Authors

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.

Avoiding Surgical Resection of Recurrent BRAF V600E–Mutated Iodine-Refractory Papillary Thyroid Cancer Involving Trachea/Thyroid Cartilage via Resensitization With Dabrafenib and Trametinib: Report of 3 Cases

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

Improving Patient-Centered Care in Diabetes With Comparative Effectiveness Research

Navigating the Biosimilar Frontier: Opportunities and Challenges in 2024

Biosimilars offer substantial promise for a new era of accessibility and affordability for patients and the broader health care industry, but better understanding of these products from payers and providers is necessary for biosimilars to reach their full potential in the US.

Medicare Advantage Reimbursement Structures Impact Home Health Delivery and Outcomes

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

Why Even the Threat of a Twindemic Isn’t Swaying the Most Vulnerable: Black Women

The fall season was accompanied by an urgent warning from the CDC of an impending “twindemic” of coronavirus disease 2019 and influenza. Despite the warnings, Black women are not lining up for vaccinations.

Reducing Readmissions in the Safety Net Through AI and Automation

Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.

Care Transition Management and Patient Outcomes in Hospitalized Medicare Beneficiaries

Hospital care transition activity facilitates uptake of Medicare-reimbursed transitional care management, which is associated with lower spending and better patient outcomes.

Evaluating Alternative Methods of Comparing Antihypertensive Treatment Intensity

Medication dose captures modification of hypertension treatment intensity more precisely than medication count, and this measure should be preferred in studies that aim to improve hypertension management.

More Employers Offer Preventive Drug Lists Over Time

More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.

Immunotherapy Treatment Can Cause Skin-Related Toxicities

There are many immunotherapy-caused skin toxicities, but most can be easily managed.

Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare Beneficiaries

Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.