Effective care management by Next Generation accountable care organizations.

Objectives: The objectives of this study were to estimate the utilization and spending impact of a standardized complex care management program implemented at 5 Next Generation accountable care organizations (NGACOs) and to identify reproducible program features that influenced program effectiveness.

Study Design: In 2016 and 2017, high-risk Medicare beneficiaries aligned to 5 geographically diverse NGACOs were identified using predictive analytics for enrollment in a standardized complex care management program. We estimated the program's impact on all-cause inpatient admissions, emergency department visits, and total medical expenditures (TME) relative to a matched cohort of nonparticipants.

The bird's-eye view: A data-driven approach to understanding patient journeys from claims data.

Objective: In preference-sensitive conditions such as back pain, there can be high levels of variability in the trajectory of patient care. We sought to develop a methodology that extracts a realistic and comprehensive understanding of the patient journey using medical and pharmaceutical insurance claims data.

Materials And Methods: We processed a sample of 10 000 patient episodes (comprised of 113 215 back pain-related claims) into strings of characters, where each letter corresponds to a distinct encounter with the healthcare system.