Authors

Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.

Hospitalization Patterns Among Older Patients With Cancer With and Without Dementia

Dementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.

Utilization by High-Cost, High-Need Medicaid Patients Receiving Social Worker Care Coordination

Complex Medicaid patients randomly assigned to receive outpatient social worker care coordination services experienced increased hospitalizations but no differences in emergency department visits or costs.

Enhancing NSCLC Brain Metastasis Treatment With MR-Guided Ultrasound: Manmeet Ahluwalia, MD, MBA, FASCO

Manmeet Ahluwalia, MD, MBA, FASCO, chief of medical oncology, chief scientific officer, and deputy director of the Miami Cancer Institute of Baptist Health South Florida, discusses a groundbreaking clinical trial for non-small cell lung cancer (NSCLC) brain metastases.

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.

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.

Telemedicine Utilization and Preventive Services Among a Rural Population

Telemedicine use in rural areas was associated with a higher likelihood of utilizing preventive services.

Effect of Remote Patient Monitoring on Stage 2 Hypertension

A community-based remote patient monitoring (RPM) program was associated with significant reduction in blood pressure in Medicare patients with stage 2 hypertension, highlighting the potential benefits of RPM with care coaching.

rVWF Safely, Effectively Manages Perioperative Bleeding in Pediatric Patients: Shayla Bergmann, MD

Shayla Bergmann, MD, explains that recombinant von Willebrand factor is both safe and highly effective in controlling perioperative bleeding in children with severe von Willebrand disease.

Inflation Reduction Act Impact on the Hematology/Oncology Treatment Landscape

The Inflation Reduction Act introduced Medicare drug price negotiations to reduce treatment costs, enhance access, and potentially reshape prescribing patterns in oncology and hematology.

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.

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.

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.

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.

Objective Predictors of Financial Toxicity in Oncology

Relationship Between Medication Adherence and Other Medicare Star Rating Measures

Performance on Medicare Star Ratings medication adherence measures is significantly tied to performance on the intermediate outcome and statin process measures.

Addressing STIs Through Managed Care: Opportunities in Medicaid and Beyond

Medicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.

Cost-Effectiveness of Implementing a Home Blood Pressure Telemonitoring Program

A home blood pressure telemonitoring program effectively reduced blood pressure in real-world clinical settings, but program enrollment expenses increased overall costs.

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.

Predicting Severe Diabetes Complications Using Administrative Claims Data in Maryland

Predictive risk scores created using administrative claims and publicly available social determinants of health data strongly predicted severe diabetes complications for Maryland Medicare fee-for-service beneficiaries.

Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children

Among publicly insured children with mental health–related encounters, racial and ethnic disparities in telemental health use widened following the onset of the COVID-19 pandemic.

Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care

On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.

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

Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending

Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.

Health-Related Social Needs, Methods, and Concerns for a Polysocial Risk Score: An Expert Panel

A polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address health-related social needs.

Impact of an Intensive Outpatient Clinic Model on Health Care Utilization and Cost

An intensive outpatient clinic model significantly reduced health care spending, hospital admissions, and emergency department visits among complex Medicaid patients over a 2-year period.

The Cost of Implementing and Sustaining the Massachusetts Model

This article presents a microcosting analysis of resources needed for the implementation and sustainment of the Massachusetts model evaluated in the PROUD trial.

From Complexity to Clarity: A Path to Value in Employer Health Plans

Employers struggle to define value from health care spending amid complexity and misaligned incentives. Achieving measurable outcomes requires transparency, incentive realignment, and gradual, employee-centered change.

Building Trust: Public Priorities for Health Care AI Labeling

A Michigan-based deliberative study found strong public support for patient-informed artificial intelligence (AI) labeling in health care, emphasizing transparency, privacy, equity, and safety to build trust.

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.