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To determine the personnel costs and revenue generated by embedding a behavioral health nurse practitioner (BHNP) in primary care clinics to evaluate and manage adolescent behavioral health needs.

We estimated personnel costs and revenue from a quality improvement project undertaken at 4 clinic sites between August 1, 2016, and July 31, 2018, at a large multispecialty medical group in northern California.

Costs were estimated by identifying the actual hours spent by the BHNP and for medical assistant (MA) support and using Bureau of Labor Statistics national data on wages and benefits. Revenue was estimated by analyzing Current Procedural Terminology (CPT) codes for BHNP visits from the Epic electronic health record and corresponding relative value units (RVUs), based on 135% of 2018 nationally unadjusted Medicare rates.

We estimate 2-year revenue of $144,449 and personnel costs (salary + benefits) of $90,431. The BHNP work totaled 1083 hours, and MA support totaled 312 hours. Using a nurse practitioner wage of $53.70/hour and an MA wage of $16.95/hour, total salary costs were $63,451; we then added benefits costs. Using the CPT codes assigned to the 768 encounters with 207 unique patients, we estimated generation of 1640 RVUs and total revenue of $144,449.

This analysis found that personnel costs ($90,514) of a primary care-embedded BHNP are 63% of the potential revenue generated ($144,449). This analysis suggests that a primary care BHNP could be a cost-saving and patient-centered way to reduce the burden on primary care providers while meeting the growing needs of adolescents with behavioral health needs.

This analysis found that personnel costs ($90,514) of a primary care-embedded BHNP are 63% of the potential revenue generated ($144,449). This analysis suggests that a primary care BHNP could be a cost-saving and patient-centered way to reduce the burden on primary care providers while meeting the growing needs of adolescents with behavioral health needs.

It is unclear on what basis Medicare drug plans impose coverage restrictions on orphan drugs. This study aims to investigate the factors associated with utilization controls in Medicare fee-for-service Part D formularies.

Cross-sectional analysis.

We used multivariate logistic regression to assess the association between orphan drug characteristics and use of formulary utilization controls in 2016. We controlled for number of beneficiaries per drug, exclusivity expiration, and the number of plans and beneficiaries per formulary. We conducted sensitivity analyses using fixed and random effects.

On average, 85% of orphan drugs on a formulary were placed on its highest cost-sharing tier and 76% were subject to prior authorization (PA). Orphan drugs with annual costs of $50,000 or more had twice the odds of having PA requirements compared with less expensive ones. Relative to orphan drugs with a single indication, drugs with multiple indications were more likely to have restrictions. Less effective drugs had 1.5 times the odds of highest tier placement relative to more effective drugs. The presence of black box warnings and patient assistance programs were associated with more restricted access. Orphan drugs with generics were less likely to undergo restrictions than those without generics (all P < .05).

Plans are making evidence-based decisions by rewarding more clinically effective and safer orphan drugs. see more They are penalizing drugs with multiple indications. Surprisingly, plans place fewer restrictions on orphan drugs that have a generic equivalent, which may further discourage generic entry into the orphan space, where competition is already sparse.

Plans are making evidence-based decisions by rewarding more clinically effective and safer orphan drugs. They are penalizing drugs with multiple indications. Surprisingly, plans place fewer restrictions on orphan drugs that have a generic equivalent, which may further discourage generic entry into the orphan space, where competition is already sparse.

Value co-creation focuses on customer participation and co-creates value with suppliers. Patients' support and cooperation can improve the quality of medical care. Value creation is closely related to participants' behavior. The DART (Dialogue, Access, Risk assessment, Transparency) model is widely used in commercial research because it defines and classifies value co-creation behavior clearly and systematically. However, there is little research using the DART model in the field of health care. This study aimed to develop and evaluate the psychometric properties of a scale measuring patient value co-creation behavior based on the DART model.

The Delphi technique was used to determine the scale content with a panel of 17 experts. A cross-sectional survey was administered to 356 outpatients and inpatients of a hospital in Guangzhou, China.

Internal consistency reliability and composite reliability (CR) were used to estimate the scale's reliability. Validity was assessed using convergent and discriminant validity.

Three rounds of expert consultation were completed before a final consensus was reached regarding scale content. The patient value co-creation behavior scale was composed of 23 items and 4 dimensions. The overall Cronbach's α was 0.934, and the CRs of the 4 DART dimensions were 0.843, 0.872, 0.911, and 0.884, respectively, showing satisfactory reliability. The average variance extracted ranged from 0.473 to 0.659, and the χ2 difference between constrained and free models was significant, indicating convergent and discriminant validity.

The scale exhibited acceptable reliability and validity and could serve as an evaluation tool for patient value co-creation behavior.

The scale exhibited acceptable reliability and validity and could serve as an evaluation tool for patient value co-creation behavior.

Some managed care companies are testing rideshare services as an approach to providing transportation to health care for Medicaid enrollees. The objective of this study was to assess whether more rideshare transportation to health care was associated with improved self-reported ride experiences and fewer late/failed passenger pickups for Medicaid enrollees.

We surveyed a random sample of Medicaid enrollees in a northwestern US state on their experiences with nonemergency medical transportation (NEMT) in the past year. We linked survey responses to administrative data on NEMT utilization from the state's transportation broker to obtain an objective measure of rideshare utilization.

We used bivariate tests and multivariable logistic regressions to examine associations between enrollee perspectives on the quality of and access to health care and rideshare use, defined as none, some, or many NEMT trips through rideshare services.

More than 35% of respondents received NEMT from rideshare services at least once.