Authors

Contributor: Beyond a One-Size-Fits-All for Managed Care Plan Benchmarks

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

Improving Glycemic Control in Diabetes Through Virtual Interdisciplinary Rounds

Patients with diabetes whose providers received advice from remote, virtual interdisciplinary rounds had a greater 1-year reduction in hemoglobin A1c than comparable patients.

A Conceptual Framework for Addressing Social Needs Through the Accountable Health Communities Model

No published studies exist on use of intervention design, implementation strategies, and theory in the CMS Accountable Health Communities Model, the largest-scale test of social prescribing in the United States.

The Implementation of Opioid Prescribing Report Cards in Medicaid Managed Care: A Community Quality Collaborative

This article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.

Antihyperglycemic Treatment Patterns for Chronic Kidney Disease and Type 2 Diabetes

This study characterized antihyperglycemic medication use after chronic kidney disease onset among patients with type 2 diabetes to uncover potential unmet needs in clinical practice.

Comparing Breast Cancer Treatment Outcomes Between Fee-for-Service and Medicare Advantage

This study examined postdiagnosis breast cancer treatment outcomes for Medicare Advantage vs fee-for-service (FFS) Medicare in Ohio and found no significant differences overall but disparities for Black patients with FFS Medicare.

Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

Impact of Psychiatric Follow-Up Frequency on Outcomes and Waiting Times

Naturally occurring variations in appointment frequencies do not appear to have a major impact on clinical outcomes, but they significantly affect waiting times.

Better Data Is Needed to Tackle Health Equity

The US federal government is finally updating its standards for reporting data on race and ethnicity – and it’s an urgently needed chance to enable a national overview of crucial data on health inequities

Disparities in Physician Access for Rheumatology, Dermatology, and Gastroenterology: A Systematic Review

This article presents a systematic review of US health care disparities in physician specialist access across rheumatology, dermatology, and gastroenterology and a call to action.

Proactive Care Management of AI-Identified At-Risk Patients Decreases Preventable Admissions

Proactive care management for artificial intelligence (AI)–identified at-risk patients reduced potentially preventable hospital admissions.

Modeling Financial Outcomes and Quantifying Risk in Episode-Based Payment Models

This article provides a description of prospective financial simulation methodology and use cases with empirical data for episode-based bundled payments, including implications for contract negotiations and value-based care redesign.

Association of Physician Specialty With Psoriatic Arthritis Treatment and Costs

In this retrospective cohort study of patients with newly diagnosed psoriatic arthritis, the authors examine the association of treatment selection and costs with physician specialty.

Equity and AI Governance at Academic Medical Centers

This study identifies limited engagement with equity among academic medical centers as they develop governance processes for artificial intelligence (AI)/machine learning and predictive technologies.

The Role of Automation in Meeting the Growing Demand for CAR T-Cell Therapies

Emergency Department Risk Model: Timely Identification of Patients for Outpatient Care Coordination

The authors created a machine learning–based model to identify patients with major depressive disorder in the primary care setting at high risk of frequent emergency department visits, enabling prioritization for a care coordination program.

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.

Diagnosis and Management of TRK Fusion Cancer

Building Community and Advancing Care at MDA 2025

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.

Approaches for Overcoming Barriers to Cross-Sector Data Sharing

The authors identified challenges to cross-sector data sharing and the approaches used to overcome these challenges in the Mid-Ohio Farmacy, a partnership to address food insecurity.

An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs

Care coaching and behavioral health provider referral programs produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat behavioral health conditions.

Appropriate ED Utilization Leading to Better Care Coordination

Addressing avoidable emergency department (ED) utilization takes interventions in partnership with providers.

Impact of the COVID-19 Pandemic on Regular Emergency Department Users

Regular users of the emergency department (ED) transiently reduced ED visits when faced with ED access barriers during the COVID-19 pandemic.

Reimbursement for Genetic Variant Reinterpretation: Five Questions Payers Should Ask

Periodic reinterpretation of genetic sequencing results presents a challenge for developing transparent and systematic coverage and reimbursement policies.

Overdiagnosis of Adult ADHD Is Exacerbating the Stimulant Shortage

The authors argue that the stimulant shortage is being perpetuated by the overdiagnosis of attention-deficit/hyperactivity disorder (ADHD) in adults because executive functioning deficits are not included in diagnostic criteria.

Journey to Anticoagulant Access Following Payer Rejection of Apixaban

Formulary restrictions can create treatment barriers for patients with atrial fibrillation, including unnecessary delays in treatment and prescription abandonment, with vulnerable populations at greater risk.

A “Sludge Audit” for Health System Colorectal Cancer Screening Services

A systematic, mixed methods “sludge audit” identified novel health system delivery targets for improving colorectal cancer screening services.

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.