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Aim: Analyze the impact of nationwide implementation of teledermatological care for psoriasis. Methods: Develop a Markov model that estimates the impact of telehealth technology for treatment of moderate-to-severe psoriasis on health and healthcare expenditures compared with in-person clinical care. Results: Lower medical costs by US$1.5 billion and total social costs of US$4.3 billion over 5 years. Patients save more than 67 million hours in work absenteeism and travel time, valued at US$598 million. Employers save US$1.2 billion over 5 years due to decreased employee absenteeism. Conclusion: National implementation of telehealth for psoriasis care has the potential to substantially reduce both formal healthcare costs and informal costs for families and patients, while maintaining equivalent clinical outcomes as traditional in-person care.

Aim: To estimate the impact of universal anti-TNF therapy in patients with moderate-to-severe Crohn’s disease. Materials & methods: Developed a population-level Markov model to estimate the impact on health outcomes and medical expenditures of expanding anti-TNF therapy use versus current treatment practices. Results: Reductions in deaths (2600), hip fractures (980), major adverse cardiac events (2700) and patient out-of-pocket medical spending (2%) over 5 years. Total societal costs would be US$22,100 higher per patient per year, primarily due to the high cost of anti-TNF therapy. Conclusion: Expanding anti-TNF therapy use among US adult patients with moderate-to-severe Crohn’s disease would reduce morbidity and mortality, decrease disease-related medical costs and increase treatment costs compared with current practice. Despite the higher costs, this approach could substantially benefit patients.

Aim: Analyze the impact of national implementation of ‘low intensity’ post-treatment colorectal cancer surveillance compared with current practices. Materials & methods: Create a population-level Markov model to estimate impacts of expansion of low versus high intensity surveillance post-treatment on healthcare utilization, costs and caregiver time loss. Results: Shifting to low intensity colorectal cancer surveillance would reduce patient burden by 301,830 h per patient annually over 5 years. Cost reductions over 5 years were US$43.5 million for Medicare and US$4.2 million for Medicaid. Total societal cost savings equaled US$104.2 million. Conclusion: National implementation of low intensity post-treatment colorectal cancer surveillance has the potential to significantly reduce burden and costs on patients and their caregivers with no added risks to health.

There have been critical improvements in dialysis care and mortality in the last decade. These improvements track with the implementation of the end-stage renal disease (ESRD) Quality Incentive Program (QIP) beginning in 2012, which aligns Medicare payments to dialysis facilities with performance on quality measures. This study explores whether the improvements in dialysis care and patient outcomes under the ESRD QIP have been shared equally among patient groups.Our analyses focus on 4 social risk factors: Black race, Hispanic ethnicity, dual eligibility for Medicare and Medicaid, and rurality. We estimated multivariable regressions using longitudinal Medicare and Consolidated Renal Operations in a Web-Enabled Network data.ESRD QIP payment reductions were more common at dialysis facilities with higher proportions of Black and dual-eligible ESRD patients. Patients with dual eligibility and Black race had persistently worse relative outcomes as the ESRD QIP was implemented. This finding was true for differences in outcomes when comparing patients within and across facilities and was not affected by the addition of specific quality measures to the ESRD QIP measure set. Hispanic patients and patients at rural facilities have generally not had worse outcomes since the start of the ESRD QIP.There is no evidence of widening disparities in dialysis care or patient outcomes across patient groups under the ESRD QIP, which is a longstanding and well-publicized concern with value-based purchasing programs. Relative changes between patient groups since the start of ESRD QIP have not favored any patient group. Many disparities in dialysis quality measures and assessment of dialysis facility payment reductions persist.

Aim: To estimate the economic impacts of increased use of specialty care infusion centers for treating adults experiencing vaso-occlusive crises. Methods: A Markov model is developed to estimate the impact of expanding use of specialty care infusion centers to treat vaso-occlusive crises compared to emergency department care. Results: Access to infusion centers for sickle cell disease could result in savings over US$1.9 billion in formal medical costs and over US$2 billion in societal costs, based on uptake assumptions over 10 years. Conclusion: Expansion of adult sickle cell disease centers across the nation could lead to considerably better economic outcomes in the form of reduced costs and hospital length of stay in addition to improved clinical outcomes as reported in the existing literature.

Aim: Estimate the impacts treating acute respiratory tract infections (ARTIs) in children aged 6 months through 12 years with narrow-spectrum antibiotics. Materials & methods: Decision-tree model to estimate children’s health, healthcare utilization and costs, and caregiver’s time and costs for using narrow-spectrum antibiotics in eligible children with an ARTI, compared with current use of narrow- and broad-spectrum antibiotics. Results: Reduced adverse drug reactions by 35,750 (14%) cases) and 4750 (12%) fewer emergency department visits, 300 (12%) fewer hospitalizations, and 50,500 (10%) avoided outpatient visits. Annual healthcare costs fell by US$120 million (22%). Total societal costs declined by US$131 million (20%). Conclusion: National implementation of narrow-spectrum antibiotics to treat ARTIs in children improves patient outcomes and reduces caregiver burden and annual healthcare costs.

Objective: To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State. Design: Practice-level, randomized prospective evaluation. Setting: Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan). Participants: Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices). Intervention: For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. Aftereach chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care. Main Outcome Measures: Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis). Results: The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization forchildren in treatment relative to control practices. Conclusions: A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years.

Objective Policies supporting value-based care and alternative payment models, notably in the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act of 2015, offer hope to advance care integration for individuals with behavioral and chronic physical health conditions. The potential for integration to improve quality while managing costs for individuals with high needs, coupled with the remaining financial, operational, and policy challenges, underscores a need for continued discussion of integration programs' preliminary outcomes and lessons. The authors describe the early efforts of the HealthChoices HealthConnections pilot program for adult Medicaid beneficiaries with serious mental illness and co-occurring chronic conditions, which used a navigator model in 3 southeastern Pennsylvania counties. Method The authors conducted a difference-in-differences analysis of emergency department (ED) visits, hospitalizations, and readmissions using Medicaid claims data and collected data about program implementation. Results ED visits decreased 4% among study group members (n = 4,788) while increasing almost 6% in the comparison group (n = 7,039) during the intervention period (p = .036); there were no statistically significant differences in hospitalizations or readmissions. This pilot demonstrated the promise of nurse navigators (care managers) to bridge gaps between the physical and mental health care systems, and the success of a private-public partnership developing a member profile to share behavioral and physical health information in the absence of an interoperable health information technology system. Conclusions and implications for practice The implementation lessons can inform state Medicaid Health Home models as well as accountable care organizations considering incorporation of behavioral health care. (PsycINFO Database Record

Aim: This article describes American Reinvestment and Recovery Act comparative effectiveness research data infrastructure (DI) investments and identifies facilitators and barriers to implementation. Materials & methods: We reviewed original project proposals, conducted an investigator survey and interviewed project officers and principal investigators. Results: DI projects assembled or enhanced existing clinical datasets, established linkages between public and private data sources and built infrastructure. Facilitators included building on existing relationships across organizations and making collection as seamless as possible for clinicians. Conclusion: To sustain DI, investigators should reduce the burden of comparative effectiveness research data collection on practices, adequately address data privacy and security issues, resolve or lessen the impact of data-linking issues and build research capacity for other investigators and clinicians.

Background The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap. Objectives The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis. Methods This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping. Results More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%; $300 and $349) but fell for those in no-gap exposure PDPs or RDS plans (decrease of 49% and 30%; $131 and $40). OOP costs for beneficiaries in partial- or full-gap exposure PDPs increased >120% (increase of $144 and $176) in the NTO group and nearly doubled for the OCC group (increase of $124 and $151); these OOP costs were substantially lower than those for teriparatide users. Both teriparatide users and NTO group members discontinued or skipped medications more often than persons in the OCC group, regardless of plan or benefit design. Conclusion Medication discontinuation and OOP costs among beneficiaries with osteoporosis were highest for those enrolled in Part D plans with a coverage gap. Providers should be aware of potential cost-related nonadherence among Medicare beneficiaries taking osteoporosis medications.

Purpose Because health insurance claims lack clinical information, comparative effectiveness research studies that rely on these data may be challenging to interpret and may result in biased inference. We conducted an exploratory study to determine if medical information contained in patient charts could offer clinical details that would assist in interpreting the results of a claims-based comparative effectiveness study of selective serotonin reuptake inhibitors (SSRIs). Methods Retrospective review of 457 charts of patients initiating SSRI treatment. Descriptive data elements included patient diagnosis, symptoms of depressive and anxiety disorders, provider's assessment, and medication treatment and side effects. Results Most subjects were excluded from the study because their charts were not accessible (58.7%), they did not have a follow-up visit (55.6%), providers could not be contacted (58.0%), or providers refused participation in the study (36.5%). Among those included in the study, most patients were noted to have depression, but most charts lacked information on the majority of depression symptoms at baseline and follow-up. Few concomitant symptoms, side effects, and other important clinical and treatment characteristics were recorded. Conclusions Inability to obtain charts due to plan or provider refusal, lack of available information in charts at key times in the course of illness, and missing data elements posed considerable challenges and prevented firm conclusions beyond those drawn from the parent, claims-based study. Copyright © 2010 John Wiley & Sons, Ltd.

Although previous studies have found no differences in response to antidepressant pharmacotherapy between selective serotonin reuptake inhibitors (SSRIs), some recent trials suggest benefits associated with more rapid onset of action.The aim of this work was to compare the likelihood that patients initiating treatment with branded escitalopram, rather than with any of 3 SSRIs (ie, citalopram, fluoxetine, and paroxetine) that are available in generic or branded formulations, would continue therapy with the initial medication after 2 and 6 months.We used propensity score-weighted logistic regression to assess the effect of antidepressant choice on the likelihood of continuing treatment, based on data from a large administrative claims database with information about US patients. We modeled the propensity to initiate treatment with escitalopram based on demographic, diagnostic, insurance, and service-use characteristics in the 6 months before treatment initiation and used the results to calculate weights for analysis of treatment continuation. The primary outcome measures were receipt of 2 prescriptions of the index drug in the first 2 months and, among those continuing at 2 months, 4 prescriptions in the first 6 months. Antidepressant choice, cost, and service-use characteristics during the treatment period were included as covariates. Patients who initiated therapy between July 2002 and April 2005 were eligible for inclusion.Based on data for 43,921 patients, at 2 months, escitalopram initiators were more likely to have continued initial medication than those receiving the other SSRIs (66.1% vs 61.9%, respectively; P0.01) and less likely to have switched or augmented treatment (4.8% vs 7.6%; P0.01). At 6 months, escitalopramtreated patients were also more likely to have continued initial medication (47.1% vs 41.0%; P0.01) and less likely to have switched or augmented treatment (9.4% vs 14.4%; P0.01).Patients initiating treatment with escitalopram were more likely to continue and less likely to switch or augment treatment at 2 and 6 months of therapy compared with those who initiated with alternative SSRIs.

Congestive heart failure (CHF) affects 4.8 million adult Americans, particularly those aged65 years, and has been described as a "new epidemic" due to the high annual incidence of the disease (an estimated 550,000 new cases per year).The goal of this research was to determine the number of Medicaid beneficiaries with CHF, identify the rate of CHF drug use, estimate adherence rates, examine factors associated with CHF drug use and adherence, and explore policy implications of the research findings.Methods used included identifying noninstitutionalized beneficiaries withor=1 inpatient claim oror=2 ambulatory claims with a CHF diagnosis and claims for CHF drugs using 1998 State Medicaid Research Files and 1999 Medicaid Analytic eXtract data for Arkansas, California, Indiana, and New Jersey. Patient adherence was estimated using the medication possession ratio (MPR) and days of medication persistence. Multivariate regression models were used to identify factors associated with CHF drug use and adherence.Overall, 84.8% of beneficiaries had claims for at least 1 CHF medication; 15.2% of beneficiaries were not using any CHF medications. Among those with a claim, the mean number of claims per month was 1.4, and 25.8% hador=4 claims per month. Mean MPR was 71.9% and mean days of medication persistence were 24.8 per month. Persons aged65 years, men, ethnic minorities, patients with hospital admissions for conditions other than CHF, and beneficiaries with high Chronic Illness and Disability Payment System scores were less likely to have a CHF drug claim and had lower adherence rates.State Medicaid agencies and Medicare prescription drug plans should consider designing targeted interventions that encourage better adherence among Medicaid beneficiaries with CHF, particularly men, those aged65 years, ethnic minorities, and patients with poor overall health status.

The Patient-Centered Outcomes Research Institute (PCORI) Dissemination and Implementation (D&I) Framework and Toolkit focus on effective approaches to planning and conducting D&I activities. The D&I Framework describes the concepts and best practices that are central to effective D&I while the Toolkit is designed to assist PCORI and its partners in planning and conducting D&I activities. It is intended as an interactive resource for teams of PCORI staff, partners, and other stakeholders who may use it to plan meetings, motivate and focus discussions, and inform work plans.

The Dissemination and Implementation (D&I) Framework connects goals for these activities with evidence and best practices, as well as core components of D&I planning and execution.

Objective We aimed to identify whether genital symptoms were associated with unrecognized herpes simplex virus type 2 (HSV-2) infection in a primary care population. Study design Five thousand four hundred fifty-two individuals aged 18 to 59 seeking general care at 36 suburban medical offices in 6 U.S. cities were tested for HSV-2 antibody and asked about 10 types of genital symptoms. In patients with no known history of genital herpes, we assessed whether HSV-2 infection was independently associated with symptoms. Results HSV-2 infection was associated with increases in reports of "sores, blisters, ulcers, crusts, or small cuts/slits" in men [adjusted odds ratio (OR), 1.79; 95% CI, 1.24-2.58] and with increases in reports of "redness, irritation, or a rash" among women (adjusted OR, 1.50; 95% CI, 1.06-2.11). HSV-2 was not significantly associated with other types of genital symptoms. Conclusions Primary-care physicians should consider unrecognized HSV-2 infection as a potential cause of some common genital symptoms.

Multidisciplinary, multi-institutional collaboration has become a key feature of comparative effectiveness research (CER), and CER funders have made promotion of these types of collaboration an implicit, and sometimes explicit, goal of funding. An important challenge in evaluating CER programs is understanding if and how different forms of collaboration are associated with successful CER projects. This article explores the potential use of social network analysis to address research questions about the associations between collaboration and the success of CER projects.

Aim: To describe the evaluation design of the American Recovery and Reinvestment Act of 2009 comparative effectiveness research (CER) investment, how funds were allocated and how CER priorities were addressed. Materials & methods: Primary and secondary data included information from redacted project proposals, an investigator survey and federal project officers, investigators and expert panel discussions. Results: More than 420 projects (US$1.1 billion) were awarded. Those generating new or synthesizing existing CER made up the plurality (194, or US$524 million). Data infrastructure projects were the second-largest area (28%, US$302 million). More than three-fourths addressed at least one priority population, condition category or intervention category. Conclusion: These investments expanded the nation's CER activities and its future capacity to conduct CER.

Aims: This study elaborates on the public's understanding of comparative effectiveness research (CER) or patient-centered outcomes research (PCOR), attitudes toward CER/PCOR and use of evidence in healthcare decision-making. Materials & methods: We conducted six focus groups with the general public – three with individuals actively engaged in healthcare decision-making and three with individuals more passive in their approach. Results: The general public has little knowledge of CER/PCOR, and its perceptions of certain CER/PCOR concepts are inconsistent with those of researchers and policy-makers. Active healthcare consumers value information more than passive consumers and are likely to use evidence in decision-making. Conclusion: Providers are an important source for disseminating and communicating CER/PCOR evidence to active and passive consumers.

To improve health outcomes, clinicians and patients must have evidence-based information available to help them make informed decisions, the knowledge and skills to use this information, and positive attitudes about the value of using comparative effectiveness research (CER) in decision making. As a part of the midstream evaluation of the American Recovery and Reinvestment Act CER portfolio, we collected information from a variety of sources regarding perspectives on CER and engagement of clinicians and patients in CER.

Background: The American Recovery and Reinvestment Act of 2009 (ARRA) directed nearly US$29.2 million to comparative effectiveness research (CER) methods development. Aim: To help inform future CER methods investments, we describe the ARRA CER methods projects, identify barriers to this research and discuss the alignment of topics with published methods development priorities. Methods: We used several existing resources and held discussions with ARRA CER methods investigators. Results & conclusion: Although funded projects explored many identified priority topics, investigators noted that much work remains. For example, given the considerable investments in CER data infrastructure, the methods development field can benefit from additional efforts to educate researchers about the availability of new data sources and about how best to apply methods to match their research questions and data.

The American Recovery and Reinvestment Act (ARRA) of 2009 directed US$1.1 billion to the US Department of Health and Human Services for support of comparative effectiveness research (CER). As part of this investment, US Department of Health and Human Services commissioned a midstream evaluation of the ARRA CER portfolio. One goal of the evaluation was to identify issues to consider for a future evaluation of the long-term impact of this portfolio and other CER investments. In planning the ARRA CER evaluation, we developed and revised a conceptual framework and related policy research questions that may be useful to future efforts to assess the impact of CER or patient-centered outcomes research investments. In addition, we explored methodological challenges related to designing an evaluation to assess investments in CER that may be informative to any future plans to evaluate the long-term impact of ARRA CER as well subsequent investments made from the Patient-Centered Outcomes Research Trust Fund.

Aim : We conducted a midstream assessment of the comparative effectiveness research (CER) training programs funded by the American Recovery and Reinvestment Act (ARRA) by examining program characteristics, planned curriculum development activities and core competencies. Materials & methods : We examined all 43 training projects funded by the US$46 million ARRA CER investment, collecting data from key informant discussions and a technical expert panel. Results : The majority of projects leveraged institutional resources to provide an individualized combination of didactic and experiential learning supported by strong mentorship. Core competencies included skills in statistical modeling, evidence synthesis (systematic reviews and meta-analysis) and general research design skills. Conclusion : ARRA-supported CER training programs enhanced workforce capacity by developing curricula and preparing CER researchers to apply emerging methods and utilize new CER infrastructure.

This chartbook presents highlights and key comparisons from the statistical compendium on Medicaid pharmacy benefit use and reimbursement in 2009 that Mathematica prepared for CMS. Mathematica has prepared similar compendiums and chartbooks for 1999 and for each year from 2001 to 2009. The 2009 compendium was prepared for 42 states and the District of Columbia, because 8 states did not submit complete data to CMS for 2009.

Launched in 2009, the Serious Mental Illness (SMI) Innovations project was a collaboration between physical and behavioral health managed care organizations and county behavioral health offices in Southeast and Southwest Pennsylvania to integrate physical and behavioral health care services for adult Medicaid beneficiaries with SMI and co-occurring physical health conditions. This is the project’s final evaluation report.

Launched in 2009, the Serious Mental Illness (SMI) Innovations project was a collaboration between physical and behavioral health managed care organizations and county behavioral health offices in Southeast and Southwest Pennsylvania to integrate physical and behavioral health care services for adult Medicaid beneficiaries with SMI and co-occurring physical health conditions. This case study of the Connected Care pilot program in Southwest Pennsylvania found that mental health hospitalizations and readmissions improved, potentially because of targeted consumer outreach and education.

Launched in 2009, the Serious Mental Illness (SMI) Innovations project was a collaboration between physical and behavioral health managed care organizations and county behavioral health offices in Southeast and Southwest Pennsylvania to integrate physical and behavioral health care services for adult Medicaid beneficiaries with SMI and co-occurring physical health conditions. This case study of the HealthChoices HealthConnections Pilot in Southeast Pennsylvania, found that emergency department use declined, in particular in one of the three participating counties.

This issue brief highlights a number of prescription drug issues that remain important for states after the shift of prescription drug coverage for Medicaid-Medicare dual eligibles to Medicare in 2006, including the use of antipsychotic drugs in nursing facilities and other settings. It focuses on Medicaid-only beneficiaries younger than 65 with disabilities and chronic illnesses, who now account for more than 60 percent of total Medicaid prescription drug spending and whose care is increasingly being provided through managed care organizations.

This chartbook, prepared for the Centers for Medicare & Medicaid Services, presents highlights and key comparisons from the state-by-state and national tables in the statistical compendium on Medicaid pharmacy benefit use and reimbursement in 2007.

Researchers interviewed oncology social workers and nurse practitioners in an effort to understand how the Medicare Part D doughnut hole affects beneficiaries’ financial access to oral anticancer targeted therapies. The findings highlight the financial obstacles associated with the Part D coverage gap, which may not be fully addressed by recently passed healthcare reform legislation.

To provide better value and improve patient care in the U.S. health care system, comparative effectiveness research (CER) needs to be disseminated, implemented, and interpreted. This brief, the second from Mathematica’s Center on Health Care Effectiveness, examines how to put CER into use at the point of care, focusing on knowledge translation, provider incentive reform, delivery system transformation, and consumer engagement.

This chartbook presents highlights and key comparisons from the state-by-state Statistical Compendium on Medicaid pharmacy benefit use and reimbursement in 2006, which is available on the CMS website. The 2006 data show the initial impact on Medicaid of the movement of prescription drug coverage for dual eligibles from Medicaid to Medicare in 2006.

To examine the association of medication adherence with healthcare use and costs among Medicaid beneficiaries with congestive heart failure (CHF), to investigate whether the association was a graded one, and to estimate the potential savings due to improved adherence.Using Medicare and Medicaid data for 4 states, adherence was estimated using the medication possession ratio (MPR).Multivariate logistic and 2-part general linear models were estimated to study the primary objectives. The MPR was specified in multiple ways to examine its association with healthcare use and costs.Adherent beneficiaries were less likely to have a hospitalization (0.4 percentage points), had fewer hospitalizations (13%), had in excess of 2 fewer inpatient days (25%), were less likely to have an emergency department (ED) visit (3%), and had fewer ED visits (10%) than nonadherent beneficiaries. Total healthcare costs were $5910 (23%) less per year for adherent beneficiaries compared with nonadherent beneficiaries. The relationship between medication adherence and healthcare costs was graded. For example, beneficiaries with adherence rates of 95% or higher had about 15% lower healthcare costs than those with adherence rates between 80% and less than 95% ($17,665 vs $20,747, P.01). The relationship between adherence and total healthcare costs was even more stark when the most adherent beneficiaries were segmented into finer subgroups.Healthcare costs among Medicaid beneficiaries with CHF would be lower if more patients were adherent to prescribed medication regimens. Researchers should reconsider whether a binary threshold for adherence is sufficient to examine the association of adherence with outcomes and healthcare costs.

This chartbook highlights national and state-by-state data on Medicaid prescription drug use and expenditures for 2005 by beneficiary characteristics (age, sex, and race), basis of eligibility (children, adults, disabled, and aged), and type of drug (brand vs. generic, top 10 drug groups, top 7 therapeutic categories, and drugs excluded by statute from Medicare Part D). Separate graphs highlight Medicare-Medicaid dual eligibles, whose drug coverage shifted to Medicare in 2006, and nondual beneficiaries, who continue to receive their drug coverage from Medicaid.

Interest in disease management programs continues to grow as managed care plans, the federal and state governments, and other organizations consider such efforts as a means to improve health care quality and reduce costs. These efforts vary in size, scope, and target population. While large-scale programs provide the means to measure impacts, evaluation of smaller interventions remains valuable as they often represent the early planning stages of larger initiatives. This paper describes a multi-method approach for evaluating small interventions that sought to improve the quality of care for Medicaid beneficiaries with multiple chronic conditions. Our approach relied on quantitative and qualitative methods to develop a complete understanding of each intervention. Quantitative data in the form of both process measures, such as case manager contacts, and outcome measures, such as hospital use, were reported and analyzed. Qualitative information was collected through interviews and the development of logic models to document the flow of intervention activities and how they were intended to affect outcomes. The logic models helped us to understand the underlying reasons for the success or lack thereof of each intervention. The analysis provides useful information on several fronts. First, qualitative data provided valuable information about implementation. Second, process measures helped determine whether implementation occurred as anticipated. Third, outcome measures indicated the potential for favorable results later, possibly suggesting further study. Finally, the evaluation of qualitative and quantitative data in combination helped us assess the potential promise of each intervention and identify common themes and challenges across all interventions.

New data, prepared for the Centers for Medicare & Medicaid Services, provide detailed state-by-state and national information on prescription drug cost and utilization in 2003 for Medicaid beneficiaries enrolled in both Medicaid and Medicare (“dual eligiblesâ€), whose drug coverage shifted from Medicaid to Medicare Part D in 2006. This brief highlights key data on drug use and spending in 2003 for dual eligibles, as well as Part D issues that these data can help to inform. Sixty-five percent of the 6.7 million dual eligibles who received drug coverage from Medicaid in 2003 were age 65 or older; the rest were under 65 and disabled. Among dual eligibles as a whole, the most costly drug group was antipsychotics, accounting for over $2.3 billion in expenditures in 2003. Ulcer drugs were the next most costly group ($1.38 billion), followed by antidepressants ($1.18 billion).

New data, prepared for the 39;47, provide detailed state-by-state and national information on prescription drug cost and utilization in 2003 for Medicaid beneficiaries enrolled in both Medicaid and Medicare (“dual eligibles†), whose drug coverage shifted from Medicaid to Medicare Part D in 2006. This brief highlights key data on drug use and spending in 2003 for dual eligibles, as well as Part D issues that these data can help to inform. Sixty-five percent of the 6.7 million dual eligibles who received drug coverage from Medicaid in 2003 were age 65 or older; the rest were under 65 and disabled. Among dual eligibles as a whole, the most costly drug group was antipsychotics, accounting for over $2.3 billion in expenditures in 2003. Ulcer drugs were the next most costly group ($1.38 billion), followed by antidepressants ($1.18 billion).

More than 227 million prescriptions for selective serotonin reuptake inhibitors (SSRIs) and other antidepressants are filled in the United States each year.

This chartbook provides a snapshot of Medicaid pharmacy benefit use and reimbursement in 2003 and shows key trends from 1999 to 2003.

Using Medicaid Analytic eXtract (MAX) claims files for 1999 and 2001, the authors describe patterns of prescription drug use and expenditures among dually eligible Medicare and Medicaid beneficiaries for all Medicaid full dually eligible beneficiaries and three important subgroups: the aged, disabled, and full-year nursing home residents. The analyses indicate great variation in use and expenditures across states that cannot be explained through differences in use of cost containment strategies. The findings suggest that Medicare Part D plans may achieve significant savings by providing incentives for greater use of generic drugs.