Original Research

Peer-viewed studies and review articles on managed care.

Original Research
Adam E. Block, PhD
Starting a health plan is difficult and success is certainly not guaranteed. Of three 2014 start-up health plans in New York City, Health Republic closed in 2015 and CareConnect closed on New Year’s Eve 2017. Only Oscar remains, and it racked up cumulative losses of $235 million from 2014 to 2016.
Original Research
Amit Chhabra, MBBS, MPH
Patrick F. Fogarty, MD
Bartholomew J. Tortella, MD, MBA
Dean Spurden, PhD
José Alvir, DrPH
Margaret McDonald, PhD
Jennifer Hodge, PhD
Andreas M. Pleil, PhD
Real-world data challenge assumptions regarding typical factor usage and expenditures associated with product switching in patients with hemophilia A. There were higher expenditures over two years on hemophilia A patients using extended half-life (EHL) versus standard half-life (SHL) products.
Review Article
Renée JG Arnold
Marc Massanari
Todd A. Lee
Elizabeth Brooks
Asthma is a common chronic respiratory disease affecting nearly 8% of the U.S. population. Fractional exhaled nitric oxide (FeNO) is a noninvasive biomarker for T2-driven (i.e., allergic) airway inflammation that could be used to improve diagnosis, optimize inhaled corticosteroid dosing, and monitor adherence.
Original Research
Elizabeth A. Brooks, PhD
Marc Massanari, PharmD
Current asthma guidelines combine treatment, follow-up, and re-evaluation to manage asthma control, reduce impairment, and decrease risk of morbidity in patients. Analysis reveals that FeNO monitoring to guide asthma management is cost effective, increasing quality-adjusted life years while decreasing costs associated with asthma management.
Original Research
Joseph A. Ladapo, MD, PhD
Matthew J. Budoff, MD
Pejman Azarmina, MD, MSc
David Sharp, DO
Alice Baker, MPH
Bruce Maniet, DO
Lee Herman, MD
Mark Monane, MD, MS
An age/sex/gene expression score helped to identify patients with low current likelihood of obstructive coronary artery disease. These patients had lower costs of CAD care during one year of follow-up. Early reductions in cardiac referrals at 45 days among these patients persisted for one year.
Original Research
David Muhlestein, PhD, JD
Katelyn de Lisle
Thomas Merrill
ACOs need to provide comprehensive care management across a spectrum of provider specialties. To do this, they need a framework for evaluating potential partners that will help risk-bearing providers establish the partnerships that will enable them to achieve their goals.
Original Research
Douglas C. A. Taylor, MBA
Jessica L. Abel, MPH
Tim Bancroft, PhD
Paul Buzinec, MS
Alyssa Goolsby Hunter, MA
Robyn T. Carson, MPH
Carolyn Martin, MSW
As expected, pharmacy costs increased with the introduction of this new treatment in a market dominated by over-the-counter and generic treatments. On the other hand, outpatient GI-related and irritable bowel disease health care resource use and costs substantially decreased among commercial and Medicare patients following linaclotide treatment initiation.
Original Paper
Holly Miller, MD
Lucy Johns, MPH
The document “Feature and Function Recommendations To Optimize Clinician Usability of Direct Interoperability To Enhance Patient Care” offers recommendations from the clinician point of view. Widespread adoption of even a few of these recommendations by designers and vendors would greatly enhance care.