Impact of ICER Assessments on Payer Decision Making in the United States

Objectives: To evaluate how payers utilize Institute for Clinical and Economic Review (ICER) assessments to inform coverage or formulary decisions. Method(s): Double-blinded, web-based survey was fielded through Xcenda's research panel, the Managed Care Network, from June to July 2022. Result(s): A total of 51 payers from health plans (n=27), integrated delivery networks (n=12), and pharmacy benefit managers (n=12) participated in the survey. When assessing the usefulness of ICER's value assessment framework (VAF) to inform formulary decisions within their organizations, 57% of payers indicated it was extremely/very useful, 33% indicated somewhat useful, and 10% indicated not at all/not very useful. Most respondents (73%) agreed that ICER assessments are aligned with their organization's internal assessment. Utilization of ICER's VAF was most prevalent in high-cost drug or disease states (78%), rare/orphan disease states (71%), and oncology/hematology disease states (67%). Payers reported less use in primary care disease states (29%), COVID-19 (8%), and digital therapeutics (4%). In the last 24 months, 20% of payers reported ICER's recommendations often influenced coverage decisions, 59% indicated occasional influence, and 22% indicated no influence. In the last 24 months, payers indicated the top 5 ICER assessments that influenced their coverage decisions included high cholesterol (38%), Alzheimer's disease (36%), atopic dermatitis (33%), multiple myeloma (31%), and chemotherapy-induced neutropenia (28%). ICER assessments that were less impactful included beta thalassemia (3%), digital health technologies (3%), and supervised injection facilities (3%). Payers reported using ICER assessments to inform both expanded and restricted coverage decisions. Conclusion(s): Payers find ICER's VAF useful to inform their organization's formulary decisions. ICER's assessments often align with payers' internal assessments and are most frequently utilized for high-cost drugs or disease states. Payers indicate ICER assessments have affected both expansion and restriction in their coverage policies.Copyright © 2023

Beyond Value Assessment: Payer Perceptions of ICER's Policy Initiatives

Objectives: To assess how the Institute for Clinical and Economic Review (ICER) has evolved its policy scope beyond value assessments in the last 7 years and explore payer perceptions of ICER's new policy initiatives. Method(s): Completed ICER assessments and policy papers published from 2016-2022 were counted to quantify ICER's activities and output. Double-blinded, web-based surveys of US healthcare payers were fielded through Xcenda's research panel, the Managed Care Network, in October 2020 (N=47) and June 2022 (N=51) to explore perceptions of ICER initiatives, including policy papers, Unsupported Price Increase (UPI) reports, and ICER Analytics. Result(s): ICER has published 65 value assessments and 17 policy papers since 2016. ICER's output of policy papers has increased in recent years (mean of 1.3 publications annually, 2016-2018 vs 3.7 annually, 2020-2022), whereas the number of value assessments has remained flat (mean of 9.3 assessments annually, 2016-2018 and 2020-2022). Payers perceive ICER's policy initiatives to be of varying degrees of usefulness. In 2020, the subset of payers reporting familiarity with ICER initiatives found the policy paper on valuing cures to be the most useful initiative (42% reporting extremely or very useful [n=38 reporting familiarity]), followed by the UPI report (40% [n=40]);the policy paper on COVID-19 pricing models was viewed as least useful (22% [n=37]). In 2022, the most useful initiatives among payers reporting familiarity were ICER Analytics (51% [n=49]) and the policy paper on orphan drugs (45% [n=47]);the policy paper on fair access was perceived as least useful (29% [n=44]). Conclusion(s): ICER's output of annual policy papers has increased over time, demonstrating ICER's growing investment in policy initiatives. Payer perceptions of the usefulness of ICER initiatives vary, with ICER Analytics being the most useful in 2022. Additional research is needed to better understand how payers use ICER's policy papers/initiatives to inform decision making.Copyright © 2023

Advantages of robotic arm-assisted total hip arthroplasty: a 90-day episode-of-care clinical utility and cost analysis.

Aim: Determine the clinical utility and economic differences over a 90-day period between robotic arm-assisted total hip arthroplasty (RATHA) and manual total hip arthroplasty (MTHA). Methods: Leveraging a nationwide commercial payer database, pre-covid THA procedures were identified. Following a 1:5 propensity score match, 1732 RATHA and 8660 MTHA patients were analyzed. Index costs, index lengths of-stay, and 90-day episode-of-care utilization and costs were evaluated. Results: Episode of care costs for RATHA was found to be $1573 lower compared with MTHA (p < 0.0001). Post-index hospital utilization was significantly less likely to occur for RATHA compared with MTHA. Total index costs were also significantly lower for RATHA versus MTHA (p < 0.0001). Conclusion: Index and post-index EOC hospital utilization and costs were lower for RATHA compared with MTHA.

Epidemiological profile of SARS-COV-2 infection in pediatrics.

Objective: To describe the epidemiological and clinical profile of pediatric patients who were treated for suspected COVID-19 infecion, between March and October 2020, at the Hospital Universitario San Ignacio (HUSI), in Bogota, Colombia. Material(s) and Method(s): Cross-sectional design. Description of patients aged 1 month to 1 day before their 18th birthday, assessed between March and October 2020, who were approached by any pediatric care service of a university hospital for suspected COVID-infection. 19, according to current national and institutional protocols. Demographic variables and the reason for consultation of all individuals with suspected infection were recorded. Only when SARS-CoV-2 infection was confirmed were variables related to clinical aspects of the disease and its evolution recorded. Result(s): 920 medical records of pediatric patients with suspected SARS-CoV-2 infection were evaluated, of which there were 157 confirmed cases with COVID-19 infection. The main reason for consultation to suspect infection was fever in 50% of the cases. In patients with virological confirmation, 32.48% of the cases attended required hospital management. MIS-C was suspected in 5 patients who required intensive care unit management. In the evaluated period, there were no deaths associated with COVID-19 infection. Conclusion(s): SARS-CoV-2 infection is related in most cases to a spectrum of mild disease in the pediatric population. This study may be larger than pediatric patients presenting with gastrointestinal rather than respiratory symptoms, and the frequency of renal complications should be taken into account in patients in whom the systemic inflammatory syndrome associated with COVID-19 is suspected.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.

Occupational Social Work: A Field of Practice in Need of Revival

The COVID-19 pandemic focused attention on the high levels of occupational stress experienced by frontline and essential workers. Occupational stress is also not unique to these workers as demonstrated by the consistently high rates of suicide within certain occupational groups. Occupational social work is the specialized field most suited to address the needs of workers under stress, yet it has been in decline in the United States since the 1990s. The factors contributing to this decline are put forward, including managed care, the dominance of the advanced clinical social work license, and the lack of a social work presence in occupational stress effectiveness research. The implications for practice regarding the actions that can be taken by the profession to revive this field and be more responsive to vulnerable workers are discussed. © The Author(s) 2023.

Management of Hepato- biliary-pancreatic Surgery during the COVID-19 Pandemic

Purpose: We examined the effect of COVID-19 on diseases treated with hepato- biliary- pancreatic surgery from the experience of nosocomial infection at our hospital. Method(s): We examined the treatment of 106 patients admitted by the Division of Hepato- Biliary- Pancreatic Surgery to The Jikei University Hospital for elective surgery from January through May 2020. Result(s): Of the 106 operations, 90 (85%) were performed as scheduled and did not include COVID-19-positive patients. Operations for 16 patients (15%) were postponed, but 5 (31%) of these operations were urgent or quasiurgent and were performed during the study period. Of 95 patients who underwent surgery, 50 (53%) had a malignant tumor, 3 (3%) had a borderline malignant tumor, and 42 (44%) had a benign lesion, of which 41 were gallstones or gallbladder polyps and 1 was an intraductal papillary mucinous neoplasm that caused pancreatitis. Surgery for the latter tumor was postponed while conservative treatment improved conditions, but pancreatitis recurred 2 weeks after discharge, leading to a quasiurgent surgery. Conclusion(s): Owing to COVID-19, 15% of the scheduled elective hepato- biliary- pancreatic operations were postponed. Even lesions considered benign or not requiring emergency surgery should be treated promptly. Thus, the timing of treatment should be determined so that the risks of exacerbation and COVID-19 can be balanced.Copyright © 2022 Jikei University School of Medicine. All rights reserved.

Management of Children with Pericardial Effusion after COVID-19 on Outpatient Level of Service

The steady increase in the number of people infected with SARS-CoV-2 virus causing COVID-19 all over the world necessitates further study of fundamental features of pandemic spreading and clinical signs of disease, especially in children population. This article presents the experience of managing patients with pericardial effusion that has developed after new coronavirus infection COVID-19. The role of timely diagnosis of pericardial effusion, principles of its diagnostics, management, and follow-up observation on outpatient level within the pandemic are presented.

"TRANSFER FOR HIGHER LEVEL OF CARE": AN EXCUSE TO GET RID OF UNINSURED PATIENTS?

SESSION TITLE: Actionable Improvements in Safety and Quality SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The overall mortality rate for patients ‘transfered’ to the medical intensive care units is thought to be significantly higher than the mortality rate amongst those admitted directly. (1) It has also been suggested that uninsured critically ill patients have a higher probability of being ‘transferred’ to other hospitals as well as a higher mortality rate. (2, 3) We aim to determine whether insurance coverage impacts the transfer of critically ill patients. METHODS: This study was conducted at a quaternary care hospital which is also a regional transfer center. We accessed the public data for the year 2020 through our institutions Transfer Center Dashboard, System Analytics. The two aspects of transferred patients we focused upon were: 1) Hospital service (subspecialty care required) and 2) Financial class. Major subspecialties included in the study were: Pulmonology, Internal Medicine, Neurosurgery, Cardiology, and Neurology. Our study was a patient safety project, hence it qualified for IRB exemption. We classified the percentage of transfers as ‘Accepted’, ‘Declined’, or ‘Canceled’;and determined the insurance status of the patient. RESULTS: We found a total of 3552 patients transfers were initiated. 31.9% (1136) transfer patients were accepted, 46.79% (1662) transfers were declined, and 21.23% (754) were canceled due to reasons including unsafe transfer, acceptance at other institutions, or death prior to transfer. Major categories for transfers were Pulmonology (16.1%), other Internal Medicine related diseases (15.3%), and Neurosurgery (11.8%) were the subspecialties with the highest rate of transfers. In terms of financial class, we determined that 44.81% (n=509) of the ICU transfers had no insurance, 27.81% (n=316) had Medicare support, and 17.81% (n=202) had managed care through a health maintenance organization (HMO);the remaining 9.59% had other insurance plans. We used a binomial test to determine the probability of a transfer under no insurance (p) with the formula p + q=1, across the total number of transfer requests (n). K was the number of actual transfers that occurred. Total transfer requests were n=3552, actual transfers were k=1136 and transfers without insurance were 509/44.8%, converted into p=0.45 with a resulting q of 0.55.For z-test, we used the formula z = ((K - np) +- 0.5) / √npq = 15.58. Our one-tailed probability of exactly, or fewer than, 1136(K) out of 3552(n) was p <.000001. Our study was limited because of the COVID-19 pandemic occurring in the same year. CONCLUSIONS: Based on our results, we conclude that the ‘uninsured’ patients are more susceptible to getting transferred to other institutions. CLINICAL IMPLICATIONS: Critically ill ‘uninsured’ patients are selctively subjected to be transfered to other hospitals for higher level of care. These transfers may have significant health implications thereby resulting in higher morbidity and mortality in unisured populations. DISCLOSURES: No relevant relationships by Joodi Akhtar No relevant relationships by Sahar Fatima Advisory Committee Member relationship with Astra Zeneca Please note: 24 months Added 03/16/2022 by FAISAL MASUD, value=Honoraria Advisory Committee Member relationship with Teleflex Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee Advisory Committee Member relationship with La Jolla Please note: 12 months Added 03/16/2022 by FAISAL MASUD, value=Consulting fee No relevant relationships by Iqbal Ratnani No relevant relationships by Salim Surani No relevant relationships by Anza Zahid

IMPROVING COLORECTAL CANCER SCREENING IN A SAFETY NET CLINIC THROUGH A RETURN- BY-MAIL FECAL IMMUNOCHEMICAL TEST PROGRAM

STATEMENT OF PROBLEM/QUESTION: Can establishing a return-bymail fecal immunochemical test (FIT) program increase the colorectal cancer screening rate in a safety net primary care clinic? DESCRIPTION OF PROGRAM/INTERVENTION: Colorectal cancer (CRC) screening rates are typically lower in safety net health systems. This trend has been exacerbated by the COVID-19 pandemic, which has limited access to colonoscopy for screening. There is evidence that FITs are costeffective and mailed FIT programs can increase screening rates for vulnerable patients. We implemented a return-by-mail FIT program in the adult primary care clinic of New York City Health + Hospitals/Bellevue, a public safety net hospital. We evaluated adults aged 50-75 who were not up to date with CRC screening. All patients due for CRC screening were only offered FIT as a screening modality. We implemented a partial mailed FIT program, in which FIT tests picked up in clinic could be returned by mail directly to the lab. Prior to our intervention, patients were required to return FITs to the clinic in person. MEASURES OF SUCCESS: We evaluated FIT completion rates within our clinic 30 days before and after the introduction of return-by-mail FIT kits in July 2021. We also evaluated our clinic's pre- and post-intervention performance relative to other clinics within the New York City Health + Hospitals system using claims data. Additionally, we randomly surveyed patients who received a FIT and did not complete it in the period prior to our intervention to assess reasons for incompletion. FINDINGS TO DATE: A total of 5,153 and 5,180 patients aged 50-75 were seen in clinic 30 days before and 30 days after the implementation of a mailed FIT program. 571 patients were provided a return-in-person FIT kit 30 days prior to our intervention. Of these patients, 289 (50.6%) completed a FIT. By contrast, 781 patients were provided a return- by-mail FIT kit 30 days following our intervention. Of these patients, 464 (59.4%) completed a FIT (p < 0.01). Additionally, the proportion of patients who completed annual CRC screening prior to our intervention was lower in our clinic (48.2%) compared to the average across the New York City public hospital system (51.4%) according to managed care Medicaid claims data (MetroPlus, June 2021). Four months following our intervention, our clinic's year-to-date CRC screening rate exceeded the average system-wide rate (59.3% vs. 57.6%, November 2021). We also called 45 patients who were provided a FIT test prior to our intervention and did not complete it. 12 patients were reached, and 2 of these patients cited difficulty dropping off the test as the primary barrier to FIT completion (16.7%). KEY LESSONS FOR DISSEMINATION: By implementing a return-bymail FIT program, we were able to increase our clinic's CRC screening rate by 8.8%. Our data are similar to previous programs implementing mailed FIT programs in safety net patient populations. Future aims are to implement a mail-to-patient FIT program in addition to our initial return-by-mail program.

An Individualized Recovery Task Checklist Which Served as an Educational Instrument in a Critically Ill and Intubated COVID-19 Patient.

This case involves a patient with severe COVID-19 pneumonia and massive pulmonary embolism requiring mechanical ventilation. His clinical course was complicated by delirium likely triggered by his critical illness and failed initial extubation, isolation from family, and escalating fear and desperation. In hopeful preparation for subsequent successful extubation, a unique approach was taken to decrease the risk of panic, delirium, and decompensation leading to reintubation. As a means of orienting him to his treatment pathway and to provide encouragement for continued recovery, an impromptu patient-directed checklist was constructed. The recovery checklist, written in simplified language, outlined the stages of severe illness that the patient had overcome after his emergent intubation. The list also outlined the tasks he needed to complete prior to hospital discharge. Unexpectedly, the checklist received a great deal of engagement from both the patient and medical team and played an important role in this patient's successful recovery and rehabilitation.

IMPACT OF THE COVID-19 PANDEMIC ON THE UPTAKE OF TELEHEALTH SERVICES: A SURVEY OF U.S. PAYERS

BACKGROUND: Telehealth services have rapidly expanded as a result of the COVID-19 pandemic. Emergency government action has helped encourage the use of telehealth services by temporarily removing barriers to accessing telehealth and expanding the scope of covered services. Many private payers have followed suit by expanding their coverage of telehealth services. However, it is unclear to what extent different organizations have expanded their coverage and if these changes will remain permanent. OBJECTIVE: To evaluate current and future patterns of coverage for telehealth services as a result of the COVID-19 pandemic. METHODS: An online survey was fielded during November 2020 to a panel of managed care professionals from Xcenda's Managed Care Network. Respondents included in the survey were required to be active formulary decision makers within an organization that currently covers telehealth services. RESULTS: A total of 39 respondents completed the survey. Respondents represented integrated delivery networks (23%), pharmacy benefit managers (13%), and health plans (64%);36% were regional and 64% were national organizations. Of the respondents, 95% indicated that their organization expanded the coverage of telehealth services in response to the COVID-19 pandemic. The most common services expanded were behavioral health visits (73%), primary care visits (70%), and specialty provider visits (54%). Additionally, 70% of respondents indicated that some or all telehealth services covered under the expansion would be permanent. 49% of respondents indicated that copays for telehealth services had been eliminated, and 55% indicated that reimbursement for telehealth services had increased. A majority of respondents reported an increase in home infusion (62%) and self-injectable medications (54%) as a result of COVID-19. Lastly, 19% anticipate the expansion of telehealth services to change their formulary management in the future. CONCLUSIONS: Payers have expanded coverage of telehealth services in response to the COVID-19 pandemic, removing barriers to access and expanding the scope of covered services. Telehealth services will remain a prominent mode of providing healthcare in the future.

The role of managed care clinical pharmacists in improving COVID-19 vaccination rates for culturally specific Medicaid populations.

Clinical pharmacists are an untapped resource in the fight against health disparities. As frontline workers, they are embedded in communities and interact on a regular basis with patients managing chronic conditions. In particular, managed care clinical pharmacists have access to population-wide data to identify gaps and mobilize resources to proactively address disparities across their community. Amid the current pandemic, there have been vast inequities regarding access to the coronavirus disease 2019 (COVID-19) vaccine, particularly for low income and underserved culturally specific populations. The pandemic has provided a case study for how clinical pharmacists can collaborate across managed care and community-based settings to work toward achieving health equity. Recent data indicates that culturally specific populations have received less COVID-19 vaccines than the White population. To address this inequity, a team of clinical pharmacists at CareOregon, a health plan in Oregon that serves Medicaid, collaborated with retail pharmacists from both chain and independent pharmacies to improve COVID-19 vaccination rates for this unique population. This paper describes the process and strategies implemented to ensure vaccine access for culturally specific populations enrolled with CareOregon. Strategies to expand vaccine access to this population involved data sharing with community pharmacists, direct scheduling of culturally specific members for vaccine appointments and partnering with other stakeholders such as community-based organizations (CBOs) to provide COVID-19 vaccine confidence training. This paper also highlights the impact of the strategies to improve COVID-19 vaccination rates for this population. Lastly, challenges and barriers are addressed, as well as lessons learned from this process.

CURRENT AND ANTICIPATED DIGITAL THERAPEUTICS PAYER PERSPECTIVES IN THE COVID-19 ERA

BACKGROUND: Digital therapeutics (DTx) have grown in recent years in terms of market size and influence. Despite increasing interest, managed care organizations face barriers around DTx management. Disparate DTx coverage has led to unequal uptake and discrepancies around utilization management (UM) strategies. Thus, an unmet need exists for elucidating DTx coverage criteria and the evidence that shapes policy development. OBJECTIVE: To understand current DTx payer coverage policy patterns and anticipated future trends. METHODS: DTx medical policy research was conducted August to September 2020 using Canary Insights (Lakewood, CO). Following this surveillance, an online survey was fielded to payers from Xcenda's Managed Care Network. Respondents familiar with DTx were asked about DTx coverage, UM, policy criteria, and COVID-19 implications for DTx management. RESULTS: Fifty respondents (54% represent health plans, 26% pharmacy benefit managers, 20% integrated delivery network) completed the survey, and 88% evaluated ≥ 1 DTx in the past 12 to 18 months. Respondents reported that mobile apps (48%) and medication adherence platforms (40%) were the most reviewed and were expected to have the greatest increase in coverage demand over the next 12 to 18 months. Respondents indicated diabetes as the highest priority (66%) with the greatest impact in addressing unmet needs (52%). For UM, DTx coverage fell under medical benefit (41%) or was product dependent (43%). In evaluating DTx, clinical effectiveness (94%), safety (82%), and FDA-approved or cleared use (78%) were indicated as absolutely needed while clinical benefit (98%), peer-reviewed publications (94%), and return on investment (88%) were most useful for coverage decisions. The most cited rationale for either covering or denying DTx was evaluation of existing efficacy and safety data vs a lack of outcomes and cost data. For reauthorization, most respondents indicated documentation of positive clinical response (80%) and total cost of care reduction (71%) as requirements for re-authorization, while citing lack of long-term clinical data (73%) as the largest barrier for establishing re-authorization criteria, and 52% of respondents were interested in subscription-based or alternative pricing models for re-authorization. Respondents indicated that the COVID-19 pandemic has not impacted DTx coverage (58%), with no changes expected in the next 12 to 18 months (46%). CONCLUSIONS: Inconsistencies in DTx payer evaluation, coverage, and UM highlight the unmet need for establishing a standardized format for DTx appraisal.

ADVANCING THE MANAGED CARE PHARMACY RESEARCH AGENDA VIA MAPPING OF RESEARCH PILLARS AND PRIORITIES

BACKGROUND: The most critical evidentiary gaps in managed care pharmacy informed the research agenda of the Academy of Managed Care Pharmacy (AMCP) and AMCP Foundation. Four overarching research pillars and six relevant research priorities were published in the Journal for Managed Care and Specialty Pharmacy (April 2020). Research pillars and priorities need to align to address evidence gaps in managed care pharmacy and support the members served. OBJECTIVE: To review and map research priorities onto pillars and determine appropriate research questions that will advance the AMCP research agenda. METHODS: The six previously-identified priorities were reviewed by the AMCP/Foundation Joint Research Committee and AMCP staff against current health care concerns and the four research pillars: 1) Real World Evidence (RWE) 2) Value Based Models (VBM) 3) Utilization Management (UM) and Benefit Design (BD) and 4) Patient Care Services (PCS). The top research priorities were selected across the four research pillars. To define research questions a Delphi approach representing managed care pharmacy stakeholders will be conducted via focus groups, priority-based workshops, interim surveys and discussion. This approach will culminate in consensus on the most essential, specific research questions for the next year. RESULTS: After the review of current priorities, two currently relevant priorities were added;addressing disparities in health care delivery and evaluating programs directed toward patients impacted by COVID. Of the eight research priorities, five focus priorities were chosen, mapped and prioritized as follows: 1) Health disparities (RWE);2) Limited data available at the time of launch due to expedited review (RWE);3) Managed care pharmacy programs focused on patient care (PCS) 4) Demonstrating the impact of formulary management on medication access and patient outcomes (UM and BD);and 5) Assessing the impact of legislative activities and policies in addressing the total cost of care (VBM). Results from the rolling focus groups, workshops and surveys will lead to a consensus on prioritized research questions to support managed care pharmacy for 2021-2022. CONCLUSIONS: AMCP and the AMCP Foundation will advance their research agenda through answering research questions aligned with the top areas of concern to managed care pharmacy. Implementing the research agenda will close critical evidence gaps, thereby optimizing medicine and improving lives.

Examining inequities related to inpatient hospital length of stay for breast cancer patients: A retrospective study during the COVID-19 pandemic

Purpose: In the state of Wisconsin, breast cancer patients from African American (AAs) communities have lower survival rates compared to their Caucasian counterparts. Multiple inequities related to sociodemographic factors, delays in diagnosis, advanced disease stage at presentation and presence of comorbidities including higher body mass index (BMI) contribute to these disparities, many of which have only widened during the COVID-19 pandemic. This study examined specific factors related to prolonged hospital length of stay (LOS) for breast cancer patients admitted to inpatient units during the pandemic. Methods: This analysis includes initial CY20 LOS medical record data for hospitalized patients 18 years and older with a diagnosis of breast cancer from 1/1/2020-12/31/2020. Supplemental data included disease registry and diagnostic data, and SES data determined by patient zip code. Poisson regression models with robust standard errors were used to compare the LOS index (LOSi) between groups of patients based on race, SES group, primary payer, and BMI. Results: A total of 272 patients with breast cancer that were admitted to inpatient oncology units were identified. Demographics included White (72.4%), Black (22.4%), and others (5.1%). Other characteristics included: low SES (8.8%), medium-low (9.5%), medium (15.4%), medium-high (11.0%), high SES (4.4%), and others (non-SMilwaukee county) (50.7%), Medicaid (8.8%), Medicare (61.3%), Managed care (29.0%), and others (0.73%). Body mass varied among the patients;underweight (0.36%), overweight (30.8%), obese (41.5%). There were significant differences in LOSi: Black (LOSi=1.24, p=0.01), medium-low SES (LOSi=1.46, p=0.02), Medicaid (LOSi=1.40, p=0.00), underweight (LOSi=1.66, p=0.00), and overweight (LOSi=1.23, p = 0.01) patients had slightly longer LOSi, with LOSi ratio above 1. Conclusion: This study shows how patient-specific factors such as race, SES, primary payer, and BMI contribute to inpatient LOS for breast cancer patients. Healthcare systems may benefit by addressing indicators and patients' factors to reduce hospital LOS, and ultimately healthcare costs.

Addressing the Social Needs of Medicaid Enrollees Through Managed Care: Lessons and Promising Practices from the Field.

With growing recognition of the adverse health impacts of unmet social needs, Medicaid managed care organizations (MMCOs) are increasingly focusing on addressing the social needs of Medicaid enrollees as part of a holistic approach to care. Information and knowledge sharing among MMCOs pertaining to lessons learned and promising practices from their social determinants of health (SDOH) targeted efforts can help identify successful practical approaches for navigating common challenges, developing robust SDOH programming, and effectively delivering whole-person care. Using data from interviews with 28 representatives of 8 national and regional MMCOs, this qualitative study describes the perspectives of MMCO representatives on the lessons learned and emerging promising practices from addressing SDOH among their Medicaid enrollees. Participants discussed the importance of member and community-centeredness, structured programming, and delivery system realignment in the effective delivery of whole person care. Ten lessons learned and emerging promising practices are discussed. Findings from this study suggest that success in addressing the social needs of Medicaid beneficiaries may be achieved through adaptive, data-driven, member- and community-centric efforts by MMCOs, facilitated by system-level changes that formally integrate social services within health care. Lessons learned and promising practices can serve as a foundation for identifying and evaluating best practices and guidelines for effective MMCOs' SDOH-related programming.