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Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Navigating Compounded Semaglutide: What Health Care Providers Need to Know

This article reviews the safety, efficacy, and regulatory concerns related to compounded semaglutide, with a focus on how health care providers can offer guidance and education to patients.

Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

Optimizing Revisit Intervals: Reducing Variability to Enhance Health Care Efficiency

The authors explore the limitations of the current system of revisit interval assignment and discuss the importance of standardization to optimize patient health care outcomes.

Understanding Insurance Coverage Policies for Incretin Mimetics for Weight Management

The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.

Medical Loss Ratio’s Role in the Large Group Insurer Market

The authors used medical loss ratio forms to assess trends in premiums, medical claims, administrative costs, quality improvement, and margins in the large group insurer market.

Integrating Research, Health Care, and Community at Scale to Address the Population Health Question

The authors discuss the need to repair a house divided among research, health care, and the multisector health community.

Potential Health Literacy Resources for Health Plans: A Narrative Review

Several evidence-based health literacy resources may be beneficial in health plan settings to improve organizational health literacy, personal health literacy, and health equity.

Harnessing AI for Population Health: A Call to Action for Policy Makers and Health Care Leaders

The authors detail how artificial intelligence could be used in primary, secondary, and tertiary prevention to improve health outcomes and provide better value-based care.

High-Intensity Home-Based Rehabilitation in a Medicare Accountable Care Organization

High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.

Integrated Care for Chronic Conditions: A Randomized Care Management Trial

The authors sought to understand the differential impact of payer-led community-based care management approaches on stakeholder-oriented outcomes for publicly insured adults with multiple chronic conditions.

Temporal Shift in Prevalence of Heart Failure Diagnoses and Comorbidities Within 2 US Integrated Health Systems

The analysis highlighted a shift in heart failure diagnoses, with hypertensive heart disease with and without chronic kidney disease as prevalent diagnoses, underlining coding variability and implications for research.

Interventions Addressing Cost-Related Medication Nonadherence in Diabetes: A Scoping Review

Many US patients with diabetes cannot afford their medical care. The authors review the impact of interventions that reduced and/or eliminated diabetes-related costs.

An Assessment of Nurse Practitioner Low-Value Care Use in Primary Care

Primary care nurse practitioners were found to use low-value care at lower or relatively similar rates compared with the general clinician population.

Mobile App Enables Accurate Remote Assessment of Atopic Dermatitis

Discover how the SkinTracker app enhances AD management through remote assessments, offering convenience and accuracy comparable to in-person visits.

Cost-Effectiveness Analysis of Ubrogepant, Rimegepant, and Zavegepant for Acute Migraine Treatment vs Usual Care

Based on this analysis, all 3 gepants are not cost-effective compared with usual care for the treatment of acute migraine.

Collaboration to Transition Members to Preferred Formulary Dipeptidyl-Peptidase-4 Inhibitor

A collaboration between a drug plan and clinical pharmacists led to nearly 50% of members successfully switching to a preferred dipeptidyl-peptidase-4 inhibitor.

Prior Authorizations and the Adverse Impact on Continuity of Care

Prior authorizations create substantial administrative and financial burdens on physicians and patients and can disrupt the continuity of care.

The Biosimilar Shift: Trending Infliximab Biosimilar Utilization and Associated Cost Savings for Commercial Insurance

Infliximab biosimilars created price competition causing insurance claims costs for infliximab originator and infliximab biosimilars to decrease, generating significant savings to the health care system.

RAISE: Elevating Person-Centered Data for Healthy Communities

The RAISE program provides awareness and shares comprehensive solutions to address the multifaceted reasons for missing and incomplete data across the real-world data continuum.

Care Quality Metrics in Medicare During COVID-19 Pandemic

Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.

Digital Health Implementation Among Older Adults: Health Technology Navigators’ Perspectives

Health technology navigators share perspectives on barriers to and facilitators of digital health access for older, linguistically diverse patients in a Los Angeles safety-net system.

ICYMI: Highlights From SPD 2025

Pediatric atopic dermatitis advances, ruxolitinib safety, IgE insights, and more at the Society for Pediatric Dermatology (SPD) 2025 meeting.

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

Coverage With Evidence Development Study Shows Benefits in Patients With Migraine Treated With Remote Electrical Neuromodulation

A coverage with evidence development (CED) study demonstrated significant and clinically meaningful benefits in patients with migraine treated with remote electrical neuromodulation (REN). Health plans should support clinicians’ REN prescriptions by ensuring adequate coverage.

The Impact of Outliers on Available Resources in a Teaching Hospital in Colombia

This letter describes the experience of long-stay patients and provides a perspective of the need for more studies on outliers’ impact on health care.

Continuously Updated Forecasting of SARS-CoV-2 in a Regional Health System

This study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.

How Michigan Hospitals Utilize Technology to Track and Target Heart Failure Care

Hospital participants shared how they have utilized technology to enhance care for heart failure patients. Below are some highlights of these resources and initiatives.

When Employee Healthcare Costs Move Stocks

Healthcare costs in America are seeping into nonhealthcare companies’ earnings announcements. None of those companies discussed healthcare this time last year.

Strong Referral Network Integrity Requires Continuum-Wide Communication and Data Sharing

Missed referrals and other appointments, often due to a lack of coordination and follow-up, have far-reaching impacts beyond lost revenue. Avoiding such consequences requires a strong referral network management plan.