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Managed Care Reflections: A Q&A With Julia Adler-Milstein, PhDTo mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The March issue, which is our annual health information technology (IT) theme issue, features a conversation with Julia Adler-Milstein, PhD, professor of medicine at the University of California, San Francisco, and guest editor of the 2014 health IT issue.
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Cross-Sector Data in ActionA look at the experiences of 2 leaders in cross-sector collaboration show how cross-sector data can guide the development of innovative initiatives to improve people’s lives.
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CMS Announces Transformative Updates to the MA VBID ModelUpdates to CMS' Medicare Advantage (MA) Value-Based Insurance Design (VBID) model broaden the scope of the existing model by testing a wide range of MA service delivery and/or payment approaches.
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Too Much, Too Fast: Providers Need More Time to Operationalize Medicare's New Radiation Oncology ModelCMS' new radiation oncology payment model is slated to begin on January 1, 2020, but the significant billing changes that the model requires will require more time.
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Measuring Value for Low-Acuity Care Across SettingsTo analyze value of low-acuity care, an existing model is adapted to highlight factors impacting how stakeholders assess emergency department care compared with alternatives.
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The Essential Facts of Life Are the Foundation of HealthOn a humanitarian mission to Puerto Rico, Adam Sharp, MD, learned that to improve health, the essentials of food, housing, and water must be available and should be prioritized over medications, surgeries, and therapies.
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Contributor: Institutional Engagement With Physicians Is Key to Managing Cost and QualityAlthough physicians’ clinical decisions serve as the biggest drivers behind the cost of care, hospitals have long been reluctant to take financial accountability. If such accountability is to be transformed from a diffuse fear to a manageable managerial task, institutional engagement with physicians will be a critical next step.
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Contributor: Solving the US Physician Diversity ProblemThe representation of Black physicians is alarmingly low, but the opportunities for change are possible and urgent. Health care leaders and human resource departments need to address these disparities, and increasing diversity among their workforce is an excellent place to begin.
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Telepsychiatry Trends to Expect in 2019As healthcare closes the book on 2018, here are trends and changes the industry can expect to see on the telepsychiatry front in 2019.
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CAQH CORE Certification Impact: Simplifying PayerThe Council for Affordable Quality Health Committee on Operating Rules for Information Exchange is making great strides in certifying health plans for implementing electronic information exchange between payers and providers. The good news for providers is that very little is required of them to reap the benefits of these certification efforts.
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Impossible Math: Financing a Freestanding Birth Center and Supporting Health EquityBirths in freestanding birth centers are increasing, and the number of birth centers is increasing, as well, but capacity is not keeping up with demand. Freestanding birth centers provide many of the same services that are provided for low-risk pregnancies in hospitals, and there is evidence of equivalent or better outcomes of care both here in the United States and in abroad. Yet, freestanding birth centers are paid less than hospitals for doing the same work.
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MACRA Continues to Catalyze Movement Towards ValueGiven that 2018 marks the last year of the transition-year policies, implementation challenges identified during the first 2 years of Medicare Access and CHIP Reauthorization Act (MACRA) preparation and execution must be addressed to ensure effective delivery of high-value care as intended.
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Lessons From a 25-Year Study of Type 1 DiabetesFrom funding innovative research to advocating for government action to providing a support structure for our community, no other organization does more to fight type 1 diabetes (T1D) than JDRF.
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Grassroots Public Health Management in Managed CareCommunity coalitions are a backbone of public health, and offer a unique perspective towards implementation of managed care disease management/case management programs.
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Successful Interventions, Positive Outcomes: Understanding the Impact of Social Determinants of HealthAlthough it’s difficult to generalize the impact of social determinants of health, addressing them is fundamental to improving overall healthcare quality for member populations.
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Increasing the Longevity of Accountability, Designing Cooperative Models, and Transferring Risk Across a Lifetime of Accountable CareTo achieve longer accountable relationships, a bridge from one insurer to another could be built through continuity of accountability amid insurance transitions, improved risk prediction, and cooperation in the design of accountable care models.
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New MIPS Improvement Activity Supports Remote Patient MonitoringDespite growth in the market, CMS has been slow to recognize the value that telehealth can bring to clinical encounters by encouraging utilization of telehealth technology through reimbursement models. However, now CMS has taken steps to encourage practices to leverage telehealth and remote monitoring activities through changes to the Quality Payment Program.
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Contributor: How Payers Can Be Effective in New Value-Based Models for CKDThe author discusses how value-based payment models in chronic kidney disease can improve total cost and quality of care for patienst with chronic kidney disease (CKD).
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Modernizing the Stark Law Will Improve Care for Medicare Patients and Lower CostsCurbs on physician self-referrals in Medicare may have made sense in a fee-for-service environment, but they present significant barriers to payment reform as the nation moves to value-based models.
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The Oncology Care Model: What to Expect in the First Data FeedEight months into the Oncology Care Model, find out what participants can expect from the first performance data feed released later this month.
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Advancing the Wave of Democratization of Cancer CareDemocratizing the complex field of cancer care is not easy. We are providing patients with key information that their own cancer is unique and needs to be treated as such, but there is a great deal of work to be done in putting that knowledge to work.
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Patients, Pain, and Access to OpioidsIs limiting or discontinuing opioid use in clinical care the answer to addressing the opioid epidemic?
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The Goldilocks Principle: A Personalized Breast Cancer Treatment That Is "Just Right" for YouMolly MacDonald, the founder and CEO of The Pink Fund, writes about how patients with breast cancer can approach decisions about choosing among disparate treatment protocols.
