OBJECTIVES This study used coarsened exact matching to assess the ability of the LACE+ index to predict adverse outcomes after plastic surgery. STUDY DESIGN Two-year retrospective study (2016-2018). METHODS LACE+ scores were retrospectively calculated for all patients undergoing plastic surgery at a multicenter health system (N = 5744). Coarsened exact matching was performed to sort patient data before analysis. Outcomes including unplanned hospital readmission, emergency department visits, and reoperation were compared for patients in different LACE+ score quartiles (Q1, Q2, Q3, Q4). RESULTS A total of 2970 patient procedures were matched during coarsened exact matching. Increased LACE+ score significantly predicted readmission within 90 days of discharge for Q4 versus Q1 (6.28% vs 1.91%; P = .003), Q4 versus Q2 (12.30% vs 5.56%; P less then .001), and Q4 versus Q3 (13.84% vs 7.33%; P less then .001). Increased LACE+ score also significantly predicted emergency department visits within 90 days for Q4 versus Q1 (9.29% vs 3.01%; P less then .001), Q4 versus Q2 (11.31% vs 3.57%; P less then .001), and Q4 versus Q3 (13.70% vs 8.48%; P = .003). Higher LACE+ score also significantly predicted secondary reoperation within 90 days for Q4 versus Q1 (3.83% vs 1.37%; P = .035), Q4 versus Q2 (5.95% vs 3.37%; P = .042), and Q4 versus Q3 (7.50% vs 3.26%; P less then .001). CONCLUSIONS The results of this study demonstrate that the LACE+ index may be suitable as a prediction model for patient outcomes in a plastic surgery population.OBJECTIVES Triple therapy is indicated for patients with very severe chronic obstructive pulmonary disease (COPD). Use of this treatment in the appropriate patient population is important to ensure optimal outcomes. This study quantified the use of triple therapy and assessed concordance with 2013-2016 Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommendations within a national health plan. STUDY DESIGN Retrospective cohort study using data from a large national health plan. METHODS To estimate the prevalence of triple therapy using claims data, patients in the first of 2 cohorts were indexed on their first diagnosis of COPD between January 1, 2012, and December 31, 2014, and required to have 24 months postindex continuous enrollment. To assess concordance with GOLD recommendations, a second cohort was created and indexed on the date of triple therapy initiation between January 1, 2013, and November 30, 2016, and required to have 12 months preindex and 1 month postindex continuous enrollment. For both cohorts, patients were aged 40 years or older, with no International Classification of Diseases code for asthma, cystic fibrosis, or lung cancer during the study period. RESULTS In the first cohort of 92,248 patients with COPD receiving any COPD maintenance medication, 17% were prescribed triple therapy. In the second cohort (n = 19,645), the majority (60%) of patients on triple therapy were classified as GOLD group A or B (ie, no evidence of any exacerbation or only 1 exacerbation not resulting in hospitalization at baseline). CONCLUSIONS Results showed that triple therapy was often prescribed among patients classified as GOLD group A or B. Additional research is required, however, to further assess whether these patients may have had an exacerbation that was not evident in claims data. Treatment of COPD should be individualized to optimize outcomes and reduce adverse events.Partnering teams for delivery of continuity of care between primary care and community behavioral health systems can learn from e-consult implementation.Several strategies have been proposed to improve referrals and communication between primary care providers (PCPs) and specialists. In this article, we describe the effectiveness of collaborative care plans (CCPs) in reducing utilization of specialist resources in a capitated health plan based in a safety net hospital. To operationalize individual care plans, a single clinic called the Total Care Clinic (TCC) was launched. Midlevel providers were assigned to subspecialties and trained in specific algorithms of care that they were responsible for. Midlevel providers in the TCC were invited to attend in-house education opportunities. These interventions resulted in an overall 33.6-percentage-point reduction in the referral rate over 7 years of observation. The largest decrease in referrals was observed in gastroenterology, which resulted mostly from colon cancer screening with fecal immunochemical tests in place of colonoscopies. No increase in emergency department (ED) visits or hospital admissions accompanied the decreased referrals to specialists. Combining CCPs with provider education and placing select specialists in proximity of the PCPs resulted in significant referral reductions to specialists without increases in ED visits or hospital admissions.OBJECTIVES Understanding variation in spending across organizations, rather than across geographic areas, is important because care is delivered by organizations and interventions increasingly focus on organizations. Accountable care organizations (ACOs) are particularly important to study given their incentives to reduce spending. Analyzing spending differences across ACOs may help identify cost savings opportunities. STUDY DESIGN Cross-sectional analysis of Medicare claims. METHODS We stratified ACOs into quartiles based on the deviation between each ACO’s risk-adjusted spending and average risk-adjusted fee-for-service spending in the same market (hospital referral region). βEstradiol We compared spending between top- and bottom-quartile ACOs on each of 7 major service categories and 10 clinical condition groups to identify areas of potential savings. We simulated spending reductions if ACOs with high adjusted spending reduced spending to the levels of lower-spending ACOs. RESULTS In 2016, geographically adjusted and risk-adjusted total per-beneficiary spending for the highest-spending quartile of ACOs was 14% higher than for ACOs in the lowest quartile. Variation between high- and low-spending ACOs was greatest, at 27%, in the use of skilled nursing facilities-a service category in which ACOs have reduced spending by the greatest percentage. Inpatient care was the largest driver of absolute dollar differences in spending, however, accounting for 37% of the total spread. If spending in ACOs above median adjusted spending were brought down to the median, savings would be 3% to 4%. CONCLUSIONS By extending the variations literature to focus on ACOs, we illustrated that meaningful further savings opportunities exist both within and across markets.