Authors

Association of Opioid Utilization Management With Prescribing and Overdose

Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.

“Can You Hear Me Now?”: Postoperative Patient-Initiated Communication With Providers

Patient-provider communication after surgery is critical for patient safety. The growth of patient-provider communication technologies has created opportunities to study postoperative patient-initiated communication.

Barriers to Accessing Online Medical Records in the United States

Patients’ access to and use of online medical records (OMRs) can facilitate better management of their health care needs; however, disparities persist. This study highlights the disparities among individuals’ OMR use and why individuals who are offered OMRs do not use them.

Safety vs Price in the Generic Drug Market: Metformin

The generic drug market focuses on price. However, multiple generic metformin drugs have been recalled due to poor drug quality. The authors examine price and quality after these recalls.

Dosage and Outcomes in a Complex Care Intervention

Associations between intervention dosage and hospital use outcomes were observed among patients enrolled in a care management program serving individuals with complex needs.

Why EOM Participation Was Extremely Low—and How to Fix It

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.

Insights Into Lipoprotein(a) Screening Trends: Analysis of a Comprehensive US Health Care Dataset

Clinical Profile of COVID-19 Infection in Postvaccination Individuals

This article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.

Impacts of Community-Based Care Program on Health Care Utilization and Cost

A community-based care management program in Rhode Island reduced hospitalizations and inpatient costs. There were stark differences across subgroups based on intensity of care.

High-Risk Care Management Impact on Medicaid ACO Utilization and Spending

In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.

Longitudinal, Relationship-Based Case Management: A Prospective Cohort Trial

A longitudinal, relationship-based case management approach significantly reduced health care costs and improved quality of life for Medicaid enrollees with complex needs over 1 year.

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.