Authors

Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.

Patients’ Needs Following Emergency Care for Ambulatory Care–Sensitive Conditions

To inform intervention development, we assessed for medication changes and patient care needs following treat-and-release Veterans Affairs emergency department visits for chronic ambulatory care–sensitive conditions.

Final PICCOLO Data Highlight Efficacy of Mirvetuximab Soravtansine in Later-Line Frα+ Platinum-Sensitive Ovarian Cancer

Mirvetuximab soravtansine continues to show efficacy and safety in the final analysis of the phase 2 PICCOLO study.

Lp(a): Evidence of a Link to Major Adverse Cardiovascular Events

Impact of Telemedicine Use on Outpatient-Related CO2 Emissions: Estimate From a National Cohort

Telemedicine was associated with a monthly avoidance of greenhouse gas emissions equivalent to the emissions of 61,255 to 130,076 passenger vehicles.

Service Line Care Delivery Model for COVID-19 Patient-Centric Care

The authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.

Cost-Effectiveness of a Multicancer Early Detection Test in the US

Multicancer early detection testing results in extended life-years and reduced cancer treatment costs through earlier diagnosis, leading to a cost-effective option in cancer screening.

Participating Faculty: Payer and Provider Solutions to Utilization Management Challenges in the Management of Rare Hematologic Cancers

Risk Adjusting for Medicaid Participation in Medicare Advantage

When comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.

Clinical Setting of Initial Psychotic Spectrum Disorder Diagnoses in an Integrated Health System

This study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

Variation in Spending Associated With Primary Care Practices

Physician practices account for a significant amount of variation in spending.

Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

Contributor: The Case for Education and Clinical Decision Support With Pharmacogenetics

Prescribing is a complex process with multiple factors to consider on top of the 3 primary questions about effectiveness, harm, and cost. Pharmacogenetics has put this complexity under the spotlight and prompted educational programs and the development of new clinical decision support systems.

Long-Term Health Care Costs Following COVID-19: Implications for Pandemic Preparedness

A difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.

Trends in Medicare Part D Coverage of Generics With Equivalent Brand-Name Drugs

High-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.

Cost Analysis of Self-Monitoring Blood Glucose in Nonintensively Managed Type 2 Diabetes

Analysis of claims data showed reduced utilization and costs among patients with nonintensively managed type 2 diabetes using self-monitoring of blood glucose compared with continuous glucose monitoring.

The Effect of Medicare Eligibility on Diagnosis of Chronic Conditions

Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions.

Addressing STIs Through Managed Care: Opportunities in Medicaid and Beyond

Medicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.

Racial and Ethnic Disparities in Prior Authorizations for Patients With Cancer

The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.

Participating Factulty: Real-World Impact of Infliximab Precision-Guided Dosing on Management of Patients With IBD

New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient Mix

On this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.

Using Data Exchange to Improve Quality Reporting, Target Outreach, and Reduce Cost

Covered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.

Investigating Real-world Consequences of Biases in Commonly Used Clinical Calculators

Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.

Assessing Surveillance Utilization and Value in Commercially Insured Patients With Colorectal Cancer

Trends in surveillance testing after treatment for colorectal cancer remained relatively stable recently, and patients who overutilized surveillance measures had quicker recurrence detection but higher costs.

Continuously Updated Forecasting of SARS-CoV-2 in a Regional Health System

This study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.

The US Oncology Network Tackles Patients’ Health-Related Social Needs by Collaborating With Nation’s Largest Social Services Support Network

The Persistent Pandemic of Violence Against Health Care Workers

The problem of violence against health care workers has escalated across the world, and tackling this issue requires the support of administrators.

A Scoping Review of US Insurers’ Use of Patient-Reported Outcomes

This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.