Authors

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.

Orexin Agonist Shows Promise for Treating Narcolepsy, Hypersomnia: Richard Bogan, MD

Richard Bogan, MD, discusses trial data coming out of the VIBRANCE studies for patients with narcolepsy type 2 and idiopathic hypersomnia.

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.

Specialty and Operator Status Influence Electronic Health Record Use Variation

Operators demonstrated specialty-specific differences in electronic health record efficiency, timeliness, and after-hours use, highlighting how workflow and training shape documentation behaviors across medical disciplines.

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.

Assessing Evidence for MTM Quality Measure Development: A Scoping Review

Quality evidence is needed to support a new Medicare Part D medication therapy management (MTM) program performance measure, prompting a scoping review on MTM services and associated outcomes.

Early Signs of Success for Missouri’s New Notification of Pregnancy

This report suggests that a unified approach to comprehensive data collection, led by a state Medicaid agency, can improve opportunities for engagement in pregnancy care management.

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.

Justified Billing Practices Can Improve Revenue for Weight-Focused Visits

Analysis of billing codes before and after implementation of a care process for weight-focused visits revealed increased primary care revenue for these encounters.

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

What Do We Do With These Prices? Ushering in the Next Phase of Price Transparency Innovation in Medicare Advantage

The problem is not that price transparency itself has failed, but rather that policy makers have focused their efforts on the wrong place.

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.

Scalable Strategies Boost Heart Failure Prescription Fills: Weston Blakeslee, PhD

Low-cost, scalable interventions can improve first-fill adherence, reduce avoidable hospitalizations, and support patient-centered strategies.

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.