Authors

The Impact of Reinsurance of Gene Therapies on Employer Financial Risk

Opportunities and Obstacles Associated With the Medicare Diabetes Prevention Program

This study describes the current opportunities and obstacles associated with Medicare Diabetes Prevention Program implementation from the novel perspective of program suppliers across the US.

Hospital Performance in a Statewide Commercial Insurer Episode-Based Incentive Program

Some hospitals were able to outperform others in a commercial insurer episode-based incentive program, but there was little evidence of global reductions in episode spending.

A Machine Learning Technology for Addressing Medication-Related Risk in Older, Multimorbid Patients

A novel machine learning system effectively stratifies emergency department use and hospitalization risk of older patients with multimorbidity who take multiple medications and provides appropriate medication recommendations.

Cost Savings Associated With a Web-Based Physical Activity Intervention for COPD

The authors modeled costs associated with a pedometer-based, web-mediated physical activity intervention compared with a pedometer alone for chronic obstructive pulmonary disease (COPD) management. The intervention was cost-saving.

Contributor: The “VET PFAS Act 2023” Promises Disability Benefits to PFAS-Exposed Veterans

The VET PFAS Act could help older veterans with toxic exposure attain the medical treatment they need by expanding eligibility.

ACA Medicaid Expansion Association With Racial Disparity Reductions in Timely Cancer Treatment

Medicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.

Clinical and Economic Outcomes of a Collaborative Cardiology Care Program

Patients with chronic cardiac conditions benefited from a health care program that strengthened collaboration between general practitioners and cardiology specialists in Baden-Wuerttemberg, Germany.

Predicting Mortality Risk Using the PREVENT Equation Across Diverse Racial Groups

This study validates the Predicting Risk of CVD Events (PREVENT) score across diverse racial and ethnic populations, highlighting its effectiveness in predicting cardiovascular risk and mortality, regardless of race or ethnicity.

Medication Adherence Star Ratings Measures, Health Care Resource Utilization, and Cost

For patients prescribed diabetes, hypertension, and hyperlipidemia medications, nonadherence to CMS Star Ratings quality measures of medication adherence was associated with increased health care resource utilization and costs.

Glucose-Lowering Treatment Patterns in Patients With Diabetic Kidney Disease

Real-world treatment of diabetic kidney disease in the United States, based on national-level health care claims and electronic health records data, is inconsistent with the current guidelines.

Managed Care Reflections: A Q&A With Charles N. (Chip) Kahn III, MPH

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The August issue features a conversation with Charles N. (Chip) Kahn III, MPH, the president and CEO of the Federation of American Hospitals and a longtime member of the AJMC editorial board.

Uptake of Oncology Biosimilars: Managed Care Strategies to Improve Value-Based Care Systems

Amazon Pharmacy: Distraction or Disruption?

After years of anticipation, Amazon Pharmacy launched in November 2020. The question is now: Is this market entry a disruption, a distraction, or something in between?

Medication Persistence and Its Impact on Type 2 Diabetes

Most newly treated patients with type 2 diabetes exhibit suboptimal medication persistence, which is associated with higher risk of hospitalization and increased medical costs.

Higher-Dose Nusinersen Meets Primary End Point in Phase 2/3 DEVOTE Study for Spinal Muscular Atrophy

Based on the positive topline data, the company plans to submit for regulatory approval for a higher dose of nusinersen for spinal muscular atrophy (SMA) treatment.

Assessing Utilization of a Marketwide Price Transparency Tool

Consumers strategically used a price transparency tool by searching more often in procedure markets with provider-specific information, higher charges, and more out-of-network claims and provider competition.

Financial Impact of Telehealth: Rural Chief Financial Officer Perspectives

Interviews with chief financial officers of rural hospitals revealed that they perceived telehealth to have some financial advantages; however, they did not believe that telehealth improved their hospitals’ financial situations.

Effects of Adjunctive Cariprazine Formulary Restrictions in Major Depressive Disorder

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Cost-effectiveness of Case Management: A Systematic Review

This systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results.

Varied Use of Step Therapy Among Medicare Advantage Plans

The frequency with which 7 of the largest Medicare Advantage plans impose step therapy protocols in their Part B drug coverage decisions varies substantially.

Predicting Mortality Risk Using the PREVENT Equation Across Diverse Racial Groups

This study validates the Predicting Risk of CVD Events (PREVENT) score across diverse racial and ethnic populations, highlighting its effectiveness in predicting cardiovascular risk and mortality, regardless of race or ethnicity.

Characterizing Obesity in a Large Health Care Delivery System.

The prevalence of obesity in the Sutter Health system between 2015 and 2020 was 35%. Differences by race/ethnicity, health insurance, smoking status, and comorbidities were examined.

Calibrating Medicaid Payment to Need for Long-term Services and Supports

Incorporating data from functional status assessments, we developed a Medicaid payment model for long-term services and supports in a community-dwelling population of older adults.

Evaluating and Improving the Delivery of Heart Care: The University of Michigan Experience

Factors Associated With Unplanned Admissions Among Patients With Chronic Conditions

This study identified risk factors for unplanned admissions among patients with multiple chronic conditions to inform focused interventions.

Treatment Modification After Initiating Second-Line Medication for Type 2 Diabetes

Among adults with type 2 diabetes who started noninsulin second-line therapy, most modified treatment within 1 year. Discontinuation was by far the most common modification.

Insurance Coverage and Health Care Spending by State-Level Medigap Regulations

Despite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.

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.

Determinants of Hospital Charges and Costs in Acute Myocardial Infarction: A Report from the Myocardial Infarction Cost Study (MICS) Group