AJMC’s Top 10 Managed Care Stories for 2014

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From a guide to treating hypertension, to the impact of wait times on patient satisfaction, to an influential editorial on a trend among health plans to put some generic drugs in “non-preferred” tiers, reader favorites in The American Journal of Managed Care franchise reflected the diverse issues facing healthcare today.

Reader favorites for 2014 reflect a variety of topics, from clinical guidelines to policy matters.

The American Journal of Managed Care will reach its 20th anniversary in 2015. Other titles in the franchise are The American Journal of Pharmacy Benefits, the Evidence-Based Series, and The American Journal of Accountable Care.

With 2014 coming to a close, The American Journal of Managed Care is taking a look back at the most popular articles across the franchise’s many journals. These most-read articles highlight the healthcare issues most important to providers, insurers, and policy makers. Reader favorites represent a variety of topics, including clinical guidance, medical cost and utilization, and patient satisfaction. Here are the most popular articles of 2014, in case you missed them the first time around:

1. The JNC 8 Hypertension Guidelines: An In-Depth Guide.
By far the most popular article of the year was this guide, which was published in the January issue of Evidence-Based Diabetes Management. The new Joint National Committee (JNC 8) hypertension guidelines advise higher blood pressure goals, reduced use of several types of antihypertensive medications, and emphasized control of systolic blood pressure and diastolic blood pressure with age- and comorbidity-specific treatment cutoffs. Read the article here.

2. Medical Homes and Cost and Utilization Among High-Risk Patients.
This March AJMC paper evaluated the effects of the patient-centered medical home (PCMH) on medical costs and utilization. The authors compared per member per month cost and utilization for members enrolled in PCMH and non-PCMH practices. They found that total costs decreased significantly more for high-risk patients in the PCMH group. The cost decrease was driven by lower inpatient costs as the PCMH group experienced a greater reduction in inpatient admissions over 3 years. Read the article here.

3. Recurrence of Breast Cancer Years After the Initial Tumor.
Evidence-Based Oncology published this analysis of recurrent breast tumors in September. Authors Marj P. Zimmerman, MS, BSPharm, and Stanton R. Mehr wrote that recurrent breast cancer remains a principal cause of death for patients who are initially diagnosed with early-stage disease. As a result, patients who do not demonstrate tumor recurrence for 5 years are no longer considered “cured,” only “cancer-free.” Read the article here.

4. A Comprehensive Hospital-Based Intervention to Reduce Readmissions for Chronically Ill Patients: A Randomized Controlled Trial. Authors Ariel Linden, DrPH, and Susan W. Butterworth, PhD, wrote in the October issue of AJMC that despite using comprehensive evidence-based intervention components, stand-alone hospitals may be unable to prevent readmissions. An analysis of 512 patients at 2 community hospitals, half assigned to intervention and the others to usual care, found no statistical difference between treatment groups on 30-day readmission incidence rates. Read the article here.

5. Novel Predictive Models for Metabolic Syndrome Risk: A “Big Data” Analytic Approach. This June AJMC study aimed to accurately predict the risk of metabolic syndrome and its various factors on both a population and individual level. The authors used demographic, medical claim, pharmacy claim, laboratory test, and biometric screening results for nearly 37,000 individuals within Aetna’s database and demonstrated that improving waist circumference and blood glucose yielded the largest benefits on subsequent risk and medical costs. Read the article here.

6. STABLE Results: Warfarin Home Monitoring Achieves Excellent INR Control. In March, AJMC published the results of a study that found point-of-care patient self-testing at home achieves high-quality warfarin therapy outside of clinical trials. The overall mean of time in therapeutic INR range was 69.7% with close to 30,000 patients studied. Read the article here.

7. Wait Times, Patient Satisfaction Scores, and the Perception of Care. The authors analyzed the impact of waiting time on patient satisfaction scores by collecting data from more than 11,000 survey responses from patients. The May AJMC paper found that not only are the likelihood to recommend and the overall satisfaction impacted negatively by longer wait times, but perceptions of information, instructions, and the overall treatment provided is also affected by increased wait times. Read the article here.

8. Is All “Skin in the Game” Fair Game? The Problem With “Non-Preferred” Generics. This editorial in the September issue of AJMC written by Co-Editor-in-Chief A. Mark Fendrick, MD, and Gerry Oster, PhD, discussed how the increasing demand that patient shoulder larger portions of drug costs is not limited to expensive new medicines like Sovaldi. They highlighted the fact that plans designating “preferred” and “non-preferred” generics are charging patients high co-pays for highly effective and widely used generic drugs sometimes without offering a cheaper “preferred” option. Read the article here.

9. Mobile Health Clinics in the Era of Reform.
In March, an AJMC study characterized the scope of the mobile clinic sector and its impact on access, costs, and quality, as well as the role of mobile clinics during a time of healthcare delivery reform and expanded insurance coverage. These clinics play a critical role in providing high-quality, low-cost care to vulnerable populations, and the authors call for strengthening the ability of these clinics by partnering them with hospitals, health systems, and payers. Read the article here.

10. Association of Electronic Health Records With Cost Savings in a National Sample.
Hospitals that use advanced electronic health records (EHRs) have lower cost per patient admission than comparable hospitals, according to a study published in the June issue of AJMC. The authors analyzed more than 5 million individuals treated at 550 hospitals, 18.9% of which used advanced EHRs. After controlling for patient and hospital characteristics, they found that patients treated at these 104 hospitals with advanced EHRs cost $731 (9.66%) less than patients in hospitals without advanced EHRs. Read the article here.

About the Journals
The American Journal of Managed Care, now in its 20th year of publication, is the leading peer-reviewed journal dedicated to issues in managed care. The American Journal of Pharmacy Benefits, provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care. In December 2013, AJMC introduced The American Journal of Accountable Care, which publishes research and commentary devoted to understanding changes to the healthcare system due to the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT:    Mary Caffrey (609) 716-7777 x 144
        mcaffrey(at)ajmc.com
        http://www.ajmc.com

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American Journal of Managed Care
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