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.
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.
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.
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.
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.
One of the major highlights of the Muscular Dystrophy Association (MDA) Clinical & Scientific Conference is that invaluable networking opportunities can help clinicians elevate their own best practices.
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.
Significant unmet needs were found among high-quality validation studies on the internal structure of patient-reported outcome measures (PROMs) specific to alopecia areata (AA), a common hair loss condition with substantial quality of life impacts.
Medicare coverage did not necessarily lead to increased diagnosis of chronic conditions.
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.
The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.
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.
Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.
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.
A panel of experts share closing thoughts and advice for the management and uptake of HIV PrEP therapy.
This study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.
The problem of violence against health care workers has escalated across the world, and tackling this issue requires the support of administrators.
This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.
Medicare accountable care organizations use preferred skilled nursing facility networks for postacute care management, although the size, structure, and resource allocation of networks vary widely.
Panelists discusses how the "vicious vortex model" explains bronchiectasis pathophysiology, where airway dilatation leads to mucus stagnation, chronic infections, and neutrophilic inflammation, worsening the condition.
The KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.
Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.
Considering the personal, societal, and economic toll of treatment-resistant depression, we must make it easier to access medicines and care that provide value, both for the patient and for the health care system.
Physicians have been facing increasing workloads making it difficult to practice medicine as they were trained, but an accountable care organization might provide an opportunity for real change to deliver high-value, compassionate care.
Previous studies have found modest uptake of biosimilars in both commercial and Medicare populations. This study finds that the uptake varies between the rural and urban provider settings.
The authors find that 340B-covered hospitals and grantees are contracting mainly with pharmacies in significantly more affluent neighborhoods than their own.