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Readmissions: What Health Plans Need to Know

Preventing avoidable hospital readmissions is considered by many to be the most important opportunity for reducing waste in health care. This podcast explains readmissions and why identifying these at-risk patients is important to health plans. Learn more.

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Case Mix Adjustment Case Study – Payer

This Case Study shows how Leicester City CCG, one of the most ethnically diverse areas of the UK, analyzed emergency admission rates for all practices, to learn that practices with lower emergency admission rates had significantly higher coding completeness and GP patient survey scores. Learn more.

Relation between primary care physician supply and diabetes care and outcomes: a cross-sectional study

Background: Higher primary care physician supply is associated with lower mortality due to heart disease, cancer and stroke, but its relation to diabetes care and […]

Home Palliative Service Utilization and Care Trajectory Among Ontario Residents Dying on Chronic Dialysis

Background: Many patients who receive chronic hemodialysis have a limited life expectancy comparable to that of patients with metastatic cancer. However, patterns of home palliative […]

Association Between Wait Time for Transcatheter Aortic Valve Replacement and Early Postprocedural Outcomes

Abstract Background Rapid growth in transcatheter aortic valve replacement (TAVR) demand has translated to inadequate access, reflected by prolonged wait times. Increasing wait times are […]

Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease

Abstract   Objectives The aims of this study were to assess variation in revascularization of asymptomatic patients with stable ischemic heart disease, identify the predictors of variation, and […]

Trends in Providing Out-of-Office, Urgent After-Hours, and On-Call Care in British Columbia

Abstract   PURPOSE Providing care in alternative (non-office) locations and outside office hours are important elements of access and comprehensiveness of primary care. We examined […]

Impact of Predialysis Psychosocial Conditions on Kidney Transplant Recipient Survival: Evidence Using Propensity Score Matching

Abstract Background: An increased number of end-stage renal disease patients suffer psychosocial conditions and may experience delayed access to transplantation due to listing restrictions. However, […]

Days spent at home in the last 6 months of life: a quality indicator of end of life care in patients with hematologic malignancies

Abstract Despite advances in the management of hematologic malignancies, a significant proportion of patients die of their disease. We used administrative databases in Ontario, Canada […]

Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada

Abstract IMPORTANCE Although cardiovascular disease is the leading cause of death in most developed countries, little is known about current physicians’ cardiovascular health and outcomes. […]

Overall mortality and causes of death in newly admitted nursing home residents

Abstract Background In spite of a rapidly ageing population, there is a lack of population-based data on mortality among nursing home residents in Southern Europe. […]

The measurement of multimorbidity.

Abstract Overview: The presence of multiple concurrent medical conditions (also known as multimorbidity) is now a common phenomenon, hence the importance of its measurement. Objective: […]

Medication use and its impact on high-cost health care users among older adults: protocol for the population-based matched cohort HiCOSTT study

Abstract Background Health interventions and policies for high-cost health care users (HCUs) who are older adults need to be informed by a better understanding of […]

Overall Health Care Cost During the Year Following Diagnosis of Colorectal Cancer Stratified by History of Colorectal Evaluative Procedures

Abstract Background The cost-effectiveness of colorectal screening has been modeled; however, the cost of health care following the diagnosis of colorectal cancer has not been […]

Association Between Switching to a High-Deductible Health Plan and Major Cardiovascular Outcomes

Abstract Objective To describe the association between enrollment in high-deductible health plans and the risk of major adverse cardiovascular outcomes. Design, Setting, and Participants This […]

Emergency department use in people who experience imprisonment in Ontario, Canada

Abstract Objectives The aims of this study were to describe emergency department (ED) utilization by people in provincial prison and on release, and to compare […]

Healthcare services use and costs for a cohort of high needs elderly diabetic patients

Abstract Background The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged >65 years. A recent study also found that almost 75% […]

Individual and social determinants of SARS-CoV-2 testing and positivity in Ontario, Canada: a population-wide study

ABSTRACT Background Optimizing the public health response to reduce the burden of COVID-19 necessitates characterizing population-level heterogeneity of risks for the disease. However, heterogeneity in […]

The influence of frailty on postoperative complications in geriatric patients receiving single-level lumbar fusion surgery

Abstract Purpose This study evaluates the influence of patient frailty status on postoperative complications in those receiving single-level lumbar fusion surgery. Methods The nationwide readmission […]

Medical use of cocaine and perioperative morbidity following sinonasal surgery—A population study

Abstract Background Topical cocaine is favoured by many surgeons for sinonasal surgery due to its superior vasoconstrictive and anesthetic properties. However, historical reports suggesting cocaine […]

Risk Factors and Outcomes of Early Hospital Readmission in Canadian Kidney Transplant Recipients: A PopulationBased Multi-Center Cohort Study

Abstract Background Early hospital readmissions (EHRs) occur commonly in kidney transplant recipients. Conflicting evidence exists regarding risk factors and outcomes of EHRs. Objective To determine […]

Understanding Deductible and Reimbursement Maximum:A Study of Rural China’s Tiered Medical System

Abstract A high-deductible coverage is shown to reduce inappropriate health care, while little is known about its effect on social welfare under a reimbursement limit. […]

Claims-based pharmacy markers for comprehensive medication management program case identification: Validation against concurrent and prospective healthcare costs and utilization

Abstract Background Three claims-based pharmacy markers (complex, costly and risky medications) were developed to help automatically identify patients for comprehensive medication management. Objective To evaluate […]

Estimating The Marginal Productivity Of Health Technology Adoption

Abstract Decisions to adopt health technologies rely, in part, on judgements about cost effectiveness. Cost effectiveness is commonly assessed against a willingness-to-pay threshold for health […]

Care Coordination Engagement Patterns in Long-Term Patients

Abstract OBJECTIVE: Health care networks are increasingly turning to programs that provide office-based care coordination to high-cost, high-need patients to control preventable health care costs. […]

More Employers Offer Preventive Drug Lists Over Time

ABSTRACT Objective: To describe trends in employer preventive drug list (PDL) offerings and associations of employer PDL offerings with employer and workforce characteristics. Study Design: […]

Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement in Frail Patients: Exploring Postprocedural Outcomes and Readmissions Using the National Readmission Database, 2018–2020

Abstract Objective Percutaneous endoscopic gastrostomy (PEG) tube placement is a common gastrointestinal procedure that provides nutrition, fluids, and medications to patients with inadequate oral intake. […]

Frailty and body composition as predictors of postoperative outcomes in patients with epithelial ovarian cancer undergoing neoadjuvant chemotherapy

Abstract Objective To assess whether the five-factor modified frailty index (mFI5) can predict adverse post-operative outcomes in patients with epithelial ovarian cancer (EOC) undergoing interval […]

Predicting Return Home After Moderate-to-Severe Traumatic Brain Injury

Abstract Background and Objectives Days alive and at home (DAH) is a validated outcome measure that captures health care transitions between time spent at home […]

Review of Risk Factors for Opioid Misuse and Addiction Following Traumatic Injury

Abstract Traumatic injuries represent a significant public health challenge, affecting millions worldwide annually and necessitating acute pain management that frequently involves the use of opioid […]

Profiling Hospital Performance Based on Mortality After Transcatheter Aortic Valve Replacement in Ontario, Canada

Abstract Background: Public reporting of hospital-level outcomes is increasingly common as a means to target quality improvement strategies to ensure the delivery of optimal care. […]

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Case Management and Care Coordination Part 2

This webinar will provide an introduction to different types of care programs in use to care for patients with existing and emerging risk and the […]

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Provider Profiling and Engagement

Presented by: Dina Goldberg
Executive Director of Population Health, Innovations and Transformation for JHHC

This webinar describes how Johns Hopkins HealthCare (JHHC) uses Provide Profile Reports, created with data from the ACG System, as part of its comprehensive Provider Engagement Strategy.

Association between use of a health information exchange system and hospital admissions

Appl Clin Inform 5:219-231. Weill Cornell Medical College, New York, NY, USA OBJECTIVE: Relevant patient information is frequently difficult to obtain in emergency department (ED) […]

Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study

Diabet Med 31:806-812. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada AIMS: There is evidence to suggest that mammography rates are decreased in […]

Postoperative medical complications associated with anesthesia in older adults with dementia

J Am Geriatr Soc 62:2102-2109. Queen’s University, Kingston, On, Canada OBJECTIVES: To examine the association between anesthetic technique and postoperative complications in older adults with […]

High-risk case identification for use in comprehensive complex care management

Popul Health Manag 18:15-22. Clalit Health Services, Tel Aviv, Israel The current study aimed to develop a patient selection process for muiltimorbid care management that […]

Paying for primary care: a cross-sectional analysis of cost and morbidity distributions across primary care payment models in Ontario Canada

Soc Sci Med 124:18-28. University of Toronto, Toronto, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Policy-makers desire an optimal balance of financial […]

Primary care physician panel size and quality of care: a population-based study in Ontario, Canada

Ann Fam Med 14:26-33. University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, […]

Comorbidity: implications for the importance of primary care in ‘case’ management

Ann Fam Med 1:8-14. Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA BACKGROUND: Although comorbidity is […]

Classifying physician practice style: a new approach using administrative data in British Columbia

Med Care 53:276-282. University of British Columbia, Vancouver, BC, Canada; Simon Fraser University, Burnaby, BC, Canada; Access Consulting Ltd, Saskatoon, SK, Canada; University of Alberta, […]

Removal or revision of vaginal mesh used for the treatment of stress urinary incontinence

JAMA Surg :1-9. Western University, London, ON, Canada; Institute for Clinical Evaluative Sciences, London, ON, Canada; Hamad Medical Corporation, Doha, Qatar IMPORTANCE: Synthetic mesh slings […]

Post-discharge intervention in vulnerable, chronically ill patients

J Hosp Med 7:124-130. Oregon Health and Sciences University, Portland VA Medical Center, Portland, OR, USA BACKGROUND: Studies suggest that the inpatient to outpatient transition […]

Patient based ‘burden-of-illness’ in Swedish primary health care. Applying the Johns Hopkins ACG case-mix system in a retrospective study of electronic patient records

Int J Health Plann Manage 17:269-282. Centre for Development of Health Services, Stockholm County Council, Sweden Patients from one municipality in Sweden utilizing primary health […]

Development and estimation of a pediatric chronic disease score using automated pharmacy data

Med Care 37:874-883. Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA BACKGROUND: Although risk assessment models for specific adult populations […]

Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice

J Clin Endocrinol Metab 92:77-81. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada CONTEXT: Bone density measurement with dual-energy x-ray absorptiometry is widely used […]

The population health approach: health GIS as a bridge from theory to practice

Int J Health Geogr 4:23. Population Health Surveillance Unit, Vancouver Island Health Authority, Victoria, BC, Canada BACKGROUND: The Population Health Approach, proposed by Health Canada, […]

Explanatory ability of the ACG system regarding the utilization and expenditure of the national health insurance population in Taiwan–a 5-year analysis

J Chin Med Assoc 71:191-199. Department of Medical Affairs and Planning, Taipei Veterans General Hospital, Taipei, Taiwan, ROC BACKGROUND: The adjusted clinical group (ACG) is […]

Impact of physician assistant care on office visit resource use in the United States

Health Serv Res 43:1906-1922. Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA OBJECTIVE: To investigate whether the use of physician […]

Provider profiling: doing it right

Healthplan 41:74-79. Medstat Group, Washington, DC, USA Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities […]

Risk of low bone mineral density associated with psychotropic medications and mental disorders in postmenopausal women

J Clin Psychopharmacol 31:56-60. Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Independent reports suggest that various psychotropic medications and psychiatric disorders are […]

Health reform, health insurance, and mental health care

Am J Psychiatry 169:675-677. Kaiser Commission on Medicaid and the Uninsured, Henry J. Kaiser Family Foundation, Washington, DC; Rollins School of Public Health, Emory University, […]

Disease burden in the managed care population at an academic medical center: the effect of adding local partners

Acad Med 80:587-593. University of Michigan Medical School, Ann Arbor, USA. jbilli@umich.edu PURPOSE: Academic medical centers (AMCs) have traditionally cared for the most severely ill […]

Building health plan databases to risk adjust outcomes and payments

Int J Qual Health Care 10:531-538. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA OBJECTIVES: To highlight the types and sources of […]

The changing shape of the physician workforce in prepaid group practice

Health Aff W4:60-63. Permanente Federation, Kaiser Permanente Health Care Program, Oakland, CA, USA Multiple factors have combined to change the size and specialty composition of […]

Does a large-scale organizational transformation toward patient-centered access change the utilization and costs of care for patients with diabetes?

Med Care Res Rev 69:519-539. Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA The authors examined whether Group Health’s […]

A hospital system’s wellness program linked to health plan enrollment cut hospitalizations but not overall costs

Health Aff 32:477-485. University of Arizona, Tucson, AZ, USA Many policy makers believe that health status would be improved and health care spending reduced if […]

Comparison of specialty referral rates in the United Kingdom and the United States: retrospective cohort analysis

BMJ 325:370-371. Health Services Research and Development Center, Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA […]

Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients

Med Care 41:842-852. Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, USA BACKGROUND: Previous research […]

Diffusion into use of exenatide for glucose control in diabetes mellitus: a retrospective cohort study of a new therapy

Clin Ther 29:1784-1794. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA BACKGROUND: Exenatide was approved by the US Food and Drug […]

Efficiency profile in the neurological referrals effectuate reference specialists: use case-mix system Adjusted Clinical Groups

An Med Interna 25:213-221. Published in Spanish. Badalona Serveis Assistencials S.A., Barcelona, Spain OBJECTIVES: To determine the general referral and neurological rate per center and […]

Is pharmacologic care of chronic obstructive pulmonary disease consistent with the guidelines?

Popul Health Manag 13:21-26. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA Chronic obstructive pulmonary disease (COPD) […]

Mental health service use before and after diagnosis of early-onset bipolar disorder

J Behav Health Serv 38:398-413. Health Service and Population Research Department, Institute of Psychiatry, King’s College London, London, UK To investigate patterns of mental health […]

Potential Medicare savings through prevention and risk reduction

Popul Health Manag 14 Suppl 1:S35-S44. Healthways Center for Health Research, Franklin, TN, USA Medicare is challenged to maintain solvency as enrollment climbs because of […]

The relationship between financial incentives and quality of diabetes care in Ontario, Canada

Diabetes Care 35:1038-1046. Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, […]

Comparison of three methods for measuring multiple morbidity according to the use of health resources in primary healthcare

Aten Primaria 44:348-357. Published in Spanish. Badalona Serveis Assistencials, Badalona, Barcelona, Spain OBJECTIVE: To compare three methods of measuring multiple morbidity according to the use […]

Heart failure in primary care: co-morbidity and utilization of health care resources

Fam Pract 30:520-524. Bioengineering and Telemedicine Unit, Puerta de Hierro University Teaching Hospital, Majadahonda, Madrid, Spain BACKGROUND: In order to ensure proper management of primary […]

Risk-stratification methods for identifying patients for care coordination

Am J Manag Care 19:725-732. Mayo Clinic, Rochester, MN, USA BACKGROUND: Care coordination is a key component of the patient-centered medical home. However, the mechanism […]

Predictors of short-term postoperative survival after elective colectomy in colon cancer patients >/= 80 years of age

Ann Surg Oncol 20:1427-1435. Department of Surgery, UW Madison School of Medicine and Public Health, Madison, Wisconsin, USA BACKGROUND: Individuals ≥ 80 years of age […]

Movement disorders in elderly users of risperidone and first generation antipsychotic agents: a Canadian population-based study

PLoS One 8:e64217. Faculty of Pharmacy, University of Manitoba, Winnipeg, MB, Canada BACKGROUND: Despite concerns over the potential for severe adverse events, antipsychotic medications remain […]

Patient and Physician Factors Associated With Pulmonary Function Testing for COPD: A Population Study

Chest 145:272-281. Institute for Clinical Evaluative Sciences; Sunnybrook Research Institute; Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada BACKGROUND: The diagnosis of COPD […]

Identifying controlled substance patterns of utilization requiring evaluation using administrative claims data

Am J Manag Care 10:783-790. HSI Network LLC, USA OBJECTIVES: To develop a systems approach to identify, for further evaluation, patients with potential controlled substance […]

The meaningful use of electronic health records and health care quality

Am J Med Qual 30:512-519. Weill Cornell Medical College, New York, NY, USA The federal government is investing approximately $30 billion in incentives for adoption […]

Copayment level and drug switching: findings for type 2 diabetes

Am J Pharm Benefits 2:412-420. University of Hawaii at Manoa, Honolulu, HI, USA OBJECTIVE: To assess the relationship between copayment level and drug switching among […]

Does increased medication use among seniors increase risk of hospitalization and emergency department visits?

Working Paper 150004. Toronto, ON, Canada: Canadian Centre for Health Economics. Canadian Centre for Health Economics, Toronto, ON, Canada Objective: to examine the extent of […]

Diagnosis and disruption: understanding guideline-consistent dementia care and patterns of transition experienced by individuals with dementia

Vancouver, BC, Canada: University of British Columbia (doctoral dissertation). University of British Columbia, Vancouver, BC, Canada Introduction: Early detection and management, as outlined in dementia […]

CareOregon: transforming the role of a Medicaid health plan from payer to partner

New York, NY, USA: Commonwealth Fund. Commonwealth Fund, New York, NY, USA CareOregon, a Portland, Oregon-based nonprofit Medicaid health plan, developed two innovative programs to […]

The knowledge of morbidity in primary care as an aid in the planning and management of the services

Semergen doi:10.1016/j.semerg.2009.12.003. Published in Spanish. Servicio Canario de la Salud, Santa Cruzde Tenerife, Spain The analysis of the morbidity and management of its knowledge is […]

Allocating funds for healthcare in Manitoba regional health authorities: a first step – population-based funding

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Dept. of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, […]

Managed care holds down costs, doesn’t hurt quality

Minneapolis Star Tribune, January 3:A13. No abstract

Risk adjustment lexicon

Reporting Framework Subcommittee of the Steering Committee of the Minnesota ACG Users Group. Revised by Chad Abrams, Terry Bernhardt, Steven Foldes, Jason Wiley, May 17, […]

Quality of care for Medicaid and privately insured children in a commercial insurance plan

Richmond, VA, USA: Virginia Commonwealth University (doctoral dissertation). Virginia Commonwealth University, Richmond, VA, USA The central thesis of this study is that exposure to the […]

Risk adjustment in competitive health plan markets

In: Culyer AJ, Newhouse JP, ed. Handbook of Health Economics, Volume 1. Amsterdam, Netherlands: Elsevier Science B. V.:755-845. Erasmus University, Rotterdam, Netherlands; Boston University, Boston, […]

Equity in health, health care services use and health care financing in British Columbia, 1992 and 2002

Vancouver, BC, Canada: University of British Columbia (doctoral dissertation). University of British Columbia, Vancouver, BC, Canada The objectives of this thesis are to identify equity […]

Work limitations and their relationship with morbidity burden in employed persons with diabetes

Baltimore, MD, USA: Johns Hopkins University (doctoral dissertation). Johns Hopkins University, Baltimore, MD, USA BACKGROUND. Work limitations are functional limitations within the work context resulting […]

The application of Johns Hopkins Adjusted Clinical Group Case-mix System in AFMS

In: Cato W, Roberts WC, ed. Proceedings of the 2011 AFMS Medical Research Symposium, Volume 4. Healthcare Informatics Track. August 2-4, 2011, National Harbor, MD, […]

Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish population

Revista Clinica Espanola 211:560-571. Directorate of Planning, Badalona Serveis Assistencials SA, Badalona, Spain Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish […]

A population-based study of healthcare resource utilization by metastatic gastric cancer patients in Ontario

Kingston, ON, Canada: Queens University (masters theseis). Queens University, Kingston, ON, Canada BACKGROUND: Gastric cancer is the fourth most common cancer in the world. Non-curative, […]

Association between use of a specialized diagnostic assessment unit and the diagnostic interval in Ontario breast cancer patients

Kingston, ON, Canada: Queen’s University (masters thesis). Queen’s University, Kingston, ON, Canada BACKGROUND: The amount of time that it takes to get a breast cancer […]

Comorbidity and healthcare expenditure in women with osteoporosis living in the Basque Country (Spain)

J Osteoporosis Basque Institute for Healthcare Innovation, Barakaldo, Spain BACKGROUND: The aim of the study was to estimate the prevalence of depression in the population […]

The Value of Patient Identification

Johns Hopkins Bloomberg School of Public Health The Value of Patient Identification Karen Kinder, PhD., MBA

One way of measuring morbidity of HA Patients

Hospital Authority One Way of Measuring Morbidity of HA Patients: from Research to Lessons Learnt Dr. Deacons Yeung Chief Manager

ACG 101

DST Health Solutions ACG 10 Lisa Kabasakalian

Applying the ACG System to support case management for the population of Eastern Cheshire

Integral Health Solutions Applying ACGs to care co-ordination, planning and commissioning Bernadette Bailey, Transformation Programme Manager, Eastern Cheshire CCG Jayne Molyneux, Care Co-ordination Advisor, Integral […]

Monday(C1)-Concurrent Resource Use and All Age Modeling – Abrams

Concurrent Resource Use and All Age Modeling – Chad Abrams