Case Studies

Resource	Category	Carriers	Purpose
Maryland Medical Assistance Program and Health Insurance – Required Coverage for Menopause-Related Treatment, Care, and Training of Clinicians This report evaluates the use, cost, and insurance impact of menopause-related treatments—especially prescription drugs—within Maryland’s healthcare… State: Maryland	Health Reform, Insurance Department	Commercial	Utilization
Using prescription medication utilization trends to evaluate health system resilience and inform future emergency preparedness The study examines how changes in prescription medication use during the COVID-19 pandemic can reveal strengths and weaknesses in the healthcare… State: Colorado	Population Health	Commercial, Medicaid, Medicare	Utilization
Evaluating the impact of health equity zones to mitigate disparities in cancer screening: study of colorectal cancer screening in rhode island This case study uses Rhode Island's all-payer claims database (HealthFacts RI) to evaluate whether the state's Health Equity Zones… State: Rhode Island	Population Health	Commercial, Medicaid	Utilization
Maryland Medical Assistance Program and Health Insurance – Required Coverage for Aesthetic Services and Restorative Care for Victims of Domestic Violence This mandate study uses Maryland's All-Payer Claims Database (APCD) to estimate the fiscal impact of requiring Medicaid and commercial insurers… State: Maryland	Consumers, Health Reform, Insurance Department	Commercial, Medicaid	Cost, Utilization
Corporate Moral Hazard In U.S. Health Insurance: Churn And Denial Rates This dissertation uses the New Hampshire APCD to examine whether commercial insurers increase claim denial rates ahead of the predictable transition… State: New Hampshire	Health Reform, Insurance Department, Researchers	Commercial, Medicaid, Medicare	Cost, Utilization
Novel approaches in linkage of data sources to explore the associations between purchase of opioid prescriptions during pregnancy and adverse neonatal outcomes This case study links Arkansas APCD and PDMP data to assess prescribed opioid exposure during pregnancy, demonstrating that combining both data… State: Arkansas	Population Health, Researchers	Commercial, Medicaid	Utilization
County-level medical debt and treatment initiation among individuals newly diagnosed with cancer This case study examined the relationship between county-level medical debt and timely cancer treatment initiation, finding that patients in counties… State: Colorado	Health Reform, Population Health, Providers	Commercial, Medicaid, Medicare	Cost, Quality
Provider networks for pulmonary hypertension in Massachusetts: Implications for improving referrals to expert care This case study found significant gaps in connections to expert care, even among providers caring for patients at risk for pulmonary arterial… State: Massachusetts	Consumers, Medicaid, Population Health, Providers	Commercial, Medicaid, Medicare	Quality, Utilization
Reclassifying Primary Care: A Decision Tree Approach to Improving Workforce Estimates and Research Using Claims Data This case study uses Virginia APCD data to develop and validate a decision tree classifier for identifying primary care clinicians in claims data,… State: Virginia	Employers, Providers	Commercial	Utilization
Medicaid Reimbursement for Maternal Depression Screening and Care for Postpartum Depression This case study uses Colorado APCD data to evaluate the state's 2014 Medicaid reimbursement policy for postpartum depression screening during… State: Colorado	Medicaid	Commercial, Medicaid	Utilization
Aligning Incentives or Gaming the System? The Impact of Insurer-Physician Acquisitions This case study uses Colorado APCD data to examine a 2017 insurer-physician acquisition, finding that integration inflated Medicare Advantage… State: Colorado	Health Reform, Insurance Department, Researchers	Commercial, Medicare	Cost, Utilization
Insurance gaps at age-19 and age-26 health insurance eligibility thresholds by childhood-onset condition severity, Colorado 2014-2018 This case study uses Colorado APCD data to examine insurance gaps at the age-19 Medicaid and age-26 commercial coverage cutoffs, finding that roughly… State: Colorado	Consumers, Health Reform, Medicaid, Population Health, Providers	Commercial, Medicaid	Utilization
Pregnancy outcomes among medically complex populations with high risk of pregnancy mortality in Virginia: a retrospective observational study This case study uses Virginia APCD data to examine how many pregnant people have severe medical conditions or complications for which abortion may be… State: Virginia	Consumers, Health Reform, Medicaid, Population Health, Providers	Commercial, Medicaid, Medicare	Utilization
Bayesian Spatial Analysis of Trends and Disparities in Telehealth Use During the COVID-19 Pandemic: Retrospective Observational Study This study aims to assess disparities in telehealth use across Virginia, focusing on demographic, socioeconomic, and geographic factors influencing… State: Virginia	Consumers, Medicaid, Population Health, Providers	Commercial, Medicaid, Medicare	Utilization
Treatment of opioid use disorder in pregnancy among individuals with and without co-occurring stimulant use disorder: A retrospective cohort study This case study uses Utah APCD data to compare treatment patterns among pregnant individuals with opioid use disorder (OUD) who also had a co-… State: Utah	Consumers, Medicaid, Population Health, Providers, Researchers	Commercial, Medicaid	Utilization
An Examination of Trends in Low-Value Opioid Prescribing for Acute Low Back Pain in Rural vs. Non-Rural Virginia This case study uses Virginia APCD data to examine low-value opioid prescribing for acute low back pain among over 850,000 insured residents from… State: Virginia	Consumers, Health Reform, Medicaid, Population Health, Providers, Researchers	Commercial, Medicaid	Utilization
Guideline-Concordant Care and Clinician and Clinic Characteristics for Patients With Schizophrenia This case study finds that for patients with schizophrenia in Massachusetts, psychiatric nurse practitioners and mental health clinics delivered care… State: Massachusetts	Medicaid, Providers, Researchers	Commercial, Medicaid	Quality
Inequitable Access to Risk-Appropriate Neonatal Care: Evidence from a Regionalized Perinatal System in Arkansas This case study analyzes a decade of birth data in Arkansas to evaluate whether newborns receive care at the appropriate level of neonatal facility.… State: Arkansas	Population Health, Researchers	Commercial, Medicaid, Medicare	Quality, Utilization
Engagement and retention in HIV care in rural Southern U.S. using an All-Payer Claims Database This case study evaluates the HIV care continuum in Arkansas, finding that HIV testing, engagement, and retention in care are all below national… State: Arkansas	Medicaid, Population Health, Providers, Researchers	Commercial, Medicaid	Utilization
Low-Value and No-Value Care in Healthcare: A Narrative Review This narrative review summarizes the concepts of low- and no-value care (LNVC), the drivers behind them, and potential strategies for de-… State: Virginia	Health Reform, Population Health, Researchers	Commercial, Medicare	Cost, Quality

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