where this change could take place. They share ideas for redesigning pediatric primary care to play a larger role in the health and well being of families, along with strategies for reform around how this kind of care is funded. Client/Partner: The Child Health and Development Institute of Connecticut
    • Corrections for Academic Medicine: The Importance of Using Person-First Language for Individuals Who Have Experienced Incarceration

      Bedell, Precious S.; So, Marvin; Morse, Diane S; Kinner, Stuart A.; Ferguson, Warren J.; Spaulding, Anne C. (2019-02-01)
      This Invited Commentary addresses the use of labels and their impact on people involved in the criminal justice system. There are 2.2 million adults incarcerated in the United States and close to 6.6 million under correctional supervision on any day. Many of these people experience health inequalities and inadequate health care both in and out of correctional facilities. These numbers are reason enough to raise alarm among health care providers and criminal justice researchers about the need to conceptualize better ways to administer health care for these individuals. Using terms like "convict," "prisoner," "parolee," and "offender" to describe these individuals increases the stigma that they already face. The authors propose that employing person-first language for justice-involved individuals would help to reduce the stigma they face during incarceration and after they are released. Coordinated, dignified, and multidisciplinary care is essential for this population given the high rates of morbidity and mortality they experience both in and out of custody and the many barriers that impede their successful integration with families and communities. Academic medicine can begin to address the mistrust that formerly incarcerated individuals often have toward the health care system by using the humanizing labels recommended in this Invited Commentary.
    • Lowering Out of Pocket Drug Costs for Consumers

      Price, Mylissa K. (2019-01-31)
      Prohibiting gag clauses could help lower consumer out-of-pocket pharmacy costs - if Pharmacy Benefits Managers don't raise prices to make-up the difference. Mylissa Price closes our blog series on President Trump's Blueprint to Lower Drug Costs in this final entry.
    • Recovery Coaches in Opioid Use Disorder Care: Report and Estimator Tools

      London, Katharine; McCaffrey, Marybeth; McDowell, Lisa; Maughan, Matthew; Tourish, Jeremy (2019-01-24)
      An extensive report on the impacts recovery coach services can have on Opioid Use Disorder care in Massachusetts accompanied by two tools to assist in understanding how to develop such services. The report defines what a recovery coach is, delves into the role experts believe they could play in the recovery process and ultimately how they could change overall health outcomes. Along with the report, the team built a recovery coach Impact Estimator Tool which allows users to calculate the caseload, budgetary, financial, and clinical impact policy makers need before making the decision to invest in new forms of intervention. Implementing a new form of health care intervention requires research and planning. Finally, they created a Compendium of Recovery Coach Certification Requirements by State, which provides recovery coach certification information for 48 states and the District of Columbia. Client/Partner: RIZE Massachusetts
    • Managed Care Looks Forward: Top Five Trends for Pharmacy in 2019

      Tran, Stephanie (2019-01-16)
      In a commentary piece for Managed Health Care Connect, our Clinical Pharmacy Consultant Stephanie Tran, PharmD, overviews the top five pharmacy trends in managed care she's looking forward to in 2019. Tran foresees pharmacists continuing "to play a critical role in a health care industry that is increasingly shifting its focus to innovation, value, pricing, and transparency." As the role pharmacists play in the health care evolves, new questions arise on topical subjects like drug pricing, pharmacy benefits managers, pipeline treatments and more. Tran starts the conversation on issues sure to be at the forefront of the industry throughout 2019.
    • Deciphering State Medicaid Programs

      Gershon, Rachel (2019-01-08)
      State Medicaid programs vary substantially from one another. For members, researchers, policymakers, and advocates trying to decipher a state’s Medicaid program, this variation can be a source of frustration, because the details of this variation can be hard to locate.
    • Homelessness Contributes To Pregnancy Complications

      Clark, Robin E.; Weinreb, Linda; Flahive, Julie; Seifert, Robert W. (2019-01-01)
      Homelessness during pregnancy poses significant health risks for mothers and infants. As health care providers increase their emphasis on social determinants of health, it is important to understand how unstable housing contributes to complications during pregnancy. We linked data about emergency shelter enrollees with Massachusetts Medicaid claims for the period January 1, 2008-June 30, 2015 to compare health care use and pregnancy complications for 9,124 women who used emergency shelter with those for 8,757 similar women who did not. Rates of mental illness and substance use disorders were significantly higher among homeless women. Adjusted odds of having nine pregnancy complications were also significantly higher for homeless women and remained substantially unchanged after we adjusted for behavioral health disorders. Emergency shelter users also had fewer ambulatory care visits and more months without billable care and were more likely to visit an emergency department. Homelessness and behavioral health disorders appear to be independent factors contributing to pregnancy complications and should be addressed simultaneously.