Subject(s)
Health Facilities/standards , Quality Assurance, Health Care/methods , Quality Indicators, Health Care , Insurance, Health, Reimbursement , Outcome Assessment, Health Care , Patient Protection and Affordable Care Act , Patient-Centered Care , Total Quality Management/organization & administration , United StatesSubject(s)
Health Facilities/standards , Value-Based Purchasing/organization & administration , Centers for Medicare and Medicaid Services, U.S. , Health Facilities/economics , Patient Protection and Affordable Care Act , Quality Improvement/economics , Reimbursement, Incentive/organization & administration , State Government , United States , Value-Based Purchasing/legislation & jurisprudenceABSTRACT
OBJECTIVE: To determine if the instant approval (IA) process differs from the traditional prior authorization (PA) process in preferred drug channeling, resultant gaps in therapy, and provider dissatisfaction. STUDY DESIGN: An interrupted time series analysis using pharmacy claims and a retrospective cohort study. METHODS: The study assessed changes in preferred drug use and subsequent cost reductions. A retrospective cohort study determined if the IA process produced fewer gaps in therapy than the PA process. Provider acceptance of the IA process was assessed using a brief survey of 240 randomly selected primary care practices. RESULTS: Market share for preferred proton pump inhibitors quadrupled from a range of 17.6% to 19.3% at baseline to 76% in the first month after implementation of the new IA policy. Most practices (81.1%) reported reduced administrative burden with the IA process. The median gaps between medication fills for patients using IA were approximately one-half those of patients using PA (P <.001) and were one-fourth in a subset of highly adherent, regularly filling patients (P <.001). CONCLUSIONS: Instant approval may be more patient friendly and prescriber friendly than PA as assessed by a proxy measure for access (gap in therapy) and physician-reported acceptance. Despite its ease of use, IA does not seem to reduce switching to preferred drugs.
Subject(s)
Consumer Behavior , Gatekeeping , Physicians , Prescription Drugs/therapeutic use , Cohort Studies , Cost Control , Humans , Managed Care Programs , North Carolina , Retrospective StudiesSubject(s)
Health Care Reform/trends , Health Services Accessibility/economics , Health Services Needs and Demand/economics , Medically Uninsured/statistics & numerical data , Delivery of Health Care/organization & administration , Health Services Accessibility/trends , Health Services Needs and Demand/statistics & numerical data , Health Services Needs and Demand/trends , Humans , North Carolina , Poverty , Quality of Health Care , Socioeconomic FactorsSubject(s)
Community Health Services/organization & administration , Health Services Accessibility/statistics & numerical data , Primary Health Care/organization & administration , Residence Characteristics , Community Networks , Delivery of Health Care/organization & administration , Health Care Reform , Humans , Medicaid , North Carolina , United StatesSubject(s)
Community Health Services/organization & administration , Cooperative Behavior , Health Policy , Insurance, Health, Reimbursement/economics , Medicaid/organization & administration , Physician's Role , Primary Health Care/organization & administration , Group Processes , Humans , Medicaid/economics , Models, Organizational , Models, Theoretical , North Carolina , United StatesABSTRACT
The United States leads the world in health care costs but ranks far below many developed countries in health outcomes. Finding ways to narrow this gap remains elusive. This article describes the response of one state to establish community health networks to achieve quality, utilization, and cost objectives for the care of its Medicaid recipients. The program, known as Community Care of North Carolina, is an innovative effort organized and operated by practicing community physicians. In partnership with hospitals, health departments, and departments of social services, these community networks have improved quality and reduced cost since their inception a decade ago. The program is now saving the State of North Carolina at least $160 million annually. A description of this experience and the lessons learned from it can inform others seeking to implement effective systems of care for patients with chronic illness.
Subject(s)
Chronic Disease/economics , Community Networks/organization & administration , Community Networks/standards , Primary Health Care/organization & administration , Primary Health Care/standards , Case Management/economics , Case Management/organization & administration , Case Management/trends , Community Networks/economics , Community Networks/trends , Cost Control/methods , Health Care Costs/trends , Humans , Medicaid/economics , Medicaid/organization & administration , Models, Econometric , North Carolina , Organizational Case Studies , Organizational Innovation , Primary Health Care/economics , Primary Health Care/trends , Program Development/methods , Quality Assurance, Health Care/methods , Rural Health , United StatesSubject(s)
Community Networks , Employment , Health Services Accessibility/economics , Insurance Coverage/economics , Medically Uninsured , Poverty , Primary Health Care/economics , Eligibility Determination/legislation & jurisprudence , Humans , Insurance Coverage/legislation & jurisprudence , North Carolina , Socioeconomic FactorsSubject(s)
Community Networks/organization & administration , Family Practice/organization & administration , Health Services Accessibility , Medicaid/organization & administration , Case Management , Community Health Planning , Cooperative Behavior , Disease Management , Family Practice/economics , Humans , Interinstitutional Relations , North Carolina , Pilot ProjectsABSTRACT
BACKGROUND: Warfarin therapy substantially reduces stroke in atrial fibrillation (AF), yet medical literature reports it is only prescribed in 15-60% of eligible patients. No current national benchmarks for warfarin use in AF patients exist, and it is unclear whether the reported poor compliance represents current rates within primary care practices. The primary study objective was to measure the rate of warfarin use in eligible, high-risk AF patients in a large southeastern group family practice. Secondary objectives were to report the demographics, stroke-risk profiles, contraindications, and reasons for discontinuation of warfarin therapy METHODS: A retrospective chart review was performed on all active patients with documented AF in a large southeastern group family practice/residency between July 1, 2000 and June 30, 2002. Data was abstracted on warfarin use, contraindications, stroke risk, and reasons for discontinuation. RESULTS: Four hundred ninety-one (491) patients were identified from the electronic billing system as potential study subjects. Two hundred eighty-three (283) patients met study criteria, with 210 patients considered to be at high-risk of stroke without contraindications to warfarin therapy. Ninety-four percent (198/210) of these patients were prescribed warfarin during the study period, and 87% (172/198) continued warfarin throughout the study period. CONCLUSION: Family physicians in this practice prescribe warfarin in AF more frequently than published rates demonstrating that high rates of physician adherence to standards are achievable in primary care. Most patients in this setting were considered high-risk for stroke.
