Authors

What Managed Care Needs to Know About Cannabinoids and Sleep: Mark Malesker, PharmD

Mark Malesker, PharmD, discusses the clinical evidence, drug interaction risks, and formulary challenges surrounding cannabinoid use for sleep disorders.

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

Health Care Utilization in Veterans With Alzheimer Disease

Veterans with Alzheimer disease (AD), identified using clinical notes, have higher health care utilization than veterans without AD.

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

Prevalence, Resource Utilization, and Economic Impact of Kidney Function and Proteinuria in Patients With Focal Segmental Glomerulosclerosis

Changes in Semaglutide Fills Following Expanded FDA and Medicare Policies

Expanded FDA indications and Medicare coverage of semaglutide for cardiovascular risk prevention were associated with increased Wegovy utilization, most notably through Medicare Part D.

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.

Navigating the Evolving Landscape of Private Cardiology Practice

This commentary examines pressures driving cardiology consolidation, the risks of private equity, and strategies to sustain independent practice while ensuring patient-centered, cost-effective cardiovascular care.

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.

Impact of Automated Insulin Delivery on Type 2 Diabetes Measures

Use of automated insulin delivery technology improves a Healthcare Effectiveness Data and Information Set quality measure in individuals with type 2 diabetes.

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.

A Patient-Centered Reconstruction of 340B in Oncology: Transparency, Equity, and Site-of-Care Accountability

Community oncology leaders urge 340B overhaul so drug discounts follow vulnerable cancer patients, with audits, transparency, and tighter contract-pharmacy rules. This commentary will be featured on the Cover of the October issue of Evidence-Based Oncology.

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?