Key Points
Question
Is it cost-effective to implement population-wide genomic screening for hereditary breast and ovarian cancer (HBOC)?
Findings
This decision analytical model study found that genomic screening for HBOC among unselected women may be cost-effective depending on the age distribution of the women screened. Cascade testing of first-degree relatives added a modest improvement in clinical and economic value.
Meaning
Population-level genomic screening for HBOC targeting women aged 20 to 35 years could be considered in settings in which the outcomes of screening can be evaluated, particularly to avoid a reduction in mammography screening among patients with negative test results.
Current guidelines recommend dual antiplatelet therapy (DAPT) consisting of aspirin and a P2Y12 inhibitors following percutaneous coronary intervention (PCI). CYP2C19 genotype can guide DAPT selection, prescribing ticagrelor or prasugrel for loss-of-function (LOF) allele carriers Nita A. Limdi,
Key Points
Question
How does the breadth of health care networks and the degree to which they overlap vary within and across specialties and insurance markets?
Findings
In this cross-sectional study of 1192 health care networks, large-group employer networks were broader than small-group employer, marketplace, Medicare Advantage, and Medicaid managed care networks. In many states, narrower networks had as much, if not more, overlap across different insurers’ networks than the broadest networks; areas with less concentrated insurance, physician, and hospital markets had narrower and more exclusive networks.
Meaning
These findings suggest that the structure of plan networks may be a factor in determining care affordability and continuity in the United States, particularly given how frequently individuals change insurance plans.
To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.
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