Association between screening for suspected COVID-19 cases and outcomes of patients revisiting the emergency department.

Objectives: Patients who revisit the emergency department (ED) shortly after discharge are a high-risk group for complications and death, and these revisits may have been seriously affected by the COVID-19 pandemic. Detecting suspected COVID-19 cases in EDs is resource intensive. We examined the associations of screening workload for suspected COVID-19 cases with in-hospital mortality and intensive care unit (ICU) admission during short-term ED revisits.

Cancellations in primary care in the Veterans Affairs Health Care System.

Objectives: Unused medical appointments affect both patient care and clinic operations, and the frequency of cancellations due to clinic reasons is underreported. The prevalence of these unused appointments in primary care in the Veterans Affairs Health Care System (VA) is unknown. This study examined the prevalence of unused primary care appointments and compared the relative frequency of cancellations and no-shows for patient and clinic reasons.

Physiologic insulin resensitization lowers cost in patients with diabetes and kidney disease.

Objective: To examine the effect of physiologic insulin resensitization (PIR) on the cost of treating patients with diabetes and chronic kidney disease (CKD).

Study Design: The mean 1-year cost of treating 66 Medicare Advantage patients with diabetes and CKD who were receiving PIR was compared with that of treating 1301 Medicare Advantage patients with diabetes and CKD not receiving PIR. Differences in disease severity were compared using mean risk adjustment factor scores.

Effects of individualized nurse-led care plans on olaparib treatment duration.

Objective: To assess the effects of a nurse-led personalized care plan on the duration of olaparib therapy among patients with cancer.

Study Design: Cohort study conducted from January 2020 to June 2022.

Methods: Data from an independent specialty pharmacy were used to identify patients 18 years and older with at least 1 olaparib (Lynparza) prescription who were at high risk for olaparib nonadherence as assessed using a pharmacy intake survey.

Medical loss ratio's role in the large group insurer market.

Objectives: To assess trends in the medical loss ratio (MLR) and understand how health insurance premiums in the large group market are driven by medical claims spending and insurer margins.

Study Design: Study of approximately 500 insurers covering more than 40 million lives annually in the large group market that submitted an MLR submission form (2014-2022).

Methods: We assessed trends in the MLR, premiums, medical claims spending, administrative costs, quality improvement spending, and margins among all insurers in the large group market.

Medicaid managed care network adequacy standards and mental health care access.

Objectives: Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions.

Collaboration to transition members to preferred formulary dipeptidyl-peptidase-4 inhibitor.

Objective: To describe the outcomes of a partnership between a drug plan and pharmacists to switch patients from brand name dipeptidyl-peptidase-4 inhibitors to the generic alogliptin.

Study Design: Single-center, retrospective chart review.

Methods: Clinical pharmacists contacted patients with primary care providers within the health system affiliated with the drug plan to facilitate the switch.

High-intensity home-based rehabilitation in a Medicare accountable care organization.

Objectives: Patients are often discharged to a skilled nursing facility (SNF) for postacute rehabilitation. Functional outcomes achieved in SNFs are variable, and costs are high. Especially for accountable care organizations (ACOs), home-based postacute rehabilitation offers a high-value option if outcomes are not compromised.

Overcoming challenges to optimize the clinical and financial benefits of in-home rehabilitation services.

The authors advocate for the implementation of value-based principles to address the underutilization and limited supply of home care and rehabilitation services.

Managed care reflections: a Q&A with Jan E. Berger, MD, MJ.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed-and what has not-over the past 3 decades and what's next for managed care. The January issue features a conversation with longtime editorial board member Jan E. Berger, MD, MJ, the CEO of Health Intelligence Partners.

High Entropy: A General Strategy for Broadening the Operating Temperature of Magnetic Refrigeration.

Lattice distortion and disorder in the chemical environment of magnetic atoms within high-entropy compounds present intriguing issues in the modulation of magnetic functional compounds. However, the complexity inherent in high-entropy disordered systems has resulted in a relative scarcity of comprehensive investigations exploring the magnetic functional mechanisms of these alloys. Herein, we investigate the magnetocaloric effect (MCE) of the high-entropy intermetallic compound GdTbDyHoErCo.

Light-Harvesting Spin Hyperpolarization of Organic Radicals in a Metal-Organic Framework.

Light-driven spin hyperpolarization of organic molecules is a crucial technique for spin-based applications such as quantum information science (QIS) and dynamic nuclear polarization (DNP). Synthetic chemistry provides the design of spins with atomic precision and enables the scale-up of individual spins to hierarchical structures. The high designability and extended pore structure of metal-organic frameworks (MOFs) can control interactions between spins and guest molecules.

Steering Energy Transfer Pathways through Mn-Doping in Perovskite Nanocrystals.

Modulation of singlet and triplet energy transfer from excited semiconductor nanocrystals to attached dye molecules remains an important criterion for the design of light-harvesting assemblies. Whereas one can consider the selection of donor and acceptor with favorable energetics, spectral overlap, and kinetics of energy transfer as a means to direct the singlet and triplet energy transfer pathways, it is not obvious how to control the singlet and triplet characteristics of the donor semiconductor nanocrystal itself. By doping CsPb(ClBr) nanocrystals with Mn, we have now succeeded in increasing the triplet characteristics of semiconductor nanocrystals.

Medical Care or Deportation: Examining Interior Border Checkpoints and Access to Higher-Level Medical Care for Undocumented Immigrants in South Texas.

We examined the impacts of interior border checkpoints on access to higher-level medical care via ground ambulance for undocumented immigrants in South Texas. Using purposive sampling, we conducted interviews (n = 30) with ground ambulance personnel in the lower Rio Grande Valley, Texas. Procedures implemented in 2018 mandate that hospitals notify Border Patrol of a patient's legal status before transfer.

Increasing Access Through Integration: Behavioral Health Services and Beyond.

An academic health center (AHC) that provides primary care to an urban, underresourced population recognized the need for an integrated model of care to address behavioral health needs. The Ambulatory Integration of the Medical and Social (AIMS) Collaborative Care Model's five pillars provided the framework and enhanced outcomes through tailored initiatives at the AHC, expanding to onsite satellite locations in senior subsidized housing, and through telehealth services. The results showed increased access to behavioral health care and improved depression and anxiety symptoms.

Impacts of State COVID-19 Vaccine Mandates for Health Care Workers on Health Sector Employment in the United States.

To assess the impact of state COVID-19 vaccine mandates for health care workers (HCWs) on health sector employment in the United States. Using monthly state-level employment data from the Quarterly Census of Employment and Wages between January and October 2021, we employed a partially pooled synthetic control method that accounted for staggered mandate adoption and heterogeneous treatment effects. We conducted analyses separately for the 4 health care subsectors-ambulatory health care services, hospitals, nursing and residential care, and social assistance-with an additional analysis of 2 industry groups-skilled nursing care and community care for the elderly-under the nursing and residential care subsector.

Research Funded by National Institutes of Health Concerning Sexual and Gender Minoritized Populations: A Tracking Update for 2012 to 2022.

To investigate trends in awards funded by the National Institutes of Health (NIH) focusing on sexual and gender minoritized (SGM) populations from 2012 to 2022 in the United States. Replicating the method of Coulter et al., we identified NIH-funded awards for SGM research from 2012 to 2022 using the NIH RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results) system.

Uptake of Recommended Vaccines During Pregnancy Among Publicly and Privately Insured People in the United States, December 2020-September 2022.

To estimate maternal COVID-19, influenza, and pertussis vaccine uptake during pregnancy by insurance type and identify factors characterizing those vaccinated and unvaccinated. We conducted a US cohort study of pregnant individuals (for pregnancies ending December 11, 2020-September 30, 2022) using insurance claims data. We calculated vaccination probability using Kaplan-Meier methods and identified factors associated with vaccination through binomial regression with inverse probability weights.

Free-Breathing Respiratory Triggered High-Pitch Lung CT: Insights From Phantom and Patient Scans.

Objective: Respiratory motion can affect image quality and thus affect the diagnostic accuracy of CT images by masking or mimicking relevant lung pathologies. CT examinations are often performed during deep inspiration and breath-hold to achieve optimal image quality. However, this can be challenging for certain patient groups, such as children, the elderly, or sedated patients.