Michael L. Barnett, MD, MS

As home-based care utilization rises, an exploration of potential unintended consequences is necessary. The authors focus on support gaps, informal caregiving, and failure to meaningfully engage clinicians.

Is specialist “gatekeeping” in modern health maintenance organization (HMO) insurance associated with differences in outpatient care? The study finds that HMO gatekeeping may meaningfully reduce specialist utilization.

Reducing specialty leakage is promoted as crucial for accountable care organizations (ACOs). This study finds that Medicare ACOs had modest reductions in specialty use and minimal changes in leakage.