Search Results (23)

Background/Objectives: Diabetes is a prevalent chronic condition and a major contributor to morbidity, mortality, and healthcare costs in the U.S., particularly among older adults with comorbidities such as hypertension and dyslipidemia. Complex medication regimens increase the risk of nonadherence, which can worsen glycemic control, cardiovascular outcomes, and healthcare utilization. This study assessed longitudinal adherence patterns to oral antidiabetic medications among high-risk older adults and identified predictors using group-based trajectory modeling (GBTM). Methods: This retrospective cohort study used 2016–2017 Texas Medicare Advantage claims. Participants were older adults with diagnoses of diabetes, hypertension, and hyperlipidemia who had continuous plan coverage throughout the study period and at least one prescription fill for an oral antidiabetic, a statin, and a renin–angiotensin system (RAS) antagonist. Adherence was measured monthly over 12 months using the proportion of days covered (PDC). GBTM identified adherence trajectories, and multinomial logistic regression, based on the Andersen Behavioral Model, evaluated predictors using perfect adherence as the reference. Results: Among 7847 patients, three trajectories were observed: perfect adherence (59.50%), near-perfect adherence (29.21%), and rapid decline (11.29%). Female sex (OR, 1.38; 95% CI, 1.19–1.60) and absence of health plan subsidy (OR, 0.79; 95% CI, 0.68–0.92) were associated with rapid decline. Female sex (OR, 1.13; 95% CI, 1.02–1.25) and age ≥ 75 years (OR, 1.20; 95% CI, 1.00–1.43) were associated with near-perfect adherence. Conclusions: Older adults with diabetes and comorbidities exhibit distinct medication adherence patterns. Trajectory-based methods can identify those at risk for declining adherence and guide interventions to improve outcomes. Full article

Background: Chronic kidney disease (CKD) is traditionally viewed as a condition marked by a progressive reduction in kidney function leading to the need for kidney dialysis or transplantation. The estimated prevalence of CKD in adults in Puerto Rico is ~20% higher than that of the overall United States (US). To address the disproportionately high rate of CKD in Puerto Rico, we created a multidisciplinary chronic disease management (CDM) program targeting CKD and diabetes mellitus (DM), the leading CKD risk factor. Methods: Over 7200 eligible enrollees in a Puerto Rico-Managed Medicare Program participated in a CDM program targeting individuals with CKD or DM as determined by administrative review. Evaluations were conducted on 4068 program participants with baseline glomerular filtration rate (eGFR) and codifying CKD stage by eGFR. A dietitian/nurse team provided dietary and lifestyle recommendations to the patient/family and a nephrologist/endocrinologist made diabetes and CKD recommendations to the primary care provider. Findings on 2095 participants with Stages 1–3 CKD with follow-up eGFR at least 6 months but less than 2 years after baseline are presented. Results: At baseline, the mean age was 74 years (range 30–101), 59% of patients were female and mean duration of follow-up from initial evaluation to second evaluation was 407 days (±159 days SD). Most participants had Stage 2 CKD (34.8%), followed by CKD Stage 1 and 3 (33.5 and 31.7%). During the follow-up period, 55.9% of participants with Stage 1 CKD remained in Stage 1, 84.9% of patients with Stage 2 remained in Stage 2 or regressed to Stage 1, while 96.1% of patients with Stage 3 remained in Stage 3 or regressed to Stage 2. Only 15.1% of patients in Stage 2 progressed to Stage 3 and 3.9% of patients in Stage 3 progressed to Stage 4 or 5. A secondary analysis comparing all 665 CDM Stage 3 participants to 117,249 historical controls found CDM participants demonstrated a higher rate of regression (20.3% vs. 15.2%; absolute difference +5.1 percentage points; p = <0.01) and a lower rate of progression (3.9% vs. 15.3%; absolute difference −11.4 percentage points; p < 0.001). Conclusions: Early findings of a multidisciplinary CDM intervention indicate that 79% of participants with CKD Stages 1–3 by eGFR had stabilized or improved CKD status. Comparison to a randomized control group to better assess for causality and longer-term CDM program follow-up on CKD status and clinical outcomes is warranted. Full article

Background/Objectives: Institutional Special Needs Plans (I-SNPs) are designed to enhance the quality of care for long-term nursing facility (NF) residents. However, utilization patterns vary significantly, and their broader impact remains only partially understood. This rapid review aims to identify, map, and synthesize the existing literature on the use of I-SNPs in nursing homes. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we conducted a comprehensive search of academic and gray literature using a predefined Boolean string. The extracted data were organized and analyzed thematically. Results: The synthesized literature (n = 12 studies) revealed four primary themes: (1) Market Penetration and Enrollment; (2) Models of Care Application; (3) Impact on Clinical and Financial Outcomes; and (4) Barriers to Utilization. Conclusions: I-SNP utilization represents a shift from fragmented FFS payment models toward integrated managed care within nursing facilities. Evidence shows a reduction in acute care transfers, although findings for other outcomes are mixed, underscoring the need for further research and policy development. Full article

Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the clinical, economic, and policy implications of MTMs. Methods: We conducted a narrative review of peer-reviewed studies, real-world program evaluations, and policy analyses. Sources included PubMed, Google Scholar, and grey literature from government, nonprofit, and industry organizations. Articles and reports were included if they examined MTMs in Medicare, Medicaid, or other high-risk populations. Results: Evidence demonstrates that MTMs improve health outcomes, reduce hospitalizations, and lower total cost of care. Case studies from Medicaid and Medicare Advantage plans, including those administered by Mom’s Meals^®, report reductions in emergency department visits, hospital readmissions, and total cost of care, alongside sustained high member satisfaction. Despite these findings, gaps in coverage and limited stakeholder awareness hinder broader access and adoption. Conclusions: Federal policy action can expand MTM availability and maximize utilization of existing benefits. Opportunities include establishing a Medicare Fee-for-Service demonstration, expanding and encouraging use in Medicare Advantage, and leveraging MTMs within Center for Medicare and Medicaid Innovation models. Broader implementation and utilization could reduce the nation’s chronic disease burden, advance health equity, and promote value-based care. Full article

Background: Effective volume management can significantly improve patients’ health outcomes, but the current situation of volume management in older patients with chronic heart failure (CHF) and multimorbidity is not optimistic. This study aimed to explore the facilitators and barriers of self-volume management in patients and to provide a basis for the development of self-volume management strategies. Methods: A descriptive qualitative research method was used. Semi-structured interviews were conducted with older patients with CHF and multimorbidity between January and April 2025 in two tertiary hospitals in Shanghai, China. Data were analyzed using content analysis. Results: Eight facilitators emerged, including the hospital–community collaboration mechanism, Medicare and long-term care insurance coverage, diverse social support, the doctor–patient trust relationship, results-oriented incentives, digital health management, high self-efficacy, and strong motivation for health. Nine barriers were identified; these were insufficient adaptability of self-volume management programs, limited access to community resources, lack of standardized self-volume management tools, inadequate multidisciplinary team communication, one-way doctor–patient communication, lack of knowledge of self-volume management, physical limitations, management negligence caused by work constraints, and behavioral habits’ consolidation. Conclusions: Self-volume management was affected by various factors. The study suggests strengthening health insurance coverage to reduce financial burden, taking advantage of family support and providing digital health management tools. In addition, healthcare providers should provide patient-centered care, enhance multidisciplinary collaboration, and address individual barriers with precise intervention strategies. Full article

By 2040, more than 80 million Americans will be aged ≥65, yet contemporary senior living communities still operate on a hospitality-first model developed for healthier cohorts three decades ago. This commentary argues that the next generation of senior living must pivot from hotel-style amenities to person-centric health platforms that proactively coordinate medical, functional, and social support. We outline four mutually reinforcing pillars. (1) Data infrastructure that stitches together clinical, functional, and social determinants of health enables continuous risk stratification and early intervention. (2) Ambient and conversational artificial-intelligence tools can extend sparse caregiving workforces while preserving resident autonomy. (3) Value-based contractual arrangements—for example, Medicare Advantage special-needs plans embedded within senior living sites—can realign financial incentives toward prevention rather than occupancy. (4) Targeted policy levers, including low-income housing tax credits for the “forgotten middle” and outcomes-based regulatory frameworks, can catalyze adoption at scale. Ultimately, re-architecting senior living around integrated technology, value-based financing and supportive regulation can transform these communities into preventive-care hubs that delay nursing home entry, improve quality of life, and reduce total cost of care. Full article

Systemic therapy (ST) and transarterial radioembolization (TARE) are widely used treatments for advanced-stage hepatocellular carcinoma (HCC). This study quantified the significant variability in treatment costs for unresectable HCC from payer and provider perspectives. An Excel-based price analysis model was developed to estimate the prices of ST and TARE over a 21-month time horizon using 2015–2021 data. Median prices were calculated from Medicare Average Sales Price (ASP), provider Wholesale Acquisition Cost (WAC), and Average Wholesale Price (AWP). Sensitivity analyses evaluated price fluctuations associated with a ±10% variation in treatment duration. ST prices demonstrated marked variability across perspectives, with the median ASP at $175,625, WAC at $198,719, and AWP at $262,892. However, TARE prices were stable, ranging from $21,594 to $24,052. Sensitivity analyses revealed that treatment duration variation resulted in price changes of $35,000–$50,000 for ST, compared with ~$5000 for TARE. The variability in ST pricing was driven by treatment duration and drug-specific pricing mechanisms, particularly immunotherapy-based regimens, which accounted for the higher cost range. Conversely, TARE’s consistent pricing is attributed to standardized procedural costs. Substantial variability exists in ST prices compared with the consistent costs of TARE, underscoring the economic advantage of TARE in appropriate clinical contexts. Full article

Background: The relationship between body composition and bladder cancer outcomes is complex. While a higher body mass index (BMI) has been associated with an increased risk of bladder cancer development, its impact on survival outcomes is less clear. This study aimed to explore the association between BMI, survival, health-related quality of life, and the performance of ADLs in a cohort of older patients with bladder cancer. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey, including patients diagnosed with bladder cancer who had recorded BMI values. Analysis of variance was used to assess the association between BMI categories and patient demographics as well as cancer/treatment characteristics. Generalized linear models examined the impact of BMI on health-related quality of life, as measured by the physical and mental component summary scores when controlling for confounding variables. Kaplan–Meier survival curves across BMI categories were compared using log-rank tests. Results: The final cohort consisted of 8013 patients (age ≥ 65) with a mean age of 77.7 ± 7.1 years, the majority of whom were White (85.6%) and male (74.8%). We observed no significant association between BMI and cancer/treatment characteristics. The severely obese subgroup had the highest rate of disability in performing ADLs (18.3%) followed by the underweight subgroup (10.3%). Overweight patients exhibited the highest physical and mental component summary scores, indicating better health-related quality of life. BMI was a significant predictor of overall survival, with overweight, obese, and severely obese patients demonstrating improved survival compared to those with healthy or underweight BMI. These findings remained statistically significant in multivariable analysis. Conclusions: Our findings suggest a dual role of BMI in older patients with bladder cancer: higher BMI provides a survival advantage and, to an extent, a QoL advantage. At the same time, severe obesity did lead to the lowest QoL despite improved survival outcomes. These results underscore the complex interplay between BMI, survival, and QoL in this bladder cancer population. Full article

This study characterizes real-world treatment patterns and economic and healthcare resource utilization (HCRU) burden associated with first-line (1L) treatment of metastatic non-small cell lung cancer (NSCLC) without actionable alterations in the United States. This retrospective observational study used Optum Clinformatics^® data. A total of 15,659 patients with metastatic NSCLC who started 1L treatment between January 2020 and March 2023 were included (52% male; mean age at the start of 1L treatment 71.7 years; 86% Medicare Advantage). The most frequent 1L regimens were immune checkpoint inhibitor (ICI) + platinum-based chemotherapy (PBCT) (47%), PBCT only (26%), and ICI only (20%). The median 1L treatment duration was 4.2 months (range 2.7–6.5) and was shorter with chemotherapy-only regimens. Outpatient visits accounted for the majority of HCRU (mean 6.6 visits per patient per month [PPPM]). Outpatient, inpatient, and emergency department visits were highest for chemotherapy-only regimens. Mean total (all-cause) healthcare costs were $32,215 PPPM and were highest for ICI + chemotherapy ($34,741–38,454 PPPM). Inpatient costs PPPM were highest for PBCT ($4725) and ICI + non-PBCT ($4648). First-line treatment of metastatic NSCLC without actionable alterations imposes a notable HCRU and cost burden, underscoring the need for better treatment options to improve outcomes and reduce economic impact. Full article

Background: Puerto Rico (PR) has experienced significant demographic changes, characterized primarily by an aging population and an unprecedented exodus of medical doctors. Ophthalmologists are of particular concern as they commonly serve older populations, and the island has high rates of some age-related eye diseases in the United States (US). Our research aims to investigate the factors driving ophthalmologists in PR to emigrate to the mainland US. Methods: This is a cross-sectional study among ophthalmologists in PR, using survey data collected from May to June 2023. This study recruited a convenient sample of all ophthalmologists practicing in PR via outreach in person and online communities. The survey covered various types of challenges faced by ophthalmologists, their demographics, and practice details. STATA/BE 18 statistical software was used for data analysis. Statistical tests, such as chi-square and proportion tests, were performed, stratifying results by age, gender, subspecialty, geographic health districts, experience, and practice type. Results: Among 130 of the estimated 218 ophthalmologists in PR, insurance/billing issues were identified as the primary challenge to practicing in PR and the primary reason to leave PR. The challenges that were identified included required authorizations for patient care, unjustified claim rejections, and threats of contract cancellation. We found that new ophthalmologists (≤15 years of practice) faced more specific challenges than experienced ophthalmologists (>15 years of practice), such as difficulty in obtaining insurance contracts. Conclusions: Insurance/billing issues are a pervasive concern for ophthalmologists in PR. New ophthalmologists are disproportionately affected by these challenges, potentially leading some to find employment outside of PR. There is a need for targeted policies—regulation of insurance contracting and increased reimbursement from private insurance plans—to reduce insurance contracting barriers for keeping a sustainable physician workforce in PR. Full article

We aim to investigate the relationships between the population characteristics of patients with Alzheimer’s Disease (AD) and their Healthcare Utilization (HU) during the COVID-19 pandemic. Electronic health records (EHRs) were utilized. The study sample comprised those with ICD-10 codes G30.0, G30.1, G30.8, and G30.9 between 1 January 2020 and 31 December 2021. Pearson’s correlation and multiple regression were used. The analysis utilized 1537 patient records with an average age of 82.20 years (SD = 7.71); 62.3% were female. Patients had an average of 1.64 hospitalizations (SD = 1.18) with an average length of stay (ALOS) of 7.45 days (SD = 9.13). Discharge dispositions were primarily home (55.1%) and nursing facilities (32.4%). Among patients with multiple hospitalizations, a negative correlation was observed between age and both ALOS (r = −0.1264, p = 0.0030) and number of hospitalizations (r = −0.1499, p = 0.0004). Predictors of longer ALOS included male gender (p = 0.0227), divorced or widowed (p = 0.0056), and the use of Medicare Advantage and other private insurance (p = 0.0178). Male gender (p = 0.0050) and Black race (p = 0.0069) were associated with a higher hospitalization frequency. We recommend future studies including the co-morbidities of AD patients, larger samples, and longitudinal data. Full article

Background: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. Methods: We utilized data from the 2020–2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. Results: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. Conclusion: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape. Full article

Medicare Advantage healthcare plans may present undue impediments that result in disparities in patient outcomes. This study aims to compare the outcomes of patients who underwent STS resection based on enrollment in either traditional Medicare (TM) or Medicare Advantage (MA) plans. The Premier Healthcare Database was utilized to identify all patients ≥65 years old who underwent surgery for resection of a lower-extremity STS from 2015 to 2021. These patients were then subdivided based on their Medicare enrollment status (i.e., TM or MA). Patient characteristics, hospital factors, and comorbidities were recorded for each cohort. Bivariable analysis was performed to assess the 90-day risk of postoperative complications. Multivariable analysis controlling for patient sex, as well as demographic and hospital factors found to be significantly different between the cohorts, was also performed. From 2015 to 2021, 1858 patients underwent resection of STS. Of these, 595 (32.0%) had MA coverage and 1048 (56.4%) had TM coverage. The only comorbidities with a significant difference between the cohorts were peripheral vascular disease (p = 0.027) and hypothyroidism (p = 0.022), both with greater frequency in MA patients. After controlling for confounders, MA trended towards having significantly higher odds of pulmonary embolism (adjusted odds ratio (aOR): 1.98, 95% confidence interval (95%-CI): 0.58–6.79), stroke (aOR: 1.14, 95%-CI: 0.20–6.31), surgical site infection (aOR: 1.59, 95%-CI: 0.75–3.37), and 90-day in-hospital death (aOR 1.38, 95%-CI: 0.60–3.19). Overall, statistically significant differences in postoperative outcomes were not achieved in this study. The authors of this study hypothesize that this may be due to study underpowering or the inability to control for other oncologic factors not available in the Premier database. Further research with higher power, such as through multi-institutional collaboration, is warranted to better assess if there truly are no differences in outcomes by Medicare subtype for this patient population. Full article

Background: The Medicare Advantage program provides care to nearly half of Medicare beneficiaries, including a rapidly growing population of cancer survivors. Despite its increased adoption, it is still unknown whether or not the program improves healthcare access, outcomes, and affordability for cancer survivors. Methods: We performed a cross-sectional study of Medicare beneficiaries aged ≥ 65 years with a self-reported history of cancer from the 2019 National Health Interview Survey. We used multivariable logistic regression to evaluate the association between Medicare program type (Medicare Advantage vs. traditional Medicare) and measures of healthcare access, acute care utilization, and affordability. Results: We identified 4451 beneficiaries with a history of cancer, corresponding to 26.6 million weighted cancer survivors in 2019. Of the beneficiaries, 35.8% were enrolled in Medicare Advantage, whereas 64.2% were enrolled in traditional Medicare. The age, sex, racial and ethnic composition, household income, primary site of cancer, and comorbidity burden of Medicare Advantage and traditional Medicare beneficiaries were similar. In the adjusted analysis, there were no differences in healthcare access or acute care utilization between traditional Medicare and Medicare Advantage beneficiaries. However, cancer survivors enrolled in Medicare Advantage were more likely to worry about (34.3% vs. 29.4%; aOR, 1.3 (95% CI, 1.1–1.5)) or have problems paying (13.6% vs. 11.1%; aOR, 1.4 (95% CI, 1.1–1.8)) medical bills. Conclusions: We found no evidence that Medicare Advantage beneficiaries with cancer had better healthcare access, affordability, or acute care utilization than traditional Medicare beneficiaries did. Furthermore, Medicare Advantage beneficiaries were more likely to report financial strain and have difficulty paying for their medical bills than were those with traditional Medicare. Despite the generous benefits and attractive incentives, Medicare Advantage plans may not be more cost-effective than traditional Medicare is for cancer survivors. Our study informs ongoing congressional deliberations to re-evaluate the role of Medicare Advantage in promoting equity among beneficiaries with cancer. Full article

The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved hospital performance. However, despite the benefits, hospitals often encounter significant challenges when it comes to sharing information with external parties. Our study aimed to identify the circumstances under which sharing information with external parties can result in changes in overall hospital costs, with a particular emphasis on various obstacles that hospitals may encounter, including lack of incentives or capabilities essential to facilitate effective information exchange. To achieve this goal, we obtain data from multiple sources, including the American Hospital Association (AHA) annual and IT surveys, the Center for Medicare and Medicaid Services (CMS) hospital compare dataset, and the Census Bureau’s small-area income and poverty estimates. Consistent with previous research, we observed a significant reduction in hospital costs when information was shared internally but not externally. However, our findings also revealed that the sharing of health information can lead to cost savings for hospitals when they encounter challenges such as the absence of incentives and capabilities regardless of whether the information is shared internally or externally. The implication of our study is simple but strong: perseverance and effort yield positive outcomes. Only when hospitals push through challenges related to sharing information can they achieve the anticipated advantages of information sharing. Based on our results, we suggest that policymakers should strategically target hospitals and providers that face challenges in sharing health information rather than focusing on those without obstacles. This targeted approach can significantly increase policy efficiency, and we emphasize the need for policymakers to address the specific areas where hospitals and providers encounter difficulties. By doing so, they can effectively “scratch where it itches” and address the core issues hindering the successful exchange of health information. Full article